HomeMy WebLinkAbout0006 COASTAL LANE ��
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Town of Barnstable °x, . *PermitJ'
Regulatory Services fee 6 months ue
w 1A MSTABLE
�j 'Richard V.Scali,Director
6 Pfl �` g ..
Building Division
Au ��� Paul Roma,Building Commissioner .' '
200 Main Street,Hyannis,'MA 02601
www.town.barnstable.ma.us
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O I �RL _ .
- ` ., � "Fax: 508-790-6230 .
EXPRESS PERMIT APPLICATION - RESIDENTIAL'ONLY
�� Not Valid without Red X--Press Imprint
Map/parcel Number C '
Property Address �o 4-5-F
, ro
►[�Residential Value of Work Minimum fee of$35.00 for work under$60,00.00 _
Owner's Name&Address O i.$ °�/Zv®`A)
Contractor's Name .�fie e, Telephone Number p
Home Improvement Contractor License#(if applicable). Email:'
Construction Supervisor's License#(if applicable)
orkman's Compensation Insurance
Check.one:
D-1--am a sole prophetor k
❑•I am the Homeowner r
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#.
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Re�que (check box) ,
� Ke-`roof(hurricane nailed)(stripping old shingles)' All construction debris will be taken to v
❑Re-roof(hurricane nailed)(nofstripping. Going over.' existing layers'of roof) ,
k ❑ Re-side !
❑ 'Replacement Windows/doors/slider's.U-Value" (maximum.32)#of windows Y -
A #of doors:
❑ Smoke/Carbon Monoxide detectors 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.
`ctpy.'of the Home'Improvement Contractors License'&Construction Supervisors License is
- Y required:
SIGNATURE:
Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc
06/20/16
MID CAPE ROOFING
11 RUSSO ROAD
WEST YARMOUTH, MA 02673
508-775-3799/508-385-8801
Barry Merrill & Paul Merrill
Job Site Address Mailing Address
e � -
Name: ``'� M
/77 � _. Name: ,
Street: CoAsl Street:
City: ,y��.4.��. City:
Telepho e• .-l�O Telephone: '
We hereby propose to furnish all the materials and all the labor necessary for the completion of:
roof replacement of the dwelling at the above address. Mid Cape Roofing proposed to remove
and dispose of the existing roof. The roof will.be replaced with CertainTeed Landmark shingles.
Aluminum drip edge will'be installed along the gutter line. Ice&Water Shield installed on bottom
edges to protect ice back-up pp g
. 15 pound felt paper will also be applied. The shingles will be
installed using 1% inch roofing nails. New pipe vent collars will be installed. Ridge vent will be
installed along the ridgeline of the roof to provide proper venting of the attic space.
Mid .Cape Roofing guarantees the workmanship for a period of 10 years. All walls and
landscaping will-be protected from damage;the property will be raked and cleaned of all debris.
All material is guaranteed to be as specified and the above work is to be performed in accordance .
with specifications submitted for above work and completed in a substantial workmanlike
manner for the sum of: .00—All discounts have been applied'.
Payment made as follows:
Deposit of: 85.00 the day job is started and remainder paid on completion.
Any alteration or.deviation.from the above specifications involving extra costs will become an
additional charge over and above the estimate and will be discussed with the homeowner.
Respectively Submitted by Mid Cape Roofing
NOTE:, This.proposal may be withdrawn by Mid Cape Roofing if not accepted within 30 days.
Acceptance of Proposal
The above prices, specifications and conditions are satisfactory and are hereby accepted. Mid
Cape Roofing is hereby authorized to perform work as specified with payments made as '
outlined above.
Accepted:
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airs JR K Type
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ment of Public Safety
Massachusetts Depart " r
Board of Building Regulations and Standards
License: CS-054428
Construction Supervisor
BARRY B MERRILL k'
312 SKUNNKETT RP
CENTERVILLEMA 02632-,';.-1 _
Expiration:
Commissioner 05/2• 1/2018
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ut an v§ foranONMaU1:UiAM10.1 W
nse TV 'af► date If found returns M z
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YJMassachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-054428
• Construction Supervisor
• r r -
BARRY B MERRILL ..
312 SKUNNKETT RD.
CENTERVILLE MA 0202p
1�_/►l"'� l� Expiration:
commissioner 05/21/2018
The Coazwompea of massadrmet&
DeparftffextafInd sdriatAcddentr
Offfike o'lmwftaf ens
600 Was hvion Street
Bastin,MA 02111
- i-Pnnv mar&gov1dia
Workers' C=3pensafi=Insurnce Afffilavit Bceders/CentractursMea cianslPh mhers
AppErart#InfarmatiGn Please Print�e Y
Na= '
Address: (( eG
eitgf ta-& v PJU=
Are you an employer?Check appropriate boa: Type of project(required):
aai a etreral coatrsctdr and I p j
1.El Lama employer with I❑ g 6. ❑New oonsizuc:tic.n
employees(full andfor part lime).* ha�elvredllse sub-camd�acfos
2. I am a sale ptopaietas orpart= Tilted on the attached sheet ?- ❑Remodeling
sbz p and have no employees These sub-coa4ractars have g. ❑Demolition
wading for aye in any capacity. employees and have wogs' 9. .❑Build addition
[NO Wo6mrs,comp-i asmmn e comp-moat-mce,
5. ❑ We are a corporatim and its 10-❑Electrical repairs ar adst-ons
3.❑ I am a homeoumw doing all work officers have ciercised theft 11-❑Phzmbsng repairs or additions
myself[No
-
8 workers' Tight of esempfion per MGM 7_._❑Roafrepairs
requ
insurance &I1 c.152,§1(4haadwe have no l
employees-(No worms' 13-❑other
comp-insurance -)
# ny app&cze-t st cbeth bm 91 mast also M outthe sectiaabeiowshusiag theawadcea'cmmp=mafiaaporuy inffiEmzffmL
I Mameva hers trhe submit this afflu3aeft imdcciug&--Y sm dmng au wa l and dma bim ant9de co cmtsmnst auhmit anew ATRIS Cinch—in sorb.
Z0==cft=Ihzt checYt}ds b=mast z ea ffi additim<al sheet sbouRag themes of the sub c a�d stye vrhethez�natf6nse ecdcdesha�
employees.Ifthesuh-c®tadashave r=pIgye?-%&ey=isrpmV2de dLeir wad'gyp•paRF—m
I am art euipIoP€r Eliot is pretuidircg x�rrr&ets'camtperlsafian utsrirartce,�nr my empFnf�ee� Setoav is flcspaficy arai jQb nice
i jm rrsadamy-
Insurance Company Name: r 1W P-S
Foficy;Ak or Self-ins- AA, 13 a 2 ti 3 1 Hxgixa nDate- 3 2
Aftach a-copy of the workers°compensation policy declaration Page(showing the policy number and ezpization date).
Failure to seaum coverage as required.under Section.25A o€MGL c�257—can lead to the imposition of criminal penalties of a
fine up to$i,500 4Q anctfor one-gear imptisoameid,as weiR as rim penalties in the fom of a STOP WORK€?RDER and a fine
of up to$Mlo a day a6pinst the violator. Be a&used that a copy of this statement mmy,be forwarded to the-Office of
luves*ations ofthe DIA for ibsrance coverage veri$cation-
I do Fier cerft;f}�warder dia pains andpenaMfes o fpedhq fhatfhe irtfbrma fortprm-i&dabMT is horn and correct
OBEdid use only. Do teat write in fuss area,to be corripWad 5y ciip artaira aoie1Qt
City or Town: Permhf &ease f
Issuing Autharety(ci r.Ie one):
L Board of Health 1 Bufffing Deparimeat I fSWrosgn Clerk 4.Electrical Inspector S.Plumbing Inspector
6.other
Corl#act Person Phone 9:
-- —- - 6
laformation and lastractions
hfiLRsacamsetfs Ge�eg Laws chaff 152 requires alI wiployerS In provide worms'sensation for fheiF=Ployees.
pmsuantto this sf�e,an�toyee is dcfzned as¢.�zy person in fbe service of�oiber ceder airy co**�"t ofhi�
espress or implied,oral or "
An mzpkayer is defined as"an fig&idnal,Pmfnershrp,association,coiporation or other legal eadhy,or airy two or more
of the foregoing engaged is a Joint ,and inchrdmg flie legal rep¢es=3 a3 es of a deceased eaaployea,or fbe
receiver or trustee of an individual,pmtlerihip,association or other legal entity,employing=Plnyees- However the
owner ofa.dweIIinghousehaviagnotm=tban three aparfmcots and-who residesfherem,orfhe occaPant ofthe -
dwelling house of another who employs persons to do mainlmance,construes on or repair work on such dwelling house
or on the group& or bmtldmg agpurfnnamt$erein shaIl not becans,of snob employment be deemed to be as cmploym"
MGL cbapfra 152,§25C(6)also states that"every sty or local licensing agency shall withhold ffie;�ccza„ce or
renewal of a Bean e.or permit to operate a bvsmess or to fr consact buildings is the comm onwealth for nay
"
applicant-Who has not produced accepizble evidence of compliance wrfhthe insurance covexa ge r��-
Addi Tonally,MGE,chapter 152,§25C(7)states fiNeiiher ,the c ingn Qealth nor nay ofits poIhical subdivisions shall
ester into any contract for the pezfurmance ofpubho work uuirl acceptable evidence of compliance wifli 1he insurance._
roqun-ements of this chapter have been presentrd to the contrartiag avih ozity--"
Applies
Please EII out the wort =' compensation affidavit completely,by checiing tire;bosses that apply to your situation and,if
necessary,amply sob co�xactar(s)name(s), addresses)andphonennmber(s) alongwiththeir=tcacste(s) of
msraance. L=d Liabr7itgCompames(LLC)or LimitedLiabfiityPartnersbips(LIP)withno employees otherthaathe
members or pmtaexs,are not regcm7td to cant'worke&compensation i asazance. If an LLC or LLP does have
employes,apolicy isreqnfied. Be advisedthatfhis af3idaykmaybe sobmittedto tbzDeparfinent of Industrial
Accidents for conformation of m¢rrr�re coverage. Also be sure to sigi¢and date the af�davit The affidavit should
be retomed to�e city or tow th n at the application for the permit or license is being requesbA not the Deparhnenf of
Fndast,MI,As " cmts. Should you have may gneslions regm�ing the law or ifyou ate required fn obtain a wormers'
compensation policy,please call the Department at the nzmbea liyt�below Self-ft=rd meanies should=frx their
self;n crr�,ce license ntmber on the appmp�ate line
City or Town Officials
Please be sure that the affidavit is complete and prinfedlegrlbly. The Departmenthas provided a space at the bottom
to fill Out inth.e event the Office ofIavestigations has to co�-tyouregmiHng&0 applicant_
of the affidavit for you
Please be sure to fill in the pemit/license number whrch will be used as amfr==nvmber. In addition,an applicant
that must submit=#Ple perinitllicense applibations is any given year,need only submit one affidavit md=fmg opt
policy information Cif necessary)and umea`lob Site Adchee the applicant should write"all locations in (city or
town),•A copy of the:-affidavit that has been.officially stamped or mmimd by the city or town may be provided to the
applicant as proo�f�at a valid affidavit is on fie fw fhfnre pe=.its or licenses A new affidavit must be Mod Olt each
year.Where a home owner or citizen is obtai niag a license or permit not related to any business or commercial v
(i e.a dog licm=or permit to bum leaves ern-)said person is NOT=JcihEd to Complete fais affidavit
The Office of Invesfigatioms would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to&m ns a call
The Depmtn=fs address,tnleghone and fax er
T tbE of MKsacht - ,
Dint cif Aoclenta
�tce of X�$o�
Fax 9 617`27 7M
x evised 424-07 WW =a s5-9PgARa.
1' 72 19�o TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , �.
,17�.. - Parcel 13
Map Permit# 7 l -7
Health Division � f TDt td*G B; c yT aLe8ssued .7 A e. G
jvj
Conservation Division /5� e l n , . Ap lication Fee el
00
20(1.� �E Il — I P1`1 1:
Tax Collector - ?C Permit Fee
Treasurer
Planning Dept: i,IVISi0N
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis +
Project Street Address
Villagev�F.�e
Owner nJwee- -i- C.®t 5 loylo.��-- Address
Telephoned O �
Permit Request 5L WC
Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay ,
Project Valuation�ff(s D® Construction'Type
Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure es4 e S Historic House: ❑Yes 'ANo On Old King's Highway: ❑Yes gNo
Basement Type: )0 Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: 'existing_ new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other
Central Air: '$Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:�l existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial- ❑Yes _I' O If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name0 �f 1 ®�'� Telephone Number 7?�
1tv
Address��'�,, a r�) L_ n License#
Home Improvement Contractor#
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE 7—/"�
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED ..
MAP/PARCEL NO. f'
ADDRESS VILLAGE
I OWNER }
DATE OF INSPECTION:.
FOUNDATION
FRAME bf-g &7 ® � �yf
INSULATION //V S !J 0 k !l� / ZG
FIREPLACE
ELECTRICAL: ROUGH FINAL
q -
PLUMBING: ROUGH FINAL
GAS: ROUGH /�FINAL f
FINAL BUILDING` 6 rl �✓ d fc A in Z
L '
DATE CLOSED OUT
ASSOCIATION PLAN NO.
r�
.q v
oFIME T° Town of Barnstable
Regulatory Services
`• RARMN aB . ' Thomas F.Geiler,Director
Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Permit no. s
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: Estimated Cost 50,900
Address of Work: C 08Z A/
Owner's Name: 0/l.-y iG
Date of Application:
I hereby certify that:
Registration is not required for the following reason(s):
FWork excluded by law
❑Job Under$1,000
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
7-"
Da e Owner's Name
Q:forms:homeaffidav
The Commonwealth of Massachusetts
_ ^ Department of Industrial Accidents'
0�I6ar eflb�rasd�ad�s .
600 Washington Street
Boston,Mass. 02111 .
Workers', Com ensation.Insurance Affidavit-General Businesses
��r'3�I�'���k ��- s..�•. "°�sS�.. ,d.rr^01•�r`•Y�w. .. � �.'..+i. � •.:.�1a'§1
c• state: zip: --:-phone#
work site location!full address!' - ,
❑ I am.a sole proprietor and have no one Business e: ❑Retail❑Restaurant/Bar/Eating Establishment
working in any capacity. ❑ Office❑ Sales(mcluding.Rtal Estate,Autos etc.)'
❑I am an em to er with em l es�full& art time): ❑Other
I am an�Tpl er providing workers' compensation for my employees working on this job..
�:: �. :.is:�<s:art' _. '7e+ •�S:•..: :p'
coiid•'ari�•iiainet ''Y � _ `
' '!, r•i• {•' ...y�:,r�;�;•.r. �:: _ :.i�,• 'i,.'_i.T; y� .. `.'`s•' •'t•r, -- •
address: 'Y
phone
insiirarice.co • r'^ _{'..4< r:k :>:;. olic. •#
:: :: ::•
I am a sole proprietor and have hired the independent contractors listed below who Have the following workers'
.compensation polices:
COIII�•an- IISIIYE: `
address:. `•• `'''s' .-
.r: r' f••t,. . •r'.
dike
i •"•a nw• ••}.
insurance co. - olic :.#. '• t ;.
/
address. • �'`} .
Cf one#:
?4:• :'•F' •'t. •.:f•a' ;•:4' '� �1-•:•].A '�.' ' .•1 t,t.: '.1:>•�; jam"
• r'•- `i::..•.i O 11C :#-;�y •.ram ..t'.d.!
'•b.:. -' . :• ..is
insurance=sb��_ `''•` '
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor
one years'imprisonment as well as civilpenalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that it
copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certi nder the pains gndpenalties of perjury that the information provided above is&ue and correct
Si�natura Date 7
Print name Phone#. .
official use only do not write in this area to be completed by city or town official
city or town: '
permit(license# []Building Department
❑Licensing Board
❑'check if immediate response is required ❑Selectmen's Office
❑Realth Department
contact person: phone#; ❑Other
(7evised Sept:2003)
n — -
Information and Instructions
Massachusetts General Laws chapter�152 section 2.5.requires all employers to provide workers' compensation for their.
employees As quoted from the law', an employee is.defined as every person in the service of another under any contract
lie
ral or written.
of hire; express or imp ,d, o
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
partnership, association or other legal entity, employing employees. 'However the owner of a
trustee of an individual,
dwelling house having not more than three apartments and who resides therein, or the.oceupant_of the dwelling house of
another who employspersbiis 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 section 25 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, 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
mpletely,by checking the box that applies to your situation.:-Please
Please fill in the workers' compensation affidavit co
supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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. .
City or Towns .
Please be sure that the affidavit is complete and.printed legibly. The Department has provided a space at the bottorri of the
affidavit for you to fill out in the event Office of Investigations has to contact you regarding the applicant. Please
be sure to fill.in the perrrrit/license number which will be u m
-used as a reference number. The.affidavits: ay.be.returned to
the Department by mail or FAX unless othei'arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give US a call.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts-
Department of Industrial Accidents
Race of ft vesUplions
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext.406
7iQ CMFL I�FPa�d'sx� ,
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PT grip tiva F jre A&ct Ar Oaa xad Trra-Fxmlly Fte3leatitil auildittp Sneed fri
MIMIMtTiK Hcasing/CcatingJ,�
MAX httfM Ceiting Wdl F1oar F3sscrn� F�uiPmr�c F.ff(cieri`I
Azzs'('lea tI'Y uc� R•vxlur� R-valuer A-values Wsu r &vsluat
g.yxlue
F 3c 57 1 to 6500 Heating Dim I7s a Nansial
0.�50 38 13 I9 10 Narrttxl
R IZ! 30 19 19 IG B i5 AFCIE
R 1Z,l� 0.52 13 19 10 Normal
also 33 13 25 r11A NIA Normal
T iSY. 0.36 39 f4 19 IQ 6
V ISy. 0.44 31 NIA 15 AFtm
13 Z5 NIA 15�g
f 5'l� 0.44 '�E 19 10 6
v 19 xarmaf
w I51/8 042 30 13 75 NIA NIA
xom�I
X IaY. a3Z 33 Iy . Z5 NIA NIA
WK 0.42 33 6 94 AFtJE
Y 0.4Z 36 13 19 10 g0•AF(1E
x f8'� 19 14 10
30
ADDRESS OF PROPERTY:
�- SQUARE FOOTAGE OF ALL EXTERtOR WALLS:
g, SQUARE FOOTAGE OF ALL GLAZING;
GLAZING AREA(#3 DIVIDED BY#2):
g, SELECT PACKAGE�Q..AA•see chart above): .
.N0TB; OT�EIL MORE IrNOLVED METHODS OF DETERMI�HG MagGY REQUIREMENTS
ARE AVAILABLE, ASK US FOR THIS LNFORMATIO�II
S p,U I,DING INSPECTOR APPROVAL;
• N0:
YES; ; .
n q.forrns-fl80303a
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings $100.00
Residential Addition $50.00
Alterations/Renovations $50.00 ® �l
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACE
square feet x$96/sq.foot= x.0041=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
7 square feet x$64/sq.foot= tT 17 x.0041=
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq.ft.= x.0041=
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf, $35.00
>500 sf-750 sf u` 50.00
>750 sf- 1000 sf 75.00
- >1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq.foot= x.0041=
STAND ALONE PERMITS -
Open Porch,. x$30.00=
(number)
- - $30.00
Deck x N
(number)
Fireplace/Chimney : x$25.00
(number)
In round Swimming g Pool $60.00
Above Ground.Swimming Pool $25.00
:Relocation/Movin.g' ; ' $150.00
(plus above if applicable)
Permit Fees '
Projcost,
Rev:063004 ,.
a
3
0
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16
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7 �
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Town of Barnstable
Regulatory Services
swxxsrnaM Thomas F.Geiler,Director
MASS.
9. ., Building Division
ArEo Grp Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-8624038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE: '071O !ze
JOB LOCATION: 0� 1
number street village
"HOMEOWNER": 19h-er R Z015 1 A4&ICJV SrD z70* ore 01 a 4
name home phone# work phone#
CURRENT MAH-WG ADDRESS: cc"s Al 1-d
d_?A1 44-e-a eq2- 01
city town state zip code
The current exemption for"homeowners"was extended to include owner-occpSied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building Permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
re ements.
r
ature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions
of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such
work,that such Homeowner shall act as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. 1n this case,our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit applihation,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by
several towns. You may care t amend and adopt such a form/certification for use in your community.
Q:forms:homeexempt
4,9 j
741/6
E T Town of Barnstable *Permit# ®P-/
O,e Rvires 6 months from issue date
• sasrtsreara, - Regulatory Services FeeKAM
s Thomas F.Geiler,Director
Fp act►�
Building Division
Tom Perry, Building Commissioner
2001Vlain Street, Hyannis,MA 02601 X.PRESS PERMIT
Office: 508-862-4038
Fax: 508 790-6230 (J' 2004
EXPRESS PERMIT APPLICATION - RESIDENTIAL
Not Valid without Red%Press Imprint TOWN OF BARNSTABLE
Map/parcel Number / V
Property Address �O C2 5 I.�Ct ►�Q_ �" yl
V -
4Residential Value of Work G 1 2 S
Owner's Name&Address V` ) f U f I
Contractor's Name / J�-e15� 1'�t Q lrv�T YvV c Vv�c�� Telephone Number
Home Improvement Contractor License#(if applicable) ��J3
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
® I have Worker's Compensation Insurance
Insurance Company Name ` i�f r H /�/1 5 S VI S 1A FYI
Workman's Comp.Policy# 3jw "O 2 3
Permit Request(check box)
❑'Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement Windows. U-Value (maximum.44) i
"'Where iequired: 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
Home Improvement Contractors License is required.
Signature - -�—
Q:Forms:expmtrg
Revise053003
r
Palle No. � 1
''...
NICi►ERSON HOME IMPROVEMENT, INC. 123709
P.O. Box 2476
HYANNIS, MA 02601 A
(508) 790-5880 Fax (508) 255-5107
HONE
TO 011ie Moran _5Q8-.7 .0n0640 __+ 6/711Q4 —
6 Coastal Lane Os P,cEIE;LOCATION'
Hyannis MA 02601 Same
Jo13 hIUP4BER -- ijOB PHONE —
Supply all permits
Cut hole through roof structure locating opening to closest roof rafter per homeowners instructions
Frame new opening for skylight
Locate and cut hole, cutting only 1 roof rafter
Supply and install 1 Velux VSE comfort tempered low a skylight with EDL step flashing
Weave roof shingles matching as close as possible
Painting by others
All trash and debris will be removed and disposed of properly
All materials, labor and debris removal each skylight installed
Only items specified above are included in this proposal
Rotted wood repair is NOT included in this proposal
Estimate does not include interior finish of trim
Estimate does not include wiring
Estimate assumes skylight going in unfinished attic
Materials guaranteed by manufacturers
Nickerson Home Improvement Inc. guarantees workmanship for 5 years ` J�
" 0
WEZ`-PROPOSE hereby to furnish material and tabor—complete in accordance with the above specifications,for:lie sum of: a�
dollars fS }.
Pavrnent to be rnade as fotlorj!F: T^
:ieposit upon signing, progress payments upon request, ce upon completion
All material is guaranteed to be as specified. All:work to be completed in a professional
manner according to standard practices. Any alteration or deviation from above specifica- Authorized
lions involving extra costs will be executed only.upen written orders- and v.,ill become an Signature
extra charge over and above the estimate. All agreements contingent upon strikes,accidents or
delays beyond our control. Ovtner to carry fine.torpedo,and oilier necessary insurance.Our (dote:Tit,-p, osa!may be
workers are fully covered by Worker's Compensation Insurance.
withdrawn by us if n t a �ap±ecf within 30 days.
ACCEPTANCE OF PROPOSAL—The above prices,specificatipns
and conditions are satisfactory and are hereby accepted. You are authorized signature
to do the work as specified. Payment%mill be made as outlined above. F
Signatures _
Date of acceptance: CCU
fd�M1301ri1 off Irui0m� gu ati 1s a License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: n
Board of Building Regulations and Standards
Registration: 133851 One Ashburton Place Rm 1301
Expiration: 8/17/2005 Boston,Ma.02108
Type` Private Corporation
NICKERSON HOME IMPROVEMENT
MARK NICKERSON
12 COMMERE DRIVE r-z—, , rf
ORLEANS,MA 02653 Administrator Not valid without signature
Liberty Mutual Group
r Liberty PO Bo\7202
Portsmouth,NH 03802-7202
Telq�hone(800)653-7893
Fax(603)431-5693
November 14,2003
TOWN OF BARNSTA 3LE
BUILDING DEPT
367 MAIN STREET
I-IYANN.tS,MA 02601-
RE: Certificate of Workers Compensation Insurance
Insured: NICKERSON BOME IMPROVEMENT INC
PO BOX 2476.
ORLEANS,MA.02653
. - Policy Number: WC5-31 S-318102-023 Effective: ." .11/6/2003 ,Eapiratioit; '`I lA8'/2004 i'
Coverage afforded under Workers Compctnsation Law of the following state(s): MA
Emplovers.L_ iability
Bodily Iniury By Accident-. $ 1,000.000 Edeh Accident
Bodily Injury by Disease: S 1,000,000 Each Person
Bodily Injury by Disease: S . 1.,000,000 Policy Limits
As of this date,the above-referenced policyholder is insured by LM Insurance Corporation under the polity
listed above.
The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions_and is not
altered by any requirement,term or condition of any or other documents with respect to which this certificate
may be issued_
This certificate is issued as a matter of information only and confers no right upon you,the cer ifiatte holder.
This certificate is not an insurance policy and does not amend,extend.or alter the coverage afforded by the
policy listed above.
If this polio is cancelled before the stated expiration date.Liberty Mutual will endeavor to notify you of such
canceltation.
AL-MORLZED REPRESENTATIVE
LIBERTY MUTUAL INSURANCL GRUUP
7ho C.dilicatc is CnCUt0 by i,JRr RIY NfUTUAL Ir SURANCr(.ROtrP tts resN us such intitrmCe;u i.5 attbrded by thwt comp;min.
cc: Insured: Producer of Record:
NICKERSON HOME IMPROVEMENT INC PIKE INSURANCE AGENCY INC
PO BOX 2476 P O BOX 16:58
ORLEANS.,VIA 02653- ORLEANS MA 02653
Town of Barnstable
Regulatory Services
9BAMSrAB
MASM&I E$ Thomas F.Geiler,Director
16.39. Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, as Owner of the subject property
Kle
hereby authorize C- to act on my behalf,
T in all matters relative to work authorized by this building permit application for:
Cof,!�f rv1 VtV
/ A M/►r
(Address of Job)
Signature of Owner Date
Print Name
. • .''+�{. t....: .� ....J,.:.. ..at.$.�. ✓3 ^.z as..j 4 r"..: ' '��F., a T."r`
Q:FORM&OWNERPERMISSION
TOWN OF BARNSTABLE .
CERTIFICATE OF OCCUPANCY
PARCEL ID 272 193 026 GEOBASE ID 37621
(ADDRESS 6 COASTAL LANE PHONE
HYANNIS ZIP -
LOT 85 BLOCK LOT SIZE
DBA DEVELOPMENT DISTRICT HY
PERMIT 43381 DESCRIPTION
PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY
CONTRACTORS:' Department of Health, Safety
ARCHITECTS: and Environmental Services
TOTAL FEES: Tt1E
BOND $.00
CONSTRUCTION COSTS $.00
756 CERTIFICATE OF OCCUPANCY 1 PRIVATE Pl *
STABLE. •
MASS.
039.
Ep�l
BUILDI IS N
BY
DATE ISSUED 01/04/2000 EXPIRATION DATE
� �_ v' �;-•: ,ram a:.z.�.
XQWN OF
BUILDTINu µPERMIT
PARCEL ID 272 193 026 G OBASE 10. _ 376211.
ADDRESS 6 COASTAL LANE PHONE 1
HYANNIS ZIP . — 1
LOT 95 BLOCK LOT SIZE
DE A . DEVELOPMENT DISTRICT HY
-PERMIT 40979 DESCRIPTION SINGLE FAMILY DWELLING
I PERNIT TYPE BUILD '.TITLE NEW RESIDENTIAL BLDG PMT
,..,. T ro, I- , , . —Department of Health SafetN.
. �:�TRACTORS. DAYS�.D�, 1�1-LDING� TNT � i
�. " IITECTwi and Environmental Services
" sTAL FEES: $321...3 THE
;:AND $..00
ONSTRUCTION COSTS $1031660.00
'I01.- S I NGLE FAM HOME DETACHED 1 PRIVATE Pit J AA,_-:.B'rAEIM +'
MASS.
1639.
4 BUILDIN-Ohl
BY
DATE ISSUED 09/1.0/1999 E'xPIlklflON :
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY;,QR SIDEWALK OR ANY,PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MY BF OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS( F,,ANV APPLICABLE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED k
INED ON JOB AND APPROVED MUST BE RETA
FOR ALL CONSTRUCTION WORK: + WHERE APPLICABLE,- SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARDKEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR
2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH-
(READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS.
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE.
4.FINAL INSPECTION BEFORE OC�UPAN&.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTION APPROVALS k PLUMBING INSPECTION,APPROVALS ;` E6ECTRIGAL INSPECTION APPROVALS
a.
2 2
3 1 HEATING-114SPECTION APPROVALS- 'ENGINEERING DEPARTMENT
l (00
2 1 VBOARD OF HEALTH
OTHER: SITE PLAN REVIEW APPROVAL
WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- _ INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS STAGES OF CONSTR;I^- MfR NTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION. �.
I
I
V
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37621
L i
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r° '- •, „ ,
N-;b�F F ESIDENTIAL EL,,G P_M_T
I
Department o Health, a et
and Environmental Services
T n t�
-. ..`..`i t .. ...,.., r� �,r�C1�L',�):. .�. ' P t�1 V A ' +� F; +►_ )ElARN3I'ABLE. s
MAss. ,��►
BUILDING.-DIVISION
l::i.t lit 1 � zu
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR.SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN-
CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED
M ER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR
ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS OBTAjKED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS
PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF(.{ APPLI LE SUBDIVISION RESTRICTIONS.
MINIMUM OF FOUR CALL INSPECTIONS REQUIRED ''
FOR ALL CONSTRUCTION WORK: APPROVED.. LANS MUST BE RE LINED ON JOB AND WHERE APPLICABLE, SEPARATE
1.FOUNDATIONS OR FOOTINGS THIS CARD.LKEPT POSTED UNTI( FINAL INSPECTION
2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CqLTI ATE OF OCCU- PERMITS ARE REQUIRED FOR
(READY TO LATH). PANCY IS REQUIRED,SUCH BUIL'OM SHALL NOT BE ELECTRICAL,PLUMBING AND MECH-
3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS.
4.FINAL INSPECTION BEFORE OI*UPANCY.
BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS E CTRICAL INSPECTION APPROVALS
-71
2 2(rt IsH
U
3 l e 1 HEATING IFISPECTION APPROVALS � NEERING DEPARTMENT 0 g.
17� 0 _It p
l 0 2 F V BOARD OF HEALTH
OTHER: SITE PLAN REVIEW APPROVAL
V
WORK SHALL NOT'PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS
THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY
VARIOUS FTAGES OF CONg7n' u^NTHS np: DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA-
TION.
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,
Map P rceI l q3 , Permit#
Health Division (� Date Issued
Conservation Division ® G �Fee ta 32
Tax Collector ,i2
Treasurer
a Z4dM
Planning Dept: ¢o � 'OMW A SEWER
BS1G IVIB ;F
Date Definitive Plan Approved by Planning Board P'� �� �!'� ucrtoN ION PRIOR
Historic-OKH P se ation/HyannisIV
Project Street Address
Village
Owner Address
Telephone —7-71 — ® t10
Permit Request To A_t'A_� k.._A
jo",��
S uare feet: 1 st floor: exis in ro osed /sy� 2nd floor:existing
proposed Total new
q 9 pp g PP
Estimated Project Cost Zoning District C— Flood Plain Groundwater Overlay
Construction Type azavi T vlGa'I'+ _
Lot Size '7. 7 Xd, Grandfathered: M4s ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family(#units)
Age of Existing Structure AI-P.tiJ Historic House: ❑Yes YNo On Old King's Highway: ElYes
Basement Type: Mfull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full:existing new Half:existing new
Number of Bedrooms: existing new 3
Total Room Count(not including baths): existing new_1r� First Floor Room Count tiP
Heat Type and Fuel: Q/Gas ❑Oil ❑Electric ❑Other
Central Air: ❑Ve"s ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 2-96
Detached garage:❑existing �❑�new size Pool:❑existing ❑new size Barn:0 existing ❑new size
Attached garage:❑existing Udnew size;34,2•L, Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ �j �7
Commercial ❑ C�Yes No If es,site plan review#
Current Use U Proposed Use
BUILDER INFORMATION
Name I&XW4 'Telephone Number 7 Z!—le `L,J
Address 5� License# d Q > 5
0 6 1 Z Home Improvement Contractor#
Worker's Compensation# TCq 46'4 IC(t 10 Y/
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ��1�
SIGNATURE '/� DATE _ Q����y
FOR OFFICIAL USE ONLY
ERMIT NO: '• '
DATE ISSUED y
MAP/PARCEL NO:
ADDRESS '' '-� VILLAGE .� 3
,F OWNER
r
+ t J
°. DATE OF INSPECTION& 7 _ {
FOUNDATION
;FRAME
INSULATION
FIREPLACE - r
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL r ='
GAS: ROUGH Y FINAL]
FINAL BUILDING wad 6
f �ear
DATE CLOSED OUT tA4 152coc> ;
} ASSOCIATION PLAN NO:
+.. s
SMOKE DETECTORS O.K.
A rSTAELE BUI ING DEPT.
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Indusionary Affordable Housing Fee
Property Owner's Name ` Z
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Project Location%
Project Valu , e all
Permit Number
Planning Dept.
FEE $
PLANNINTAR'IIM NT
INITIAL.,M. BATE S61 J0,gJ
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Western S OCompany D
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LICENSE AND PERMIT BOND
F For County, City,Town or Village Only-Not Valid for Bonds Required by the State.Not Valid for Contract, ;
Performance,Maintenance, Subdivision,Agent to Sell Hunting and Fishing Licenses or Utility Guarantee Bond.
G y
KNOW ALL MEN BY THESE PRESENTS: BOND No. L&P-4 2 9 H 9s7 41
Thatwe, Bayside Building, Inc . y
u
of the Village of Centerville State of Massachusetts as Principal,
and WESTERN SURETY COMPANY, a corporation duly licensed to do business in the State
of Massachusetts , as Surety, are held and firmly bound unto the
Town of Barnstable , State of Massachusetts , Obligee, in the amount
(Valid only when a County,City,Town or Village is named as Obligee)
of Three Hundred Forty and 00/ 100***************DOLLARS ($ 340 . 00******)
(NOT VALID FOR MORE THAN$25,000)
lawful money of the United States, to be paid to the said Obligee, for which payment well and truly
to be made, we bind ourselves and our legal representatives, jointly and severally.
THE CONDITION OF THIS OBLIGATION IS SUCH, That whereas, the Principal has been
licensed to construct a single family dwelling at Lot 77 ' Kilgore Drive
Hyanni s , MA 02601 85 ft . frontage by the Obligee.
NQW, FORE, if the Principal shall faithfully.perform the duties and comply with the laws and
or rs. rnq,cf all amendments), pertaining to the license or permit, then this obligation to be void,
o ' e1 eii� ��,1n full 'force and effect for a period commencing on the 7 t h day of
19 9 9 , and ending on the 7 t h day
9 0 0 0 , unless renewed by continuation certificate.
3 hi bK1,
may iirminated at any time by the Surety upon sending notice in writing to the Obligee and to`®'Of the Obligee or at such other address as the Surety deems reasonable,and at the expira-
tioi�� ) days from the mailing of notice or as soon thereafter as permitted by applicable law,
which��sr,this bond shall terminate and the Surety shall be relieved from any liability for any subsequent
acts or omissions of the Principal.
Dated this 7 th day of S eT r e m b e r
Principal
Principal
Countersigned WE STE RN S U E T Y C 0 M N Y
G - -rBy By T
1-2
G
G
Resident A e t President
ACKNOW GMENT OF SURETY
STATE OF SOUTH DAKOTA ss (Corporate Officer) G
County of Minnehaha } G
On this day of ,before me, the undersigned officer,personally
appeared Stephen T.Pate ,who acknowledged himself to be the aforesaid officer of WESTERN .
SURETY COMPANY, a corporation,and that he as such officer,being authorized so to do,executed the foregoing ;
instrument for the purpose therein contained,by signing the name of the corpor, n by himself as such officer. ;
rt IN WITNESS WHEREOF, I have hereunto set my hand and official sea)/ ;
f .}Cry����'1��G4GCeGf:C:G6!'?iJC�4J9:�• _ _ ; .
J. RHONE 9
G (SEAL)Li
NOTARY PUBLIC s ;
SOUTH DAKOTA ,c otary Public, South Dakota
s My Commission Expires 6-12-2004 Western Surety Company * 101 S. Phillips Ave. 9
G Form 849•A—12.97 `'°''y`'���'��'��'�'��'����p+ Sioux Falls, SD 57104 • 1-605-336-0850 ,
1
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F U
ACKNOWLEDGMENT OF PRINCIPAL
u (Individual or Partners) °
' STATE OF
6
n �
b SSs
° u
County of n
v °
i G °
On this day of ,before me personally appeared
G
G n
n U
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b known to me to be the individual described in and who executed the foregoing instrument and
F
F °
acknowledged to me that—he_ executed the same.
n °
R U
` My commission expires
t
,F
Notary Public
ACKNOWLEDGMENT OF PRINCIPAL
(Corporate Officer)
STATE OF
r, ss
County of
4
c
On this day of ,before me,
personally appeared , who acknowledged himself to be the
` of , a corporation,
and .that he as such officer being authorized so to do, executed the foregoing instrument for the pur-
poses therein contained by signing the name of the corporation by himself as such officer.
:4 My commission expires
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• Notary Public
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DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Number Expires:
Restricted To: 11
BRIAN T DACET
�"�"�x fi%►tu� 61 FERNBROOK IN
CENTERVIIIE, MA 12632
:L 71050
Restricted To: 11
11 - 35,011 cf enclosed space
I (M61 C.112 S.61t)
1A - Masonry only
16 - 1 6 2 Family Homes
Failure to possess a current edition of the
Massachusetts State Building Code
Is cause for revocation of this license.
F COMMONWEALTH OF MASSACHUSETTS --
=AIl rMEN IT OF INDUSTRIAL ACCID:EN'TS
600 WASHINGTON STREET
ames Car-;^oel: BOSTON, MASSACHUSETTS 02111
�,omm:ssicne' WORKERS' COMPENSATION INSURANCE AFFIDAVIT
(liccnsct1permincc)
with a principal place of business/residence ac
C'_C Al TFl�e ✓l LLF , AM . U..� 6 3_,2
(Ciry/sutcaip)
do hereby certify, under the pains and penalties of perjury, dur:
[q/'1 am an employe. providing the following workers' eompens:rion coverage for my employees working on this
job.
/9Wl (AA,lb C&50."ILTy TCIr oo
Insurance Company Policy Number
[ ) 1 am a sole proprietor and have no one working for me
( ] I am a sole proprietor, general contractor or homeowner (cirr'e one) and have hired the contractors listed bc:cw-
who have the following workers' compensation insurance polio
4 Y S i i� 1)le NX-16 IAA . �^ C. P O d f It) 1-(
Name of Contractor InsLrnce Company/Policy Number
Name of Contractor Insurance Company/Policy Numbc:
Namc of Contmcror Insurancc Company/Policy Number
D I am a homcowne- performing all the work myself:
NOTE: Plcase be aware that while homeowners who employ persons to do maintenance,construction or repair work on :
d-c:ling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not geocrAl v
considered to be cmplove.s under the Workers' Compensation Act(GL C 152,sea 1(5)), application by a homeowner for a lice=sc
or permit may evidence the Icgal status of an employer under the Workers'Compensation Act.
undc-st:.-id that a copy of this statement will be forwarded to the Depar::c-.:of Industrial Aeadc srs'Ofnce of Insurance for cove::;:
ver:iic:-.ion and th:. failure to secure eove:agc as required undo:Section 25A ofhdGL 152 can lead to the imposition of eiminal pcnz:.;s
consisting of a fine of up to Sl 500.00 and/or imprisonment of up to one yc:a:td civil penalties in the form of a Stop Work Order
fine of S 100.00 a d:v a€ains: me.
Sicncd this dry of , 19
Lic��scc'Pcrmittcc Liccasor/Pcrnit-ror
SUBCONTRACTOR'S INSURANCE
ENGINEEER:
BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866
(W) LIBERTY MUTUAL - WC1312595563023
WELLER & ASSOC: (L) NAT'L GRANGE MUT. - MSP45246
EXCAVATION & SEPTIC:
ROBERT J. OUR (L) U S F & G - 1MP30109550901
(W) U S F & G - 771521.695
DECO CONSTRUCTTON (L) TRAVELERS - 660364IC8342
(W) LIBERTY MUTUAL - 312446298044
FOUNDATION:
BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267
(W) LIBERTY MUTUAL WC1312201785044
WELLS:
DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92
(W) WAUSAU - 151300062926
CELLAR/GARAGE FLOORS:
MICHAEL BROWN: (L) AETNA - MP0023672849
FRAMERS:
ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9
(W) AETNA - 006C0023972416C
MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356
(W) LIBERTY MUTUAL - WC1312492127024
MASON:
SHERMAN, WAYNE: (L) COMMERCE INS CO - N60689
(W) WAUSAU INS - TO BE ASSIGNED
ELECTRICIAN:
CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649
(W) MISCELLANEOUS INS CO. - 0708878 91 1
PLUMB & HEAT:
WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9
- (W) EASTERN CASUALTY - POLICY IN MAIL
ALARM SYSTEM:
BALTIC SECURITY : (L) FTRST FINANCIAL - FF0131 G400831
(W), COMMERCIAL UNION - CB0743379
CENTRAL VAC:
VACUUM HOUSE: MERRTMACK MUTUAL - SBP1608045
TNSULATION:
MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3
(W) U S F & G - 7711099932
SHEETROCK:
MEL REED: (L) WORCESTER INS - CB817530
(W) COMMERCIAL UNION - CBH557387
INTERIOR TRIM:
DAVID' S REMODELING: (L) COMMERCIAL UNION - NB F821442
14 & R CARPENTRY (L) MARYLAND INS. GRP- SCP30235965
(W) CIGNA PROP & CAS . - C80049997
OAK INSTALLER:
ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652
PAINTING:
CAMPBELL PAINTING: (L) TRAVELERS - 168025IK4083COF
(W) AMERICAN POLICY - WCC 186604
GARAGE DOORS:
ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301.
(W) COMMERCIAL UNION - CBII573757
S'.I'ORMS & GIITTERS:
ALTJUITNUM PRODUCTS: (L) AETNA - MPOO21014146
(W) AETNA - JC892588BO
OAK FINISHER:
AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0
CARPET, VINYL & TILE:
CARPET BARN: (L) VERMONT MUTUAL - SBP6507393
(W) PHOENIX INS. - 6NUB476J652794
TILE INSTALLER:
TONY AVERTNOS : (L) ASSURRANCE CO. - CFP26528977
(W) HARTFORD FIRE - 77WZCY2409
WIRE SHELVING:
CAPE COD CLOSETS: (L) U S F & G - BSC146983441
APPLIANCES:
KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098
(W) HARTFORD INS CO - 77WZNB1603
MIRRORS & SHOWER DOORS:
L & M GLASS : (L) COMMERCIAL UNION - CBR409003
(W) U S F & G - 0071439933
LANDSCAPE & SPRINKLER:
COY'S BROOK: (L) COMMERCIAL UNION - ABR345850
(W) CIGNA COMPANIES - C41138178
DRIVEWAYS:
NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945
(W) THE PHOENIX - UB387K530
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CERTIFIED PLOT PLAN SHOWN Orr THIS PLAN S LOCATED ION
ON
FOR THE GROUND AS SHOWN HEREON AND
LOT 85 COASTAL LN. HYANNIS, MA. THAT IT CONFORMS TO THE MINIMUM
BUILDING SETBACK REQUIREMENTS OF
THE TOWN OF BARNSTABLE.
PREPARED FOR
BAYSIDE BUILDING INC.
at�"o% OF Nff .
SCALE: V = 30' SEPTEMBER 7, 1999 ^ ` N tv
Weller & Associates G , , . O�
1645 Falmouth Rd. —Suite 4C Centerville, Ma. 02632
(508) 775-0735
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LOT
85
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PROPOSED PLOT PLAN
FOR
LOT 85 COASTAL LANE HYANNIS, MA.
a
PREPARED FOR
U STEVEN W .
BAYSIDE BUILDING INC. RUMBA y
°3 9^fS510N '
SCALE: 1" =30' JULY 12, 1999 p.
`1- L�`1- 1
Weller & Associates
1645 Falmouth Rd. —Suite 4C Centerville, Ma. 02632
(508) 775-0735.
e
MAScheck COMPLIANCE REPORT
Massachusetts Energy Code Permit #
MAScheck Software Version 2 . 0
Checked by/Date
� f
CITY: Hyannis
STATE : Massachusetts
HDD: 5973
CONSTRUCTION TYPE: 1 or 2 family, detached
HEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 9-8-1999
DATE OF PLANS : 9/9/99
'PITLE : LOT 85 COASTAL LANE
PROJECT INFORMATION:
COBBLESTONE LANDING II
C`'OMPANY INFORMATION:
BAYSIDE BUILDING, INC.
COMPLIANCE: PASSES
Required UA = 357
Your Home = 313
Area or Insul Sheath Glazing/Door
Perimeter R-Value R-Value U-Value UA
--- -------------------------- - ---------------------- --------------------------
CEILINGS 1540 30 . 0 0 . 0 54
Tr;ALLS: Wood Frame, 24" O .C. 1672 19 . 0 3 . 0 88
G.T._A7ING: . Windows or Doors 207 0 .350 72
(.;LAZING: Skylights 32 0 . 600 19
DOORS 21 . 0 .350 7
F.l',OORS : Over Unconditioned Space 1540 19 . 0 73
---------------------------------- --------------------------------
COMPLIANCE STATEMENT: The proposed building design represented in these
documents is consistent with the building plans, specifications, and other
calculations submitted with the permit application. The proposed building
has been designed to meet the requirements of the Massachusetts Energy Code .
The heating load for this building, and the cooling load if appropriate
has been determined using the applicable Standard Design Conditions found
-n the Code . The HVAC equipment selected to heat or cool the building
sha.11 be no greater than 1250 of the design load as specified in
sections 780CMR 1310 and J4 . 4 .
Builder/Designer Date _!�
,J
MAScheck INSPECTION CHECKLIST
Massachusetts Energy Code
M.AScheck Software Version 2 . 0
LOT 85 COASTAL LANE
DATE: 9-8-1999
Bldg.
Dept .
Use
CEILINGS :
1 . R-30
Comments/Location
WALLS :
( ] I 1 .. Wood Frame, 24" O.C. , R-19 + R-3
Comments/Location
WINDOWS AND GLASS DOORS :
] 1 . U-value : 0 . 35
For windows without labeled U-values, describe features :
# Panes Frame Type Thermal Break? [ ] Yes [ ] No
Comments/Location
SKYLIGHTS :
1 . U-value : 0 . 60
For skylights without labeled U-values, describe features :
# Panes Frame Type Thermal Break? [ ] Yes ( ] No
Comments/Location
DOORS
) 1 . U-value : 0 . 35
Comments/Location
FLOORS:
1 . Over Unconditioned Space, R-19
Comments/Location
AIR LEAKAGE
I_ ) Joints, penetrations, and all other such openings in the building
envelope that are sources of air leakage must be sealed. Recessed
lights must be type IC rated and installed with no penetrations
or installed inside an appropriate air-tight assembly with a 0 . 5"
clearance from combustible materials and 3 " clearance from insulation.
VAPOR RETARDER:
[ ] I Required on the warm-in-winter side of all non-vented framed
ceilings, walls, and floors .
,
MATERIALS IDENTIFICATION:
�- Materials and equipment must be identified so that compliance can
be determined. Manufacturer manuals for all installed heating
and cooling equipment and service water heating equipment must be
provided. Insulation R-values and glazing U-values must be clearly
marked on the building plans or specifications .
DUCT INSULATION:
( ) ( Ducts in unconditioned spaces must be insulated to R-5 .
Ducts outside the building must be insulated to R-8 . 0 .
DUCT CONSTRUCTION:
[ ] All ducts must be sealed with mastic and fibrous backing tape .
Pressure-sensitive tape may be used for fibrous ducts . The HVAC
system must provide a means for balancing air and water systems .
TEMPERATURE CONTROLS :
[ ) Thermostats are required for each separate HVAC system. A manual
or automatic means to partially restrict or shut off the heating
and/or cooling input to each zone or floor shall be provided.
HVAC EQUIPMENT SIZING:
[ ] Rated output capacity of the heating/cooling system is
not greater than 1250 of the design load as specified
in sections 780CMR 1310 and J4 . 4 .
MISC REQUIREMENTS :
[ ) Refer to 780 CMR, Appendix J for requirements relating to swimming
pools, HVAC piping conveying fluids above 120 F or chilled fluids
below 55 F, and circulating hot water systems .
---NOTES TO FIELD (Building Department Use Only) ---------- ---------------
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