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0016 CARLA ROAD
III I i '� lj I i I 1 d Application number....... Fee ..........................2.�........................................ SAR,ti5TA.8L�£. • Q, MAs. �i4�9. lding Inspectors Initials............ ................. FEB�E6 19 Z0i9 Date Issued `0� Fb ....................I. I. �. Q11Vh'OF 8A% n Map/Parcel......c. .f>/e�:......� Q....................... OLE TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 6,,V�C,4W t NUMB R STREET VILLAGE Owner's Name: (AC V'U'z-- Phone Number Email Address: Cell Phone Number C.C� — V Project cost$ �i Check one Residential Commercial J OWNER'S AUTHORIZATION As owner of the above property I hereby authorize 1k LC.'01�' to make application for a build' permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Q Siding Windows (no header change)# � Insulation/Weatherization ® Doors (no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layeWCCOA�-t, shinales) '� c Construction Debris will be going to ) `(G-+V� U54. CONTRACTOR'S INFORMATION(( Contractor's name 71TOi Home Improvement Contractors Registration(if applicable)# I�7( (attach copy) Construction Supervisor's License# sue (attach copy) Email of Contractor (1^')�VKc,Y' C.xv�I •r?G 7' Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS/N A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. t =7 APPLICATION NUMBER y *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side i HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: i Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. Commonwealth of tAassachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction Supervisor CS-005867 c-xpfires: 1 1112120 19 TIMOTHY PEARSON P.O.BOX 519' u ' N;. CENTERVILLE MA_02632 czD Commissioner_. IVY-,_ v , Cl�G' I(.I!^7%17If^(171RlrCC!•lI�O`�n�r'`C7rJ:JU^(.YL[tf1GIIf • Office of Consumer Affairs&Business Regulation " Registration valid for Individual use only HOME IMPROVEMENT CONTRACTOR 9,, TYPE:,;Qoraoration before the expiration date. If found return to: Registration 1>=xp__-_r___ation Office of Consumer Affairs and Business4Regulation 100879 06/23/2020 One Ashburton Place-Suite 1301 Boston,MA 02108 MARKWOOD CORP TIMOTHY M.PEA 6lSI 110 BREED'S HILL ROOD UNIT 10 (J Not Valid Without signature . HYANNIS,MA 02601 Undersecretary ; 4; 4 The Commonwealth of Massachusetts Department of Industrial Accidents J. — Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): r�CAk_CX" -4` Address: �\o �C> City/State/Zip: 0060( Phone #: 47�Y--7 79-b 3 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with k 4. I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance. required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof re airs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other k-> comp. insurance required.] *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $C ntra•t r o �o s that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. r �� Insurance Company Name: Policy#or Self-ins. Lic.#: kf 5731 S `ll7�%g Expiration Date: Job Site Address: S�p (�r�'14 V� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certr the pains and penalties of perjury that the information provided above is trues and correct. Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/.License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia DATE(MMIDDIYYYY) .4C40R0® CERTIFICATE OF LIABILITY INSURANCE - �;��. 07/16/2018 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 NAME: Mary Connor SULLIVAN GARRITY 8r DONNELLY INSURANCE AGENCY INC PHONE Ext: (508)453-2586 ac No: @gg kathleen. E-MAIL ADDR eddis s dins.com 10 INSTITUTE RD INSURERS AFFORDING COVERAGE NAIC# WORCESTER MA 01609 INSURERA: LM INS CORP 33600 INSURED INSURER B: MARKWOOD CORP INSURERC: INSURER D: 110 BREEDS HILL RD UNIT 10 INSURER E: HYANNIS MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER: 291749 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POILIffPOLICY NUMBER MMIDD EFF MMIDD� LIMITS LTR ' COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGETO S CLAIMS-MADE OCCUR PREMISES Ea occurrence S MED EXP(Any one person) S N/A PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY❑JE0. LOC PRODUCTS-COMPIOPAGG $ OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED • PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I ST TOTE I I OERTH AND EMPLOYERS'LIABILITY YIN N ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? I NIA WA NIA WC531S319674048 06/06/2018 06/06/2019 (Mandatory in NH) E.L.DISEASE=EA EMPLOYEE S 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govBwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MarkWOod Corporation ACCORDANCE WITH THE POLICY PROVISIONS. 110 Breeds Hill Rd Unit 10 AUTHORIZED REPRESENTATIVE Hyannis MA 02601 i _' DaDannieell ro4ufe M.Cy,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD °FTHE rn� Town of Barnstable *Permit# l �' Regulatory Services if ee s 6 months from iss ate * BARNSTAB 9� MASS. SFp y� Scall,Director i6 39• �Q� ?01j BuI ding Division � Paul Roma,Building Commissioner/y�lit ain Street,Hyannis,MA 02601 YJ ✓w.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY d Map/parcel Number Not Valid without Red X-Press Imprint Property Address W CA fn N%3 ems; Residential Value of�L_C_CYN Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address U i Contractor's Name HCe�1e_(�Ll�CL �f} \n, TelephoneNumber �(J9-7 �e-V?3V Home Improvement Contractor License#(if applicable) ` 97( Email: +1 Vile t-LoCoj 14e- Const ction Supervisor's License#(if applicable) 60�19? Workman's Compensation Insurance Check one: ❑ 1 am a sole proprietor D,oKam the Homeowner I have Worker's Com ensation Insurance Insurance Company Name �� (y Workman's Comp.Policy# 1. ;E; 3 I S 31tqtv7 kb 4i? Copy of Insurance Compliance Certificate must accompany,each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) e-side Replacement Windows/doors/sliders.U-Value 4 3b (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 fired. SIGNATURE: C:\Users\decollikWppData\Local\Microsoft\Windows\INetCache\Content.Outl000k\\L7U69LF2\ XP ESS(2).doc 0 1/ 17 � ,Yrr7G Wx0? 77ie Conitanioantvealtla of Massachusetts Dep artment of Industrial Arcadents r—{y Office of Investigafions _ 600 Washington Street Boston;',JM4 02111 ` ivivw.inass.goi dia Workers' Compensation.Insurance Affidavit-B><rilders/Conk•actors/E,lectriciansfPhambei- Applicant Information Please Print 'b 1Vatne(I3nisaness/Orgauiz tionFl4rdiraidual): r�%(�L . Address. City/State/Zip- Gr�� VV). OZUJ Phon g: Are u an employer?Check thg appropriate box: j�` Type of project(required): 1_ I am.a employer-with 4- ❑ I am a general contractor and.I have hired the sub-contractors o ❑ r cvus a titian employees(full.and/or part-time)-* �. Rem®�� 2..El am a sole proprietor or partner- listed on the attached sheet_ N ng. ship and have no employees These:sub-contractors have: 8. ❑ Demolition working for me in any capacity. employees and have workers' .� �`• 1 9. ❑Building addition [No workers-'comp.insurance comp_insurance. required.] 5. ❑ �,We are a corporation and its 1Q.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing,repairs or additions myself[No workers'comp. right:of exemption per il'1GL 12.❑Moof repairs insurance required.]I c_ 152, §1(4� and we have no employees.[No workers' 13.❑Other comp.insurance required.] 'Auy applicant.that checks box 41 most dw fill out the section below showing their workers'compensation policy information I Hotneowners who submit this affidndriaduating they are doing all,woA and then hire outside contractors must submit a new affidavit iflalfAg such_ Contractors that chew.this box must attached au additiomA sheet showing the name of the sub-ccatmmrs and state whether at not those emities have employees. If the sub-ccnnactorshaceemployees,they must}amvide,their workers'comp.policynumber. I ant air employer,that is providing itrorkers'compeatsa art insurance,for lrry einpIa Res. 8R10t4'is tI4R pvitcy'rtrrrJ fu6 s tR Inforination.surannceeCompany Name: '' 1L t y 1"J(i(/JG✓r�v► Policy or Self-ins_Lic. W�.�3 I S 3 -tlo� Expiration Hate: Job Site Address: 1 co `C 14 City/State/Zip: 'i G►��`�� � �V'r• ���/ 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?5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.004 and/or one-year m4m.sonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to S250A a day against the violator. Be advised that a copy ofth s statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification.. I d0 1rRYRb r CRrtl.6,u!i tire pains alyd penalties of pRY)4Ery that the iirforrr'rdrtial4,proi�irledi abm=R i5 t4,tiR andcorrect. Siena tune: �j ems / Date: q4-34 ` Phone#: V` 6 ?� " �/ 70r Official rise only. Do riot write in this area,to be c inpleted bp'city or tnavir,v�cinI City or Toum: PermitfLicense Issuing Authority(circle one): 1.Board of Health ?.Building Department 3.Cityllown Clerk 4.Electrical Inspector 5.Plumbing Inspector 5.Other Contact Person: Phone#: DATE(MMIDDIYYYY) A"eO hr CERTIFICATE OF LIABILITY INSURANCEFL... 08/25/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Mary Connor SULLIVAN GARRITY& DONNELLY INSURANCE AGENCY INC PHONE (508)453=2586 —_ a E-MAIL ----- ADDRE_SS: Mary.connor@sgdins.com 10 INSTITUTE RD INSURERS AFFORDING COVERAGE NAIC# WORCESTER MA 01609 INSURER A: LM INS 33600 -- — INSURED INSURER B MARKWOOD CORP INSURERC: INSURER D: 110 BREEDS HILL RD UNIT 10 INSURERE: HYANNIS MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER: 186482 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR, POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE I]OCCUR DAMAGES(RENTED PREMISES Ea occurrence) . $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ -.._......- -------...-- — — -- POLICY❑PRO JECT ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) $ AUTOS — AUTOS -.DILY - ........ ---.........--..-.__....... :..:........`---...— --- — HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X SPER TATUTE OERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? I N/Al NIA NIA WC531S319674047 06/06/2017 06/06I2018 -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION .DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.. Markwood Corporation 110 Breeds Hill Road Unit 10 AUTHORIZED REPRESENTATIVE -- Hyannis MA 02601 j�t / Daniel Nl CrO y,.CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety •Board-of Building Regulations and Standards Construofia t Supervisor a .. TIMOTHY PEARSON P.o.Hox 519 CENTERVILLE MA 02632 (� l� Expiration: Commissioner .: 11/12/2017 3. C%Fkfariirirrrrernr:rc�/�a�C>/l�r�:,rrc�rtrr//1 ,...Office of Consumer Affairs&Business Regulation License or registration valid for individual use only �i HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: F Registration 100871 Type: ; Office of Consumer Affairs and Business Regulation 4� r Expiration ;6/24%2018 Private Corporation ! 10 Park Plaza=Suite 5170 -Boston,MA"02116 MARK WOOD CORE I TIMOTHY PE'ARSON {' y 110 BREED'S HILL ROAD:UNIT,,!0 :,; ,•;,,- HYANNIS,MA 02601 Undersecretary Not valid without signature GF THE Tp� * IARNSTABLE, '039. Town.of Barnstable i639• ♦0 Regulatory Services Richard V.Scali,Director Building Division Paul Roma Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder ; "as-01wner of the subject property hereby authorize`� k-�'`1 I Y ICE`\ C to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\fNetCache\Content.outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 -��- Ila OS33S °FIRE r° Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee 3S-r BARNsrABLE, '*` 9e_ MASS. $ Richard V.Scali,Director ®PRESS PERMIT o i639• 1� ArFD MAC� Building Division AUG 2 02015 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE www.town.barnstable.ma.us Office: 5W7862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel NLltrtber (�a Property Address 19 cct`rkc. `�` . (�(JLM\NA. residential Value of Wok$ ' l.S Z�0 Minimum fee of$35.00 for work under$6000.00 Owner's Name .Address 5GG) NLON-re—, �� S cx��ncr c, C�cSry��� t-�.�\ �"��►" C�ai-�G�1 Contractor's Name (VIKQyaf5[,t1 Q�IL(.�S�(1 `-`� Telephone Number 9D� 28 U73-tf Home Improvement Contractor License#(if applicable) gj�1 Email: A�w4• 4-- Cons action Supervisor's License#(if applicable) J U1�1 7Workman's Compensation Insurance Check one: ❑ lama sole proprietor am the Homeowner I have Worker's Compensation Insurance p D Insurance Company Name Workman's Comp. Policy# ux1 = 3 uS - J Vqui� ( Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) IlAe-side Replacement Windows/doors/sliders.U-Value " 31 (maximum.32)#of windows 5 #of doors: w c>— Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required'.Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. "Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is ed. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc A Revised 040215 4 lbe Conimortivealth of Massachusetts Departrneatt of Indrtstrial Accidents 1 ti r Office of InvestigationsA@ 600 Washington Street r' Boston,MA 02111 * jvnw.nias&gov/di r Workers' Compensation Insurance Affidavit-BuiIdersJContractorslE.lectric ans/Plumbers Applicant Information pease Print Le gib Name(Businesa,OrganizatioDU&viduaa): Address: CityfStat&Zip: t ��Z X \�• �.� Phone A, ���/- 779-07-5 AV an employer?Check the,appropriate box: Type of project(i equirrd)c 1am a e i 10, r:with 3 4. ❑ I am a general contractor and I 1'. 6. ❑New construction erraployee (full and/or part-time).* have hued the sorb-contractors 2.El I am a sole ptopnetor or partner- listed on the attached sheet ?. ❑Remodeling ship and have no employees These.sub-contractors have g. ❑Demolition. working for me in any capacity. employees and.have workers' � 3' r t5''- 9. ❑Building addition [No workers- comp-insurance comp_insurance.l required:] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a Itonre�+jvner doing all work ❑ !; • P ni<<:Plf No workers'comp. right of exemption per MGL (� n insurance i equiced:]'s c. 1.52, §1{4h and we have no ��Oflhoefr'U employees_[No workers' 13. \ NkO corup.insurance.required] 'Any applicant That checks b&%fl Hurst also fill our the section below showing their workers'compensation policy information- Homo wnns who.subma this affidsvit indicating they are doing all work and then hire outside contractors mast:submit a new affidavit indicating such. rcontractoss hat chec_�tb's ba c must attached au additional sheet shorting the mmne of the sub-tout-actors aad:state whether or not those entities have employeeL. Ii the suns-conant tors have employees,they must provide their workers'comp.policy number. 1 aen an.ertrplotyer Mat is providing ttwrkers'coeerperesation i serra.trc or grey enTl ogees. Beloiv is tare policy and job site information. Insurance Company Maine: Policy br Self-in L c.4: 3�S— 3 k 5-- Expiration Date: Job Site Address,: City/State/Zip: (4L C .,,,, LOU(,/ Attach a'copy.of the.m-brl:e:rs'compensation policy declaration page(showing the policy number and expiration date). Failure to secure cc ^erago as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a. fine till to S 1,500,00 andfor 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 clay againsst the violator. Be advised that a copy of this statement may be.forwarded to the Office of Investigations of the:DIA for insurance coverage verification. I do hereU)p ciartflil itrrder thepains and penalties of peijury that the information provided abm a is trite and correct S1enatus'e.: Date: Phone t?f eraI ruse,omit'. Do not nrite in this area,to be completed by city or tott'n:officiat Citi or To u: PermitlLicense Issuing Authority(drele one): 1.Board of Health ?. Building Department 3.CitydTown Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: 6 . [_DA7E_(MMIDD1YYYY) ACC>R V CERTIFICATE OF LIABILITY INSURANCE en412015 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 SULLIVAN GARRITY& DONNELLY INSURANCE NCONTACT AME: - - 10 INSTITUTE ROAD PHONE FAX WORCESTER, MA 01609 (A/C,Not: E-MaIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC If INSURER A: LM Insurance Corporation 33600 INSURED -INSURER B MARKWOOD CORP INSURERC: 110 BREEDS HILL RD UNIT 10 HYANNIS MA 02601 INSURERD: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 25974443 REVISION NUMBER: _- -THIS.IS TO-CERTIFY THAT-THE-P_OLICIES_OF_tN_SUR.4NCE-LISTED_BEL O. .HAVE_BEEN.-ISSUED TO THE-INSURED-PIAMED-ABOVE-FOP.THE-P-OL!CY-PERIOD-- --— INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER:D000MENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE'ISSUED OR MAY PERTAIN,'THE-INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS'SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EXP LIMITS LTR POLICYNUMBER MM/DD/YYYY MWDD/YYYY COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE 5 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence S 5 MED EXP(Any one person) . $ PERSONAL 8 ADV INJURY. $ GEN'L AGGREGATE LIMIT APPLIES PER: 'GENERAL AGGREGATE S JECT LOC POLICY PRODUCTS,-COMP/OPAGG S OTHER: g. AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT S Ea accident ANY AUTO - - - BODILY INJURY(Per person) S ALL OWNED SCHEDULED - BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE - S HIREDAUTOS AUTOS _ Per accident S UMBRELLA LIAB HOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S __rDEDTJ RETENTIONS $ A WORKERS COMPENSATION WC5-31S-319674-045 6/6/2015 - 6/6/2016 ,/ STATUTE OERH _ AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N❑N �NIA E.L.EACH ACCIDENT $ 100000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) - E.L.DISEASE-EA EMPLOYE $ 100000 If yes,describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE 200 MAIN ST. ACCORDANCE WITH THE POLICY PROVISIONS. WILL BE DELIVERED IN SE HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The-ACORD name and logo are registered marks of ACORD 25974443 1 1-319674 115-16 WC I %artik Wali 18/14/2015 11:52:03 AM (EDT) I Page 1 of 1. - FTHE rq�, * BARN STABLE, �! M^ 9•. Town of Barnstable i63 ♦0 Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I f he subjectproperty as Owner o f � hereby ) �V'^authorize 0u"-V-3,11 CU O' to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\DecollikWppData\Local\Microsoft\Windows\Temporary Internet File\ ont nt. utl00k\2P1 IDHR\EXPRESS.doe Revised 040215 t Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration =-_ - Registration: 100871 Type: Private Corporation Expiration: 6/24/2016 Tr# 250303 MARKWOOD CORP TIMOTHY PEARSON 110 BREED'S HILL ROAD UNIT 10 - HYANNIS, MA 02601 Update Address and return card.Mark reason for change. ❑ Address Renewal Employment Lost Card SCA 1 ES 20M-05111 .. ____.,_____--��e.`���c��ia�icdracce{cll�a�C�iF'`a:rtac�uJel1� _ --•— - --•--- ---,`-__.___�. __" _� §Z\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR- before the expiration date. If found return to: {� ' egistration: ,;100871 Type: Office of Consumer Affairs and Business Regulation -�. xpiration: 6/24/2016_^ Private Corporatioi 10 Park Plaza-Suite 5170 Boston,MA 02116 MARKWOOD CORP TIMOTHY PEARSON 110 BREED'S HILL ROAD UNIT_:10 HYANNIS,MA 02601 Undersecretary Not valid without-signature .� �. a Department at Public safeW.' gM Massachusetts- i Board of Building" �iatior�s and standards ctruction SuPer"sor ,p ion. 05867 . r 'incense C5 0 N c 1. p yfEARSONTIM { P.O.BOX#519 . 62632' Genterviile MA , 11112/2015 commissioner. # b 4. t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 6 q A b Z3�o Application #o��/S Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee g V I SV Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address I(o (fuY C. 4-V.)• Village Owner Address r Telephone F��3 Permit Request o a"»0') ^ 1rCG.r Fr►��/ Cr P 1 Lc> C.�jU' L,Y' 1 S r 1 • L�C�✓' Ur-�. L�J�(S t't ��d C L✓' 4 Square feet: 1 st floor: existing 'proposed 2nd floor: existing proposed -Total ew Zoning District Y`_ Flood Plain Groundwater Overlay Project Valuation UC,> Construction Type Lou," Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supportng documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes �Ko 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: -3 existing aew Total Room Count (not incl ding baths): existing 6 new V First Floor Room Count 1 Heat Type and Fuel: Ga ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ®°No Detached garage: isting ❑ 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 ��V)cl\ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name / Pcrtrx', ` Telephone Number �u� —�7�-U7�� Address uKt-(t?icense # � ? 14(4C4YAV1%1N. C) Home Improvement Contractor# Y�7 Email 1'►'! Q(�(G�tr�C�Gr •HG Worker's Compensation #(Ax g- 31 S—314G711-ck ti ALL CONSTRUCTIb DEBRIS RESULTING FROM THIS PR�ECT WILL BE TAKEN TO r SIGNATURE DATE �/ f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER E DATE OF INSPECTION: FOUNDATION FRAME g INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i 4, r GAS: ROUGH FINAL ` FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 600 W rS n Street "Bortary—W 02ZII • wtt�w.mussgnv��ra Work=' CompemationTnSM-=ceAffdaviL-BurlHers/Confractnrs0ectdPia]WPhmibers A.PpRewdInformatibn l� ' Please Print j e "b Name(s�essl - �G.Y' ' citp/Statdzip: (44 n n" (4 YA. Gam► Phone#: � v7 Are feu au empIoper?Meck&e appropriate box a of ecf Type prof (teed): am 1. I a e�plopw wit£r 4. [Q I am a ge•.orral ca& ctor and I cmp*ecss(hR and/or part time).* haves hired the sob-c=tact= 6 0 oonshvciion 2.[] I am a sole proprietor or pmtam- listed aoa$e attached sheet 7. Remiodrimg ship and have no earploy= Mesc bave S. (l Danolitian W013dng forme m any capacity employees eadhave we lcen- [No 'conip.hi sm- ance Comp.kslIIaI=t- 9• ❑ ""`""�addrttpn n4 d1 j• ❑ We are a corporatiM and its 10.❑Blcctricalmpaas or additions 3.❑I am ahmnwwner doing all work office hope mm-ciiscd thek 11.0 Phmbmgrepairs or additions n0.yself [No wnzi�caul. . ziglrt of per MQ. i smmm re�-J t e.LA§1(4),and we have no IZ_❑Roof repairs m employoes.[No wo±s' 13.Q 00ie;r CZMp.7nC•nl'anfrregiouLl *Any appIicmitthatehcdabax#I=stRImMOmtihe-tbnbcinwshoWagtlLdrwocrss'eompms6onP� 9�a�fio� t Hnmanwacts who=1.*ffiis atdavk kfi of ag fly are doing 4 wade and thm hh.oamda a ffiut subn anew affidavit iadir. gyach tCoatm r tas thteheckthh box n=t arched in ndditirml dmdsbowi3g.6c riot of the sob-=nits and Stec wheihcr arnotft=c„'ties hags -3PI0pas Ifthe soh Edna hive=3p1nY-S, Yt P vgide their wawa'c°mR Party y®bQ ram an ern Pkyer that is praYidmg work a cotrTemation insr ranee for my r�rrP�J'� 78dow it the policy,and job site • injarmatinr� - � ; Instaanec Company Name: tl�; 1' \ L✓� Policy,#or Self-ms.Lic: irati onDain rob SitzAddrzss: Ci�r/StAMTJp:J4-4_(--A C>-CIO "�1. Attach a copy of the workers'compeasat on policy decLumfion page(showing the policy number and ezpiratiaii dame). FaUr=to sccum coverage asrequardunder SecticnZA ofM(3L av M can Icadto rho imposition of criminalpenalties of a tine Irp to$1,50-0.00 and/or one-year fioprisaamcnt,as wra as civR peoaIiics in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statemrmmay be fnrwm-dcd to the Ofam of Investigations of fm DIA for msnranm coverage vedficatiam I do hrr arras and penardes ofpedmY that the h7fmmadorc praFided above it trur and correct S tme Phone 0177 dnl use only. Do not write in f z&area to be eon kiwi by city or tMM offh*z City or Town permii/T.irr�,c� IssodngAuffiority(circle one): L Board ofHealth 2 BmildmgDepartment 3. .--•- . I g -•p --_.• ..- _. ..._-•- _ . �. Cdy/'Tawn Clerk 4.RIectzical7rispeetor 5.Plnmhing 7nspednr 6 Mir Contact person: none#: Information and Instructions Massachose#t Gc=ral Laws chapter M rsgrrs 4 emiploy=m provide worl='compensation for ffick employ=. Pmrsnant-t o this stdiitry an azplayre is defined as R.every person.na See service of another—fI saycont3dofhfir, express or implied,oral or wzhen�" An.eajvkaye: is defined as'an.individnaI,pmt=rs*,essocialion,corporation or other legal en f,or any two or more of the fixrgoing engaged m a joint eofesprise,and including the legal repireseafaiives of a.deceased employer,or the receiver or trustee of an.blividnal,parhzdhip,association or other Iegal ex ty,employing employees. However the owner of a dwcHinghoose havingnot more than three eparI f and who resides therein,or the occapant of the - dweIImg house of anofler who employs pmsons to do maintenancrr,coon or repair work on such dwelling house or an the grounds or building apptnien ark thereto shag not becanse of such employmeat be deemed to be an.employer." MGL chapter 152,§25C(6)also stairs flat aeverysfata or local licensing agencyshall withhold$re issuance or renewal of a license or permit to operate a business or to construct buxildings in the commonwealth for any applicautwho has not produced acceptable evidence of cdmplianee with the*assurance.coverage required." Additionally,MGM cbaptsr 152,§25C:(7)slates`Neither fire commmrwealth nor ray ofits poIitical subdivisions shall ...... ewer info arty cantract fur the perf=unm ofptrblic woikuofil acceptable evidence of compliancev;itli the kmran__rp, requrremerzfs of this dLVtrr have been presented 1D the contracting authority." A.pplicamis Please 51 otrt the worms'compensation affidavit completely,by rhecl:ing the boxes tbE±apply to your sifnation and,if necessary,supply sob-coniz or(s)nanjo(s), ad&ess(es)andphame nt—ber(s)aIongwifhthcir cetiificate(s)of msmrance. Limited Liability Companies(LT-Q or Limited Liability Partnerships(LIT)withno employees other than the members,or partners,are not mquaed to cry woricers'compensation insurance. If an LLC or LLP does have employees,apolicy is regoiizd. Be advisedthatthis afffidavitmaybe sahmitfed to the Department of Industrial Accidents for confirmation of insurance coverage, Also be sure to sign and dafe the affidavit. The affidaYit should be retrnned to the city or town that the application for thepennit or license is being requested,not the Depa t nent of Indnstrial 14_ccideais. Shouldyou have any questions regarding the Iaw or ifyou are required to obtain a workers' compensationpoliey,please caU fhe Department at fie number listed below. Self-io red.companies should eater their self-insurance license nimmber on the apprmgiiafE line. City-or Town Officials Please be smre fiat the affidavit is complete and printed Iegibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to coufact young the applicant Please be sure to fill in the pen�'/liceose number which will bo used as a reference number. In addition,an applicant that must submit multiple penniVhcense applit ations in any given year,need only submit one affidavit mdicaimg em=t policy information Cif necessary)and under"Job Site Address"$e applicant should writ-,"all locations in (city or town)."A copy of the.aff davit that has been officially stamped or roavimd by the city or town may be provided to the - applicant:as proof that a valid affidavit is on fide fur ftmm pe®its or license& A new affidavit must be filled oitt each year.Where a home owner or citizen is obtaining a license or permit not trrlated to any business or commercial venture (ie. a dog license or permit to bum leaves etc.)said person is NOT rcgahzd to complete this affidavit The Office of Investigations would Him to f ink you in advance for your-cooperation and should you have any questions, please do not hesitate to give us a call The Depmtn mfs address,telephone and faxnmmbea: T1�e ntet13t of Ma&whusetls . Damtmmt cif lnbst al Arcideuta mice of hVe&tgaUO= �G4�a�hmg�an Baste,MA 02111 Ta A 617 727-4900 Oxt 4€6 or 1-M MASS Revised 4-24-07 Fax#617 727 7749 .mas5auvidia 711j1_!2514 6:_'2:06 P.N_ PST (GMP-3) FRCM: _0.0005-TG: 15087783.770 Page: 2 of 2 ACo CERTIFICATE OF LIABILITY INSURANCE °A'E°"M°°"'"Y' �. 7114/2014 TNIS 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 EIELOW. 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'mayrequire an endorsemerrt�"'A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER SULLIVAN GARRITY&DONNELLY INSURANCE NAI"ME: - 10 INSTITUTE ROAD PHONE Fax WORCESTER,MA 01609 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC t INSURER A: LM Insurance Corporation 33600. INSURED NSURER B: MARKWOOD CORP 110 BREEDS HILL RD UNIT 10 NSURERC: HYANNIS MA 02601 NSURERD: NSURER E: NSURER F: COVERAGES CERTIFICATE NUMBER: 20876087 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED-ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D SUBR POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE ,ry yy�p POLICY NUMBER - (MM$JD MMMDIYYYY LDAITS COMMERCIAL GENERAL LIABILnY EACH OCCURRENCE $ CLAMS MACE F—IOCCUR, PREMISES Ea occurrence)TO RENTED $ MEDEXP.(Any one person) $ PERSONAL&ACV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY11 PERO LOC PRCDUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ rEa accident ANv AUTO BOCILYINJURY,Psrperson) $ ALL OWNED SCHEDULED BOCILYINJURY{Par accident) $ AUTCS AUTOS NON-OWhED PRCPERTYDAMAGE $ HIRED AUTOS AUTOS rP racadent UMBRELLA LIAB OCCUR , EACH OCCURRENCE $ - EXCESS LIAR HCLAMS-MACE AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION - WC5-31 S-319674-W 602014- 616l2015 �/ TOTE I ER AND EMPLOYERS'LIABILITY . Y/N ANY PROPRIETORIPARTNERIEXECUTrVE E.L.EACH ACCIDENT $ 100000 OFFICERrMEMBER EXCLUDED? ❑N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100000 If yes,descnbe under DESCRIPTION OF OPERATIONS babes E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Worters compensation insurance coverage applies only to the workers compensation laws of the state of MA. Th s certificate cancels and supersedes all previously issued certificates,only as they relate 10 workers'compensation coverage CERTIFICATE HOLDER CANCELLATION TOWN OF SANDWICH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 16 SAN SEBASTIAN WAY SANDWICH MA 2563. n - - - - AUTHORIZED REPRESENTATIVE.. . - ..1 . LM Insurance Corporaton ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CE.iT nO.: 20876087 CL=EYT CODE: 1319574 Lucy Garfield 7/14/2014 9:09:4E AM IE7T) Page 1 of 1 ofTME Town of Barnstable ` os Regulatory Services 'CINSTAXIM KUMg Richard V.Scab,Director 16.1►a��a. Building Division Tom Perry,BuRding Commissioner 200 Main Street Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Ik P(A sc('� U ,as Owner of the subject property hereby authorize / I M & Ir l�1� Cc l�, to act on my behalf, in all matters relative to work authorized bythis building permit application for. (Address of Job) 'Pool fences and alarms are the responsibity of the applicant. Pools are not to be filled or utilized before fence'is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name oil- 1� Date Q:F0RMS:0WNWERMISSI0NP00LS towiot ot-Barnstabie Regulatory Services axe r :Richard Y.ScalL Director 130dinig Division ILAIMMARM Tom Berry,Building Commissioner 200 Main Street, Hyannis,MA 02601 w*vw town.barnsiablema.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION --- -- —1'IeuePrint DATE: JOB LOCATIM number slxect viIIagc "HOMEOWNER"• . name home phone# work phone# CURRENT MAMJNG ADDRESS: --• --- ------•—---- mty/>nwn s>�z zip codo ' The current exemption for"Homeowners"was extended to include owner-occRied 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 OR HOMEOWNER Person(s)who owns a parcel of lend 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 considered afhomeowner. Such`homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsrble 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 reguIations. _ The undersigned"homeowner"certifies that he/she undr_rstar;ds the Town ofBarnstable Building Department minimmn inspection procedures and requirements and that he/she will comply with said procedures and requ cements- aft=Si o gn ofH mm wnu • Appmval of&uildingOfeial 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 EREMETION ' 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-IS) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this rase,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:IWPFIIBSIFOR1viSlbmldmgpermitfo=IEXP M&doe Revised 061313 „ J �e sartment of put�iic Safety massacii setts - Re uI_,jons and Standards Board-cf 3uildnc . ` - �onctruction 5ugentsor License'- CS-005867 or My PEARSbN Ilm P.O,BOX#519 02632` Centerville MA 1 1U1212015 C.Mmissioner J: I � Office of Consumer Affairs and Business Regulation y 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100871 - Type: Private Corporation Expiration: 6/24/2016 Tr# 250303 MARKWOOD CORP TIMOTHY PEARSON 110 BREED'S HILL ROAD UNIT 10 HYANNIS, MA 02601 Update Address and return card.Mark reason for change. =-- (-1 Address ❑ Renewal .[j Employment [I Lost Card SCA 1 C 20iu1-05111 -___----- ------- -- iie =pie-»adveccercl(�.c`✓lam ac��c ell: ` Office of Consumer Affairs&Business Regulation License or registration valid for individul use only t�OME IMPROVEMENT CONTRACTOR' before the expiration date. If found return to: T e: Office of Consumer Affairs and Business Regulation �2egistration: A.00871 YP o _. 10 Park Plaza-Suite 5170 9 rxpiration: ;6/2412016:; Private Corporatio-, Boston,MA 02116 MARKWOOD CORP TIMOTHY PEARSON 110 BREED'S HILL ROAD'UN T 10 HYANNIS,MA 02601 Undersecretary Not valid without-signature f r , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 7� Map Parcel.` 0010 Application #7 Health Division `. Date Issued Conservation Division_ Application Fee Planning Dept, Permit Fee Date Definitive Plan Approved by Planning Board 01 -- Historic - OKH _Preservation/ Hyannis c--P=ro-jest:Street A" d'-d COL.-C-6- Vi�llag`e k-A S �Qwner J= ��O�. i• G�SCc� ��Il t°�r� Address:-,try �r-�q �� Y-�[ �4 0,n n l\-s Telephone S" -7)1 Lf 43 .--Permit_Requestr 7O �7'L stA\cl G- 3 VV x ( `Z'b Y'oc>P over- 0 6u�,Ao- nj Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ,Project-Valuation_;. 500O 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 L"No On Old King's Highway: ❑Yes VNo Basemjt Type: &1 Full ❑ Crawl ❑Walkout ❑ Other Basemen.,t Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number o{Baths: Full: existing _ new Half: existing new Number of Bedrooms: 3 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 INFORMATION GUILDER;OR__)HOMEOWNER) Name T /2 -71S Telephone=Number �/_,..__ C::::.*ddress�!-AQO- )f7� t& 9le I��License# Home ImprovernentaContractor-#.- Wor�er,s%-,Tm—pj7—sat[on#�.. AL CL ONSTRUCTION DEBRIS,RESUETING FROM THIS PROJECT-WILL,BE T*KEN TO"-`"' �"�' 1. s FOR OFFICIAL USE ONLY APPLICATION# ' DATE ISSUED z— MAP_/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 'INSULATION- FIREPLACE ELECTRICAL: ROUGH FINAL L PLUMBING: ROUGH FINAL .GAS:.- L- ROUGH --. - FINAL . .r .;.FINAL BUILDING'. , k_ r E v DATE_CLOSED OUT , ASSOCIATION PLAN NO. The Commonwealth of Massachusetts .( Department of Industrial Accide'nts Office of Investigations 600 Washington Street Boston, MA 02111 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Appp iicca^n^t�Inform ation IeV Please Print LeLzbly CNai1T� 8{Biisincss/Organization/Individual): -�i� 2'ililT 1, Addres_,,C�-�/ 1�iP_"G.� CL�. 4----�_ ppsty/State/Zip: �4-m�,44 0�11 0 Phone #: Are you an employer?Check the appropriate box: [13 f project(required): .❑ lam' a employer with 4. ❑ I am a general contractor and I °i mployees(full and/or part-time).* have hired the sub-contractorsew construction I am a sole proprietor or partner- listed on the attached sheet temodeling ship and have no employees These sub-contractors have emolition working for me in any capacity.. workers' comp. insurance. uilding addition [No workers' comp, insurance 5. ❑ We are a corporation and its required.] officers have exercised their lectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL umbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no oof repairs insurance required.] t. employees. [No workers' comp. insurance required.] ther °Arry applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. ' t HHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit-a new affidaviCYndicating such, xContra torso that check this box must attached as additid al shed'showing the name of the sub-contractors-and-their workers'comp.�polir information. ry I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required undler Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un pains and penalties of perjury that the information provided above is true and correct ......... -•_- Date: Phone#: �� 2 01" Official use only. Do not write in this area,to be completed by city or town official City or Town:. Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6..Other Contact Person: Phone#: t J , Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs'per oas to do maintenance; construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." SN MGL chapter 152, §25C(6)also states that"every,state or local.licensing agency shall withhold the issuance or renewal of a license 1.or permit to operate a business or to construct buildings in'tl►e commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.,$ Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter inio any contract for the performance of public work until acceptable evidence of compliance with the insurance requirement's of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractors) name(s), address(es)and phone numbcr(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number Iisted below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that'the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant PP that must submit multiple permit/licease applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would 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`: �` Y Thee Commonwealth of Massachusetts Department of Industrial Accidents Office of InvestigAtions 600 Washington Street Boston,MA G2111 Tel. # 617-727-4900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/ctia r THMEr° Town of Barnstable 0 • Regulatory Services _MAE& * Thomas F. Geiler,Director BuildingDivision n Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 WIM-to wn,b arnstab l e-ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign: This,Section If Using A Builder h�r yt� L6, r ram. , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this buEing permit app on for. k 0,AIk V6S t4A o24.01 (A.ddr�ss of Job) h�412 117 MA Date Print Name p If Property Owner is aPP1Y�gfor pest please c, omplete the Homeowners License Exemption Form on the reverse side. Q:F0 RMS:0 W NERp ERMLSSlON t:txa r� . Town of Bar nstable ,. Regalatory Services s.�xxsrwsrs Thomas F. Geiler,Director "•�� Building Division ��ED Nt>+�k • Tom Perry, Building Commissioner 2D0 Mairi-Street_Iiyanum MA_02601 www.to wn.b a.rustabl a-m2-us Office: 508-862-403 8 Fax: 508-790-623 0 HO1 MOWNER LICXNSE EXEMPTTON Please Print DATE: JOB LOCATION: numbs street village "HOMEOWNER": name bone phone# work phone# CURRENT MAILING ADDRESS: city/town states zip code The current exemption for"homeowners"was extended to include owner occupied d Lings of six units or Iess and to allow homeowners to engage an individual for hire who does not possess a-license,provided that the owner arts as supervisor. DEFTIIT.I'ION OF HOMEOV-1NER Persons)who owns a,parccl 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 nne 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 Ofncial, that he/she shall be responsible for all-such work m-fDrmed under the building permit. "(Section 109.1.1) Tl�e undersigned"homeowner'assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.hr/she understands the Town of Barnstable Building Department rn==1m inspection procedures and requirements and that he/she will comply with said procedures and J requirements. Signature of Homeowner Approval of Building Official Notes: Thrce-family dwellings containing 35,000 cubic feet or larger will be rcquimd to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that: "Any bamcciv=performing work for which a building prnnit is requimd shall be ezcmpt from the provisions of this sectioa.(Seetion 1D9.1.1-U=nriag of u7 utruetion Supenzsors);provided that if the homeosynr atgages a pcman(s)for hiro to do such work,that such Homeowner shall act as supervisor.", Many homcownca who use this= tion are unaware that they y=zs surrvng the responsibilities of n supervisor(see Apprndix Q. Rules&Regulations for Licensing C=structicn Supervisors,Section 2.15) This lack of awa==s bften results in sa-ious problems,particularly when the homeowner hires unlicensed persons. In,this case,our Board cannot proceed against the unlicensed person as it�rould with a li=sod Supervisor. The honccowncr acting as Supervisor is ultimately responsible. To muum that the bcmeownr is fully aware of his/hrrrasponsibrlitics,many conztnunities require,as part of the permit application, that the homeowner certify thai he/she undrstands the responsibilities of a Supervisor. On the last page of this issue is a form cut7s ay used by several towns. You may care t amend and adopt such a formlcertifieatian for use in your community, Q:forms:homoerxmpt Massachusetts- Department of Public Safeth Board of Building Regulations and Standards Construction Supervisor License License: CS 98618 ALEXANDER A ANDROSENKO 100 PARK TER DR#154v STONEHAM, MA 02180 Expiration: 7/14/2013 ('oinmis.iner Tr#: 17237 ' 1 �� ,t Office of Consumer Affairs&Business "t HOME IMPROVEMENT CO Registration NTRg Regnla6on CTOR ExplraUona 19291 T ;t } 12 To294209 Ype, ALEXANDER C( yS r r ,ALEXANbER q 100 PARK TERRw1� f1{f3' F STONEHAM,: * Undersecretary ■ ■ ■ ■ >,,.)y'"'� ;�✓ to w',rr Y �� s�` a f £�r a 1 £szxs� U s.S � �"rirf�'. ,� r�. . t � .,'.fib �,.�,..,-m�k✓�u' �! 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Xl- ,'CII� E i r�J ry ... --------- - �:...:.. 2�.. . .-_�1F ..._.T_. :__ ... .. i 1 �1 E E � F�--- ' t 9 : 5 .L fv �- �t 0 i 1 TOWN OF BARNSTABLE permit No. • BUILDING DEPARTMENT t "OWL I TOWN OFFICE BUILDING Cash ,�,8 4 4 0�0 O). 7 HYANNIS.MASS,02601 Bond CERTIFICATE OF USE AND OCCUPANCY I issued to Anthony Zombas 1 , Address Lot #63 , 16 Ca iu Road I: Iivannis M Iss . USE GROUP FIRE GRADING OCCUPANCY LOAD_ THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119,0 OF THE MASSACHUSETTS STATE It BUILDING CODE. September: ,1,8,: 19,.,�. . .••.:.. <C�fG� ,�", . i Building Inspector f TOMICFUMWABLE BUOAINGS OFFICE. Payable to: DA ACCTSpiros Balodimas VENDOR35 Carla Road _ Hyannis, MA 02601 AMT. -- M.,,try rV c.l A P •EOM t •4. 1 YZ t ' 7 l p _ t Al Y i : 1 /v " � � � � V :�. ���,�/I+o �F'aa,.ii... ... „�y� to�•...,�•"',4";n- ,n..cL'i`�� t' ��P — __ ` }1 '• , \ ,fit: ;;. • r: '4 , 1 '� � � � C•�'Y.•ra��Nh��'•1•{'•L't_S":'+R'._. • r� O i AN i l C' 7'/.cy 7-A/.47- T.S/,C-/-=a e '/� .- G<-T/OiC/ !1 y�1/J/J/S. "✓f"t-55 SC,q L L:=- . -C EQUi�F�1E.c/TS orc Tf�/6' 7`oYtiit/a,�' i �OCg7',E'r� lyiT-h�/.v TyE .�,Coa�Pl�4/ / '�i4T '12-15-88 G c��'li• aA XT,E�P_E�t/YE 11V Fe BASSO ON r4�f/ .eEG/STE,eEp L�q,�/� SU�YE� /C,4l /7- �P�oFTHE To�o TOWN OF BARNSTABLE OFFICE OF BAH39TABL MASR BOARD OF HEALTH �p 1639. MypY p 367 MAIN STREET 'E M� HYANNIS, MASS. 02601 July 6, 1988 Mr. Anthony Zorfibas+ 84 Circuit Avenue Hyannis, Ma 02601 Dear Mr. Zombas: _ You are granted a modification of the variance granted to Mrs. Leah S. Dane dated July 22, 1987 from the Interim Groundwater Protection Regulation limiting daily sewage flows to 330 gallons daily per acre in critical zones of contribution to public water supply wells. This variance modification will allow you to install an on-site sewage disposal system at the property ;listed orr- kssessor's Map 248, Lot 90 Carla Road, Hyannis, Ma., provided the following conditions are met: (1), The septic system must be installed in strict accordance to the submitted plan. (2) The designing engineer must be onsite and supervise construction of thl�__M onsite sewage disposal system and must certify in writing.tothe Board of Health that his design has been strictly adhered to prior to the issuance of a Certificate of Compliance. j (3) The dwelling cannot have more than three (3) bedrooms and one family room. Sewing rooms, dens, lofts, mudrooms, enclosed porches, finished cellars, and similar type rooms are considered bedrooms accordingi to the Department of Environmental Quality Engineering. t (4) It shall be recorded on the deed that the onsite sewage disposal system shall be pumped every three (3) years and written certification submitted to the Board by a licensed septage hauler. (5) The dwelling must be connected to public water. (6) The dwelling must be connected to town sewer when thle Board determines it's availability. i (7) Variance expires August 1, 1989. i This variance modification is granted because the area is almost fully developed with similar sized homes. Only two other vacant lots are;left. It is unlikely that an additional similar sized dwelling would significantly alter the poor .1 y Mr. Anthony Zombas ; July 6, 1988 quality of the groundwater in the area. Very truly yours, Grover C. M. Farrish, M.D. Chairman Board of Health Town of Barnstable GF/bs i /OF BARNSTABLE, MASSACHUSETtS ��®� 48l-090 .� - r :. DATE January 4, 88 PPLICAHT Splo m r Balidoas 19- - PERMfT NO i' ADDRESS 35 Carla Rd.; <Hy. #010579 r. (NO.): ASTREET1.' FICONdI• L/tCEHSEI PERMIT'Ta Build Dwellincr i _. (TYPE'OF 1MPROV •II. 'STORYSln le :1 aml1 •.:-�Dwe11 UMBER OF .� EMENTI. in a y WEL.L.ING'UNC'($• NO. (PROPASED.US -T•i !iT._itocATior+I Lod. 463 ` 16 Carla .Road H annis MA. , ZONING, • (N0.) (STREET). DISTR I,CT ......:'. ...v...• .. ' •BE`TWEEN• .. .. ...(CROSS STREET) )AND - ' - (CROSS ST REI;T1. ,• •OU1306VISION LOT LOT':.:.. BLOCK SIZE BUILDING IS TO BE FT, WIDE BY i FT. LONG BY FT. IN HEIGHT'AND SHALL CONF6� IN CONSTRWCTI TOi,TYPE:'. USE GROUP Y BASEMENT WALLS-OR FOUNDATION ��EMARKS:- Sewage #88-91 V (TYPE) 4. RE (Spero Balod;imas):' VOLUME 21..00 SC(� �• ESTIMATED COST. 90. OO:O.00 [� rt. r " (CUBt.C/50 DARE FEET). I. ' FEE•. (T• • OWNER AI7�YIOYl: ZOItl}JitS A06RE$$-HtYZiIl2lis � BUILDING.DEPT. i BY �. r f�t 0' ANY APPLICABLE SUBDIVISION RESTRICTIONS, MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR 'APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS-BEEN PERMITS ARE REO,UIRED FOR 1. FOUNDATIONS OR FOOTINGS. MADE:, WHERE A CERTIFICATk OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL " T"IC6`L, PLUI.IDING ANU MEMBERSIREADY TO LATH). QUIRED,SLICH BUILDING SHALL NOT BE QCCUPIED UNTIL) 3. FINAL INSPECTION BEFORE FINAL INSPECTIQN HAS BEEN MADE. OCCUPANCY. i. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1: y _ r z 5w�- 1 7 - 92 t HEATING INSPECTION APPROVALS EN ERIN D PARTME T n S r VP 2 s � ell. G C B ARD OF H ' • IIOTHER CA_ SITE PLAN REVIEW APPROVAL 1: V B k I h . WORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF PATE THE CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE, INSPECTIONS INDICATED ON THIS CARD CAN j ARRANGED FOR BY TELEPHONE OR WRITTi NOTIFICATION. BUILDING PEKIIT No. DM== ASSESSORS PARCEL fi0. a C4 8 CONTINUATION OF ROAD BOND The undersigned owner/contractor hereby agree to maintain their road bond is force until the following work itzms are completed to the satisfaction of the ` or Section or the Department of Public worms: Eng_ne__�rg tm t: loan and seed shoulders as soon as weather pe—its: other (ex-mlain) Ab G , / 77� L LOCATI N: I l_4 —� A(� vu SIGNED (print na=e ) :�';" dC��O:cIZn`1=0N ' AsP'ss_o4r,�°dffio8 {1st.floor)::{" r 1�� ° . Assessors map"and`lot number. CF?HE TD ,p; DESIGNING,ENGINEER MUST S -Board-of Health .(3rd floor): " Ij�STALLATIO Sewage Permit number.-............................ N AND • ` • IE SY CERTIFY IN ��' LE, o f`: S EM WAS 'INSTALLED IN Engineering.Department (3rd floor) ` f, House-^nu'mbe� .... . �r.. . ......: _�7 C®RDANCE TO a Y'J ale PLAN. APPLICATIONS PROCESSED 8 30-9 30'4A.M, and; 1t00-�2:00""P•M only ' SEPTIC SYSTEM wA�l '. ,j µTOWN -`OF 'BAR�I��S TAB rvLE - . B'UILDING`� INSPECT .p a t.APPLICATION FOR «PERMIT TO .... ,•,,,,- .................... . .. {� 4* TYPE ,OF` CONSTRUCTION Ctw �,,i�,�,� //t7 ` .... t 4 •• .. .......19 O TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit•according to the following information; 3 � Location .............. :. ...................^................ ........... ......... ....... Aq......... 1 roposedUse .......... ................. ............. ... ..............'C Zoning District - . . : :(1?'1. # 5...............Fire District .... .......................... ....... ' Name of Owner ........'.. ..............................Address Z Name of Builder, ..... .,...L.� GZ.d�1Q:...................Address ...„,1; Name of Architect .............................:....:....................:. Address ........:j.......:.....:..... ......^.......::.:.... ...............:....`......... Number of Rooms ............. .............. :......,...Foundation .... r��?...,,CG?!/ G2e� '• ............ Exterior l :.:. ?u-<` ..' l Roofing O ��.. ......... ....... g •.......... ..... ,. ... . Floors C.l. ..... :L r..:...........`.:.............................Interior, ;).......:.' ..`.... .C—� ......'.................... Heating /..?�� '..... `�'��..1 ....... .. �-.....Plumbing _ / �:. r 2 .......................... Fireplace Approximate Cost ......................................... ..�v�... .... Definitive Plan Approved by Planning Board ___ __________________ __`•19�P�__ « Area OC/�� ..:...-..... Diagram of Lot and Building with Dimensions �' g g Fee �l..5 !....... .. . SUBJECT TO«APPROVAL OF BOARD OF HEALTH �k 6 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I he agree,,to"conform to all-the Rules and Regulations of the Town of Barnstob egarding t e ob e construction. , ` Name ... .... f d• es ' Construction Supervisor's -License ......... ............. + Z OMBA3, ANTHONY � � 71 N 32536 12 Story - - ............... Permit for ..... .............. Sin X le Famil Dwelling - . .............................. ..................... .......... . Location Lot .#.63, 16 Carla Road f �r ................. HXannis .................... .......... �. - ` • a ' . 4�. � .. R . ... .......... ................................... - Owner .....Anthony...Zombas........:............. .� �.� }`4 Type of Construction ¢ ,Frame......... ...... a v� ..... .........:......................................................... Plot ............7............. Lot ................................ �v 9 Ir �f Permit Granted .....January!.4 ,...:.. ..�q 8 9 - V _ Date of"Inspectionm!ec.. �. .. 19 aiL Date mpleted .... .....` .;7 (' } �tJ e o v v e r- 1 i 1 �Aurd � -dr�ch S G- ,. TEMPORAIRY r TMr TOWN OF BARNSTABLE 3 36 Permit No. ......:......... BUILDING DEPARTMENT I ""'T I TOWN OFFICE BUILDING Cash .Y• HYANNIS.MASS.02601 Bond,..,e CERTIFICATE OF USE AND OCCUPANCY Issued to Anthony Zombas t < Address Lot #63, 16 Carla Road I4yannis, Mass. USE GROUP FIRE GRADING' OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID. AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH .TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSA'CHUSETTS STATE BUILDING CODE. 1 July 31 92 /,�i ,�-P�--" ........... ............... 19................. � ........... ....�... i Building Inspector 'y i Y "ra wPjE.. 4 T E M P O R A R Y TME>, TOWN OF BARNSTABLE 32536 Permit No.. BUILDING DEPARTMENT t ....n ` ................ ! TOWN OFFICE BUILDING Cash HYANNIS.MASS.02601 Bond ................ 1 CERTIFICATE OF USE AND OCCUPANCY Issued to .t Anthony Zombas Address Lot #63. 16 Carla Road Hyannis, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH ,TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. July 31, 92 .. ............... .... 19............. ......... .......... Building Inspector *IMF>o, TOWN OF BARNSTABLE Permit No. ..325 ....36:...... BUILDING DEPARTMENT I .AXI } cash (5440,OOa TOWN OFFICE BUILDING ��0 r►Y' HYANNIS.MASS.02601 Bond ,,.., CERTIFICATE OF USE AND OCCUPANCY Issued to Anthony Zombas Address Lot #63, 16 Carla Road Hvannis, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. September l8, 19 92 ....... ....... ... .............. .......... G ........ Building Inspector t Town of Barnstable *Permit to c2jd`I o017 7 Expires'6 onths from issue date �_� Regulatory Services Fee S PERMIT Thomas F.Geiler,Director JAN 1 X 2007 Building Division Tom Perry,CBO, Building Commissioner TOWN OF SARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint p/parcel Number $ lo- (p 3 )perry Address ,- G � Residential Value of Work 11, t y5',00 Minimum fee of$25.00 for work under$.6000.00 rner's Name&Address Pa S CQ l and Z7/1 G /7 rr lit CarIG 15 fn� Cato t utractor's Name L7 Pfl/ II o/rIe �0�1/I t21J0gC? Telephone Number So 8'a 9Y'bIS 7 )me Improvement Contractor License#(if applicable) 150c O instr=6=8upervisor's-hicerrsr*tff-apphab-le) lWorkman's Compensation Insurance Check one: 21-am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance -urance Company Name orkman's Comp.Policy# )py of Insurance Compliance Certificate must be on file. rmit Request(check box) Re-roof(stripping old shingles) All construction debris will betaken to W dS* &pt'C S S ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) '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 ofAhe Home Improvement Contractors License is required. :GNATURE: Forms:expmtrg vise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111' www.mass.gov/dia Workers -Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information /� Please Print Legibly Name(Business/Organization/ludividual): . (o.G.ql)DO YO/1 e I77p/,!ten o�C� . Po. ss ,',?s Address: Ce I C�ur►Wa[e. ' tnlau B ( I,J2S+ . YO��o�W DNA 026 ?3 City/State/Zip: V ffnOLA, ' Yb A 02,05Phone t So g- d-4 K'O/S 7 Are you an employer? Check the appropriate bog: :Type of project(required):. 1:0 I am a employer with 4. ❑ I am a general contractor and I loyees(full and/or part-time).* . have hired the sub-contractors 6. ❑New construction . 2. I am a'sole proprietor or partner- listed on the-attached sheet. 7. ©Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' $• 9. ❑Building addition [No workers' comp,insurance comp.insurance.required.] 5• ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work . 1 L❑Plumbing repairs or additions ' myself.[No workers' comp. right of exemption per MGL 12. repairs insurance.required.]t c. 152, §1(4),and we have no employees. [No workers' 13. Other ,51d¢(,./a�� . 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. 1contractors that check this box must attached an additional sheet showing the name of the gub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer,that is providing workers'compensation insurance for my employees. Below is.the policy_,and job site' information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. ' I-do hereby certifyjundlehe p ins•and penalties of perjury that the information provided above is true and correct. Signature: Date: / NLQ 7 Phone#: 50 8' t{—O I S-7 Official use only. Do not write in this area, to be completed by,city or town official. City or Town: " Permit/License# Issuing Authority(circle one): :1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6..0ther Contact Person: Phone#: 1I11U�IIlA.L1�il A.lill 111�L1 1��l.iVia� . Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter.152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit-to'operate a business or to construct buildings in the commonwealth for any applicant who'has not produced:acceptable evidence of compliance with the insurance coverage required." Additionally,MGL ehapter.152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public-work until acceptable evidence ofcomplladce, with lie insurance- requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers,' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate-line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the-affidavit for you to fill out in the event the Office of Investigations has to contact you regarding.the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.-In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in - (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have-any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:_ .e Com onweal of Ma�ae,usetts - Depa0ment of IndwWal Accidents . . Office of faaVest gatl4lis 600 wawn ri street Bostonx.MA E12111 . TO.#€617-727 00.0 ext 406 or 1-877-MASSAFE Fax##617-727-7749 Revised 11-22-06 www.mamgov/dia Town of Barnstable ~o Regulatory Services h ► BARNSTABLE, y MASS. $ Thomas F.Geiler,Director �p 039. ♦0 �Ec M►►r A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 r Property Owner Must Complete and Sign This Section If Using A Builder I, 1"C(SCal and Mill G 4 Y/M-C , as Owner of the subject property hereby authorize Q dto0 f 0M? /174/n-Nnoae-e— to act on my behalf, in all matters relative to work authorized by this building permit application for: A101 60(46 Ln (Address of Job) Signature of)C)wner Date pas Ca( Print Name F r Q:FORMS:OWNERPERMISSION q�r pi, � g 4. JOSEPH D. DA j'.UZ d�� C '%='^!-' ONE: 775-1120 Building Cammissionrr_ _ (/ EXT. 107 • , Y TOWN OF. BARNIPTABLE BUILDING INSPECTOR TOWN .OFFICE BUILDING HYANNIS, MASS. 02601 July 30, 1987 To Whom It May Concern: The property listed on Assessor's map 248 lot 090 located on Carla Road, Hyannis, is a buildable lot subject to the provisions of the Board of Health. Peace, seph D. DaLuz Building Commissioner JDD/gr S I • N�tl �,. �"- �- JOSEPH D. DA4_VZ TELEPHONE: 77S-1120 Building Commissioner EXT. 107 TOWN OF,, BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 July 1, 1987 To Whom It May Concern: The property listed on Assessor's map 249 lot 215 located on Linda-Lane, Hyannis isla buildable lot subject to the provisions of the Board of Health. Peace, Joseph D. DaLuz Building Commissioner JDD/gr 7 t J �A.s r�►• p • 30AC 44-1 64 69 A6 AC j Y%t ti'V'A e a to A-7.-.. 12 X.O & O }ext HAC :SB AC 3 3 A 3.2 6s 0 1 .99A4 1ba 3 . LA•F rob f ll y J&1 ate} s 59 6�� 6 Isa • o .uAA �_:aswA 03AC i� yJtr 34� 11 ♦ L`K'' Yt 27AC �-�•�, 7 '= ALaJRTI wA'1 ,2.I AG. - Lb•A m" tag ! • :.J 111' 16 s •` R _ n,�s. O .t,Ae 1 .i,►s . .s o ae 23•a -6OI e 1 160 ;Qm►.0 a Mnc too OI 60 SAL L, ' E•. .N«t t si 1 ..:44a .a4.c I a p A � . sy1 0 .tore i lz 32 QI 6e LlV' sow' *.. JJI. 29► a s u $ 52 53 -rso' 1D2 z3rr. 1 Et ,yAC. .ss.• is At L t�\ 46AC .24AC' V' S 13Ae M Y zl = t0• ; .1aM a 6e' Q © t. 91 .4JA6' « ,Z\K Al1lA �1 £ (APo a-s'1t) Z64 (ly c I .?BAC y list ! 0 ^• ��.y( .1JI ..�Ii0A1. P st! yZ6 .2 TOwN CONsfwvA71W - ) 7 ♦ .. '.20►C• .&JAL .O 'Jl A6 444 11 �`y A7y. A` K ; ° .s� 49 •. a 20 ® t!o 'o +b4 I ' �Y7•�,', :;i:. / 7 b� "1T� $ 4• 46 .32 AC 0/y �i m ' 1 ♦>� . • 56 45 /J2, c 7 7 �r#.� lob 4ssAQ .20� 47 42 : 50 AC. ZyacAC 46 '' 1 400 o i�t� ti4,y. 41np COPPER LAat 1!4 6 110 40 27 Ao @ ~ 13y Ito ,0 140 9 23X .2•A oo+ 26AC Ite M a N3 6e 91 '� ♦ s o Sl a se Jpq 0 B.toAt. a�A• g SD 19 AC • 0 126 " 35 1lSAc ! T I ., o0� y AC e O yq4 o a 156 S WWAC..' .D • J•A• 4 `a 127 .. ��� 0 0 ° s•'J' 2 AC . 3 6 _a {A& . fee .13AC PRCPARCD,UNDER THE GRECTION Of-THE '2 9 s OI BARNSTABLE BOARD .Of'ASSESSORS ��CI6 tCALt ra 100• AM AIRMAP.INC, IlA4l, COMI ,f,, • r. 'WT ��� �� �tU �'� �, � -�� - - ��� I _ _ _ _� 4 I. __ _ Compliments of LUJEAN PRINTING CO., INC. ------------- s r d y 'IT, --- -- - i - - _ - i. it I .T i ! �. �RO[S( F ,s t I ua A ' • - it q ' . i i, --r ! P FIRST • __ - q ` •, '' � /b-�t�1lUti5,�-�LTEIZ�i�UNS _ CiV 4 N la c tit E Bruc•-I Devlin Design® 77423"773 Y : . r \ • .. �TEk�;12C�1i,RE. ... a •.r .! . 1 I i v4K LoIL EG1RN.b� > Y r � I ' .. • :�. �. i•,�:_ r_._I, III I I (! �I I I. I I �- I .I i a / . - a r 1i - • � I I �� I Ii _ I� 1 i ., ^ .. ' • - _ .RCR^t1�\,//LI Low .r. Y ` r, y �'• _ III • r ' � r 4 \ {:6' _..,:-Td _ _ - _ 1 _ • z. 1...3�ShItnPPtUS_' - I. ' ., i � •• - .. _. i - �W lr ' 1bM •W CL F1 i4r5 �•�>r lr.l kp : i , i , - I ..I. Vur-u,uus wwLL M_ 1 I .. .. • J . - .. I• � .. � , .. - f. r - 5{Xl1a2L1CrsrR_�nomU��S'¢_��T�uTU'yi:5 'Eticx)R PL N . ° 'p c AOO MO W S E/,LTLR/�..t c)N 5 --- - o B=}3^^C_3_DeYV 111 ILa CAR.LA Lt.IE W elf A N N is •!�/`�• i . 77+23"773 I AWC Guide to Wood Construction in zr,h RW A,..110 mph Rind Zone - AWC.Gad&to Wood CarLt&acalon 1.High Wind Areas:110 mph Wind Zone _ S APPLICANT TO COMPLETE 6 5115HIT M.H PEW11T APPLICATION A IYC Guilts/o.TO C 1 141,W/ird Areua:1/0 ipph 1{7nd Zone .. ymr(L'oncnucdan is Fl(glr f67rrd Arc<.a./lo,nph.lYnrl Znne (V[aSSa.CfILISetLQ,.i (,7e�for Col)i pllance(,ea cmnssul-z.l.l)'•-- as �e Checklist po chug or Co p p CMR A0I1 ) _ A GVL(rurrlc In f - '• - - - ._. ... .-.. F J ."LoadtlllaA D Well CY!Vlaedorl , . Massachusetts CheylLlist for Cym.p)IanL a pxn cnm ael.z).�1' u i I M Bach tts Ch far Compliance pegchm Massa efts Checklist f m fiance eg ')•(' Oh k L,alerel(Ilo..dr f(i)t m.gH4rllk) -.- Roma 71...-...._._1:ttN__I•�'�\SLR_....-...L a. Fmm Tahka ig and it and laplbn of wet nheaMing and Building Aspect We.detamine Percent W % a . .. Is aX nRCt3la-1�(i�lr=1 Comp11.... Nonlosdbsaiklg.WaN Canrl:♦1R d j Shaml and Na118PadM en reWkemb - . Wars/(ro.a(:led rn4lon..k x4 RehN'a} ___�._-� _ _✓ b. Wood Swcbinl PanNs shag bed Hh BU WrJmeaa pan"o studs, Wktled sa follows: �1 . �/ Void tleaAlq WaWlQpardng,(ism.d largaaLpbeN Dbyf check pP'p 10 f Thl+el I..P.".shalMhulauia wehabalpN azl+patetlM to+tuN. 1.1 SCOPE . 110 Tph .. -} _ .. ........•.•.•„...•.. ..B _:[_' ''Header Bpiaa .._ 9 r, n-5 11' N. pal h n Dour Wm . Wind aped C3.eia Dustl...... ..........- ............ ......... .. R ........-' tW 6111Pkb SgYM'' .- R•6 e8'.� ® W Wind Exposure Gregory...... [ In 511' EJ(l5 j ✓ Full H6119 Sfyde:,irfo !snide)_......_-,..._ Rahh'8.:._ _._ to pnpb�fy mne0ucilon.Panels shop �llacMd fD b�Dtlom plppa rW top nam0ar of Iha double- 1 + ND /ar Como" •+Tnb N. On NA sdry vomWcpan,uPP+rP n41a p. pper top J, onsldarae eekry)1„_ands•52ef4�- N .S1 1 . ._ --yy :........ ._._....___..._--. pbb ndlo band, tl bo0om Mp?nel�WWI r atlaGunard of kwx Papal shag be made t0 bend diet t.2 wPPLICABIL ItY arodl wM1ich tweeds Bin l2 skpapnaN b. 12.51212 �y I Number oR6tanee( .,...(Fly 21....•...•..•.... - 1,'J a.sa3' ALL ......_..__..._„__.....,_..__....._..,...__Roble e}_._...__,.......:_.. tO i s12' bwefeQsdNunt lMdO to Rlale al Pod Coorh�INn Roof PltGn.....:..........................._........ IFly2)....._......... ...... td a SBO' cdai+elyne@mda(no:p! .(Task eh___.----------.__.-...__.�;_ mob+ _of. - . r Mean Roef Ha gM.._....................._.... ..._......:.__.....(Ry3)....._......................_...._ a6..sB0 ✓ExW10/Witl9haiNinpb Rs U(1Dfl end ghearSNeAbnouwh r .alagpo as on Ou below: end . Soloing wldtn,w................................._. '........_lFlg9}•.........._......_.........._._ I.f^j3: Feetmum nWdleg OhnedefT W Saildmg LanBN,L_......................._.....__............ •3.0``.ia SB' •_]� Naneial HalpMof Tdbsl OpaNrgt 9- . v. RoAronkl nag apatlng al double' ,beMldab,and mldale WY rod el3urn 'mruerpir9ros bldaw� Iflal HarkmkpNalNng Panel Alpdmem BOding A•Pah1 R j. g pan ng ....._........lFlg 41.....: EW.NS f Sp&d.,_, - - Nom' B o a a .. EdO+Nert SPa Ong-..:.-• f.f, n. " ,r -Hal Hal ht rT II st0 -.._ eWe Oor no�eallleaa)_:._...__-_ 1 _6I/ R:IJINa/Goading:-•-_,._ �(�gals 10}_._._..___..,.._.._-.___ �A. - ' 1.3 F,RAMINO CONHeCTIONS -------^" ' ahk 21_._..,....... (ne.WA4d-,; on,uWX•+Ida 10 g t: .V :. L III .�r Genual wmpnanu with framing coon Parwlt Flig+1e10Ht3HaaNlnD r-•.-__.-._items fo)-__, i.t keerePAn9rt- mat . �._....:.nrr _ j aN enmam N"AQD eTgYvn+e mTibe-e_to - -- usu1Ox pr D ar... ....._ ........._ ..... �". y 2.2 - - ,+ �w _. ! - shiit:emf.rmorl oaf led Wmmdq nalb)(iabla . 5/8•Soo lt Pm+ T-+^� 1•:_ _ .'..._....,'..R((FlFFoiMygb S65le)1)...a.-...)........-...._...............-.._................._............_................_....-.___._.__ ...�IA,a z z i s s._- V laadmng;. ___..-.t_._°B.'_B_•(D_o aq nW neayk).,__:_._._.-. _ • , _aa+Fat Fu T Felghtn+alhng (table 11)-- 6Mdleon alg MNNgoWeflwdh0P inB ._................._ 7x3 iY: waN 5ma r - _ . • -� Ruled for WlM SWedT.�r.__ _ ROQP3. i .. y �I" ) I I ' r mynp« tme AWC.Fmn Tool:see SBRS WebWk) - '6 II VeAiwl and Hot®Ny N Ilnp . ...._...._. Hoof frambg spans dnbad2--- _-.fFarpaflem 1 Laa• 4Tas 3.t TCOORT ed.._......._.... .(Per TBO CMR Che 551 -" • W Oved'-+•- i .-_.-(F,gura 10)........... malreraf 2 or Ll3 - oorYTa70ilifar5d _-_..._..........._...(FiD al........_.._. Tmaa'or fiA'..:bun econs,aatto+dba"Walla }I •t - . . m Pr- Pen, 2'Gom 2 d 1.r Well(R9 B) .. , /n sd �-" UPaQ__._-•,•-•-_.__...._..__-_Roble lYl._.-....._.__.._-...._U. plf � r - a........-.(Ra 7).._........-.,..._. ,. tauPd.._y.__---„_•_--.(rank 121._..._,...__...V..._.�.__L.S�y,.prc It' �jy . lw Pend AlktJtmam ......_ i.. •. ..- / shear_,___._. -•Reel 12}-le 13). ..:._.._-_--- --6i-at (Fig al........................._..... ,/ - .. ppon n9 oe aen (Flg0)....:_......................_:... .:. -. 9be _ Ma.lf repot tlea e.. k - . _-....... .12780 CMR Chapter 55)......._. _�. , .: __ _ - • Podggee pCglneaa not used par Pa�1 2 b 13). .. n .-. .Gatr7RRRke OSUboker. - . FkasSl,avaway�'R+-- .. ...........:.lpar78y GMR Chapter 55)....._.,..-:._... old mot':. .Tyra Rasa C'nn+WoN rer4on•L adb®Qag WaDa - ore ); .' `�fLS smell l2 ar L.r1. �/• ... FtE6r3Fea0D'd3-rim s e,ie.edBjln .�. .... - ». g._.... '......:.(T qe,2):.y-d Hal t' t. l;(no�d led Han 1wy)'.R r4)..,.. L: _ ... R-1 Wofting Type--- (p CMR Ch+P(ero bg 591•:.-_-.._, , i'. on N.A Page t 1 See OalaN eta J i.t wwLLs ti y s.1p' - . Well MeighQ ..(FiD.7B end Table S7 - -L,d. �"''•"•.. ,+.. RoofghNlb ng 71Jarlpae:•_-.-�._._ a Lp•dne.nng.w:IM. .._.. - - rts2a., --- - - g « • _ . .•.. .(Re fO and rank s) - - - FiookSHdlHkq Fackahla-.:.._- _ Ra21-- i , 27/18•WSP --,___. cal and N�6/ Non4.aay1l+s+M1iOQ:wda lefn.i24,o.a VMi e H rl7ardel Naito 0 yd - s.'. (or Panel A fachmenl -i a,g ...._.....,_,....FI l0end Tei)le 5).,-...,. tan; S _......_:.... ..... _D e9." - 'Ieiisa be matin ifasrwraty.ercludiilB die ap+dBa-p0orl nafid Im2.b ramplYwpll Uro'reauuameNa N ' .'- - I Wall Stud P ig _-(Figs 7 a B)......:..:... .-_._. i Ma d1aPl� • , .Walt Slo .-__.-. ..•_.`_...•_ - enllralY�r1 aweq meld elrape end bed downs aro.rol / , 1 � '7ag Cb1R 99a'f,2-1.1'IOemt IPONa ohedmatk inati fn its the roll - � .�/ 4:2 EXTERIOR WALLS' _ iagdred Ste SUW. R 0'in: // Steel 2030 pa, guru 5 - WoadStud$ (T bl 5) .... '-'7" b. 20'G.egs: foaabeenn8 walls..... - - (Yble S).. -( , i a 'UptlIr 6CWs. Nan-Laadbeamg walk ...............- Aag r ! ` Goole Ed Wall Smdngl _ 6. S4aPipaf'f.7Waa 17 '+ - : . s Full Height End All$wd -(R9 t41.,........ w:Oening fledrejr 1p oan,$ha - Q2Vl)3 ' F„lsapllm:0yr,5g h01Bhk ar,uptd 3fL cnW be PamUOed when 5%be0dadd6le.Pera+at(uBfielght slfeaNny WSP Aftic Fla.,Length _ .(Egli) z'0B)N - , GYpsum Cdhng Lu19N(H WSP notdsedl :.(R41t1 - .._- r I - fequnemeMs iha•nMTaldea lO erM:iM , end2x4CoDd slsteml SWe 662 .,(R91tF.•-......... 4Rspemld in endfalit orWas b.Y,L I. T/ishoaom sa plate n:eittaAo weM rdlal has minlmdm 2A.rominatdunlalesa Ye+afaa lreeted ll2-yreda_ .. ar1 x3eailing Nnig.telps 01C apadng rtun wiN?x4 Plaekinydll - e e X O we TOP Plate l3 end Table 6l..... .. r -.t : Y,, f - Splice LanBlh - l'abl _ ... 1,. - .. ' .sa. spgce car nemion(da'anedmmmonn Ha)_L... •,.( sal............. , .. ..- , _ I , F�� ' ,�. _ _ - - •. a- DOUBLE TOP ALATE 11 g MPH EXPOSURE B WIND ZONE: "'" "' - ,.- I• •Table g.General Nailing Schedule.. - :t:, Number of^-_Number oP NallSoeclnu .JOINT DESCRIPTION - Common Nail Nails. .R 0011115LE HEADERr. . • " :• k01n 1o'Raear Roealatied) 2-10 '241d ' d' each and _ . .. - oard to Rafter End Darted) 2-16d J-ifid each end - - ' • _ at N(Facs+fallad) Zt6d • 5-i8d .dt joints EAC4 OF,HEADER I' . WallF i FFQUIREMEMB AT Top plarw interoacOo - .rMNVg•tUl'1 _ 8Wdto'6Wd(Pac4+laged) .16d 210d. 24 a.a. OTUD HEADER.SPAN- ♦Hggpey NUMBER.OF UPLIFT LATERAL _ Header 9dHeadar(Face-n?ged) 16d -1 d 16',o.m alon8 edges '! :tea S� FU1,L{1pJGHT-' PJ1TE�tD . Fl rF - - OUBLE JACK STUD - TUDV -. i NEAPRIQ 00 mmklp _ ) Joist fu Slil,Top Plate or Gtrd�(foe-Nalled)(Flg•14) 4•ed '41gd ,each an �2' 2-�XA I 211 132 wall _ To 1coNra snap WINDOW VW.PLATE - . .heeN,ng ed ddnc to last(TPe+a m) .. . 2-ea 2-1otl aeon end. 3' 2,21X4 �2 416 I9a man e.fend - - - S•fed' 4-16tl' .each block' 1 WddnBb.SNI age P G ea19(FaGe�f11s0 _ 0. . naa« .LgdgaF pm or I edj 33,laed ^'..3au ^ perl�i .':f' -.lr.2X4' 2 "' >~+7 i��� Jokt on Ledger toassin(Tiwhlalfe) - ---- --' - ---- -- - - d.<M,� ,: " Bend Joist to Joist(En"aBed)(FIg.14). -. 3.16d S i I'4�16d perlt of • g' .,y' 3 . . , '„ :BmW Jolatto Sill orToP Plate(Too-naliad)(FIg.14) - + 2-16d 1 ,P, _ i7 G 2 I - a(6 _ 5� Nyi.ror PId7B ._ Root estru rnell Pa lela'.:' - 9TC7 -462 . .. Rafters or Waeee apatgtl up to lit ac.. ad. lad 8•edo./6'.fled - ........- --------------- ' 2-2XIZ 3'' 1108 526. W"', -ttS HBAOGi-Wn1 - Reeore or Waves epaeedover 16'a.F•: -` ad i 10d W midge/4'fieltl.-. /.__'_rr____ 1,24 - as coMPION X4Lel AT m oo;1°d Gahla an dwail rakayr mks truce wlo Babla weBieng 8d. ' -f 1gd 6'edge/e'flaldO' }2XI2O 4 - ),385 p' x 3'o e -r' Gable arldmil lake or rake trues w/atrild"I out lookero Btl tOd 8',edBel I3'field '•T ° ° d ° 4 4 _ - �;'' • •:Gebb endwell rake'orrakolruae W/.bokopt blocks Btl iod 4'edpe/4'fleld y D•4 d4 D4 de d d•aO der:°D -df. °-+; ° '. °. .a .IY *5:+2)RIO 4 1524. 126 . calling ShaathlOB - •�Cl ., e, .:•IC :. + 'a/'' - BNdoi ar dula- GypeumWagbowd 6dawlera Cadge(laHelA' .°o•4 ,°D•e•.°d'4 .°din•.°d• °A.� °de Tl $Lt 9. Wr41:L OPENINGS - A© TYP.ANCHOR al AND ° g` ER6 . axrEnios w 11 SheaMIOB .. - - .. °. 'a• ,•, ,e,•4'a. 3"xy°xi14'PLATE WAVIER I° e , IN LOAD$EARING LUAL Etude spaeeduoal clurs pto 24'o:a s0a.°d� .- :v -. r.r. e - W and 2r�W Fiberboard Pahefe Od 0).•.. ,7 edge/Witold l °Df e,�° a a•! _ .. _ ... 10d d da d ° ° . - e, ''° ' - 7etlg ,...e ..de:�d•e °d•e d d+ Al. d'4 d'e - L5 I r 7S Gypsum yYallboad8d acalere� ' D•Floor Sheathing- - g or less reanpad lad 6'ed8�12'fled': - , ` . d e11 Greater Olen l' � 10d � led 6'�edgel e'1(etd(•1)Corrosion resl5lant 11 gage nails and 16 gaga aeples are PermlHeq diapkiSC for eddltlonal requlremaMs.Noll uhd.l•hi ad - NaU:Unless otherwise stated,abe,,gNen for nark are contmyn wile si?ea•Box end pheumaticnalts of egeM)lairt s t diameter and equal or greater lenBUllo the epeae8 joc*on napslmay be'6ubetItuted unions otllarwlea It Gcfz�c-l-A tJ�-- A P�1 wo oaroN Sh : 774239*773.... _ jA S t illf, OF BARNSTABLE R �s �0 _ { 2� i �,