HomeMy WebLinkAbout0050 ARBOR WAY f ---"Oot
f
*Permit
Town of Barnstable # iQ / 7" 62
Building Department Services Expires 6 moVthsfrom issue date3
MAS9 Brian Florence,CBO
,' ' Building Commissioner a
o 200 Main Street,Hyannis,MA 02601 � ` �
- www.town.barnstable.ma.us
Office: 508-862-4038 F . 0-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL 6k(kUA81V-Sf48LE.
Not Valid without Red X-Press Imprint
Map/parcel Numbero��� a •; /
Property Address -1:7 0 P 50k V"k T
❑Residential Value of Work$ S670190.DO Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address A-VACte & f�P S E L Z
50 A-60,42 — RZ4tNO 1 S
MAA-
Contractor's Name Telephone-Number ID
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box);� Re-roof(hurricane nailed)(stripping old shingles)'All construction debris will be taken to SAIRNA l_A8AI� 6 0MPS .
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
® Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
"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
requi ed:
�SIGNAT-URE:-' _
QAWPFII.ES\FORMSIbuilding permit fomisTMESS.doc
08/16/17
Ile Co womwealth of Aassadlrusetis
Department cr,f rndushial Accideranr
Office oflnmfigadom `
600 WashhVton Street
Boston,AA 02111
mviumass gvvIdia
Workers' CampensafionInsurance Affidavit BmitderdContractar&MecEr cians/Phambers
A wHeant lufmmiatign Please Print
Naiz>e
Address:
cftat �i��Sl sib Phone
Are you an employer?Check the appropriate bom ` Type of project(required):
1.❑ I am a employes with 4. ❑I am a general contractor and I 6- ❑New c:aasirUction
employees(fo11 andfof parttime)* have hired the sub-contractors
2.❑ I am a sale proprietor or partner- listed oat the attached sheet 7- ❑Remodeling
ship and have no.employees. . These smb-cm ractam have g.,❑Demolition
cA ng any ty-
w o wodcers cfl insurance comp- �c&a xva�ess g �BRuil�addition.
� � comp.
r -j 5. ❑ We are a corporatim and its lO'.�II��repairs az a di ioas
3- I am a homeoumer doing all work ' officers have exercised their 1L❑Plumbiagrepairs or additions
mysel€ AP-o workers' right of exemption per MGL insurance required-]T c-152,§1(4�and we have no 11)—❑RD Other
r
employees.[No worms' 13-❑f7ther
comp.insurance regaired_]
•Any agpficantdat d edmbax#1 IImst also fiIIo�th¢sec�oubeimvs sing ffieir err'compensatiaapoli�p iafoamaEiaa
I Hameoways who submit this affidavit i g tiney are daio;all Want sad&m hire auw&contmctars— submit a new affidxv t indicaaioo sach-
TCaattx1um thzt cbecl*this b=must attaeh su additinmal duvet shoRing the name of&a sub-coatuctam sad state whether ar not those emitksbaae
employees.Iftbesub-c==ctmhateemplo5w%t5wy=srpmuidetbg&Rarken'rangpalizFnunsbeL
-Taman errfpfoper that is prauiding workers'compmsadun iimirance for wy enrplojwes $eTaw is fltepaUcy avid jab sifa
informafiara. -
Insurance Company Name:
'Policy,4*or Self--fns.Lie-9 Expiration Date:
Job Sate Address- CitylStatelzap:
Attach a copy of the workers'coanpmsatiea policy declaration page(shaving the policy number and eapiration date).
Failure to secure coverage as required under Section:25A of MGL c.152 can lead to the impositim of criminal penalties of a
fine up to$150a OO and/or one_yearimptisontnent,as well as civil peualties.in the faun of a STOP WORK€)RDERand a fume
of up to$250-QO a day against the violator. Be advised that a copy of this statement sway be fa twarded to the Office of
Investigations of1he DIA for icsumam coverage verific ahon.
I do hereby cm cruder the ' s andr penalties ofpe ury that f ie infarmadmi proW&d abmw h true and correct
CSismatnre - Date- 'c)123 '!__
Ojkiaf use only. Do not write in this area,to be cornpi'eted by trip ortorr n ofj`aerat
City or Town.: PermiffLicense 4
I=mg Authority[oracle or►e):
1.Board of Health 2.RwIding Department 3.C<ityffown Clerk 4.Electrical Fnspector S.Plumbing Lmspector
6.Other
Contact Person: Phone 9-
6
Laformation and Tns-rxctions
Massaclmsetfs Gretieral Laves chapter 152 regoaes all=ployers'to provide wall='campeusafion frr their employees.
p �this ,a a�&Y=is defined as".e veal Person in ffie service of another undue any cor>ira ct ofbire,
express or implied,oral or VIMeu."
er is defined as"an mcfividuaI,partnership,association,corporation or other legal entity,or arty two or more
Au. Ioy
of the faregomg engaged is aJ omt and incTn�the legal representatives of a deceased employer,or the
eo�se
receiver or trustee of an mdividnal,partnership,association or other legal entity,employes eraployees. However the
owner of a dweIlmg house having not more than three apartments and vvho resides therein,or the occupant of the -
dwPTTmg house of anod er who employs persons to do maw ce,construction or repair work on such dwelling house
or on the grounds or building appmtenartjhe=to sha.Ilnotbecayse of such employmea the deemedto be an m3ployer."
MGL chapter 152,§25C(6)also states that"every sfafe or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings is the counmonwealth for any
applicant Who has not produced acceptable evidence of compliance with the insnran.ce covexage regnirect"
Additionally,MCrL.chapt=152,§25C( )sus`fileither the cononwealth nor nay ofits political subdivisions shall
enter into any contract for the perfc=mw ofpubho work twill acceptable evidence of compliance with the fits n Dd-
ru irranen s of this chapter leave been presented to the coding authority."
Applicants
Please fill dot the wotT='compensation affidavit completely;by checking the boxes that apply to your siination and,if
necessary,supply sob-contractor(s)name(s), address(es)and phone m— er(s)along with thmr cmtFaca t*)of
insraance. Lmmited Liability Companies(LLC)or Lmnited Liability Par umml ups(LLP)witb.no employees other.thm the
members or parineas,are not rcgrm-d to carry workers' compensation i m ante. If an LLC or LLP does have
cmpIoyees,a policy is rmfai red. Be advised that this afftda-vitmaybe submitfDd to the Department of Industrial
Accidents for confamaiion of msul snce coverage. Also be sure to sign and date the affidavit The affidavit should
be-rst=ed to the city or town that the application for the permit or license is being requiested,not the Depar[me at of .
InrTnctt jal A cci eatsv Should you have airy questions regarding time law or if you are regan'ed to obtain a workers'
compensation policy,please call the Depariin ent at the number listed below. Self-insured companies should enter their
self-n sarance license number on the appmpriate line.
My or Town Officials
T -
Please be sure that the affidavit is complete and primed legibly- The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office ofInvestigations has to contact you regarding the applicant
Pleases be sure to fill is the permit/license number which w11 be used as a reference number: In addition,an applicant
that must submit M.u14I0 pennitlIicense applications is any given ycEr,need only submit one affidavit i3adicat4g can ent
policy inibrmation Cif necemaiy)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 fide for fbfnrepeimiis or licenses. A new affidavit must be tilled out each
year.Where a home owner or citizen is obtaining a license or permitnotrelatedjb any business or commercial venture
(Le_ a dog license or permit to bum leaves etc.)said person is NOT rulaired to complete this affidavit
The Of 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.
Depadmmt ofliidilacialAccidenta
600 Wa&bhOGn Stmd
2`(,-L 4 Cl'-727-4- c xt 4-06 Qr 1-977-MA&&A
Fax 9 617 727 774
Revised 4-24-07
was.-gagidia-
WE Town of Barnstable
Building Department Services
MASS. ' ` Brian Florence,CBO
6s¢ ►``� - Building Commissioner
` 200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038.E Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
u as Owner of the subject property
_ l p perty-
t.
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 theaapphca.nt Pools
are not to be filled or utilized before fence is installed\l nd all final
inspections are performed and accepted.
Signature of Owner Signature of Applicant
- 4
Print Name .Print Name
Date
Q:FORM&OWNERPERMISSIONPOOI S
Rer.08/16/17
Town of Barnstable
Building Department Services
Brian Florence,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
MAM www.townbarnstable.ma.us
i639•
�p Mld
Office: 508-862-403 8 Fax: 508-790-6230
HOMEOWNER LICENSE EXEIV MON
DATE:
Please Print
• �t.../
T
JOB LOCATION:
number pp street village
"HOMEOWNER": A /AQ K PPS L �/yc tj •LA EES
name home phone# work phone#
CURRENT MAILING ADDRESS: •SO D W A
MxAm 'f cz� CIA p o
— L tY town• s state yip 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 quir ents and that he/she will comply with said procedures and requirements.
S• of meowner
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
this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in
your community.
Q:\WPFLI.ES\FORMS\building permit fmms\EXPRESS.doc
08/16/17
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application # c2d/ C�d O --
Health Division Date Issued /Z-Z'"1 7
Conservation Division Application Fee
Planning Dept. Permit Fee 5, `� ( v
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis 0
Project Street Address
Village
Owner ��Y r- G Address r UL L
Telephone 0 3 V1 - GC)
Permit Request lS l� Sp �nr C5 od� -Q � t s� ti �k�� w k� t �S
Square feet: 1 st floor: existing proposed 2nd floor: existing � proposed Total new ''--
Zoning District VIR> Flood Plain Groundwater Overlay
Project Valuations WO Construction Type
Lot Size Grandfathered: ❑Yes d�fNo If yes, attach supporting documentation.
Dwelling Type: Single Family )d, Two Family ❑ Multi-Family (# units)
Age of Existing Structure C5- Historic House: ❑Yes ;a No On Old King's Highway: ❑Yes XNO
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 I new '-- First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existin6q- New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: ❑ existing ❑ new sigk Pool: ❑ existing ❑ new size Barn: q e fisting ❑new�siz A
Attached garage: ❑ existing ❑new siJ4%-Shed: ❑ existing ❑ new size/ q Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ `'
Commercial ❑Yes Ao J.f yes, site plan review# = c
Current Use 5 AcK Proposed Use �k
APPLICANT INFORMATION
(BUILDE7,C�4
HOMEOWNER)
Name 6cva" )&Stx Telephone Number 1!5 � (9 Y0.5�59
o'� a P +►'� License # ��
a2(oAddress (5
Home Improvement Contractor# lb�52a2
Email L° > ?S�� l� �G - C�rw. Worker's Compensation # Ix 1 QotCj 1 S y
ALL CO &RUCTION DEBRIS RESULTING F M THIS PROJECT WILL B�E�; KEN TO dtkWt
DATE
SIGNATURE j [
FOR OFFICIAL USE ONLY .�
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
t
1
y
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
ASolarCitY.
/ -
1
OWNER AUTHORIZATION
Job#: 6.Z`2 T- do
Property Address: 5-0 A R(36,2 1/y4 V/z Ny yAN,riz 5 /(�/`l 1 0 Z (0 1
ALVA ��,� �lf��C�J
I as Owner of the subject
property hereby authorize SOLARCITY CORPORATION to act on my behalf,
in all matters relative to work authorized by this building permit application.
S gnature Owner: Date:
SOLARCITY.COM
AZ ROC 2437TVROC 24545WI=77408,CAUCF888104.C0F M41,CT KG 0&M&ELC 012=5;DO g71HI1486rECC90+14AS:M£T-20770,MAHC 1M72tMA Eb1 t3",MO MMC 12WD ,
.hVtaHIICi194110016pB00134E901737JW.ORCB180498=82ME11O;PA}gDPAQTT343,rtTwwo0Q,.wAwL,.PC•9190iWARC905P62014WLARCTYCORPORpT".ALL Rom PEDERVW .
•
M�1EttCh�;lttU ilot>a*tmam at�ube��s �
some of llul#0109 4e9a04twp s,v St+muft
c.Hrir CS-108616
JASON PATRY
821 SMWART DRWE
Abington MA 02351 _
t
02IM2019 .
Omer of Couoaur Albin&anion Regalmdoo'
t 'HONE IMPROVEMENT CONTRACTOR- !t
RegletMon: 2IWM Typo
X lratl= ryry
�p : 3f8l2017- tiut►ptemoM C'
SOLAR CITY CORPORATION. '
r JASON PATRY I
24 ST MARTIN STREET OLD 2UNI
&Ak BORbUGKMa01752 uoeeraeretary j
.. V//(./'V 1. j f"•`�t ��L,,/,-rvi it l (1+4(/J/ 4's.r/ !I /
Office of Consumer Affairs d Business Regulation
10 Park Plaza Suite 5.170
Boston, Massachusetts 02116
,Home Improvement:Contractor Registration
t 4, Registrations 166572 .
Type: Supplement Card
++ Expiration: 3/8/2017
SOLAR CITY CORPORATION
CHERYL GRUENSTERN -
24 ST MARTIN STREET BLD 2UNIT 11 ,, - -•- - -•-
MARLBOROUGH, MA 01752 . f
Update Address and return card.Mark reason for change.
SCA1 G Address Renewal ' ? Employment Lost.Card
`^ef�r•�f`:tuir•ii/r-rtill/�f��((��i.tJt'f/(,:;��e. - _
..w. [lice of Consumer Affairs&Business Regulation License or registration valid forindividul use only
'OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation.
egstration: 168572 Type:
t ••�P,#Ri
� 10 Park Plaza=Suite 5170-
Expiration: 3/8/2017 Supplement Card Boston,.MA 02116
SOLAR CITY CORPORATION
CHERYL GRUENSTERN
3055 CLEARVIEW WAY
SAN MATED,CA 94402 Undersecretary ,Not valid without signature
t
f
t
The Common wa M of Massachusetts
Department of Industrial Accidents
I Congew Street,Sake 100
Reston,MA 0211 d-2017
www.►rtrc.>rsgav/ditt
Arrarkers'Compensation insurance A!1'idatnt:Builders/CentmdardElectriclatasMu' ahem
TO BE r1I.SD WITH THE PERMrITING AUTHORITY.
Agglieant Information Fierrse Print Lcaibly-
NaMe(BwinesgOrgunizatinii/Endividual): SalarCity Corporation
Address: 3055 CleaMew Way
City/Staie/Zip: San Mateo,CA 94402 phone# {Sid$}765-2489
Are you an amoom?Check the appropriate box: Type of project(required):
1.141 trm acmplo v wim 15,000 osnployers(full zndlorpz%irac).x .7. []New construction
2.01 ran a sole proprietor or partnership and have no employ=Nva-ims for ox in 8, l�mo�l g
a"capacity.M kurkvrs'camp.instuwo requited.]
3.(J)amabmwownerdnipgall work mysdr.JNuworkeWconw.insuranoomquiredl► 9' 0Demolition
I0[]Building addition
4.01 am a hemmwncr and will W hiring wntmt ws to conduct all work or my propcxtp. l wfl1
erm that all exwewtom either have urorkers•'compensation insurance ware sole 11.Q Elect ical repairs or addillons
prolutdors Wilk no anployeas.
12.0 Plumbing repairs or additions
So I am a gaiml.romaactur aid 1 have hired the sub-crmtmcton listed on the attached sheet. I3.❑Roof repairs
Thee mb-aonirnaom have employees and have wwkas'cane.fim anae t
&E J We are a wrpmation and its officers have mercised their right of exemption per MOL c.
I4.❑� Othev s r panels•
152,§1(41 wW we have no employees,(No workers'ramp.imurarex mquiral
*Any apglicart that Checks box Nl must also fill ont die seetiou below showing then wakors'caapeumtioa policy in o =don.
t I k s tft krbrali this a[tidsvit indicKing they are doing all work and d=hive outside.contractors must satin a nary airdavii indicating strut
Cocuanws that eback this bore mast oltwi A an additiond shed ftwtng the==of ft sub-contractors and state%viud r tw not those entities have
employees• if the xub-co"mwAors have anployccs,lhcy nurst provide their ►vdrkem,coup.po rwmber.
1 am an employer t/sat is providing workers'compensation bmmncefor trip empfoyws. Sdow b the palicr and jab site
iuformario►a: ,
Insurance Company Name:Amerlean Zurich Insurance Company
Policy#e7r Set!ins.Lie.l#: WC0182015-00 Expiration/Date: 9/1/2016
50 Arbor Way Hyannis,MA 02601
Job Site Address' City/sta w0p:
Attach a copy of the workers' campeogation poltry deelaration page(showi g the policy number and explration date).
Failure to secttre coverage as required under MGL c.152,§25A is a cai;trinatl violation punishable by a fine up to$1,500.00
wWar one-year imprisonment,as well as civil penalties in the form ofa STOP WORK ORDER and a tints of up to S250.00 a
day againstthe violator.A copy of this statement may be forwarded to the Office,ofinveWgations of the DIA for insurance
eovm a verification.
I do kereby cerdfv under the pains and penalties ofperjury that the Information provided above is true rnrd correct.
asap Pa November 19,2015
Off klal use only. Do not wrlie in this area,to be completed try city or toner o,alclal.
City or Torun: Petrmit/License#
• • r
Issuing Aptilority(circle one):
1.Board of Health 2.Building Npartmenl 3.City/Town Clark 4.gleettrtcal inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
` DATEP AWOD YYYV)
A`C>RH CERTIFICATE OF LIABILITYINSURANCE W17015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER.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 T14E ISSUING iNSURER(S), AUTHORIZED
REPRESENTATNE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pofty(1es)must he endorsed. If SUBROGATION PS WANED,subject to
the terms and conditions of the policy,certain policies may require an endorsemenL A statement on this certificate does not confer rights to the
certificate holder In Kau of such endo►sement(s).
PRODUCER CONTACT - -
MARSH RISKS INSURANCE SERVICES —..._._—._._...... ._... ... .(•pF.._..._ .. ........... ....:.___T--
345 MEORNIA STREET,SUITE 1300 PIS ................. .. ..............1i! slick_
CALIFORNIA LICENSE N0.0437153 E-MAIL
SANFRANCISCO,CA 94104 '........ _....__.._...__.__...—.—. _..__.._.:..__.._
Aft SNanwS>:olt4t5-743-M34 -----...... _........:..#silo s)nFFoRwwocoVEnnGE:.... .. .__._.. NAICI
998301-STND-CAWUE-15-16 __._._..__.. INSURER A;Zwkh A +hwat ce Company
W 5URCD INSURER B.NZA WA
Salty Corporation --_
3065 Clerhow Way INSURER c:NIA
San Mello,CA 94402 INSURER D:American Zurich Irswance Company 40142
RISURER E: —
INSURER F: .
COVERAGES CERTIFICATE NUMBER: SEA-=13M" REVISION NUMBER:4
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.ISSUEII OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS.
TYPE OF INSURANCE ....._ J.....rA$bLT9tJfJii... .......... CVNUMA9ER .. ...^ POLN:YEPF POLICYEXP LIMITS
LTR t
A IX ;COMMERCIAL GENERAL LIAMITY CsLOD182016-00 09F}112015 113111131=6 EACHOCCURRENCE
F--"-7 � AMAGE TO RENTED ..... ..,.
F �CLAIMS41ADE I JOCCUR I PREAII.SE$..{Ea.Qcalr[ence}... 5--....._._ 3bOD.6D0
X SIR SZ50 000 i i MED EXP
5,fl00
PERSONAL&ADV INJURY S _ 3,600,00
_..
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 6 000,000
Al POUCY PRO.
RO PRODUCTS:COMPIOP AGG $
OTHER. s
A Auromoa;LELamlly 8AP011I2017.00 lN/09I2f115 1001016 COMBINED SINGLE LIMIT $ 50000
OMY INJURY(Per person) S
X ANY AUTO
X ALL OWNED X SCHEDULED I BODILY INJURY(Per accident) S
.._. AUTOS AUTOS PROPERTY DAMAGE ..:.....................�.......
NOW01ANIED S
X HIREDALROS X.. AUTOS I I. _. Eia[II}........ ................... .......
COPAPICOLL DED: S $5,000
UMBRELLA LIARHCLAMAS-IMDE
OCCUR ` ! EACH OCCURRENCE S
EXCEBS LOAD r i AGGREGATE S
OEB t RETENTIOfdS t S
D WORKERSCOq{PENSJLTION iWG01$20141H)(AO'u) 091D1RD]5 1091Dtl1016 X KTgTurE_ ._..RH
AND EMPLOYERS•UA2=Y -
A ANY PRoaalr raRra,RnERIEXECUTIVE r I N WC0182015-00(MA) 09N112015 1 0112016 E.L.EACH ACCIDENT S 1.000,0M
4FF1GEFtRAEM9ERE%CLUDED? NIA,, .........
(Marrdatoy In NH 1�WC DEDUCTIBLE.=,0W E L..DISEASE.EA EMPLOYEE S 1,000,000
'DESCRI �Of OPERATONS below I E.L.-DISEASE-POLICY LIMIT $
j
DESGiUPTION OF OPERATIONS I LOCATIONS 1 VEHICLES IACORD f0t,AdraSonal Remarks Sctwdula,may Ire aftombad If amm Spam Is regWraal
EYldaice ollnswance.
CERTIFICATE HOLDER CANCELLATION
Sdw(Ay Corpordion SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
3055 CIm"Iew Way THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
San Meted;CA 99402 ACCORDANCE WITH THE POLICY PROVISIONS"
AUTHORIZED REPRESENTATIVE
of Marsh Risk&Insurance Services
Chor(esMarmolejo
C 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 2612014101) The ACORD name and logo are registered marks of ACORD
Version#53.4-TBD
tV
G'4 ar�
®I r i
16
November 15 2015
RE: CERTIFICATION LETTER '
Project/Job#0262254
Project Address: Marcondes Residence
50 Arbor Way
Hyannis, MA 02601 '
AHJ Barnstable
SC Office Cape Cod
Design Criteria:
-Applicable Codes= MA Res. Code,8th Edition,ASCE 7-05,and 2005 NDS
- Risk Category = II +
-Wind Speed = 110 mph, Exposure Category C
-Ground Snow Load = 30 psf
- MP1: Roof DL= 9 psf, Roof LL/SL= 21 psf(Non-PV Areas), Roof LL/SL 21 psf(PV Areas)
Note: Per IBC 1613.1; Seismic check is not required because Ss = 0.18757 < 0.4g and Seismic Design Category(SDC) = B < D
To Whom It May Concern,
A jobsite survey of the existing framing system of the address indicated above was performed by a site survey team from SolarCity.
Structural evaluation was based on site observations and the design criteria listed above.
Based on this evaluation, I certify that the existing structure directly supporting the PV system is adequate to withstand all loading
indicated in the design criteria above based on the requirements of the applicable existing building and/or new building provisions
adopted/referenced above. This review relies on the roof's structural system having been originally designed and constructed in
accordance with the building code requirements and having been maintained to be in good condition.'
Additionally, I certify that the PV module assembly including all standoffs supporting it have been reviewed to be in accordance with the
manufacturer's specifications and to meet and/or exceed all requirements set forth by the ASCE 7 standards for loading.
ThePVcontained-in
. s
assembly hardware specifications are contained In the plans'submltted for approval. Additionally a summary of the structural
review is provided in the results summary tables on the following page.
Sincerely, K.
JUKI
Digitally signed by Humphrey 0 ST ucTURAL
Humphrey No.51933
Professional Engineer Kariuki � RFcisTE�```�
T: 443.451.3515 Date:2015.11.16 10:03:03.-05 00 .
email: hkariuki@solarcity.com
3055 Clearview Way San Mateo,CA 94402 T(65%638-1028 (888)SOL-CITY F(656)638'1029 solarcity.com
AZ R0O 24377).GA 09L9'888104.00 LV'8641,.ETHIC M32778.401410 71101466,:OC H1S 7110U.8%HI QT 29770,MA HICr 168572,MO MHIC 128948:Nj iwHQ618o800. -
- 'OR CC!}'1804$$,PA 079343,TX TOLR 27006.WATa0L:S01.AR0'81gp7.+i:2WSSCIrrC{tY"All;righla roaervad:• , �
�\!• Version#S3.4-TBD q
Qp9;5®IarC't
y
HARDWARE DESIGN AND STRUCTURAL ANALYSIS RESULTS SUMMARY TABLES
Landscape Hardware-Landscape Modules'Standoff Specifications
Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR
MPi 72" 24" 39" NA Staggered 78.5%
Portrait Hardware-Portrait Modules'Standoff Specifications
Hardware X-X Spacing X-X Cantilever Y-Y Spacing Y-Y Cantilever Configuration Uplift DCR
MPi 48" 19 65" NA Staggered 87.0%
Structure Mounting Plane Framing , Qualification Results
Type Spacing Pitch Member Evaluation Results
MPi Pre-Fab Truss @ 24 in.O.C. 200 Member Analysis OK
Refer to the submitted drawings for details of information collected during a site survey. All member analysis and/or evaluation is based on framing information
gathered on site.The existing gravity and lateral load carrying members were evaluated in accordance with the IBC and the IEBC.
3055 Clearview Way San Mateo,CA 94402 T(650)638-1028 (888)SOL-CITY F(650)638-1029 solarcity.com
AZ ROC 243771,CA CSL8 888104.CQ EC 8041,CT HIC 0632778,OC HIC 71101486,DC HIS 71101488.HI OT-20770,MA HC 108572,MD MHIC 128948,NJ 13V1406160600,
OR CCB 180498,PA 077343,U TDLn 27006,WA OCL SOLARC-91907,0 2013 SolarOily.All dglNs reserved.
i
1�
STRUCTURE ANALYSIS - LOADING SUMMARY AND MEMBER CHECK- MP1
Member Properties Summary
Mpi Horizontal Member Spans Rafter Pro erties
Overhang 1.16 ft Actual W 1.50"
Roof System Properties San 1 Y= " :"5:21 ft Actual D :3.50".
Number of Spans(w/o Overhang) 2 San 2 7.14 ft Nominal Yes
Roofing Material Comp Roof.:' San 3 ""'
Re-Roof No San 4 S. 3.06 in.^3
Plywood Sheathing Yes, San S. ` . t I`°,° 5.36 in.^4-
Board Sheathing None Total Rake Span 14.38 ft TL DON Limit 120
Vaulted Ceiling No`w 'PV 1 Start `;1.42 ft:_";"; '',Wood Species -SPF
Ceiling Finish 1/2"Gypsum Board PV 1 End 13.50 ft Wood Grade. #2
Rafter Slope - 200..- . PV 2 Start " A. � ..Fb• ",875 psi
Rafter Spacing 24"O.C. PV 2 End F„ 135 psi
Top Lat Bracing - Full''�"`: " - PV 3 Start _e „_ E 61400000 psi
Bot Lat Bracing At Supports PV 3 End Em;,, 510000 psi
Member Loading mary
Roof Pitch 5 12 Initial Pitch Adjust Non-PV Areas PV Areas
Roof Dead Load DL 9.0 psf x 1.06 9.6 psf 9.6 psf
PV Dead Load PV-DL„ 3.0 psf x 1;06 i 3.2 psf
Roof Live Load RLL 20.0 psf x 0.98 19.5 psf~
Live/Snow Load " LL' SLi'2 1 ° '30.0 psf x 0.7,E I x 0.7, .re 21.0,0sf 21.0{psf;-° ,
Total Load(Governing LC TL 30.6 psf 33.8 psf
Notes: 1. ps=Cs*pf;Cs-roof,Cs-pv per ASCE 7[Figure 772] 2. pf=0.7(Ce)(Ct)(IS)py; Ce=0.9,Ct=1.1;IS=1.0 t
Member Design Summary(per NDS
Governing Load Comb CD CL + CL - CF Cr
D+ S 1.15 1.00 1 0.92 1.5 1.15
Member Anal sis Results Summary
Governing Analysis Max Demand @ Location T-Capacity DCR Result
Bending - Stress -1315 psi 6.4 ft -1589 psi 0.83 Pass
[CALCULATION OF DESIGWKW_INDLOADS7- MP1 t`
Mounting Plane Information v
Roofing Material _Comp Roof
PV,$ystem_ Type. - ffi7 ;- City tTM -
Solar SleekMoun - .
Spanning Vents No
Standoff Attachment Hardware .. " a Comp Mount Type C
Roof Slope 200
Rafter S acin 24s'0 C.- - ----�---�_ -
P.__9- s.
Framing Type Direction Y-Y Rafters
Purlin,S-acm X-X Purlins_Only - - ;NA`
Tile Reveal Tile Roofs Only NA
Tile Attachment System 7TIle Roofs Only T �° NA -
Standin Seam/Trap Seam/Trap Sp acin SM Seam Only NA
Wind Design Criteria
Wind Design Code ASCE 7-05
Wind,Design Metho-d_ s . -3-- - : Partially/Fully_Enclosed Method _
Basic Wind Speed V 110 mph Fig. 6-1
Exposure Category x C Section 6 5.6.3_
Roof Style Gable Roof. Fig.6-11B/C/D-14A/B
Mean Roof Hei ht 17 h~ _ 25 ft . Section 6:2
Wind Pressure Calculation Coefficients
Wind Pressure Exposure KZ 0.95 Table 6-3
Topographic Factor Krt 1.00 , Section.6.5.7
Wind Directionality Factor Kd 0.85 Table 6-4
Importance Factor, a ,- gy I . w r 1.0 a - Table 6-1
Velocity Pressure qh qh = 0.00256(Kz)(Kzt)(Kd)(V^2)(I) Equation 6-15
24.9 psf
Wind Pressure
Ext. Pressure Coefficient U GC u -0.88 Fig.6-11B/C/D-14A/B
Ext.Pressure Coefficient Down GC D°Wn '. 0.45, '; ' Fig.6-11B/C/D44A/B
Design Wind Pressure p p = qh(GC) Equation 6-22
Wind Pressure U -21.8 psf
Wind Pressure Down 11.2 psf
ALLOWABLE STANDOFF SPACINGS
X-Direction Y-Direction
Max Allowable Standoff Spacing Landscape 72" 39"
Max Allowable Cantilever - .Landscape 24
Standoff Configuration Landscape Staggered
Max"Standoff Tributary Area _ Trib "' g -20 sf.
PV Assembly Dead Load W-PV 3.0 psf
Net Wind.Uplift_atStandoff :_ �• -actual -z• e -392
Uplift Capacity of Standoff T-allow 500 Ibs
Standoff Demand Ca aci DCR 7 78.5%
X-Direction Y-Direction
Max Allowable Standoff Spacing Portrait 48" 65"
Max Allowa-tile Cantilever Portraits .m 19"
Standoff Configuration Portrait 'Staggered
Maz Standoff Tributay Area ~Trib � - >22 sf
PV Assembly Dead Load W-PV 3.0 psf
Net ind,Uplift at Standoff M-Tactual n -435 Ibs_
Uplift Capacity of Standoff T-allow 500 Ibs
Standoff:Demand Ca aci -' 0%DCR 87.
Qyo�TMEro�� TOWN OF BARNSTABLE
i •
i SAHHSTAHLt i
9� 0 pyp\e� BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .. .. .. ': .... .:.........v....f�. .. ../ ..? ..6.1.................?........!
TYPEOF CONSTRUCTION ..../....IL...:....................,..............................................................................................
................................................19........
I TO THE INSPECTOR OF BUILDINGS: z
The undersigned hereby applies for a permit according to the following information:
Location .......A ...j.. .............. . ...�,.... ..��f-f.��...?�t..L... ......................................................................
Proposed Use / . ' �. ?7..�./.�j......... .e-/.f/....,:...Gj....................................................................................
/ a
ZoningDistrict ........................................................................Fire District ..............................................................................
Name of Owner ..�ff .�/.../—C40.44L;�R..1..1t ...Address ....... ...............
Name of Builder ..?',.�'.,5. /.1. ......
..�?.�(�..`j.f�.a3....Address ....................................................................................
Nameof Architect ..................................................................Address ...............................................A.......
..
Number of Rooms .. =:.......vZ................................................Foundation , ,�..i<6.C�. ... .............
....:.......:, .
Exterior ... .h�.?.,�-' ` .Roofing ..r.....4? l�.Cl.l:...`
Floors � �Q �� ........................Interior .........
....... '. . . .......... ......`..................
Heating, :. .. ... ....................................Plumbing ..4M rC >!: A. -,. 4.........
L5 07Y1J, v 7I
Fireplace ... ..........:................................................:...............Approximate Cost �...
Difinitive Plan:Approved by Planning Board ________________________________19________.
�� 7—:S
Diagram of Lot and Building with Dimensions
D b
< 0
O
2m� � mil M
z � _ (J) 2
M M
00 rn -0OZ
r
NX
/ n 00 ti i0
R o M rri M <
coo
co
r rAN-
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name -- .... .
...... ...............
�oee�z F.
Coughlin,, -- Joseph � !
� |14
No _�� !... Permit --.xmu� o--..� ___. T
�
| .
wi'^ul= family `^=~l^-^^~g /
� --'--'^--------^^---'--------'' |
� n =a�Arbor Way
[ Lpcpnnn°:—' .....................................................Bmd
. - .
` --.------^�,�.���.------------.
F.
Owner --._..������--..�������^. ----'
� .
�
zrozne i
Type of Construction .......................................... '
(
---.—~---.-----------------
Plot --------- Lot ----------'' \ �
- �
Permit Granted --Ap ---.--..lA 70
Date of Inspection ------------lg
�
Dote Completed —.� ��----. lA ��
. -_-- —. - 10
�PERMIT REFUSED_ �
�
^-------.--.----------. 19
�
--------.,.----------------.
�
|^---'--'~^---------^^---^----'
�
^^----~-------'^^^^'^--^^—'—^--^''
�.---.---.—,—.----.—,.—.---.---.—.'
| \
^ .
Approved ................................................ lQ � ^
/
/
----....---.-----.,..—.------.—..
----.--------------.—.—,.....-
�
| ' -
• ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Permit#
� f? 1STAB
Health Division 0 - LE Date Issued ; /O
Conservation Division LZ CZUJ'�AiFI�2 .9; 2 Application Fee
Tax Collector Permit Fee
Treasurer SEPTIC SYSTEM MUST BE
INSTALLED IN COMPLIANCIF
Planning Dept. MM TITt.E 5
Date Definitive Plan Approved by Planning Board C`-'"0N1,MErMTAL COM AM
Historic-OKH Preservation/Hyannis
Project Street Address 50 AR30k U)f►y
Village hYA+viv6
Owner A L VAC ito, 14,4g co mbey Address SO /3,C-B0_ wAY
Telephone 50F - '77/- 70 99
Permit Request (CV (o K 16
Square feet: tst floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
ed
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
t.
Dwelling Type: Single Family �Q Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes r`r7 No On Old King's Highway: ❑Yes W No
Basement Type: JQ Full ❑Crawl ,❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing •3 new Half: existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing 3 new First Floor Room Count
Heat Type and Fuel: M Gas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes W No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size
Attached garage:Q existing ❑new size Shed:A existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑ No If yes,site plan review
Current Use Proposed Use
BUILDER INFORMATION
Name VACIR MA&Cwyk)E-!�. Telephone Number ;7�1—
Address. (7 AIQ,6o2 rj:Ay License#
AMA Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 2 Z AP2 D`�l
FOR OFFICIAL USE ONLY
PERMIT NO. ?
DATE ISSUED `
' MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
f
DATE OF INSPECTION:
FOUNDATION Z-1d-o-
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING • -
DATE CLOSED OUT
ASSOCIATION PLAN NO.
F
yJ
a �
r
x .ry,y„ f :rz?4 •. ..t,.s ,y _ ,..•_; ,,.1..
. • _ __ t The Commonwealth of Massachusetts '. .
_ -- Department of Industrial Accidents
600 1Washington Street -
V Boston,Mass. 02111
Workers'.Com ens ation.I�nsurance Affidavit-General Businesses
• name: IC e��t;�a :: •
WA
CitNN rS • ' state: MA zip: o?.&0/ one# _ 17
work site location full address
® I am.a sole proprietor and have no one Business Type: El Retail❑Restaurant/Bai/Ea 9 Establishment
working in any capacity. . 0 Office[] Sales(including Real Estate,Autos etc.)'
❑I am an em to er with . em to ees(full&part time). ❑Other
L� I am an.'employer providing viorkers compensation for my employees working on this job.
com. Tomes
insurance.ca;tr,. i a:..}6^._;� 3..�.,,. . ;:,4;..
I am a sole proprietor and'have hired the independent contractors listed below.who have the following workers'
.compensation polices:
com'an"'naame: <.
:e i' :4!• ,rl' h�:. _ :fr^:.�:�.�" '1•,r::: .., , •rfa.a,.' .'•"•' ,.j.•:•�I i.i•:.� ..
.. ski •.r: i?.t•F:;::j, + .i 1 :(� '�t'•','�...•
address:. > • •( ��:•- ::.•. - .a_ "'
rr• 'S.,.. :•; .`i,i
..
�.�•:•: .. }r, ''~r•a'.��.,: ..f`•f'�'�>M1li.•Tly^ie :r.}.:;:� ,(:' `.� •' ''r"'���:` ,i. r:' S�' .
coin an. naix.. :�' t•;: :1;-;•:
address:. ,
.. .;r . •hone:#= _•�l
CIpo
111117
' .. 'r,'. •.i.r• .:r• a:k': y,��r .}.• :.,.k.. ,•.Y:. •'si:•,c: :a.:, <':.1'.:},:`'
iiisurnncs sb:
under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
Failure to secure coverage as required
one years'imprisonment as well as civil penalties in the foim of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that%
copy of this statement maybe forwarded to the Office of Investigations of the DIAfor coverage verification
I do hereby cart' er the ns and penalti of perjury that the inform ation provided above is true and correct
Date
Signature . .
Print name ALVA Ilt ,y1ARGONdF3 Phone# 77/ 70ryX
official use only do not write in this area to be completed by city or town official
city or town: permft(license# ❑Building Department
❑Licensing Board
Q check if immediate response is required []Selectmen's Office
❑Health Department ,
contact person: phone#; ❑Other
(revised Sept 20M)
Information and Instructions
Massachusetts General Laves chf pter�152 section 25 requires all employers to provide workers' compensation for their.
employees: As quoted from the 'law", an employee is.defined as every person m 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 mare of
the foregoing engaged in ajoint 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 therem, or the occupant of the.dwelling house of
anoti,�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 deemedto be an employer...,. : .::. . . .
MGL chapter 152 section 25 also'siates that*e'very state'or 16cal licensing agency shall withh�lci the Ssuance or renewal
of a license rmit
or pe ,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 regquired. Additionally;neither the' '
commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with t�e insurance requirements of this chapter have been presented to the contracting .
authority.
Applicants
Please f4 in the workers'�eoupensatiorr affidavit completely,by checking the box that applies to your situation..Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits maybe 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 regardinethC"law"or if you are
required to obtain a:workers.'compensation policy,please call the Deparhi�ent at the number listed below. .
City or Towns .
Please be sure that the affidavit is complete and printed legibly. The Departzent has provided a space at the bottoni 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 perry it/license number.which will be used as a reference number. The.affidavits,may be'.returned to.
the Department by.mail or FAX unless other'arrangements have been made.
The Office of investigations would lice to thank ybu in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call' '
The Department's address,telephone and fax number: ,
The Commonwealth Of Massachusetts
Department of Industrial Accidents
BMW of Wesdoatlens
600 Washington Street
' Boston,Ma. 02111
fax#: (617)727-7749
„hn„P:U- r61 T 777.4900 ext:406
of ,E rot 'Town of Barnstable
Regulatory Services
913 I,E,$ Thomas F.Geiler,Director
�p 1639• k,� Building Division
RFD MAC
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Fax: 508-790-6230
Offi • 508-862-4038
Office-
permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
n,alterations,renovation,repair,modernization,conversion,
MGL c. 142A requires that the`Yeconstructio
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work ?, Z K !6 X rlb Estimated Cost �'Ob•Oct
Address of Work:
Owner's Name: A L.V�C R M.¢r2GoNvr�
Date of Application: ZZAP�o�
I hereby certify that:
Registration is not required for the following reason(s):
DWork excluded by law
❑Job Under$1,000
[]Building not owner-occupied
®Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOUR ITRATION PROGRAM OR GUARANTY MM IMPROVEMENT FUND UNDER MGNOT L c 142A.
ACCESS TO THE .
SIGNED UNDER PENALTIES OF PERJURY
a ermit as the agent of the owner:
I he p
reby applyfor
ntractor Name Registration No.
Date
\ O
2 Z 1PROL/
Date 0 e s Name
Town of Barnstable
Regulatory Services
saaxszABM Thomas F.Geiler,Director
Mara
039. A`�� Building Division
RFD MA'1
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax:.508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: ,j 0 4R saR WAY N�/}�//✓/s
number street village
"HOMEOWNER": �LVAGIIC /y1A7?60A-0IT -77 / — 70 9�
name home phone# work phone#
CURRENT MAILING ADDRESS: 5fi-rl E
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 d requirements and that he/she will comply with said procedures and
requir nts
Si ai6e of Home caner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control. .
HOMEOWNER'S EXEMPTION
The Code states that: "Any.homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt ,
Oc T�o PROP 1?,' � IkJES A ( oT STANDARD LEGEND
NOTE:not all symbols will appear on a map
=.�
-' - GOLF COURSE FAIRWAY
49
EDGE OF DECIDUOUS TREES
# 44
M /� EDGE OF BRUSH
Q ORCHARD OR NURSERY
1 GE OF CONIFEROUS TREES
-..
MARSH AREA.
r
- EDGE Of WATER
DIRT ROAD
❑ E---PARKING LOT
PAVED ROAD
C�
>\ MAP 28 / - --- DRAINAGE DITCH
----- PATH TRAIL
MAP 289 PARCEL LINE**
/ MAP 326 �—MAP#
Q 021E— PARCEL NUMBER
MAP 289 039 , # t o #367 E HOUSE NUMBER
# r ........._...-._....._..... 2 FOOT CONTOUR LINE
13
J 10 10 FOOT CONTOUR LINE
# d on NGVDase 6 Elevation b 29
`,•�a.9 SPOT ELEVATION
STONE WALL
-X--X- FENCE
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-»--i 4- RAIL ROAD TRACK
STONE J. ETTY .
o SWIMMING POOL
PORCH/DECK
BUILDING/STRUCTURE
• "" DOCK/PIER
HYDRANT
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T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N I T o SIGN ® STORM DRAIN
N PRINTED SCAIf:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James
-I 1"=10D'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted ham 1989 aerial photographs by GEOD 0 UTILITY POLE II TOWER
w e 0 20 40 National Map Accuracy Standards at this do not represent actuol relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards
: 1 INCH=40 FEET* enlarged scale. on the map. at a scale of 1"=100. Parcel lines were digitized from FY2004 Town of Barnstable Assessors tax maps. * LIGHT POLE o EtECfRl(BOX
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Marcondes LOT # 289039
50 Arbor Way
Hyannis, MA 02601
508-771-7098
-16 444
16 DECK 16
16
46
26 HOUSE 26
46
22
5 FOP 22 5
Barnstable Assessing Search Results Page 1 not 3
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Home: Departments:Assessors Division: Property.Assessment Search Results x
- 50 ARDOR WAY
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Owner:
MARCONDES,ALVACIR&ROSELI Property Sketch Legend
Map/Parcel/Parcel Extension a
289 /0,,9Z
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Mailingddress �
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MARCONdES,ALV/ CIR&.ROSELI 16 -
45
50 ARBOR WAY
OAS
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HYANNIS, MA. 02601
t
2004 Assessed Values:
OP„
Appraised Value Assessed Value ''
Building Value: $98,500 $98,500 -
¢ h•
Extra Features: $25,400 $25,400
Outbuildings: 500 $500
9 e
Land Value: $ 100,400 $ 100,400 Interactive Property Map: Ma requires Plug iri: a „
Totals:$224,800 $224,800 1 have visited the maps before +' 10 {First time users
- Show Me The Ma a -�. � Click Here
April 2001 photos available
Sales History:
Owner: Sale Date Book/Page: Sale Price:
MCDONOUGH, KIERAN F 6/15/1986 C106970 $ 125,000_
http://w.ww.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/AssessO3/displayparce103.asp?mapp... 4/2 1/2004
Mid-Cape Hyannis
hearses Way
Hyannis, MA 02601
(508) 775•-6112
Sold To Ship To `
CASH ACCOUNT CASH ACCOU14T
q MA , MA
ACCT # QUOTE# TERMS ENTERED SLM EXPIRATION
y90001—�_-5002600^--__. _______CASH
_____.__._.___.____.__.___._______04/21/04_._._--S 04/22/04
Quantity U/M Des _____:.__...___
_---- W_.___._____ ,^Yc�ription__.__�._._____._._.___.__.__.__.__— i *---* _____..
c* Extension_.___._.
4 PC 2X4X16 #1SYP .40PT DAT--WAX 10.240 40n96*
2416PT
LN# a 1.10
2 PC 2X4X12 #1SYP o40PT DAT--WAX 7„020 14004*
2412PT
LN# e 120
130 EA 36" PT SYP 2X2 BALLUSTERS Oo`)20 11'�e 60�c
36BALPT
LN# 0 130
35 EA 5/4X6X16 SELECT .40 PT DAT 15.375 538.13*
LAX COATING
54616
LN# e 140
2 PC 2X12X12 #1SYP o40PT DAT 24.400 48a80*
21212PT
LN# e 150
1 PC 4X4X8 #i.SYP 4 40PT` 8.801, 80 80*
448PT
LN# n 160
2 PC 2X4X16 #1SYP o40PT DAT—WAX 10.240, 20n48*
2416PT
LN# a 170
30 EA 36" PT SYP 2X2 BALI_USTE R S Oa`�20 270 60
36DALPT
LN# N 180
4 EA 5/4X6X12 SELECT .40 PT DAT 11.018 44000
WAX COAT
54612
LN# % 190
PLEASE EXAMINE WITH CARE AS QUOTATION COVERS ONLY THE ARTICLES SPECIFIED. NO
RESPONSIBILITY IS ASSUMED FOR ERRORS IN CALCULATION OF SIZES AND LENGTHS.
April 21, 2004 1500a41 OTa709
QUOTE x
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