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Home My WebLink About0221 BUCKWOOD DRIVE �, � � L� .�.-- ._ o- :barn 1 , Co . F is 1 i ._ e a, 1 ,� e f S � F`'� �- !'12 3`/� f f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION y Map Parcel Application # „/`�/6i- o� 7Yd Health Division Date Issued.. Conservation Division ' Application Fee Off lV OF ?��S Planning Dept. �.g,9 Permit Fee 3,S' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address t' I Village (UM ► S 0+�ne ell '� ��t)2�l'he �!{ AddressZn Telephone s b Pe rmit Request 01Y1 e oun-) '-it 4, 13)� 'f��`(r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) am C'61 ►'i 1 ' ' Telep hone Number 5y�' ~ T' , Address ` Shy L, License# Home Improvement Contractor# Email b `� C S;, dV e-r Worker's Compensation # P ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE,, OA2�AM4DATE �� FOR OFFICIAL USE ONLY APPLICATION # L DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. TOWN OF BARNSTABLE BUILDING PERMIT(APPLICATION 4 Map I Parcel J t Application # 7?0 4 F•, Health Division A Date Issued Conservation Division Application Fee . S Planning Dept. ;Permit Fee 3 S� Date Definitive Plan Approved by Planning Board ?57 HistoricR- OKH _ Preservation/ Hyannis Project Street Address- Village �-� ` o YU(1), S i Owner&NeA1 i1 U�;.i 1�' �v5 Address ,% S c Telephone ct 5 Permit Request _.. .on,,)r..e_ -U.wte e, R-2`-�CARe -In _01(�) )rP\m , b _L yn Square feet: 1 st floor: existing proposed 2nd floor:. existing proposed Total new Zoning District Flood Plain Groundwater jOverlay C Project Valuation 1 U b Construction Type `' �'� Lot Size Grandfathered: ❑Yes * ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# un'its) .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) f Number of Baths: Full: existing new Half: existing new - Number of Bedrooms: existing _new 1 Total Boom Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air:. ❑Yes a 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 ❑Inew size _Shed: ❑existing ❑ new size = Other: Zoning Board of Appeals Authorization ❑ 'Appeal # Recorded ❑ Commercial ❑Yes ❑ No 1 If yes, site plan review# Current Use\ L =� Proposed Use. r APPLICANYINFORMATION (BUILDER OR HOMEOWNER) Name ((lZ! � �� Telephone Number t "Address �� l� _License# c0) S Home Improvement Contractor# Email �111�C0 0 '� Um C1�1 S "t Worker's Compensation # t ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r SIGNATURE 01 /`Y DATE - U �' t � FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. iL �'Ir CQralomv►ea '3s e�,fassrifclrr�setts .7epartwmt cr,fIudzrs Accid Qua ofFm?estigt,`iOM . _ 600 Washington met _ Boston,MA 02111 t iv n v masxgav1dza Workers, Campen'safr�n 7usn=ce .davit Bugders��nft—AdursMectricianslPhum.hers �phcant T31ffcu #,ten Please Print -Nam C L) Add;>e1 C2 Xre}ou an employer?Checkthe appropriate ba= Type of project-(regaio ed)- I.❑ I ant a employes with. 4. ❑lam a general confrsctor and I 6. [:]New oomaUUCtion employees(fall andfor part4une * havehiredthe sub contmcton 2.❑ I am a sale proprietor orpartaw- listed on the attached sheet•. 7. ❑Remodeliztg and have These sub-contractors have s4sp a so employees $. ❑Demolition , wodnng for one is any capacity. employees and have wogs' 9. ❑Building addition INo wohms'camp.fimmance camp-msuran-mm-1 - �ired 5. ❑ We are a corporation and its 10-❑Electac d repairs or a,d�ians 3.4j I ream a bQmeowner doing all work officers have exercised their ' 1L❑Plumbiag repairs or additions myself[No worbus'camp- Tight of esempfion per MGL 12.❑Roofrgmirs inc�ercq ired,j 7 c.152,g1(4h andwe have no employees.(No wodmrs' 13.❑other cow- requirE-) 'Amy aggEia=&st cbecUbos in mnst also fMoutthe sedioabelowshuwiag theirumrlsere c=ypensaffi„�.pcycyinf3m=Uam. l Ekmeownerswbo submit dhis of dng i g they aredoing Owe*am$thenhim outside cnntmaors— submitanemafdavit irdirwin such rCautzactosffut e%eclr tId9 Uax mast attarhed snadditimi'l sheet shoydmgthenoeof the sub-c�sad siatewhedLer ornotthose ealitiesb.ave employees lftbasub-cm,.*air hzveemployaes,flLey=stpm-v- etheir wadra'tamp.po-licyuomber. I am an erripir r tleatis pra�ztiucg�vrrrkets'eoarpertsatferrt i�tsrirar�cs for ar3�earlviny�ee� Below is CliffPVHd7 and jah site infot�rsalioa E Insucaace Company lMame: Policy 4-or Self-ins.I.ic- ExpigatioaDdte: Job Sits Address Cityf5 . Attach a copy of the warners'compensationpolicy declaration page(showing the policy munher and expiration date). Faahmr to secure coverage as required under Section 25A of M(M th 15 can lead to the imposition of criminal penalties of a fine up to SL,50DOD aadfor oni;y6arimprisona=4 as well as cif penalties in the fanm of a STOP WORK ORDERand a fine of up to$250-00 a day aggainst the violator. Be adtised that a copy of this statement noy be forwarded to the Office of Iuvesttgati ms ofthe DIA for msmz+cL-coverage-imcffic ion- ydo Du ty csrti tote pains and penaMes oflredkq that tha infarmadvnpemi&f abmw is true and carrect sit tre: Dom: o`-. , 696 Piw � b �"7 _ q S 4)O �,�al�an�t£�: ,T?o not a�rEfe Ert flats area,iii be rxrrr�pleteti by taffy r�rta�ru a;�al. , City or Tow PerndtlLicense# Leg Auflar4(circle one): L Board of$eaIth r.BmIRng I}epartment 3.CSty/Towa Clerk 4.Electrical Inspector 5.PIunbmg Inspector 6.Other Contact Person: Phanr<#: haformation and lnstrucflons MasmcJi ct is C=neaal Laws chVter M req=m all=gIoy=to provide WorIM&canrpensatian far then£employees. pa au to this sib,as Brrp&gme is&feed as .evay p=On-in IhO service of 2710ffier•under any contact ofhae, express or impli.ec%oral mr W.Ufiro_" An ezV&ypr is defined as rah ind'rvidBal,parinersbzp,associafian,crnpor-dim or of ii Legal entity,or nay two or more of the foregoing=gaged is a joint use,and inclndmg the legal represeabdVes of a,deceased employer,or the recerv=or trustee of an mdividnal,paxtnaship,association or otherlegal entity,employes employ. However the owner of a:dwelling house having not more than three apartments and Who resides ,or the occ¢pamt of the - dweIIiag house of anoffi=Who capm3's persons to do maintenarim,construction or reps work an such dweIling house or on.the grouri& or building appartmaaf th to shun notbm=e of such earployment be deemedto be an m:ploym" MM chapter 152,§25C(6)also sites that"every sfata or local Ucet�snag agency Shall withhold the Lss¢ance at IIsnness or to construc t bufi ' in the comma :wealth for any reaeWal of a license or permit to operate a b dings aPPTicanfmho has aotprodnced acceptable evidence ofcdmpIam with the isurance.cove;rage re4�-�Additionally.M(M chapter I52,§25C(7}states al�Teither'the �conor nay ofrfs political subd ivisions shall evid e ' m of like With lhe instu-�oe. emfer iintoany contractforthe pert=ozmance ofpnbIrc vac u�aoceptabl e;a comp . rrrzm-� cntS ofthis cbaptrrhavebeMP=CMfed•:)the MIZEra�Mlt oizty." ; Applicants please flI opt fhe wows'compensation affidavit completely,by eher l— &o boxes Ihat apply to your situation and,if necessary,supply soh-contr�s)narae(s), (es)and phone-= er(s) along With their certfcate(s)of „mince. Limited Liability Compazaes(LLC)or Lm nted Liability Partnerships(LIP)Wit no empIoyee$other than the mr**+1� or partners,are not repaired to carry workers' compensatim insurance. If an LLC or LLP does have employees,a policy isretpired. Be advised that this affida:vk maybe snbm=tu-,dto the;Department ofIndustrial Accidents for conffimation of msm-ance coverage Also be sure to sign and date the affiftVit The affidavit should be returned to ihe city or t Dwn fhat the application for the permit or Iicense is being requested not the Department of Isdnstzial Asp dzn-ts Should you.have any questions regardmg fhe law or ifyou air requited to obtain a W0330ers' compm,a;r,n policy,please call the Depm fineof at the aronbm listed below. Sf-0--insured companies should enter ijieir self-insurance license number on the appropdatn line. City or Town Officials t _ Please be sore that the affidavit is complete andpri3'edIegibIy. The Department has provided a space at the bottom of the affidavit for you to fill out in.the event the Office oflnvesfigati om has to contact yonregarding the applicant_ Please:be sure to fll in the pen ziVlicease rnrnber which wi71 be used as a refw. mce iruniber. In.addition,an applicant that must submit multiple p=tllicMSe,applitetions in any given year,need only submit one affidavit indicating current policy infosiation('if necessary)and undra"lob Site Ads"tie applica:lf-shoild write"aII locations in (may or - town) A copy of the-affidavit that has been.officfaII stamped ormmiced.bythe city orrtown maybe provided to the - applicant as proofthat a valid affidavit is on file for future peanits or Iice;uses_ A new affidavrtmust be fiIled out each year.Whem a home owned or cities is obtaining a Iicmlw or permit not relai ed in any business or commercial ventrE (ie- a dog license or-pennit to bum Leaves eta.)said person is NOT required to complete this affidavit The Office of Invesiigafimns Would Iike too thank you in.adv`�ce for your cooper ion and should you ha ve any gvnstions, please do not hesitate to give us a call. The Departmenfs ads,telephone and faznIImber_ . �cif�d�ia�A�cidents ' Odra=of IQyegfrgati=i Fax f l'-727 7M Revised 4-24-07 �3SgQg ToWn of Barnstable ` $ Regulatory Services. XAM a . ` Ricbard V.Scah,Db=Wr. Building Division. Paul Roma,Bmldmg Commissioner 200 Msin Street,Hy=iis,MA 02601' www.town. mrnstable.mans . Office: 50"62-4038 ' Fibc 50&79MZ O - - Property Owner Must Complete and Sign This Section a, If Using A Builder . ,. as Owner of the subject property hereby authorize to act on my behalf,' in all.matters relative to Work authorized by this budding permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be fiIled or utilized befort fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:F0RMs:0RRERPF.RM=0NMIS Town of Barnstable Regulatory Services dE Richard Y.Sca14 Director Building Division Paul Roma,Building Commissioner 200 Main Street, Hyann*MA 02601 www.town.barnstablemaus Office 508-862-4038 Fax: 508-790-6230 _ HOMEOWNER LICENSE EXEhWnON DATE: (}'� ^ — �� ) 1 Please Print `� ,d VJ BUC-r<W aod S JOB I.00Anom number street village "HOMEOWNEt". name.,--name.,--j home phone# p� work phone# S A CLMREkMAUING ADDRESS: i % `'OK sme 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. DEFINMON 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 heJshe understands the Town of Barnstable Building Department minimum inspection procedures and requir=ents and that he/she will comply with said procedures and requirements. Q. ` j ►2J / Sig SignEM of Homeo lt Approval of Building Official �1 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 U HOMEOWNER'S EICEAWTION 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 IWPFa ES\FORMS\buildiog p=nh formslEXPRESS.doc ? 06/20/16 1 1 S � �'laa � ��5 �,�o� �� \��N \ � �-� _ ,. . � . . � J� � _ .,1`�\ .- .. F . l� `,�� ,�v _� �R�'�` , , � �� _ . �. °�� :_ _ . . h �� ' _' s �. � ��. ,. , � e eL y /3,r, 5'2 .n e z -7Z , _ k VOP , „ y e 1 Cc Se wt r1 ( - ' . . e Ol �J � � Town of Barnstable0 RECEIPT H" 200 Main Street, Hyannis MA 02601 508-862-4Q38 ;a � Application for Building Permit R.. Application No: TB-16-2780 Date Recieved: 9/22/2016 Job Location: 221 BUCKWOOD DRIVE,HYANNIS Permit For: Building-Restore to Single Family Contractor's Name: State Lic. No: Address: , , Applicant Phone: a (Home)Owner's Name: MCAULIFFE,BEVERLY A TR Phone: (Home)Owner's Address: 46 FISHER ROAD, HYANNIS,MA 02601 Work Description: restore to single family by removing kitchen cabinets&sink capped behind wall in basement. Total Value Of Work To Be Performed: $100.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 5681, I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: MCAULIFFE,BEVERLY A TR 9/22/2016 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees ` Total Project Cost : $100.00 Date Paid I . Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 9/22/2016 � $85.00 101 Check Total Permit Fee Paid: $85.00 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued -Z7_! Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address � ��-. � fir. Village��i<r.►,,, Owner / ►` AU Address S,ri+C_ Telephone 71)-137+0 Permit Request "K-., CC 1�.,�•�� . a fiL� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new :Zoning District Flood Plain Groundwater Overlay Project Valuation )Sze, — Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0�-' 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) Lid � i—n Numb era of Baths: Full'existing new Half: existing new Number of Bedrooms: existing _new TotaILRoom:Count (not including baths): existing new First Floor Room Count Q_ -w . Heat Type and Fuel: �DGas ❑ Oil ❑ Electric ❑Other Ain Cer t l Air�J❑Yes _�U No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy r'onstriveflon Telephone Number . PO Box 52 Address West Dennis, MA 02670 License # Cell (508) 280-6964 - r-g�,�86 � 1C 169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO V SIGNATURE DATE f' S t FOR OFFICIAL USE ONLY .. i APPLICATION# - DATE ISSUED' MAP/PARCEL NO. ` t ADDRESS VILLAGE OWNER " w DATE OF INSPECTION: f sr. FOUNDATION FRAME INSULATION a FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL F FINAL BUILDING DATE CLOSED OUT ASS.OGIATION PLAN NO. 11 e� OWNER AUTHORIZATION FORM I, er's Name) owner of the property located at (Property Address) (Propedy Address) hereby authorize + , (Subcontractor) an authorized subcontractor for RISE Engineering,to a on my behalf to obtain a building permit and to perform work on my property. 02 1 a4. Owner's Sign e Date The Com7wnwealth of Massachusetts Deparbnent ofIndustrialAcc den& Office of Investigations UW- 600 Washington Street Boston,MA 02111 . www.massgov/dia Workers' Compensation Insurance Affidavitf Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le gib Mike McCarthy Name(Business/Orgmirafim/Individual): PO Boat 52 _ West Dennis, MA.02670 Address: (' 11 (508) 281 -6964 CSL-58633 VIC-169393 City/State/Zip: Phone A=am employer? Check the appropriate box: ' Type of project re 4. Iama en YP p l (.'qe�: 1. employer with ❑ general contractor and I.employees(fdl and/or part-time) * have hired the sub-contractors 6. ❑New c onstraction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity, employees and have workers' [No workers'comp. insurance comp.insura tnce 9. ❑Building addition required.] 5. ❑ We are a corporation and its 100 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their I L Plumbing ❑ mg repairs or additions myself [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required_]t c. 152;§1(4),and we have no employees. [No workers' I3 tliier comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information_ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConh actors that check this box must attached an additional sheet showing the name of the sub-contractars and state whether or not those entities have employees. If the'snb-cofactors have employees,they mast provide their workers'camp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is th'e policy and job site information M Insurance Company Name:_ l ' Policy#or Self-inns,Lic.#: lit! -�s,- 1 a'�rSG'�I j,� Expiration Date: 7/l 71,Y Job Site Address: City/State/Zip: 1 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIAformsurance coverage verification. I do hereby certify p and penalties ofperjury that the information provided ab is tree and coirect Si mature: Date: 7 / Phone#: Official use only. Do not write in this area, to be completed by city or town oJjzciaL City or Town PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Towu Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#• Massachusetts -Department of Public Safety Board of Building Regulations g and Standards Construction Supervisor License: CS-058633 MICHAEL J MCCR PO BOX 52 W DENNIS MA 6267k y »: 1 Expiration Commissioner 04/10/2016 Office-of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121` . MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 WEST DENNI A 0267 Update Address and return card.Mark reason for change. SCA 1 Co 20M-05/11 Address Renewal Employment Lost Card t ki< t • ac RO O 10 O CERTIFICATE OF LIABILITY INSURANCE OA10YY(Y) �. /16/2016/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01962-001 ;CONTACT_NAME . p� Bryden&Sullivan Ins Agcy of Dennis Inc W.I.Ext);. (508)398-6060 (508)394-2267 PO Box1497 r EnMI-�,RE-- So Dennis,MA 02660 I ADDSS INuRflRA A.I.M.Mutual Insurance Company 33758 - _ INSURED --- --- SIiREi.Bj.---- ---- --- Michael McCarthy Construction Inc P O Box 52 West Dennis,MA 02670 -�- _ j1N_SVRF,l3_E`---- —--.—_.._..- -— -- -- -- --- _ �i INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT!CNS OF SUCH POL!CIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. IL7R: . .-..... ... ___. . _.- IA I WUVD i- - -------- .... _-_. --- POLLICCyy-gy�p—ppp-�-p�� y��---- ------..----- - --- ---_.. ._.. TYPE OF INSURANCE POLICY NUMBER I(MM/D0 MMID�/Yl1Y). LIMITS = -i---�- - - - - - - — I--- ----- -- - GENERAL LIABILITY j -- -- _- I �EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY I DAMAGE TD $CLAIMS-MADE I OCCUR ;MED EXP(Any one person) S : r- PERSONAL&ADV INJURY' ---- L GE NERAL ...._$_.._......_...___— ._.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG '$ POLICY PE LOC _._. :.._._.. .-. - AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT ANY AUTO I BODILY INJURY(Per person)- $ - --ALL OWNEDISCHEDULED !AUTOS AUTOS I BODILY INJURY(Per accident) $ — HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS --- - ----- -..------ (Per accidentl $ - -- - � j UMBRELLA LIAB j OCCUR I TEACH OCCURRENCE F$ EXCESS LIAB CLAIMS MADE i AGGREGATE I$ DED RETENTION $ $ j WpRKERS Cpry�P�NSg7�pN I ! X 'TORY L MITS OER - AND EMPLOYERS LIABILITY _...-- -- ANY PR�pFjIE�QR/PARTNER/E ECUTIVEr/�I' I E.L.EACH ACCIDENT $ 500,000.00 A ;oFFICER/MtEM tR ExCCLUDDEEt� I Y I I N/A! VWC-100-6017656-2013A 7/17/2013 7/17/2014 r - -- — -— - - --- - (Mandatory In NH) �--�-� I ' � � �E.L.DISEASE-EA EMPLOYEEI $ SOO,000.00 rE-L DISEASE EA-S—E-POLIC_Y.LIMIT- -----' ---50-0—,00--0-.-0' .0� C O VUPERATIONS belowD ...DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF SANDWICH Attention: BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN HALL ANNEX THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N Sandwich,MA 02563 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i Town of Barnstable -ildi ost Thi rdSo That.�t is; ,isible From.the Stree;, A' roved Plans Must beeRetarned::ort.Job and,this Card,Must be:K T.: P sGa. Pp 3 nw;vuw ept - v. Pe •. .MAS9.- ..: - F - Posted Until Final.-1 s .ect�on Has �....� Where a.Certificateof;OCcu ane;pis<.Re ,aired such Burl--din shalhNot he,Occw untltl anFlnal<In ection;has been:- ry� : p . sp � made Permit No. B-17-201 Applicant Name: Nathan Tissot Approvals Date Issued: 03/01/2017 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 09 01 2017 Foundation: e t p / / Yp g Location: 221BU CKW00D DRIVE HYANNIS Map/Lot: 271-113 � Zoning District: RC-1 Sheathing: -.. A S& Sri ' Owner on Record: BETTY LLOYD W&HORTENSE R EUROPE ,�=;Contractor Name: SOLAR CITY CORPORATION Framing: 1 Address: 28 POPIS ROAD � Con�tractorUcense 168572 2 .._ .<a NANTUCKET, MA 02554 Est Project Cost: $8,000.00 Chimney: Description: Install solar electric panels on roof of existmghouserwith any Permit Fee: $90.80 upgrades,when applicable,specified b Desi n To.;be interconnected - - Insulation: pg pp p Y g A �, � � � . with home electrical system. JB-0263561 7.02KW 27 Panels Fee Pa�d`� $90.80 ".Date 3/1/2017 GO Final: y �I Project Review Req: Install solar electric panels on roof of existinghousewith any T _ , . 4L by Design To � st Plumbing/Gas g/Gasupgrades,when applicable,specified interconnected with home electrical systern1B"02�63561 Rough Plumbing: 7.02KW 27 Panels Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by`this permit is commenced within sa months after'issuance. %�rE l�. Rough Gas: All work authorized by this permit shall conform to the approved application and tI approved construction documents for whichittiis permit has been granted. All construction,alterations and changes of use of any building and structuresRshallbe in compliance with the local zonin b =laws and codes. p g Y ,�- ��i Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the A work until the completion of the same. A- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the B�uildin andKFire Officials are on th s�permit. Service: go Minimum of Five Call Inspections Required for All Construction Work: ft 1.Foundation or Footing Rough: 2.Sheathing Inspection . . ,. .T s 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final' Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. . ., :. Final "Persons,contracting with,unre istered.;contra�tors:do.not:have access to the uarant :fund"` as set forthinMGt c:142A g y Fire epartMent Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-"ISSUED RECIPIENT. :. dNLEM6t�L S E�✓T Town of Barnstable � cEIPT 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-201 Date Recieved: 1/25/2017 Job Location: 221 BUCKWOOD DRIVE,HYANNIS Permit For: Building-Solar Panel-Residential Contractor's Name: SOLAR CITY CORPORATION State Lic. No: 168572 Address: 24 ST MARTIN STREET BLD 2UNIT 11, Applicant Phone: (508) 640-5839 MARLBOROUGH, MA 01752 - (Home)Owner's Name: BETTY,LLOYD W&HORTENSE R Phone: (347)445-1500 EUROPE- (Home)Owner's Address: 28 POPIS ROAD, NANTUCKET,MA 02554 Work Description: Install solar electric panels on roof of existing house with any upgrades,when applicable,specified by Design; To be interconnected with home electrical system. JB-0263561 7.02KW 27 Panels Total Value Of Work To Be Performed: $8,000.00 Structure Size: 0.00 0.00 0.00 Width. Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. . I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Nathan Tissot 1/25/2017 (508)640-5839 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $8,000.00 Date Paid i Amount Paid Check#or CC# Pay Type Total Permit Fee: $90.80 1/25/2017 $90.80 XXXX-X}CC{-XXXX- Credit Card 5477v.. ...... .. ... ... ._.._...... Total Permit Fee Paid: $90.80 �- TOWN OF BARNSTABLE BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT 3 Date X �� Rec'd By Assessor's No. Last Name First Name ORIGINATOR Street Village. State Zip Telephone: Home Work Description: _ -COMPLAINT c INQUIRY Gt/ L� Requestor's Signature 7 "7 COMPLAINT Street Address LOCATION Aa OFFICE USE ONLY INSPECTOR'S Date /�%� Insipector ACTION/ COMMENTS FOLLOW-UP ACTION ADDITIONAL INFO. ATTACHED COPY DISTRIBUTION: WHITE FILE YELLOW - INSPECTOR PINK - INSPECTOR (RETURN TO OFFICE HGR. ) MISC1 [ ] [R271 113. ] LOC]O:e21 BUCKWOOD DRIVE CTY]07 TDS] 400 HY KEY] 180645 -=-MAILING ADDRESS------- PCA] 1011 PCS]00 YR]00 PARENT] 0 MCAULIFFE, FRANCIS P & MAP] AREA]50AC JV] MTG]9201 MCAULIFFE, BEVERLY A SP1] SP21 SP31 221 BUCKWOOD DRIVE UT1] UT21 .24 SQ FT] 1900 HYANNIS MA 02601 AYB] 1975 EYB] 1975 OBS] CONST] 0000 LAND 24800 IMP 59100 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 83900 REA CLASSIFIED #LAND 1 24,800 ASD LND 24800 ASD IMP 59100 ASD OTH #BLDG(S)-CARD-1 1 '59, 100 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 221 BUCKWOOD DR TAX EXEMPT #DL LOT 18 LC 35404-A RESIDENT'L 83900 83900 83900 #RR 0193 0075 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE]06/86 PRICE] 1 ORB]C106638 AFD] I A LAST ACTIVITY]05/18/87 PCR]Y R271 113. P E R M I T [PMT] ACTION[R] CARD[000] KEY 180645 00000000] PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP NEW/DEMO COMMENT [ ) [ ] [ ] [ J ] [ ] [ ] [ ] [ ] [ ] [ ] [?] R271 113. AP P R A I SAL DATA KEY 180645 MCAULIFFE, FRANCIS P & LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RC- 1 24,800 59, 100 1 A-COST 83,900 B-MKT 76,500 BY 00/ BY /00 C-INCOME PCA=1011 PCS=00 SIZE= 1900 JUST-VAL 83,900 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 50AC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 50AC HYANNIS PARCEL CONTROL AREA TREND STANDARD 10] 10 LAND-TYPE 24800] 102000 LAND-MEAN -76% 83900] 75048 IMPROVED-MEAN -21% 25% ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 100%] LOCATION-ADJ ' APPLY-VAL-STAT 1 LNR]LAND LFT/IMP]ADJS/SB/FEAT STR]STRUCTURE ARR]AREA-MEASUREMENTS NOR]NOTES COM]MARKET INC]INCOME PMR]PERMITS GRR]GRAPHIC FUNCTION-[ ] STRUCTURE-CARD NO-[000] DATA-[ ] XMT[ ?] Raw x � esrtl `teal and Commercial Builder r SPECIALIST- QuaL� o - CCARTHYC Y r ',' WWI October 21, 2014 Town of Barnstable C' Thomas Perry CBO -0 Building CommissionerLn 200 Main Stret" Hyannis, MA 02601 t + RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201404020 at 221 BUCKWOOD DRIVE has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction ,_,-.^-, ,� � .. ...� .�-...�,_-.- ..-ti.'�s.-...�+r..-mot,�„•,r..,.n^-++^v.- •�w.o_-.-.. i'"^*•.•r-'.-� .1" •- +•,r`^-•*-`-� ' "� y //, 5 �y Assessor's map and lot number .............I.�•..•..l�•.�••.- }P,tISTA}_}_ED IN �� ICE W T H ARTICLE it r G� A �1TA tY �� 1$ Sewage Permit number .�............... :.. . . ......... .. ....J;W1 - . , �� - � PyOFTMErO�y WN OF BARNSTABLE Z BARNSTABLE, M6 9 Or• BUILDING INSPECTOR 7 APPLICATION FOR PERMIT TO ..7�. ...... TYPE OF CONSTRUCTION ................... ./l G }!1. .................................................................................. �r,ate..... -:....................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...../...... `C'.. .Q( .......1.../.. :....... T........................... ................................... ProposedUse .....;7< .!..Gz '0 ........................................................ ................................................................ Zoning District ............. ..ti.t...' .`:.............................Fire District . Name of Owner >��.� f.!c� l ....G�� Tl��............Address ,1...� ��G r1�.411 J .. . . ........ �(1l Glv> Name of Builder,4.A�..2� . / f. /.••AddressQ:. / ...L7.�!' �r-llll,%....« �• i✓�A� " Name of Architect ........................... :- --' ::: -...................Address .................................................................................... 1r Number of Rooms S .Foundation Exierior ....................................................................................Roofing ................ ..................... ............................................. Floors ..................Interior ' ... �Lg, 1Heating /...�... ..... ��. a ......Plumbing 1......�'t r� ,.... Fireplace ..................................................................................Approximate Cost ...d.ez.r.p....r........... . Definitive Plan Approved by Planning Board -------------------_-----------19________. Area V a A•�� ...... ......... ..... .. Diagram of Lot and Building with Dimensions Fee ............../........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Wj 7II. 9?f I hereby agree to conform to all the Rules and Regulations of the Town off�Barnstable re gc ding the above construction. � ^� Name ................... .I....................... ........................' Mehta, Raghbir 77/-yclf to No 17586 permit for ,, remodel 2nd ................. floor of dwelling ��"2 ' ............... .............................................. ✓c lralje Location 1 Buckwood Drive " "�`'� ............................................................... , H annis Ra hbir Mehta Owner ...............�................................................. � �.._- A Type of Construction .........frame. ................................................................................ Plot ............................ Lot ................................ 1 r ' February14 75 Permit Granted 19 t Date of Inspection ..... ......... t Date Completed .�ic¢:: .. ....�.1:..........19 � • ..t 1' PERMIT REFUSED A .................................... 19 It _ •.............................................................................. } r ............................................................................... - 'F t ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's map and lot number rr .......... `1-76 L Sewage Permit number ....��¢�(. i� Il pF THE TOWN OF BARNSTABLE Z MARNSTLBLE, i " q BUILDING INSPECTOR 'ED MPY a' APPLICATION FOR PERMIT TO ..... ...... I;f„�.. .... .................................................. TYPEOF CONSTRUCTION .....................::'T...... 71rC....................................................................................... r' fiF' �•--� ..........19 2:.Z`�. ATO THE INSPECTOR OF BUILDINGS: The undersigned rhereby applies for a permit according to the following information: Location �"��!'��" /�,� �) Z�/1. ' Proposed Use =� �.. !?/+I,T„j rJ/............................ ,! t Zoning District ..................... .A.. ... ...............................Fire District ...... .......................................................................... Name of Owner .......................................Address ...:..... ....P. �.?.e;�.'.?'......:!.: •/.. Name of Builder ��•� -a•. r •��,�!/�! / /,•Address�..../� !%vn� ��....... ...... ��lii......''/ ref, L) Nameof Architect .................................:.:..............................Address .................................................................................... I Numberof Rooms ...,.: ..;.. .:.. ..........................Foundation .............................................................................. Exierior ....................................................................................Roofing ............. .. ............................................................. . ,_1 ��..rl' lix' Floors ....................Interior .....:,.:.. . ... ... . . . Heating �i-. �... ,`ii Y 'f !�/J t� / � / .!...f. �%/_.. ../......................................� ................. �'.. .....Plumbing ..... Fireplace ..................................................................................Approximate Cost ....%:?.:/ J ................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area ....................................... .. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH S��UOO I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................................................................................. floor of dwelling PERMIT REW/UlD ......................................7................... 19 ...................................../..................................... ^ --------------~..~--------- ................... .......................................................... �