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Home My WebLink About0044 DALE AVENUE t i I Town of BarnstableBuilding Pt ThisGardSoTh'atrt is VisibleFrom,the Str.,eetr-Approved:Plans Must be Retained on Job andthis Ca�d�Mustsbe.Kept �AItNSC'ABLE, a ;os"�x= �rf E n Permit Posited-Unt(Final InspectlonHas Been Made w , Wher de e aCert�ficate of:,®ccupancy►s Required,such Building sFra114Not be Occupied until a Filial Inspection hasbeen ma Permit No. B-17-4435 Applicant Name: CRAIG N ASHWORTH Approvals Date Issued: 01/23/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 07/23/2018 Foundation: Location: 44 DALE AVENUE,HYANNIS Map/Lot: 286-011 ., Zoning District: RF-1 Sheathing: Owner on Record: SHAY,JAMES P&MONICA A ,. ContractorName -; CRAIG N ASHWORTH Framing: 1 Y Address: 9A WYNDEMERE DR �✓ Contractor License CS 015851 2 SOUTHBOROUGH, MA 01772 Est Project Cost: $45,000.00 Chimney: Description: Dig Out Interior of EXisting Crawl Space to Create more Full Height $279.50 Insulation: Space Inside The Foundation Add Bulkhead. #" Fee Paid $279.50 Project Review Req: MAY REQUIRE ENGINEERING. 8; ,� Date 1/23/2018 Final }: ass "'M y3 �s6�rr Plumbing/Gas L Rough Plumbing: fil uildin Official B g Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authon¢edby this permit is commenced within six months after issuance. Rough Gas: All work.authorized b this permit shall conform to the approved a IicaUon;and the'a roved construction documents for�wh�cl tFiis permit has been ranted. Y P PP PP , , PP P granted. Final Gas: All construction,alterations and changes of use of any building and st guctures shall<be in compliance with the local zoning by laws%rid codes. This permit shall be displayed in a location clearly visible fromaccess street or roadand shall be maintained open fobpublic inspection for the entire duration of the �� Electrical work until the completion of the same. , R �� 7. ., Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Bwldmg and fire officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work a Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work.shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Applicatio I 4 Q Health Division � Date Issued . h ' '3 Conservation Division ( 41��, � ��,4_,! Application Fee Planning Dept. tiQr ` �j Permit Fee Date Definitive Plan Approved by Planning Board `�f Historic - OKH _ Preservation/ Hyannis !/°dj Project Street Address Village Owner 5 Airess V � Telephone S(A Z8 11(05 C 0 tF_1 0C9,Ts-s Permit Request J) l ^k"ate c,O cT- B Z S'i v`� C Sty l A�-Q �c9 Cts2 o-� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain \ Groundwater Overlay Project Valuation Construction Type v a� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl . ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded 0 Commercial ❑Yes ❑ No •Q�If yes, site plan review# Current Use 5��'`��°�' Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Z� A. d6 rri s +-Sn .7mr.. Telephone Number Address /_3? 0_64civi I le,- Wst .A znii.5"le &L License cJ(;Ae/rVI f'le ,d A u(,-js Home Improvement Contractor# /01-2-®/ Email�'�, l J �n) r r 15 ,Od MWorker's Compensation # W z// � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i 12/28/2017 09:15 5084908624 JIM SHAY PAGE 01/01 4 E Town of Barnstable. Regulatory Services Thomas P.Geller,Director Building Division Tom.Perry -Buildiu�,Commissioner 200 Main Street Hyannis,MA 02601 www.town.bamstable -ma-us Office' 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This 'Section If Using ABuilder A,vas Ovmer of the subjl, subject property hereby authorize E.B.Morris& Son Inc. to act on my behalf, in all matters relative to work autliorized by this building Permit application for; . 44 Dale Ave,Hyannis (address of Job) L4ipatWure of Owner Date Tames Shay and or Monica Shay Print Name Commonwealth of Massachusetts ' Division of Professional Licensure Board of Building Regulations and Standards ri onstr Ciction Sbpg>rvisor , CS-015851 €' Tres 09/28/2019 CRAIG N ASHWORTHr � = § ; 138 OST W BARNSTABLE OSTERVILLE MA 6655" i t)/C1 10�J Commissioner 0 n q i isiness Office of Consumer Affairs and B Regulation r 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration -- Registration: 102014 Type: Private Corporation . Expiration: 6/30/2018 Tr# 288022 ERNEST B. NORRIS & SON INC Craig Ashworth 138 Osterville W. Barnstable rd. - Osterville, MA 02655 Update Address and return card.Mark reason for change. SCA 1 t: 20M-05/11 Address Renewal ❑ Employment Lost Card rj%/�� o��rnr•v. .///rr�1:;rc%sae/!; License or registration valid for individual use only cam` Office of Consumer fFairs Bus' cis egulation g HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:J . . 9 102014 Type; Office of Consumer Affairs and Business Regulation k : Expiration.:. .fi%30120.18 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 ERN EST S. NORRIS&SON Ih1C Craig Ashworth •� 138 Osterville W.8arnstable=rd: Osterville, MA 02655 Undersecretary Not valid without signature I The Commonwealth of Massachusetts Delmitinent oflridustrial Accidents Office of Investigations 600 Washington Street Boston,.,V4 02111' " � >;t�tvit�.rnnass.gottldin Workers' Compensation Insurance AffillaNit: BYlildersl'Contrac.tot-s/Elec-tricianslPlumbers applicant Information Please Print L,ezibly Name E.B. Norris &Son, Inc. Address. 138 Osterville West Barnstable Road City/StatelZip: Osterville MA 02655 Phnne #: 508-428-1165 Aree you an employer"Check the appropi-late box: Type of project(required): 1.[] I am a employer with 20 a. ❑ I am.a general contractor and I 6. ❑New construction emTloyees(full an&or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 7. ©Remodeling ship and have,no employees These sub-contractors have 8. ©Demolition working for me in any capacity. employees and have workers' 9 �]Building addition [No workers'comp.insurance comp.insurance.' required.] 5. ❑ %Ve are a corporation and its ME]Electrical repait^s or additions 3.❑ I am a horneoumer doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MOL 12.❑Roofrepair% insurance required.]" c. 152,§1(4),.and we,have no employees.[No workers' 13.0 Other coalp.insurance required.] . °Aay applkant that checks beet 91 mast also tall out the section'below showiu their workers'coutpensationptslicy information. Y Homeowners wbo submit itds sfffidatii indicating they are doing art work and taeu bite outsidta contractors toast submit a new affidava lttdicatiug such. :.Contractors ttut check this box must attached an additional street showiag the owne of the sub•cmtrsctors and state whether or not those ensicies bate employam if the sub-cournaors have employees,they tmtst provide dh it warters'comp..policy number. I air an LsurpIRver fh at is,protddhig war'trerS'CDaa7pensla.tion insurance for roar.'employ-ees. Belotr is fhepolit y and job site (a[foraatastitiaa. Insurance Company Name: Employers Mutual Casualty Company Policy#or Self-ius.Lie.:: 5H4695418 Expiration Date 5-3-18 Job Site Address: 44 Dale Ave CitylStatelZip:Hyannis,MA 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 ofMOL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 aurdior one-year imprisontnent,as well as civil penalties in the f6rm of a STOP WORK ORDER and a retie of up to$250.00 a Clay against the violator. Be advised that a copy of this statement may the forwarded to the Office of Investigation of the DIA for insurance coverage verification. I do eerpr .oa d wins and ties o perjaaay th t tine inforrraaanon yrot xded aabore ft true and sarroct Si mature.: Date: 12127-17 Phone#: 508-428-1165 Official aunt oatly. Do not torah M#Iris area,to be coa.npdeted bkv oily or Lott+aa official City or Tovm: PermidUcettse# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. C.it;;lTmim Clerk 4,ElectricM Inspector S.PIumbing Inspector 6.Other Contact Person: Phone#t. 6 Client#: 646400 2NORRISEB ACORM' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/24/2017 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 NAME: Dowling&O'Neil Dowling &O'Neil Insurance Agency A/CO No Ext:508 775-1620 FAX 5087781218 973 lyannough Rd, PO Box 1990 E-MAIL Hyannis, MA 02601 A/C,No ADDRESS: COI@doins.com 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Employers Mutual Casualty Company 21415 INSURED INSURER B: E. B. Norris&Son, Inc. INSURER C 138 Osterville-West Barnstable Road Osterville, MA 02655 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND 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 INSR WVD POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY 5D4695418 5/03/2017 05103/2018 EACH OCCURRENCE $1 000,000 X COMMERCIAL GENERAL LIABILITY PREMISES ERENTED ote $100 000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PR CO LOC $ JET AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ' DED I I RETENTION$ $ - A WORKERS COMPENSATION Y I N 5H4695418 5/03I2017 05/03/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY TOR LI IT E ANY PROPRIETOR/PARTNER/EXECUTIVE l E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S191305/M191303 CBD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION • r _ Map, o�� Parcel d , Permit# r Health Division!/ Date Issued Conservation Division r .� !S�' -� � /Q �._a Application Fee ® ' �© Tax Collector 1�l ��dy pe�zN k/Permit Fee S 3 Treasurer 1 Planning Dept. EXISTINGAPMOYM �7 Date Definitive Plan Approved by Planning Board - LIMITED TO 4 •.. OF® Historic-OKH A/4 Preservation/Hyannis W-4 "s Project Street Address l L Village YA 14j IS �4 ET 0i-772 Owner JA 6-.5 1p 161oNI G14 14, JW14 Address .3 Z Got/Ms C.A,y ,v 771$64,14,g Telephone C D �'�3 tibKfZ6S - 7 Q 5 Permit Request 114!FV ' 2�p L-12P * S 7'"j— S et • Square feet: 1 st floor: existing 2 7 0 proposed 2 74-0 2nd floor: existing 2 1670 proposed 215 a Total new 4 Zoning District Flood Plain h I A Groundwater Overlay Project Valuation 7q/,7 Construction Type V J Q/It4E:' Y..f Cz ...... Lot Size 2 Ac key- Grandfathered: ❑Yes /Q(No If yes, attach supporting-documentdtion. Dwelling Type: Single Family '�' Two Family ❑ Multi-Family(#units) _ Age of Existing Structure s Historic House: ❑Yes )4No On Old King's Highway: ❑.Yes; CiQo 3 Basement Type: Full 'Crawl El Crawl Other Basement Finished Area(sq..ft-.) � Basement Unfinished Area(sq.ft) (a 9 S Number of Baths: Full: existing new 1 Half:existing t 2 new Number of Bedrooms: existing {2 new & Total Room Count(not including baths): existing new O First Floor Room Count Heat Type and Fuel:/J Gas ❑Oil ❑ Electric ❑Other Central Air: )<Yes ❑ No Fireplaces: Existing �_ New 10 Existing wood/coal stove: ❑Yes �010 Detached garage:X existing ❑new size tT Pool: ❑existing ❑new size Barn:❑existing ❑new size N Attached garage:$)existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes EYNo If yes,site plan review# Current Use_ ��S/ Proposed Use BUILDER INFORMATION Name 4 /�C_Telephone Number Address c�� `S License'# Home Improvement Contractor# f Worker's Compensation# i00C 37000&730 l2003 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO J F — DATE SIGNATURE r - I FOR OFFICIAL USE ONLY PERMIT NO. DAT;E.ISSUED :< NO.MAP/PARCEL ADDRESS VILLAGE ` OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION /�✓S !� (Z i�! � C."�� (7 = 41 FIREPLACE ELECTRICAL: ROUGH rne�00 FINAL ' ti PLUMBING: ROUGH FINAL i( r GAS: ROUGH FINAL;. ' cri —FINAL,'. _ - _ ..ram �• �"' FINAL BUILDING Jp DATE CLOSED OUT ASSOCIATION PLAN NO. , , Jan 19 05 03: 03p p. l 01/19/2005 15:28 FAX 508 775 7877 EB NORRIS Lluuliwl r. ryr j T.own.:of 3arnstable Regulatory,Services _ snat�ustz, _ Thomas j?,Geier.Director; '� =�A *•� dig Division c ` awl TomYerrY, BuildingComrmssloner . 200 Mam 8tCc $Y=3'3,MA 02501 :„ WWw.tona ba wtable,=,us - Fax: 508190-6230 office: 508-862-4038 Property Owner Must Complete ancd Sign TMs Section . if using]&Builder S Owner'of the subject property hereby authorize �: to act on Wbehalf, in all matters relative to Workauth0r17Ad bythis building perait application for. Le /-7 gr ' piddress ofjob) S" atue of Prat Name RESIDENTIAL BUILDING PERMMT FEES APPLICATION FEE , New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 S� Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 0 square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 3 �� I2 7� square feet x$64/sq.foot= 7 x.0041= 3$' 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 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) Deck x$30.00= D (number) Fireplace/Chimney x$25.00= � (number) Inground Swimming Pool $60.00 D Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 d (plus above if applicable) Permit Fee Projcost Rev:063004 �/�P. [�p�/Jt/I77AYJt,IA./P.2IlI• IJ/...•%'[IJ'JJ2l,•�/I.JP� ' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 015851 Birthdate: 09/28/1953 Expires: 09/28/2005 Tr.no: 6861.0 Restricted: 00 CRAIG N ASHWORTH 385 SEA STREET, HYANNIS, MA 02601 Administrator t 91te Board of Building Regula ions and Standards One Ashburton Place - Room 1301 4 ' Boston. Massachusetts 02108 " Home Improvement Contractor Registration Registration: 102014 Type: Private Corporation Expiration: 6/30/2006 ERNEST B. NORRIS & SON INC•. Craig Ashworth '`:� r +• F 385 Sea St i' Hyannis, MA 02601 Update date Address and return card.Mark reason for change. °i Address Renewal Employment Lost Card �,i;i. q �lLC �dIJ�//9'I.O4Z6(/PiCLN.iG O��/�GCZtMILC/LLGO(iGU� Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 102014 One Ashburton Place Rm 1301 e Expiration: 6/30/2006 Boston Ma.02108 Type: .Private.Corporation ' !;g-;i, ERNEST B. NORRIS&SON INC i. Craig Ashworth 385 Sea St Hyannis, MA 02601 Administrator of valid without signature rl, i CF=HE Tpy, Town of Barnstable y Regulatory Services * BARNSTABLE. Thomas F.Geiler,Director 9`bA,1639. a � Building Division BD MP Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT ; HOME IMPR0VEN[ENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modemization, 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: z�� D� �©lew9W 5 Estimated Cost Address of Work: �W_P� ��h.l(,1�' /G—r`�la til�1l�S 1a�P_ Owner's Name: FS � 0 AJ l C A- A 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 PROGRA114 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 Date Owner's Name Qcforms.homeaffidav The Commonwealth of Massachusetts Department of Industrial Accidents Office of/osesUffations 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name: �� (M ✓ �/ location city L/,�Lj P.J 1 5►"O K7- phone# ❑ I am a homeowner pert rming all work myself. ❑ I am a sole rietor and have no one worki>1 in ca achy �g am an employer providing workers' compensation for my employees working.on this,job. tompanv name•.::.: `l�aa::::::8; >:'::N�azs 1�:'; .o: ..: . ..:... .. ..... . :.... .... 7..:::.::.:::::::.:. ........................... ....:.::..�:.: .ta.. ................:.......... ::::: :..:...................:.. .......::::::::::.: . ......... .....::.,.....................::::::::::..:.........:..:::::.:>::::::::::::._. «»,...... .. . . ..... .................... ............... phone#. y :':'?:>:%%::'i::>:::::::::?'%%':iif::''':ii:.iii Y:ii:::%.;`:i:; :.:::i'::is:'s:':i'%i:J:.':i:.:.i:.::::::;iiiji:;i:Y:%v'viiii:;Yi:{i iiiis:iii iii ii:iii:%i;i i:,ii'?:•iii:i::};": :..•:•L ... .,:�<}:�•i::.::::'".:}:::::::>:isv?s}::i>:{::i::;:::....:. :::i<.:..�.:a.3 V.. . .❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices; COlnl) V as`�'nam .... .<< „dire .. ...... ........ ..................... ............... .........:::::::::::.::::.::.:..: - �:8ri•i: :• ...................................................... <... �j ��•�/' ;i:;Y'i�;:;:�ii�:;:}�:;::�:i:}:�.y'..i:�Y:i:::4:!:'::::%:iiii:%C::%:ii;:;iFyCiii'>ii:%%<... :�:::iiii::}i%iY:is%:`�:s is%�iiiii:}:ilvi iiii'riiJ?:•:'::i:;iiji i i iiii::%::%%%:ii:C::i:iiiiiii:y:i•:,i':..:•;':'''•"'''.::•:::::::::•.v:::::::v:.:;.:::; :::::::.�::: ::.,:::.::::.�::.::::::.:.�::::.;..:-.::::.;'.;:.;;;;;':.:::.;:;;:<.;:.:.:;<;.::.;:;.;::.;>:.;::.;;;:.:><:>::.:;:.::.;:�:::;�:.;:<.::.i:�o one t9 .. :::::....:::....:. >'> < :�•: i:%%:ii::iii:i.'•i:i:v:?ii:?:JY i:4:!:v:::::%:j iiii't'viiiiiij>:::{i::ii�%:ist::::%::Y::iv{;4i::L%::';:::j:?ii%:::%:::i::i`::i::::::?.i::^:Ni: �� :�::::j:;ii `:�:"�:�::iii:;:::;i5%:;ii}:.yy%:;:;i:%,>?"::::::::.�•:.i:?.i:::%%:^.:.:�:•::::.iiii:::^:-iiii:^:4:<i.:: iiiiii:`:iiiii �:•4i....iii }'•,'•'^i;:::.i::.:}�::v.:�::::::::::.:•:::-i'tin}•::::::•::::niv::::::• ...........::^i:•.;:•v::N:::.�::.�::v::.�:::::v.�:::::•.�:.�:::•:•::.:.......................................... .-- i::6:•:ni•%%:;riiiiiii}i:%:ii::i:i:iiiiiii:v":iiiiii}iiiiiiii:iii:4+: :: iiii?iiiiw?i%C: %%:i::ii'ii : iii ti%4i'LL%::i4ii:LC::�::v:-i:•: e any nam address. litin > ? >` i :[;.;titi:%:i:%:i:!:i:ii:iiiiii::iii'ii:<y:iii:i�i:iii::tiiiiiS.::•iii::::::}j.::i:i%::i:%:i::i:Y:.::;:!;:,i::::�'%::i::i':i:%y::�{'r,:..:>�;:;ii:::::}i::':%vi::i::�::;i'. i .. i%:.iii::i; ..... :�.1II1'8n oli Fwh a 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 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification 1 do hereby certify under the pains and penalties of ped at the information provided above is tnu.and correct Signature Date printname Craig N. Ashworth phone# 508-775-0457 Ccontact y do not write in this area to be completed by city or town official permit/llcense# ::C3BH uilding Department icensing Board mediate response is required electmen's Office ealth Department n• phone#; Other (revised 9195 P1A) Permit Number x REScheck Compliance Certificate Checked By/Date Massachusetts Energy Code RES checkSoftware Version 3.5 Release lc Data filename: W:\Projects\Shea\shay rescheck.rck TITLE: Shay Residence CITY:Barnstable STATE:Massachusetts HDD: 6137 CONSTRUCTION TYPE: I or 2 Family,Detached HEATING SYSTEM TYPE:Other(Non-Electric Resistance) DATE: 01/14/05 DATE OF PLANS: 1/14/05 PROJECT INFORMATION: Shay Residence 44 Dale Avenue Hyannisport,MA COMPANY INFORMATION: Ivan Bereznicki Associate,Inc.,Architects 9 Wendell Street Cambridge,MA 02138 COMPLIANCE: Passes Maximum UA= 146 Your Home UA= 145 0.7%Better Than Code(UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1: Cathedral Ceiling(no attic) 1446 31.0 0.0 47 Skylight 1: Wood Frame:Double Pane with Low-E 8 0.370 3 Wall 1:Wood Frame, 16"o.c. 644 13.0 0.0 39 Window 1: Wood Frame:Double Pane with Low-E 166 0.340 56 Boiler 1:Gas-Fired Steam,92 AFUE COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in RES checkVersion 3.5 Release I c (formerly MECchecl and to comply with the mandatory requirements listed in the RES checkInspection Checklist. The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. ,�/ 4. o�- Shay Residence 08000 Exterior Window & Door Schedule File:Shay schedules Printed: 1/14/2005 44 Dale Ave, Page 1 of 1 Hyannisport, MA Notes: Desi natio IType JUnit Size Imanufacturer lunit# lGlazing IMuntins Notes A Head Double 3'-1 3/8"x 4'-8 3/8" Marvin CUDH3224 Insul. low E B Clad Double,. 2'-7 3/8"x 4'-8 3/8" Marvin CUDH2624 Insul. low E Hunci Ivan Bereznicki Associates, Inc. Original Issue Date:1-14-05 9 Wendell Street Cambridge, MA 02138 Revision: # Date: phone: (617) 354-5188; fax: (617�,868-5764 9� 75.00' N75 00'00'W - r d Stacka�da Fence A^S 01 1s _ Alllll ohr-- S.ptic Sy.t.m Component. I Sly .loa WIF S.r.p. c U01 ti � 55 N QZ Porch nmj T a'g \ uAol Jel°N eo9.I L5'OL=1� :\'8 � 19 2�.1 - '1g .o13 � m 0 /6' a soli je AS Pp1I'oN J�Un m gJ.V10 O Ta P8. ? � N po O \/ T 9'L y'f � •, VP/B7 Pnl Y \ ' Pronr. aro � V e >. !3p 30 97, ,y 17 �WideJ - S59 08.20E 1�e 1a 91 m� _ ^I \ Of J 4 NldOl nr P y1' 1 b , (6 a 601 \ . \ of I x� of � x "I al 91 of 14 I 01� _ 13 —I0 12 I WUJ d1*01,100 99 1 09000 Z A1� I t661 D D D D D SHAY RESIDENCE RENOVATIONS 8 N M AN BEREZCKI ASSOCIATES,INC. ARCHI'fECfS .D: BAve. i O b "T VOAT,MA A m0ir))mm.un.(eiD wW mu) ♦ I , �',!I! _-''- _ T � 'i 11� l�� T-� � :!ilk I - --_ i- li III •un naw -'_- I I'� t ��I -- } K u —ry— . I :I• lid i�,i _ _ d.___4r __ .. j $ - _. .... I i , .— iO" I , I I " I I! .. I T(Til �O 0i ® i _ ! D�DRDD I m z ��f - BEDR I I i fu.R�DM i I p a IWK f✓ � I i � lJ i I — i I I I 1 I BEDROOM., � I 0 i _ I , FLOOR ... ...- � «.• .._ .. ___ - PLANS I , I I I I \ nuu O • ISSUE • I i SECOND FLOOR PLAN - FIRST FLOOR PLAN N r; m . HE mm-M- 1 u WEST ELEVATION ¢ x e zs_ - BTU I Z1' o ° r SOUTH ri ram. AND WEST ELEVATIONS I SOUTH ELEVATION ' I A3.0 Ci vi FF • - 6s I I w F77'1. 0 j ED EAVE DETAIL r SHAVING/CLOSET AREA WEST EAST EL Fm _ EVATION,DETAILS Ll - _ • (1 MASTER - ----------................. BATH NORTH EAST ELEVATION e Z 1 . .. ...:. .__........ ..... ................ . ' U Ea s 0N �a TB KEY PPLAN1EL J K - - =M.,d ---------------- - �_ _ o SECTION"A" L,---- -- — -- .�� .-- ------fir--- ----- -- — ------ ' BULL IHG ' - eFnmrt . - � �Z SECTION THRU MASTER BEDROOM/STUDIO A4.0 N �a - a w a w� .. AT KEY PLAN O Lj- o - SECTION..g,. BUW- - ISSUE SECTION THRU BEDROOMS 1&2 - _ A4.1 Y I — I -- - I wl.c na iurc� --__--._I. Vl I ! I 1 I I _ 1 1 1! 4 I 1 I F ------ Pei ji _ o 0 FOUNDATION PLAN W/ FIRST FLOOR FRAMING WALL TYPE LEGEND - FOUNDATION AND PE" asue - - FIRST FLOOR FRAMING, ^^// 77777 O 8 A Uz ,. I wll �w'000e :iwu nt wm.:eu w:umc I 11 w II �U 9c _ -L 9 ' 4 I r I I z � rB.l 4. 1 oayro.aor.� I � I -•e I: ._. W b g2 =Q .Y I - .. II - I BURflts - . I w P 2 t xyrrs i r _ -�I eeoacau." i i ROOF AND i SECOND FLR. I�- I FRAMING I .., j I_.1,.... I I.. .. .. .... ........... r PLANS iL I i ouuaE 1 .— .. .. _..... —_._ ... - BUE ISSUE UE ' fir! �J SECOND FLOOR FRAMING PLAN- � - V� ROOF FRAMING PLAN _ S 2. ?' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel. ® t , Application # I %V 1 OF B`,(: I',BLE. .-Health Division Date Issued 4 > ' 57 :conservation Division Application Fee jPlanning Dept. Permit Fee ` ,Date Definitive Plan Approved by Planning Board u. `"�_ PC- Historic - OKH _ Preservation / Hyannis Project Street Address �. 4ve Village Owner � A� ®/J 4Address Telephone Se>.ai "� Permit Request Ai' . , bb Square feet: 1 st-floor: existing proposed nd floor:existing proposed Total new Zoning District,-.1 Flood Plain 4 Groundwater Overlay IV At" Project VAluation ��O Construction Type( sc�' Lot Size=� r1� 1 Grandfathered: 0 Yes If yes, attach supporting documentation. Dwelling Type:Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure dAkAW Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes No Basement Type: FullCv'rawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) O Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not includin baths): existing ew First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ther Central Air: ❑Yes ❑ No Fireplaces: Existir} New Existing wood/coal stove: Yes ❑ No a.a�2o Detached garage:Y existing 0 new size—Pool: ❑existing ❑ new size _ Barn: ❑ existin w size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ n w size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded Commercial ❑Yes No If yes, site plan review# /.X Current Use f Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 'G' ®� l`� �U C—Telephone NumberSel Address MA icense #__._ Home Improvement Contractor# Worker's Compensation # /� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO PlAbo " SIGNATU 6E DATE { FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0._ go I ADDRESS ff -'' VILLAGE,, t OWNER r � G DATE OF INSPECTION: r FOUNDATION FRAME Ile INSULATION FIREPLACE .F' r x. '`•� ELECTRICAL: ROUGH 'T" FINAL i PLUMBING: ROUGH FINAL t ! 'GAS: , ROUGH!A FINALS ? ` ,s F<INAL 17 DATE CLOSED OUT , ASSOCIATION PLAN NO. F ` f The Commonwealth ofMassachuseits 3 Department of Industrial-Accidents Office of Investigations. 1 600 TYashington Street Boston,MA 02111 �a w lymmass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezib Name(Business/Organization/Individual): F�kOGI&� 60P45 se r� - Address VSTP—N1�Ve, — W' - 4M<&"1rAIZVL.r_ irP-J1 UL City/State/Zip: y >✓t KP, Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.9 1 am a employer 4..❑ I am a general contractor and I 6. New construction with employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g• ❑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 addition 3.❑ I am a homeowner doing all work officers have exercised their 11- Plumbing repairs or addition _v mys0f:_[No yrorkers'_QQznp,.....____...._.: right of exemption per MGL ❑ p :".._._ _r__:__ ...-.. .. ___ -. 12. ,Roofse aus.......... . insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13•9 Other_kn EXl SI- comp.insurance required.] (2) v✓I NDo t)5 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy informat--,-» t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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. Belofv is the policy and job site information. 'r ' Insurance Company Name: I! c k"91 A (I►��V P-4- -De Policy#or Self-.ins.Lic.#: V1/JD6Q. 7_,Q70 w Expiration Date: �1 Job,Site Address: +I- DAB TI yIr City/State/Zip:'��/1��y Attach a copy of the workers' compensation policy declaration page(showing the policy3number 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 fi. 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 certi der the pains and es erjury ih information provided above ' true`and correct Si ature - Date: Phone#: 2� Official use only. Do not tMte in this area,to be completed by city or town official City or Town: Permit/License# 11 Tcenino Anthnrity fnircle nnel: 5 Client#:646400 2NORRISEB ACORD. CERTIFICATE OF LIABILITY INSURANCE 0DATE(MMIDDIYYYY) 5/26/2010 'PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling &O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR . ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Acadia Insurance E. B. Norris&Son., Inc. INSURER B: 138 Osterville West Barnstable Road - INSURER C: Osterville, MA 02655 - INSURER D: INSURER E:' COVERAGES 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 CONTRACTOR 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS W DD' - POLICY EFFECTIVE POLICY EXPIRATION LTR INSRE TYPE OF INSURANCE - POLICY NUMBER DATE MM/DD/YY DATE MMIDD/YY LIMBS A GENERAL LIABILITY BINDER307009 05/03/10 05/03/11 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED • E ES(Ea occurrence) �$250 000 CLAIMS MADE 51 OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 000. GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 000 0O0 POLICY PRO-JECT LOC A AUTOMOBILE LIABILITY BINDER307008 05/03/10 05/03/11 COMBINED SINGLE LIMIT $ ANY AUTO - (Ea accident) ALL OWNED AUTOS BODILY INJURY $1 000,000 X SCHEDULED AUTOS (Per person) r X HIRED AUTOS BODILY INJURY $1 OOO,OOO X NON-OWNED AUTOS (Per accident) r . PROPERTY DAMAGE (Per accident) $500,000 GARAGE LIABILITY AUTO ONLY-'EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY BINDER307011 05/03/10 05/03/11 EACH OCCURRENCE $10 000 000 X OCCUR CLAIMS MADE ' f AGGREGATE $1 O 00O 000 DEDUCTIBLE $ X RETENTION $O $ IR A WORKERS COMPENSATION AND BINDER30701 O - O5/O3/1 O O5/03/11 - X WC STATU-Y LIMITS - OTH- OR EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $SOO,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT` $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions,exclusions,other.. limitations and endorsements: Nothing contained in'the certificate of insurance shall be deemed to have altered,waived, or extended the coverage provided by the policy:provisions. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _3p_ 'DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA.02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S69611/M69610 CR © ACORD CORPORATION 1988 I Office of Consumer Affairs.and usiness W_ Regulation �E� � 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 102014 fT a r Type: Private Corporation Expiration: 6/30/2012 Tr# 200714 ERNEST B. NORRIS & SON INC Craig Ashworth 138 Osterville W. Barnstable rd. Osterville, MA 02655 Update Address and return card.Mark reason for change. 0 Address ❑ Renewal ❑ Employment Lost Card DPS-CA1 Co 5OM-04/04-G10O1�216 �p \ Oftice of Cofume A�a,rs � Vines�'tegu� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Type: Office of Consumer Affairs and Business Regulation Registration: p^1,02014 YP g 1= 10 Park Plaza-Suite 5170 Expiration: ,6/30/2012 Private Corporation i Boston,MA 02116 '-R x ERt�fEST B. NORR,I,S-&,SON_INC ; Craig Ashworth 138 Osterville W.Barnstable Osterville, MA 02655 = Undersecretary Not valid without signature i 1 _ Massadmsettti.- Del), ient_of Public SafctN 1 Board of Buildin-Romlations':ind Standards Construction Supervisor License License: CS 15851 Restricted to- 00 ,,n , .CRAIG^N,ASHWORTH . 1 138 OST W BARNSTABLE (; OSTERVILLE, MA 02655 rc " _ -- - yam Expiration: 9/28/2011 t ('uuunissicmcr Tr#: 3091 s Town of Barnstable Wgulatflry Semees i t ,�xNsrsr I ... Thomas R"or,Director Tom-Pexry,Wiling CouMissioner 206 iv!ein Strut,Hyaais,MIL 02601 . �♦...�,_.—_..._.____..__....... ., - w.wW,ta�t.barns�blerr►a.us �............ . . ::::.". "' FaxLL $OS 790-6230 O£lai-508-862-4038 ......._. :............. .........._....__..._._ finer must Complete and Sign This Section. -. f UsA Buitiker I,�... 6W 4:.:. i ?as Owner of the subject pxopeny h=by 2Uth0ziz� �� •'�4�� a� i ��_to act on nV b6a f, in o f=tiers work ausfiotized bytu bijM4 permit 2pp4caticm f or. :. .C-A+rldzess.0f.Job) _ 127t - I zgn*.ofner hiot Nazi «... Tf 6pejt is a for per please complete the Homeowners License Exemption Form an the.re xse side. � Q;PbRMS:DWNBRYF.17MiS51DN . ' - Gmrvl NWn 20't PLCE55 PANEI I . ANDERSON WINDOW I 1L 20't 2X6 Gw,46E 700R WECN. I 20't r3 5VOPING GLUE 60ARD/PLA%ER g" 16"O.C. ANDER50N WINDOW R-14.8 9 2" ZX9 AZEK 51LL DLUE 60ARD AND PLA5IYR g' 18 OLOCK5 ICYNENE.R 14.8 x4-ON.FLA1- 1 _ I3B OsL-111e W.6amtdk Rd _ - Osterville,MA 02655 - Alternate#I:For pergda over garage door - (505)420-1165, � Jw 56-q Graz 2 E�TION 4417z1e Aye. vr, 1ON5 Pt.MA SHAY �4/-7/II A-I oFY row Town of Barnstable *Permit#. y Expires 6 months from issue date „P Regulatory Services Fee MASS. a; Thomas F. Geiler,Director Alfb�,�A Building Division Tom Perry, CBO, Building Commissioner -PRESS PERMIT 200 Main Street,Hyannis,MA 02601 www.town.barnstable:ma.us pJC.r 8 2070 Office: 508-'862-4038 1 ax: 508-790-6230 EXPRESS PERMIT APPLICATION - I2ESIDENTIA� {L SARNSTAKE Not Valid without Red X-Press Imprint Map/parcel Number 2 / O Property Address Arq• VA 1:...E AVG� � ft IJ W5PQF—T-t h Residential Value of Work �j,o,o© Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S�, 1 AW1Es mooWA l Contractor's Name ERNEST E, NPIZ'KI5 Se SOQ 1 10G• Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) Z! ❑Workman's Compensation.Insurance o Check one: o C) ❑ I am a sole proprietor c� ❑ I am the Homeowner I have Worker's Compensation Insurance -" W co Insurance Company Name ACADI1'V =:z `� tt � Workman's Comp.Policy# �JIN�Lf� 3D�70 �d JA Cr' Copy of Insurance Compliance Certificate must accompany each permit. ►-+ �' r� r 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 ANDsRSEN #of doors 5 PICTUREV� tTS. Replacement Window doors/sliders.U-Val ue (0 2.& (maximum .44)#of windows IG 1 C/hSEMEiJ�5.. ,. r *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is required. SIGNATI7RE: The Commonwealth of Massachusetts -- Department of Industrial Accidents Office of Investigations _ CS j� 600 Washington Street 140 Boston, MA 02111 rvww.mass.gov/dia Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individnal): F_?W GS 1 0 OR-12WS Sam �"��• Address: City/State/Zip: 1r,RJ I VLe KPV Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with 4. I am a general contractor and 1 6. ❑New construction employees (full and/or part-time).* have hued the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ?. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition [No workers' comp. insurance comp.insurance. required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions rrryself,..[No,worke.�s'_coznP right of exemption per MGL 12.�_Roof,repairs... insurance required.] re u t c. 152, §1(4), and we 13. have no q ] employees. [No workers' (� Other comp. insurance required.] I 6 Vl/l Nflo lU5 *Any applicant that checks box 41 must also fill out the section below showing their workers',compensation policy informati n. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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 isproviding workers'compensation insurance for•my employees. Below is thepolicy andjob site information. Insurance Company Name: /1 �fll/� lIV��►" Policy#or Self-.ins. Lic.#: t;1 AJr6Q. 7-707011 Expiration Date: 0 Job Site Address: +I- DAL rf W City/State/Zip: /1 �/ (/�, 17 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 tip 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 certi der the pains and ;��information provided above is true and correct. signature Date: 7 0 � A Phone#: 28 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 Phone#- J r 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 another who employs ersons.,to do maintenance, construction or repair.work on such dwelling house dwelling house of anop I g - employment or on the grounds or building appurtenant thereto shall not because of such 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-contractors)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 pers,are not required to carry workers compensation insurance. If an`LLC or LLP does have artn 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 Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia �.. .. Town of Barnstable :� = gAaKSTl►s7 i Thomas F."ar�nireaor KA89. :_, ... ....,....�..__..._....... .... Tom Perry,BUHdfng Cumt ssionir 200 Msju Street,Hya=i%MA 0260I —_ �_...._.....m.._...._.:..... w.ww.town.barnstableina.us _.__........ , . F 230 Offiac::.508-862-4038 -Fax, S 8 0 -79 ........... ... .... ...�..�..w.._�'r�p�rtY der Must Complete and Sign Thisectio Hu. Sim Buff er } ............................... . ....... . , Owner of the subject pxopeny lembyattho to ac on rq behaif, in A matters re]at"rve to WO&4uth6=d by dt s baditg permit ap&ation for. : .(Addmis-of job) y /Q / 7 i of C*ner Da Print Name D,... .. .... ...w.,....,�,...._........ .........W,. ...... .......... f 'ro a C?wne is applyung for pern,it please comple,te the Homeowners License Exemption Farm on the,reverse side. a i + q.PORMS:0WMeRP1EftPAiSsi0ri ` Client#:646400 2NORRISEB DATE ACORD- CERTIFICATE OF LIABILITY INSURANCE 05/26/2010 ) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 9 y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Acadia Insurance E.B.Norris&Son.,Inc. INSURER B: _ 138 Osterville West Barnstable Road INSURER C: Osterville, MA 02655 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MM/DD/YY DATE MM/DD/YY A GENERAL LIABILITY BINDER307009 05/03/10 05/03/11 EACH OCCURRENCE $1 00O 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $250 OOO CLAIMS MADE 51 OCCUR MED EXP(Any one person) $5 OOO PERSONAL&ADV INJURY $1 OOO 000, GENERAL AGGREGATE $2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 OOO OOO POLICY JE�7 LOC - A AUTOMOBILE LIABILITY BINDER307008 05/03/10 05/03/11 COMBINED SINGLE LIMIT. $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $1,000,000 X HIRED AUTOS ' BODILY INJURY $1 OOO OOO rX NON-OWNED AUTOS (Per accident) > > PROPERTY DAMAGE $5OO OOO (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY BINDER307011 05/03/10 05/03/11 EACH OCCURRENCE $10 000 000 X OCCUR ❑CLAIMS MADE AGGREGATE $1 O 000 000 DEDUCTIBLE $ X RETENTION $O $ TH A WORKERS COMPENSATION AND BINDER307010 05/03/10 05/03/11 X WC srArU- FR EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE - OFFICER/MEMBER EXCLUDED? NO - E.L.DISEASE-EA EMPLOYEE s500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. f s CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN. 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #SI69611/M69610 CR © ACORD CORPORATION 1988 .y ;.. ,, Massachusetts- Department of Public S tfet� Bom-('I of Building Regulations and Standards y Construction Supervisor License License: CS 1158511 Restricted to .00 Ncll sy� 'k. y u CRAIG.N ASHWORTH 138 OST W BARNSTABLE - OSTERVILLE, MA 02655 Expiration: 9/28/2011 ` r Colliuis", lei' a Tr#: 3091 ' t Office of Consumer Affairs and usiness Regulation �= — =. 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Home Improvement Contractor Registration Registration: 102014 �fi ? Type: Private Corporation � T Expiration: 6/30/2012 Tr# 200714 ERNEST B. NORRIS & SON INCH Craig Ashworth 138 Osterville W. Barnstable rd. ti t M Osterville, MA 02655 2Y. Update Address and return card.Mark reason for change. El Address ❑ Renewal ❑ Employment ❑ Lost Card DPS-CA1 is 50M-04/04-G101216 \ Office ot�of me�i�rsinesaf"on License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 102014 Type: Office of Consumer Affairs and Business Regulation I= 10 Park Plaza-Suite 5170 i Expiration 6/30/2012 Private Corporation \= � � .: Boston,MA 02116 ERN ST B. NORRIS Craig Ashworth 4T 138 Osterville W.Barnstabl"e rd' Osterville, MA 02655 .` Undersecretary Not valid without signature J f . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map g'r�7 Parcel Application# i2o© ( "J� Health Division Conservation Division Permit# Tax Collector Date Issued AR Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved"by Planning Board N IJA Historic-OKH N A Preservation/Hyannis NIA Project Street Address DA LF, A V k (I °°- Village YAQQ1,6P©�-_T AA&W-d!h Owner 5HAY„2ARe6 2 $ KVOJ1,CA A. Address ,AI& 0171q- Telephone CIO 6•V2 WQM:R 2 & � 196 115 0451 Permit Request PEPLACL DOOR N PI CNN C Q TO O �-' f'; tp I)OVAn V . VEPLA CE W IIJ D OW PE OVATE: 0011 By V ica,''w(wvouo 0 ) 1146 �LP_ PEV Amy TR f7tA e2 I r2l 06 1C71v Square feet: 1 st floor:existing proposed 2nd floor:existing 9,ffo proposed Total new—0 Zoning District kE Flood Plain WA Groundwater Overlay MIA Project Valuation Construction Type WI? FP_Am6 Lot Size 01b arty Grandfathered: ❑Yes 4 No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure � �s IV-70 Historic House: ❑Yes V No On Old King's Highway: Cl Yes A No Basement Type: 0 Full 9 Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) /A Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 4 new n Half:existing ( new 0 Number of Bedrooms: existing 5 new 0 Total Room Count(not including baths):existing I new First Floor Room Count Heat Type and Fuel: 10 Gas ❑Oil ❑Electric ❑Other' R 0 IT WATER Central Air: 0 Yes ❑No Fireplaces: Existing I New 0 Existing wood/coal stove: ❑Yes J4 No Detached garage:,)existing ❑new size N A Pool:❑existing ❑new size A 4 Barn:❑existing ❑new size Attached garage:A existing ❑new size MA Shed:❑existing ❑new size NIA- _Other: Zoning Board of Appeals Authorization ❑ Appeal# N/A Recorded❑ Commercial O Yes )9 No If yes,site plan review# Current Use S1(2 IJ Proposed Use G�, BUILDER INFORMATION Name �7 ,i,��L1S, �f�C- Telephone Number Address -2fj,E License# CS 0(5 55� Yk N O IS , MA 0 2� I Home Improvement Contractor# Worker's Compensation# WC SW b� J 1�.M6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _ Yl•�•1 SIGNATUR DATE �` 11 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT J ASSOCIATION PLAN NO.. s -6n•»xiir.a•�ruealt� orf.;`luq�acfu�elCci Board of Building Regulations and Standards License or registration valid for individul use only expiration date. if found return to:before the ex _• - HOME IMPROVEMENT CONTRACTOR P Board of Building Regulations and Standards Registration: 102014 One Ashburton Place Rm 1301 Expiration- 6/30/2008 Boston,Ma.02108 Type: Private Corporation 7 , -,�ERNEST B.NORRIS&SON INC :-'7 �;r • Craig Ashworth 385 Sea St ��- �~ Hyannis, MA 02601 Deputy Adm inistrator ator of valid without signature x� I � I•. • i i t f •I �' r • 1. � i 677/ oard Of Buildingg eqgulations One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS Birthdate: 09/28/1953 015851 j Expires: Restricted To: 00 CRAIG N ASHWORTH 385 SEA STREETA. HYANNIS, MA 02601 I ' Tr.no: 5196.0 oPs•CAt 0 SOM•04/05-PC8688 Keep.top for receipt and change of address notification. i, i t r {LC T/Jd/!Y!)"C4Y000�CCZGCK- O� �ICIZ:kkLC1LCWCCC,I �I BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 015851 Birthdate: 09/28/1953 Expires: 09/28/2007 Tr.no: 5196.0 Restricted: 00 I CRAIG N ASHWORTH . 385 SEA STREET G— a HYANNIS, MA 02601 Commissioner 2 :. .,.+...:....:. ,..._—....:.i..._ .r.d -.rti..w+..�a• y __ ....,... "l It M ,'Y. 2�: ti —a a�..... ... ..,:...... ......��--._ .. .-. '.... ......Y... n.. _ ,_ . _ - .. - ... S_..._ — ir . _� _ ��L..��ilf�'p{An .::'•tip.::=.si-- ---•• ..• •:. • •- 1R�1R tOlfA�t'O6�Bblt�SW-M .. . z..:. ... . P= 505-790•-6730 Office: 508 8"3S propert owner must complew This Soctiou - • If Using A$uldez �j d� YtLI V�I�S' ma&onmrloe�slf, in aIl re tc Va*w��'Y*4 P�aPP °afar. s ofjo ) S Of a . i • 1 OpTHE l Town of Barnstable Regulatory Services Mass. $ Thomas F.Geiler,Director �A t6;¢ �0 9. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. 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:_ A Lam,U 9LO—,W I R&1J oyATl 0 0 Estimated Cost a �I Address of Work: �' n/Z1� Ar. i R YA WW W t5 y%-Y r A Owner's Name: SH AY, -7AM Ee & MO 11 L,& f Date of Application: h To IW 6 I hereby certify that: Registration is not required for the following reason(s): E]Work excluded by law ❑Job Under$1,000 OBuilding 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 PE Y I hereby apply for a permit as th gent of the owne . DatVContractor Name Registration No. OR Date Owner's Name Q*Tmrhomeaffidav Datei 8/11/2006 Time: 11:18 AM To: @ 7,15087757877 Dowling & O'Neil Page: 001-002 Client#:646400 2NORRISEB ACORDTM CERTIFICATE OF LIABILITY INSURANCE 0DATE 8/11106D/YYYY) 'PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS.UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St.PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE. NAIC# . . INSURED INSURER A: Associated Employers Insurance Compa - E. B.Norris&Son.,Inc. INSURER B: - P.O.Box 486 INSURER C: - Hyannisport, MA 02647 INSURER D: INSURER E: COVERAGES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION 'LIMITS LTR NSR DATE MM/DD/YY DATE MMIDD/YY GENERAL LIABILITY EACH OCCURRENCE $ ED COMMERCIAL GENERAL LIABILITY - PREM SES(aEoccurrence) $ CLAIMS MADE D OCCUR - T MED EXP(Any one person) $ PERSONAL&ADV INJURY $ • GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: a PRODUCTS-COMPIOP AGG $ -71 POLICY JE O LOC ' AUTOMOBILE LIABILITY r. u COMBINED SINGLE LIMIT. $ . ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY'• SCHEDULED AUTOS r.~ - (Per person) $ HIRED AUTOS BODILY INJURY NOWOWNED AUTOS - (Peraccident) < $ - . PROPERTY DAMAGE $ (Peracxident) - GARAGE LIABILITY • - AUTO ONLY-EA ACCIDENT $ ANY AUTO '' - OTHER THAN EA ACC $' - AUTO ONLY: - -.AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ J OCCUR CLAIMS MADE _ AGGREGATE - - ' $ - 1', - $ DEDUCTIBLE - " $ ' RETENTION $ TH- A WORKERS COMPENSATION AND WCC5000673012006 05/03/06 05/03/07 WCSTATU oER EMPLOYERS'LIABILITY - .. `,t TORY LIMITS ER - - E.L.EACH ACCIDENT" $500,000 ANY PROPRIETOR/PARTNERIEXECUTIVE _ - OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $SOO OOO If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000 OTHER - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions,exclusions,`other limitations and endorsements. Nothing contained in the certificate of , insurance shall be deemed to have altered,waived,or extended the t Y ° coverage provided by the policy provisions. a CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL: III DAYS WRITTEN Main Street - - NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL - Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. - AUTHORIZED REPRESENTATIVE - - ACORD 25(2001/08)1 Of 2 #43940 MAK ©ACORD CORPORATION 1988 _ The Commonwealth of'Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M4 02111 ''M �.•`' www m ass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunabers APPUcant Inforffiation Please Print Legibly Name (Business/Organization/Individual): C✓OZ1,ELVT �- I�J06Z[ZlS 11c 7 �11C Address: /j89 �07A City/State/Zip: - HYANN�,, MA 09_0 Phone#: 54g-•-77 5 0+51 Are you an employer? Check the-appropriate box: Type of project(required): 1.❑ I am a employer with 4. Z I am a general contractor and I 6 New construction employees(full and/or part-time).- have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ 7. Remodeling ship and have no employees These sub-contractors have 8, .❑ Demolition working for me in any capacity.• workers' comp.insurance. 9. 0 Building addition [No workers' comp. insurance 5. ❑ We are a corporation and,its required.] Iofficers have exercised their ' 10.0 Electrical repairs,or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 1 13,❑ Other 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 anew affidavit indicating such ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors sad their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: tk-Muk1G Policy#or Self-ins.Lic. #: [('�',_ (off�v01��(� Expiration Date: n6-10�3 J o-7 Job Site Address:_ 44 bAI;L City/State/Zip: YA WQ I ejyo-p—T._y k OUO 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 0 ffice of Investigations of the DIA for insurance coverage verification. I do hereby cerd er the pa'ns a e a ' s o jury that the information provided above is true and correct Si afore: Date: L 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/Towu Clerk 4.Electricai inspector 5.Plumbina insp-for 6. Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 6r Map Parce{, '� �` Permit# S JL Health DivisionA' . '- Conservation Division 30 p ( V ✓ £3 " q Z 'C � �tGnCl�L�ji itc�i�7 �� 1 1 i Tax Collector ``;i,7 (� "fee Treasurer .- Planning Dept. C3i tia'' 'Ui~s IN p. _ Date Definitive Plan Approved by Planning Board 1A_ VOTE TITLE 5 t Cr r j, VOTE CODE AND Historic-OKH Preservation/Hyannis � TOY01M REGUL 9.71ON3 r' Project Street Address Village Owner J Address 7 2y�fj �y Telephone Permit Request_V 19167 P6-9C_A� A-1,J V 22Nk' r " �cr AJ.fkal -E�MV66,J &?y "b ap� 1,5 pmcwl,06�w e Square feet:jl floor: existing 2S proposed 28 O 2nd floor: existing proposed 76� Total new G Valuation C gbh Zoning District Flood Plain /�o� Groundwater Overlay 1_�(h Construction Type pw*e Lot Size • 2/& Grandfathered: ❑Yes Pf No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 11A Q 4 e, Historic House: ❑Yes No On Old King's Highway: ❑Yes No Basement Type: 4 Full A Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 4/'i Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing , new Number of Bedrooms: existing_ new 10 Total Room Count(not including baths): existing // new O First Floor Room Count Heat Type and Fuel: XGas ❑Oil ❑ Electric ❑OtherT Central Air: ❑Yes No Fireplaces: Existin�g1 New Existing wood/coal stove: ❑Yes VNo Detached garage existing ❑new size k�7 Pool:❑existing Cl new size Barn:❑existing ❑new sized Attached garage:❑existing ❑new size � Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ANo If yes, site plan review# Current Use � /O Proposed Use ��'��"1c�; BUILDER INFORMATION I Name Ote� Telephone Number Address License# VAS ✓O//5 Home Improvement Contractor# /0.20/6� Worker's Compensation# WC e,- moo®6 73612,0 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE G' t ' FOR OFFICIAL USE ONLY h - PERMIT NO. t DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNEt i DATE OF INSVECTION: FOUNDATION ' 'FRAME A&fjC.&J INSULATION JI1/ S 0 SZia y ,- Jo O A f-' ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT _ ASSOCIATION PLAN NO. - RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEET New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET LIVING SPACE square feet x$96/sq. foot= x .0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE �a _ 0 -square feet x$64/sq. foot= -- x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ftf >120 sf-500 sf $35.00 >500 sf-750 sf 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.0031= STAND ALONE PERMITS Open Porch _ x$30.00= �� (number) Deck _x$30.00= (number) Fireplace/Chimney x$25.00= O (number) . Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 0 Relocation/Moving $150.00 t (plus above if applicable) Permit Fee projcost Mar 29 04 01 : 31p p. 4 03/29/2004 09:52 FAX 508 775 7877 E9 NORRIS WJuuz Town of Barnstable Regul dory Services I nwtu+su+a Thopat'kF.Geller,Director s� 0639. �,d $ui1r4ng Division - Tom Perry,,jBdUding CommMoner =0 Mafia sk6% Hyaauis,MA 02601 Office: 508-862.4038 Fax: 508 790-6230 • Property Ownet Must Complete and Sign This Section If Usitig A Builder ez•of the.aubject pzopett-7L. _._. ._. .: . hereby authoziae -act on=y.b.ehiK. it all matters relative to work autlro,izeA.bP th s buWag.p e it-applic-i-6m,for: (Address o£Joh) • ' ' _ ZLg 6 tease of Owner Priat I�Tame i 9/t e I - Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement.Contractor Registration — F a Registration: 102014 • I r� Type: Private Corporation Expiration: 6/30/2004 ERNEST B. NORRIS & SON ING'°r; Craig Ashworth - 4 y 385 Sea St Y ` Hyannis, MA 02601 e. Update Address and return card. Mark reason for change. g (-1 Address. F-1 Renewal f-1 Employment (-'I Lost Card r ,per 1,e eowwvnwnawaldi qe✓ffawaduwe0 Board of Building Regulations and Standards License or registration valid for individul use only i - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:' 102014 Board of Building Regulations and Standards - ` One Ashburton Place Rm 1301 Expiration 6/30/2004 Boston, Ma. 02108 Type: -Private Corporation ERNEST B. NORRIS B`SON INC' Craig Ashworth 385 Sea St � i Hyannis, MA 02601 ---" - i ...... �eistr tnr �otlid without signature i r r i i' 1, I: . ✓1LP. l/J0097/IYI,09Y.U/6CI,�U[ OJ�:l�.I1�JJlLl,'�LI.J6l�6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 015851 Birthdate: 09/28/1953 ilk Expires:.09/28/2005 Tr.no: 6861.0 Restricted: 00 CRAIG N ASHWORTH 385 SEA STREET HYANNIS, MA 02601 Administrator The Commonwealth of Massachusetts " = Department of Industrial Accidents office 0110yestigali0os 600 Washington Street c}� f Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit %/ name: location: city Qhone# ❑ I am a homeowner performing all work myself. ❑ lamas I have no one works in capacity �g am an employer providing workers' compensation for my employees working on this job. : ::.:.:..:.::.:::.,: ...... ................:.}:. 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QrflncC.CO............................................................................................................................ 011 ..............:..;:::::::::+..:.::. ::::.:.:::::.::::::.:::::::.:;:.}:;.;:..}}:.;:.:::_.}:<;.:.:: Faihue to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1,500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I_understand tbat a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify under the pains and penalties of ped. at the information provided above is trice and correct Signature Date print name Craig N. Ashworth phi# 508-775-0457 Ccheckif ly do not write in this area to be completed by city or town official lak town: permit/license i$ ❑Building Department mediate response is required ❑Licensing Board ❑Selectinen's Office ❑Health Department n: phone k; ❑Other ormad 9195 PIA) SHAY.RPT MAScheck COMPLIANCE REPORT I Massachusetts Energy Code I Permit # I MAScheck Software version 2.0 I I IChecked by/Date j CITY: Hyannis I I STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 3-30-2004 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required uA = 87 Your Home = 87 Area or Insul Sheath Glazing/Door Perimeter R-value R-value u-value UA ------------------------------------------------------------------------------- CEILINGS 415 38.0 0.0 12 WALLS: wood Frame, 16" O.C. 360 15.0 3.0 24 GLAZING: windows or Doors 78 0.400 31 FLOORS: over unconditioned space 415 19.0 20 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed buildin 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 in the code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and 34.4. Builder/Designer Date 3- a MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck software version 2.0 DATE: 3-30-2004 Bldg. l Dept. ) use I i I CEILINGS: [ 7 ! 1. R-38 I Comments/Location I I WALLS: [ ] I 1. wood Frame, 16" O.C. , R-15 + R-3 i Comments/Location i Page 1 SHAY.RPT { WINDOWS AND GLASS DOORS: [ ] J 1. u-value: 0.40 { For windows without labeled u-values, describe features: I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location { FLOORS: C ] i 1. over unconditioned space, R-19 { Comments/Location I { AIR LEAKAGE: [ ] ( joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. Recessed i lights must be type IC rated and installed with no penetrations I or installed inside an appropriate air-tight assembly with a 0.5" J 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: [ ] I 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. I Pressure-sensitive tape may be used for fibrous ducts. The HVAC isystem 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: [ ) I Rated output capacity of the heating/cooling system is { not greater than 125% of the design load as specified { in sections 780CMR 1310 and 34.4. I ( MISC REQUIREMENTS: [ ] ( Refer to 780 CMR, Appendix j for requirements relating to swimming I Cools, HVAC piping conveying fluids above 120 F or chilled fluids ( elow 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department use only)------------------------- 0 Page 2 03/22/2004 11:36 5084283115 SULLIVAN ENG INC PAGE 14 Sullivan Engineering Inc. 7 Parker Road/Box 659 Osterville, MA 02655 Peter Sullivan P.E. Klass. Registration No. 29733 phone: 508-428-3344 e-mail:PSullPE@aol.com March 19, 2004 Conservation Commission Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: SE3-4243/Shay/44 Dale Ave., Hyannisport Dear Commission, Please find enclosed the recording information for the above referenced file. The Order of Conditions was recorded today at the Barnstable Registry of Deeds Land Court as document number 960,805. I trust this meets your present needs. Any questions please feel free to call. Very truly yours, Paula Sullivan Sullivan Engineering Inc. Cc: James Shay Members of American Society of Civil Engineers, Bosmn Society of Civil Engineers -SLOPED TO SH ATER ��MAX. DECK EDGE ALUSTER RAILS JOISTS f l � ® J IN RISER i r) STRINGER BOLTED TO THROUGH CARRIAGE WITH SPACERS BOLTS BETWEEN STAIR CARRIAGE WITH STRINGER DECKING JOIST PRESSURE �lo� SILL TREATED j SEALER SILL ANCHBOLT OR •, p , 3/4 SLOPE TOP OF TOP 3/4- OF WOOD SPACER CONCRETE '. DECKING -� FOUNDATION 4-j METAL �® WALL HANGER GRAVEL BALLAST ON �- BLOCKING PLASTIC MEMBRANE V �-- JOIST LEDGER BOLTED TO • BUILDING WALL p•: SPACER: SOLID WOOD PROVIDE FOR :.v• •• .• •'o• BLOCK OR EXTERIOR DRAINAGE OF : ••. 4 GRADE PLYWOOD AREA BELOW o. `• o: • BUILDING WALL DECK � '. ' ' . , .e CONNECTIONS AT BUILDING WALL 03/22/2004 11:36 5084283115 SULLIVAN ENG INC PAGE 02 Massachusetts Department of Environmental Protntlon DBP sue Nu,ro.r Bureau of Resource Protection -Wetlands WPA Form 5 — Order of Conditions SE3-Va3 NAMMassachusetts Wetlands Protection Act M.G.L. c. 131, §40 F'rwMed by DEP and Town of Barnstable Ordinances Article XXVII A. General Information Important: Front: When filling out forms on Barnstable the computer, Consemadon Comrrmisslon use only the tab key to This issuance if for(check one): move your cursor-do Order of Conditions not use the return key. ❑ Amended Order of Conditions _Q To: Applicant: Property Owner(If different from applicant): James P. &Monica A. Shay Name Name 32 Lovers Lane Mailing Address - Mailing Address Southborough MA 01772 Citylrown State Zip Code City/rown State Zip Code 1. Project Location: 44 Dale Avenue Hyannis Street Address City/town 286 011 Amemors Mapfftt Number Pmrce!/t-ot Number 2. Property recorded at the Registry of Deeds for: Barnstable County Book paoo 170993 L cin dC-. 73�11--!- Certificate(d royistered land) —..— . ._. 3. Dates: _February 4,2004 March 9.2004 __ HAR 17 2004 Date Notice of Intent Filed Data Public Hearing Closed Date of lesumme 4. Final Approved Plans and Other Documents (attach additional plan references as needed): Revised Site Plan March 10 2004 Title Date Title Date Title Date 5. Final Plans and Documents Signed and Stamped by: Peter Sullivan, PE Name 6. Total Fee: 165.00 (from Appendix D:Wetland Fee Transmittal Form) raw ra7 03/22/2004 11:36 5084283115 SULLIVAN ENG INC PAGE 03 Massachusetts Department of Environmental Protection DEP rug N Bureau of Resource Protection -Wetlands $ WPA Form 5 - Order of Conditions NAM pEmAdW by DEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and Town of Barnstable Ordinances Article XXVII B. Findings Findings pursuant to the Massachusetts Wetlands Protection Act: Following the review of the above-referenced Notice of Intent and based on the Information provided in this application and presented at the public hearing,this Commission finds that the areas In which work Is proposed is significant to the following interests of the Wetlands Protection Act.Check all that apply: ❑ Public Water Supply ❑ Land Containing Shellfish Prevention of Pollution ❑ Private Water Supply ❑ Fisheries Protection of Wildlife Habitat ® Groundwater Supply ® Storm Damage Prevention ® Flood Control Furthermore,this Commission hereby finds the project,as proposed,is: (check one of the following boxes) Approved subject to: ® the following conditions which are necessary, in accordance with the performance standards set forth in the wetlands regulations,to protect those interests checked above.This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above,the following General Conditions, and any other special conditions attached to this Order.To the extent that the following conditions modify or differ from the plans,specifications,or other proposals submitted with the Notice of Intent,these conditions shall control. Denied because: ❑ the proposed work cannot be conditioned to meet the performance standards set forth In the wetland regulations to protect those Interests checked above. Therefore,work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these Interests, and a final Order of Conditions Is issued. ❑ the Information submitted by the applicant is not sufflclent to describe the site,the work,or the effect of the work on the interests identified in the Wetlands Protection Act.Therefore,work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and Includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued.A description of the specific Information which Is lacking and why It Is necessary is attached to this Order as per 310 CMR 10.05(6)(c). General Conditions (only applicable to approved projects) 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures,shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal,state, or local statutes,ordinances, bylaws,or regulations. WpdaKE.dee•nv.�r15+0I PWv 2 of 7 03/22/2004 11:36 5084283115 SULLIVAN ENG INC PAGE 04 Massachusetts Department of Environmental Protection DEP FUe Number Bureau of Resource Protection -Wetlands WPA Form 5.- Order of Conditions SE3-4203 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provldsd by DEP and Town of Barnstable Ordinances Article XXVII B. Findings (cunt.) 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: a. the work is a maintenance dredging project as provided for In the Act;or b. the time for completion has been extended to a specified date more than three years,but less than five years,from the date of Issuance. If this Order is intended to be valid for more than three years,the extension date and the special circumstances warranting the extended time period are set forth as a special condition In this Order. 5. This Order may be extended by the Issuing authority for one or more periods of up to three years each upon application to the Issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used In connection with this project shall be clean fill.Any fill shall contain no trash,refuse, rubbish, or debris, including but not limited to lumber,bricks, plaster,wire, lath, paper,cardboard, pipe,tires, ashes, refrigerators,motor vehicles,or parts of any of the foregoing. 7. This Order is not final until all administrative appeal periods from this Order have elapsed,or 0 such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded In the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land,the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work Is to be done. In the case of the registered land,the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done.The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of work. 9. A sign shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection"[or, "MA DEPI "File Number SE3-4243 " 10. Where the Department of Environmental Protection is requested to issue a Superseding Order,the Conservation Commission shall be a party to all agency proceedings and hearings before DEP. 11. Upon completion of the work described herein,the applicant shall submit a Request for Certificate of Compliance(WPA Form 8A)to the Conservation Commission. 12. The work shall conform to the plans and special conditions referenced In this order. 13. Any change to the plans identified in Condition #12 above shall require the applicant to Inquire of the Conservation Commission In writing whether the change is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and Inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order,and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that evaluation. wvarwms.cx•r«.W SM aapa s a 7 03/22/2004 11:36 5084283115 SULLIVAN ENG INC PAGE 05 Massachusetts Department of Environmental Protection DEP FAe Number, Bureau of Resouroe Protection -Wetlands 11 WPA Form 5.- Order of Conditions SE3- 43 - �� Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ProNded by DEP and Town of Barnstable Ordinances Article XXVII B. Findings (cont.) 15. This Order of Conditions shall apply to any successor In Interest or successor In control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 16. Prior to the start of work,and If the project Involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland In the vicinity of the proposed work area shall be marked by wooden stakes or flagging.Once in place,the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 17. All sedimentation barriers shall be maintained In good repair until all disturbed areas have been fully stabilized with vegetation or other means.At no time shall sediments be deposited in a wetland or water body, During construction,the applicant or his/her designee shall Inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed.The applicant shall Immediately control any erosion problems that occur at the site and shall also Immediately notify the Conservation Commission,which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary.Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. see attached Findings as to municipal bylaw or ordinance Furthermore,the Barnstable hereby finds (check one that applies): Conservation Commission ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: Municipal Ordinance or Bylaw Cl%don Therefore,work on this project may not go forward unless and until a revised Notice of Intent Is submitted which provides measures which are adequate to meet these standards,and a final Order of Conditions is issued. ® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw, specifically: Article 27 of Town Ordinances Municipal Ordinance or Bylaw c1tadon The Commission orders that all work shall be performed in accordance with the said additional conditions and with the Notice of Intent referenced above.To the extent that the following conditions modify or differ from the plans,specifications,or other proposals submitted with the Notice of Intent, the conditions shall control. Wpwtmid.doc•rev.SM W04 P040 4017 r 03/22/2004 11: 36 5084283115 SULLIVAN ENG INC PAGE 06 SE3-4243 Shay Approved Plan a March 10,2004 Revised Site Plan by Peter Sullivan,PE Special Conditions of Approval L Preface Caution:Failure to comply with 1A Conditions of this Order of Conditions can bave serious consequences. The consequence may include Issuance of a stop work order,fines,requirement to remove unpermitted structures,requirement to re-landscape to original condition,inability to obtain,a certificate of compliance, and more. The CXJWW Condtftns of this Order begin on page 2 and continue on pages 3 and 4. The Special Conditions are contained on pages 4.1,4.2 and 4.31f necessary.An conditions require your compliance. H. Prior to the start of work,the following conditions shall be satistlied: 1. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved.herein.General Condition number 8(recording requirement)on page 3 shall be complied with. 2. It is the responsibility of the applicant,the owner and/or successor(s)and the project contractors to ensure that all conditions of this Order are complied with. The applicant shall provide copies of the Order of Conditions and approved plans(and any approved revisions thereof)to pwJect contractors prior to the start of work. Barnstable Conservation Commission Forms A and B shall be CprMkted and returned to the Commisssii phor to the start of work. 3. General Condition 9 on page 3(sign requirement)shall be complied with. 4. The Conservation Commission shall receive written notice 1 week in advance of the start of work. III. The following additional conditions shall govern the project once work begins. 5. General conditions No. 12 and No. 13(changes in plan)on page 3 shall be complied with, 6. The Conservation Commission,its employees,and its agents shall have a right of entry to inspect for compliance with the provisions of this Order of Conditions. 7. This permit is valid for 3 years from the date of issuance, unless extended by the Commission at the request of the applicant Caution:a future Amended Order does not change the expiration date. p.4.1 03/22/2004 11:36 5084283115 SULLIVAN ENG INC PAGE 07 8. CCA-treated piling and structural timber(greater than 3 inches thick)are allowed. Otherwise,no CCA- treated or creosote-treated materials shall be used. 9. Sediment controls shall be deployed on an as-needed basis in consultation with the conservation agent. 10. The proposed drainage improvements(for driveway and patio shall be implemented. 11. No area shall be left unvegetated for more than 30 days.All areas disturbed during construction shall be revegetated immediately following completion of work at the site. Mulching shall not serve as a substitute for the requirement to revegetate disturbed areas at the conclusion of work. 12. All restored lawn areas shall be underlain with a minimum of 4 inches of loam. 13. Herbicide,pesticide and fertilizer use is discouraged on lawns within Conservation Commission jurisdiction. If fertilizer is used,only slow-release low-nitrogen fertilizer shall be applied. Over-fertilizing shall be avoided. IV. After all work is completed,the following condition shall be promptly met: 14. At the completion of work,or by the expiration of this Order,the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Barnstable Conservation Commission E1 Shall be completed and returned with the request for a Certificate of Compliance. Where a project has been completed in accordance with plans stamped by a registered professional engineer,architect,landscape architect or land surveyor,a written statement by such a professional person certifying substantial compliance with the plans and setting forth what deviation,if any,exists with the record plans approved in the Order shall accompany the request for a Certificate of Compliance.At the SEA the a Certificate of Co li=g_an undated Nguema of color ph tagWhs of the undisturbed buffer zone shall be alIQ submitted. p.4.2 03/22/2004 11: 36 5084283115 SULLIVAN ENG INC PAGE 08 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP Me N'm"r WPA Form 5,- Order of Conditions sE3-4243 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 �1OYesd°t'Deg and Town of Barnstable Ordinances Article XXVII B. Findings (cont.) Additional conditions relating to municipal ordinance or bylaw: see attached This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Conditions i'!4,from the date of issuance. Date This Order must be signed by a majority of the Conservation Commission.The Omer must be mailed by certified mail (return receipt requested)or hand delivered to the applicant.A copy also must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office(see Appendix A)and the property owner(If different from applicant). Signatures: ]Ld On f� � Of ;),1 0 Day Month and Your before me personally appeared Loe(7 _ to me known to be the person described in and who executed the foregoing instrument and ackn �thae/shex u 7e s/her free act and deed. /+ N Public My Commission Expires This Order is issued to the applicant as follows: .1by han elivery on- ❑ by oertified mail,return receipt requested,on MAR 1 7 2004 Date Date wv6f0"M.d=•rw.3mm Pips 5 of 7 I 03/22/2004 11:36 5084283115 SULLIVAN ENG INC PAGE 09 Massachusetts Department of Environmental Proton WL Bureau of Resource Protection -Wetlands DEP FRO Nwnber: KAM� WPA -Form 5. Order of Conditions SE3-4243 Massachusetts Wetlands protection Act M.G.L. c. 131, §40 PM VW byD0 and Town of Barnstable Ordinances Article XXVII C. Appeals The applicant,the owner,any person aggrieved by this Order,any owner of land abutting the land subject to this Order,or any ten resents of the city or town In which such land Is located,are hereby notified of their right to request the appropriate DEP Regional Office to Issue a Superseding Order of Conditions. The request must be made by certified mall or hand delivery to the Department,with the appropriate filing fee and a completed Appendix E: Request of Departmental Action Fee Transmittal Form,as provided In 310 CMR 10.03(7)within ten business days from the date of Issuance of this Order.A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she Is not the appellant. The request shall state clearly and concisely the objections to the Order which Is being appealed and how the Order does not contribute to the protection of the interests identified In the Massachusetts Wetlands Protection Act,(M.G.L.c, 131,§40) and is Inconsistent with the wetlands regulations(310 CMR 10.00). To the extent that the Order Is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations,the Department has no appellate jurisdiction, D. Recording Information This Order of Conditions must be recorded In the Registry of Deeds or the Land Court for the district In which the land Is located,within the chain of title of the affected property. In the case of recorded land,the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In the case of registered land,this Order shall also be noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions.The recording information on Page 7 of Form 5 shall be submitted to the Conservation Commission listed below. Barnstable Conservation Commission wprtomr.dw•rev.aosm r�ea� 03/22/2004 11:36 5084283115 SULLIVAN ENG INC PAGE 10 Massachusetts Department of Environmental Protection Bureau of'Resource,Protection -Wetlands DEP Re Number: NAM. { t WPA Form 5 - Order of Conditions SE3-Q43., a0" Massachusetts Wetlands Protection Act M-G.L. c. 131, §40 PruMed by DEP and Town of Barnstable Ordinances Article XXVII D. Recording Information (cont.) Detach on dotted line, have stamped by the Registry Of Deeds and submit to the Conservation Commiuion. To: Barnstable Conarmbon Commission Please be advised that the Order of Conditions for the Project at: "Dale Avenue Hyannis r r SE3-4243 Project Locadn DEP Flo Number Has been recorded at the Registry of Deeds of: Cow' Book ft96 for: Pmpody Owner and has been noted in the chain of title of the affected property in: Book Pape In accordance with the Order of Conditions Issued on: Date If recorded land,the Instrument number identifying this transaction is: Insbumor t Number If registered land,the document number Identifying this transaction is: Dommont Number Dry s 1P60:805 03-19--3004 1.47 INVIISTAILE LM CKV IIESIBIRT Signature of Appikrard wpr�,%a,e•rw_an a+M hp�7d9 i u s; i lJ 1 Ilr � f ®❑ - Lj I MM I � 143 _ . Z, _ . I li I ! � z Au1 o 1 � I t I I I! i SECOND FLOOR PLAN FIRST FLOOR PLAN it FLOOR PLANS • � I I I •I DESIGN 1 e T ILSSUE AlI I I. I _ - - _-_- b�L tin `} U U �F t s ar U U ` �. UJIF- a., R, - Z 44,r.z h--- : -------- u z mz !7- FIT] mn— LL . � ' ��•' �w = EAST ELEVATION jr - _ JMF- .-__.__ - ---—-- SECTION, ELEVATION i v_ r f SOUTH`ELEVATION SECTION THRU LIVING RM ' �••�+ i TOWN-OF, RkRNSTABLE s` BUILDING PERMIT PARCEL 1�D 286 011 GEOBASE ID 18917 + " ADDRESS 44 DALE AVENUE PHONE HYANNISPORT ZIP — LOT BLOCK LOT SIZE DBA DE PMENT DISTRICT HY PERMIT 74421 DESCRIP ION RANGE WI DOORS ONLY REKNIT TYPE BMISC TITISCELANEOJ PERMIT CONTRACTORS: ERNEST B NO IS & SON, INC. Department of ARCHITECTS: Regulatory Services TOTAL FEES: $133.50 BOND $ 00 p�Fve CONSTRUCTION TS $ ,00 .0 l i 753 MIS N T CODED ELSEWHERE 1 PRIVATE * RAE1 MBLE, MA & i639. BUILD] G DI ISION BY / /I DATE ISSUED 01/29/2004 EXPIRATION DATE 4-Y r i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIO&Jj �D Map c Parcel O Permit# Health Division _ oc) �55 I fey '` f`� Date Issued Conservation Division / ! / �f� Fee �®�• � � Tax Collector SEP't�C !DUST SE Treasurer WTAMINCOMWE Planning Dept. ENRENTALCMAND Date Definitive Plan Approved by Planning Board TM REGULATIONS Historic-OKH AJ ,4 Preservation/Hyannis Q� Project Street Address 6( ' E 34 4� Village AJ LS D Owner Address Telephone i Permit Request -<J X Square feet: 1 st floor: a Jisting .Ze-mr� proposed O 2nd floor: existing proposed D Total new , '<!!D Valuation D a Zoning District Flood Plain � Groundwater Overlay Construction Type d 594,q E Lot Size a� -4 GAS Grandfathered: ❑Yes N'No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure &4�1e5 Historic House: ❑Yes ANo On Old King's Highway: ❑Yes �1No Basement Type: /�Full X Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new 1�5 Half: existing 1 new Number of Bedrooms: existing S new Total Room Count(not including baths): existing —new O First Floor Room Count fo Heat Type and Fuel: �Gas ❑Oil ❑ Electric ❑Other �f4D Central Air: ❑Yes XNo Fireplaces: Existing _� New Existing wood/coal stove: ❑Yes 11110 Detached garage:existing-8 %w__size 2-40A� 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 }� l V&-W Proposed Use r BUJILDER INFORMATION ' Name r� /y� lS ,y�2_2 x) G Q C, Telephone Number Address `��.� �� -57 License# �►'�ilJ �5 Home Improvement Contractor# Worker's Compensation# wcc- ,5,4D01KA0l2,o03 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE d ' FOR OFFICIAL USE ONLY 4 1 ° f :PERMIT NO. DATE ISSUED MAP/PARCEL NO. = ADDRESS VILLAGE OWNER' ; ° DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE 1 r ELECTRICAL: ROUGH FINAL PLUMBING: ROIJH�H �.. FINAL GAS: ROso U �. � -FINAL , FINAL BUILDING DATE CLOSED OUT ,,r co ASSOCIATION PLAN NO. / i L� Op iME r, The Town of. Barnstable e4sxsrnsLr- MASS. g Regulatory Services 1659.��0 Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. 60 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. p�A?l D Estimated Costi4 �� Type of Work: --- Address of Work: Owner's Name:. Date of Application: & — I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law QJob Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WIM 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 owner. Contractor Name Registration No. Date OR Date Owner's Name q:forms:A ffidav:rev-07060 t i ✓12P �OOIUIYLOYLC(/P.CL��IL. Q/�.l�,JJ(LC�LI� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 015851 Birthdate: 09/28/1953 Expires: 09/28/2005 Tr. no: 6861.0 Restricted: 00 CRAIG N ASHWORTH 385 SEA STREET ,, y HYANNIS, MA 02601 Administrator 91te Board of Building Regulations and Standard s M •°' One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement:,Contractor Registration � Registration: 102014 �} Type: Private Corporation j Expiration: 6/30/2004 ERNEST B. NORRIS'& SON INC .` Craig Ashworth � 385 Sea St �,� Hyannis, MA 02601 �, > �1 Update Address and return card. Mark reason for change. n Address ►-1 Renewal Fl Employment r- Lost Card Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration T02014 Board of Building Regulations and Standards Expiration 6,30/2004 One Ashburton Place Rm 1301 Boston,Ma. 02108 Type w Pnvate Corporation l ? r 3 ERNEST B. NORRIS &SON INC Ij Craig Ashworth 385 Sea Sty Hyannis, MA 02601ithqt atof valid w *nure f ' The Commonwealth of Massachusetts =- Department of Industrial Accidents Office olldsestioatioos 600 Washington Street c Boston,Mass. 02111 �u Workers' Com ensation Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ lamas I etor and have no one worldn in ca achy �g am an employer�roviding.workers'.compensation for my employees.working on this job. ............_..._....... .... _...... ..... ........_.......... address.. . _ ::....,.......... .. . :. :::::i.::.::.:: .citY: :.:::.::.::.•......:..:•.::.:.::•::,.:.... ...... ........ . a one#............ ..,,.::,.,:.: Soo .. . . .rs :. .::::::::.,:..,.::.::..,.::::.:.:;:.;. Insurance co..::..... ................._........... ........ . _.. `............ . .. _._.............. oii¢v.#............_........._...4:5 ',.:.. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices; :CO11tDa Y >: '{ s#:::::?:;::: # . adte :.:........................... -t ......................:.•.;.•.:..-•-:•:::•::•:•.v::.v:nv::::v:.v::.:�::::::::::::.�::::::•:.v:x:.�::::. :.:.............:..:.,.r:: :•.rv:.v:::x:::r,...v..............:.:.::r;:v..................v.n.....,..w.:...v. 4..♦ ...................................................................:.........:,.....�...........:...x...........n.....f.............n.......::v-:...v:::v::.v.�::::::::::........... ,....,..::{4::i4:•iiY..i:•ii:•ii:{:•,4:4:{•4vn.,i{•.'�: ......v.......::w::•m:::::::.v::.v::::::::.v:•:::w::::::.:v::.::::::::..:....::..:.::.::..:..::::..�..............�:::::::.:�:::::w::.. ..........................:::::•::::•:•::.::.........................{.................U...C..v..: ::::••.:.v:::.s...............................................................................................................................::is ii::::::: ......:..: ..........................:...:::........................................2..................... :. ...{i:is{4:':ii:!ii;•ii:v::$i:{i!{6:•ii:•is4}::4:4i:is4:•i::i:{4i:{}i::.•i::•}i:i'i:i:<ii:;:{!i:::i:iii:; :i..........:...?......ii::::i:;i:;:y;:;:�iii:i.iiY:iii:...L(.� b mOtr�: vn•): ............................. nahrance..ca.:.::...:....,.:.:.::..,:.:,..:::...:...,.. .:.,...::.:..,.,:,.......... :.:•.,:::...;:,...,...,::.:,..,.. .. . . o�cstl� :........._.:,,.::.::.:..:.:::.:•:::::.::,.:::..:::.::.:::..::.:,::•.:::,:•»;fi<:::::»::<•:,:>::<: :.::.:.::.::..::....:..:.::.:.:...::.:.: ::::..:....:...:...................,................................:....:...............................................,..:.::::::::..............:::::.::.....:.:.....:.:..:::..:::........................................... ....... ........... ....................................:..................... S :�r181IIes: :::::: : ?:;:;:;:::::::::: :';:;:;:...:::::`::::r::;?::;: ::>;::: :?`.•.:•:.`•.•:':?::::::;:::;:::;:;:;:;:::::: :::is2;:;:::: ::::.,:::::;:; :..... ....::::;:;:;.comp n adires s.. `'.`^' Ape# ` ............. <s>:'z <>:` `> <s>< '<>?>'> '• '.`:>. :: ::..:::::::.:: :.:. :.... :.::::•::::;:•:::::::::::.:.:......::.:....:....:....::::.:::... ntnrancec :: 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 and/or one years'imprisonment as weIl as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of ped at the information provided above is true and correct Signature Date �. printname Craig N. Ashworth phone# 508-775-0457 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 []Health Department contact person: phone#; ❑Other i�evieaa 9195 P1n) I RESIDENTIAL BUILDING PERMIT ' 'ES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE n square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= v 00 0x.0031= O plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. >120 sf-500 sf >500 sf-750 sf 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.0031= STAND ALONE PERMITS , Open Porch _x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) permit Fee `D � ire— projcost II 7_1 77m T - 13 1 �Ir - - 1 _ f � d 8 I L ` 1 ............... r 1 SECOND FLOOR.PLAN � � I li i. � FIRST FLOOR PLAN ! i FLOOR PLANS I = :sale • j -- -- ------1 j Al ` I I vi m O z dRF m �d ry i rl � J L _ l I2 I w �� t W-L EAST ELEVATION j . .rn Zs SECTION. I ELEVATIONS IEEE: o � _ � DESIGN SOUTH ELEVATION e.� .. SECTION THRU LIVING RM �'"""' L 1 I IT 71 �i Hall, I L : _ WEST ELEVATION ALT.] W F _ I • - WEST ELEVATION ALT.2 ET T TT " - ----= ALTERNATE •-^ -� - ELEVATION _ I 1 -77 7-1 1�.. . ..... .._ _ ..._.."......_-_..__-....-.__._.._.....-------._. .. + 3 WEST ELEVATION ALT.3 _-- _ ---- 10-k IL 4 1 E r 1 I � Xt • , , t r 3 4 IVA - a s} Q ,.. �•.,..:�.,... .,»�"� I d 4 G r • t w5r � ti, � y � f ,< Atf F• � ! iS .�1y �•� _ ---.. .__ ._.,._ - _ __- _ � as . .� T r, _ - t �'IIIIRII —OVrtFA IIII I'I I 1 20'SEraKR WE 20•SEf"O,Lad DECK PORCH I �(nj I I I I I FWE Oi.opa OEIXBG 1 � 00wN • I OOwx III o -- I I ¢(cl I FnR I I II I I j I I me II ^ I WILE.p F0.F5 1 PORCH eoocs II /}"I sE KN w/oaavEas 9 — i I A I I I I A I r l LIVING ROOM T r e STUDIOR7E�ROOM k'1 1 I IXm DEN._ __.. -.!......__ I I I I RCigN xBOYE I I I PROIEGr Y.D0�0100 I II - - 0 OrcRuaw1 xBfRF3 lwYCE ILL E(STL FOYER lVms H ml asw c.Bc OO FaaEEn c6atiERr I I I I e ._ '7 i ;, B1Li-N DRFSRR I I I 1 aGLOS I — 1 I ! sw uaasr TH ai - ! )1.I T.. / I .. / e I � ✓' la swR.,'e,.-,.: avaEr x— ..._._ _..._...i , 'i'— — _ _._._ __ _ — I. y !O_.- Iryy/ PpEo _ / I x-e•x '-e•pPErpw - - ! e I I 3-,•,B I sRnr,In I 1 I r T I W/ .V-..I I .I ,"- �rua/sxowEa I AwE ! —� A I i L 1 r-w.a•n•.IVa. _ AELL IX IWG NGfI W/FOYER OOdt IE—cERNG OF RseRD CfflRL as I Iola I DINING ROOM I r I W ��•.� -gr;tE BEDROOM w2 I ' w I I• I _ ! �• ,�� w I PLAY ROOM I f^ rl Doc R I O e i C m m? I SRRIGNr I I - f. .I I GJ i�I c B I I `1 I �'A I I aa.l I 1 DECK GO! 1 I I ! BlffLeR'S , I / 19 LJ I PANTRY PANTRY -- - - , ` BATHw3 RE;-- � I � L 1 I (?EpLlaCIE I • � I '. —I I KITCHEN I Fw 1N SCALE:I/C=1'-O" —...i f•�� _•� l__.- t_._..._-_._i i• ._.J I DATE:1/14/O5 I l( J I I REVISIONS: it II �, o I I BEDROOM I 1 aN.•4 Q ! I I _ I SUITE I 7 BEDROOM 45 Q I— I I BREAKFA ! BBDROOM44 1 I I ENTRY - I I FLOOR PLANS ----- -- I WALL LEGEND I ! - I ! BUILDING ExsrwG vuls O I I PERMIT I FIRST FLOOR PLAN Issue + ! SECOND FLOOR PLAN MtS 10 BE REIWE0 j======= SCxIE V4'•I`0' r ut raawws ME paavx nao I � I i A2. 1 I I I ! I ! I I iibl"u � r K gs*�n y �� ' �uA.s •2 s _ t \ � - pi ?• H YA NN \ 00, If/ Fence * x x l 1.`` SteM Corr,\nentUght s \ \ Guy \ * * V 6 �� /F Cor°9e Utility Lawn — 1 Pole LOCATION MAP: Scale: 1" = 2000'± I Iz5i z6gCA / con C. I o ;' 5.5, ASSESSORS REF.: 20 �- / qZ Nzr 0 Map 286, Parcel 11 _dory II � I 79 Lawn 1 • V°c / ' \ OVERLAY DISTRICT: / 1 Gas Meter / ff=20.97' (msl) Porch j AP - Aquifer Protection District o As Shown on Plan Entitled 191 cbryy� "Revised Groundwater Protection Overlay Districts" - April, 1993 \ FLOOD ZONE: \ Top of Coastal Bonk _ (TOB Definition) I I � v / i j �', Zone C \ I I \ ^ Elec. Meter c / p o ; Community Panel No.o^ ZONE: m #250001 0008 D r\ v, I .•� ... 1/ 2DwellingF j/ July 2, 1992 RF-1 1144 Area (min.) 43,560 SF Frontage (min) 20' \ \ '�►< \ of Width (min) 125 / \ c� ° \ \\ ey \ \� I 19 Underground Water Line Setbacks: \ 1 7.5 •' j Top of Coastal Bonk Marked by Others , iw \ ! (TOB Definition) o Fran t 30 \ \ ° as-1 Side Side 15' ° Rear 15' \ B/dh\ NOTES. O ` O d 1 25.1' # � i P •• , Kl ��Light PO�CF11 \ 4 3 STkPS Eh1 1.) The property line information shown was �@Mo t Ltt" sT. gRlcl compiled from available record information. PLANT N-Ex18T - !y _ - p sT °�1,' I-A\,v4 2.) The topographic information was obtained 'a�J c ,4b 'Sep cti Rery 'NSTq`,` from an on the ground survey performed on 1< Q�c ArMT `q'0rv ,q°R9M, ► _ -or between .04/DEC/03 and 06/JAN/04. 0i R O OV w L _ tl8cg 1Ns a 'r Ta 3.) The datum used is NGVD '29, a fixed mean . AtSrp e S \ 3 7�` �'ALLIST TI RE^+o1 sea level datum. T ,�y/ PreMo� 12'-1sMasR N - / — O t AHTI1�c.Ek15 _S�NE R T'4fNI111G - �c r - , w 4.) The location and size of the septic system O�? NIIV6 'JCL 11'q^E o� ,j4 lg_ T Op B �! iI INs-r `-AIALLL Components is approximate (from town as-built card). ALL. 1tysT� s�E I®..NIG�DRYg L4N .- Fa9e / OeT'el'NALAFk4O LAN os ApITTING / or�o Water f LCBOG MIN LOCAR-A"V d L F'L4rr Got ORS) fnd AL.�t`/O �NITHN TO eACN ALA AROUND Benchmark: From Hyannis Town Hail: Take Main Top of LCB fnd Street Into town and follow to the West O \ \ El.=15.31' NGVD' 29 ( ) End Rotary; Take a right off of the rotary onto Scudder Ave. You will come to a Top of Coastal Bank \ \ \\ ' 1\0 stop sign and after stopping you will Q (TOB Defnition) \ \\ r 7. \ continue straight across the Intersection; G \ \ k After the second stop sign, continue straight on Scudder Ave. and as the road curves to the right, It becomes Dale 15— / \� \ k—.`c Avenue and the house is on the right #44 (Just after the curve in the road). PLAN VIEW Scale: 1'I= 20' #31 Dale Ave. I \ \72 \77\ / 1 I I Top of Ccastol Bank / _ I (TOB Definition) // — JI I Floodzones From FIRM Map 4F Comrrunity—Panel No.250001 0008D Map Revised July 2, 1992 AO ----/ Zone C _ ' Zone L'—TO (el.14) — — -- _ _ _ _ _ _ _ _ _ _ _ C)AN ELL-I W: — — — ---- -_-- F.F 20.q-7 PROP. PLAN. PROP. PC Rc" ARecq 13i_2u Et_ 19.G3 I CL_ 20.-60 9 �� `1 slog. p�a�e Ayctdu•� � , WALK 41 Nantucket Sound e Iry O 1s I-ItG41 SITTING IZ 9F LONG 136RM . I!�) _- ,,� " EX19T• WAL-L(PROP.7 W/ PIER$..LpROP.) GRAOIs WECP 1-IOLC5 PR OP.30 t-151, WIGH 1NSTAL.L FR6NCH Dlkk%M W//�1"� STONE RETA►NING- P�RFuaATL= P\PL=.-DISCHARv� VVAL-L_, AN LeA44 PIT- SECTION A-A RMV►SION -a/10/0`j ADDep ADDiT►ONAL DRAINAGE NOTES Scale: I"=10' Title: PREPARED FOR: PREPARED BY.• SITE PLAN Sullivan Engineering. Inc. CapeSury _. - -- - _. p u - 6ro• 1� e,88 \ \ \ \ 1 \ 7500, LC C lc iz 0,00 \ \ \ \ \ \ \ \ \ 23 SePtic enca k x *� �* ' \ sGuy . Ught \ \ \\ \ 1 v St O G � °�O9e Utility Lawn LOCATION MAP: } Pole LC,-r Scale: 1" 2000'± F �' i' 5.5 00 ASSESSORS REF .- \ 40 —20 Map 286, Parcel 11 20 \ V r I I /9 Lown Gas Meter OVERLAY DISTRICT: 1 rr=2o.s7 (m5r) 011cn !r ry AP — Aquifer Protection District 1 ° As Shown on Plan Entitled \ �•� 19.f• � 4 m� >e =\off Revised Groundwater Protection \ Top of Coastal Bank \ o _� Overlay Districts — April, 1993 (TOB Definition) I I o v; FLOOD ZONE. \ I a , Zone. C 1 ^ I1 Elec. Meter c ! �o ,° ° Community Panel No. \\ I ° 2 sty W/F if #250001 0008 D ZONE: Dwell #44g /! July 2, 1992 RF-1 Area (min.) 43,560 SF \ ; l of ' ; i, 3° 19" Frontage (min) 20' Underground Wafer Line Width (min) 125'. Top of Coastal Bank i Marked by Others Setbacks: o \ \ ( ! (TOB Definition) Fron t 30' ° 2s' Side 15' • ,,• '"�e �. �° .o Rear 15' reo •�- c O O ° B/dh 1 ' I d 25.f --- , . NOTES: t`P-S tz ,S 1.) The property fine information shown was compiled from available record information. _ ANTS EX� NG 9T. �OGoJ cob ` S oR H�` �Rb Sr� 2.) The topographic information was obtained ER Nc p t_1, from on on the ground survey performed on ,I e�co \ �99N, \�eo ReMT t_q loth A`q°RAND or between 04/DEC/03 and 06/JAN/04. :,41Z . \ J - 3 ��, i�6Tq��'IIST TI Tien, ` J. The datum used is NGVD '29, a fixed mean . / o '�/ t z—, a r aja IN se:7 level datum: LA, �VL 5 RE Qo\i t `16' pR tirlrvc 4 s`AVVN g IN'NGwq,Lf 4.) The location and size of the septic system �'G wgR�A E4C5�o�� LAN S�ApLL �`'4Lt, • components is approximate (from town os—buiit card). 1`L v G \ IN L• s�E/IB 4e7(O� pLgN 1 G %/ L4 H S 1 / Fy9e / / / O�1EP1NAy�Ra NpscArp1TT1T) oil (6O q L Lp Drk'A a P NG e ore Water /N LCB� O GAL INFO �4Tlo'Y d'L '-AN Got TpR9n1tC fnd ` w�2�STNE�o DQcq Tn f 'vc �i r A S MAROLJN 14 Benchmark: Y Top of LCB fnd From Hyannis Town Hall: Take Main rrj\ \ \� ` �� El.=i5.31' (NGVD' 29) Street Into town and follow to the West End Rotary; Take a right off of the rotary p rap or coastal sank \ \ \\ \� onto Scudder Ave. You will come to a Q (TOB Definition) \ \\ ( / y; \ / stop sign and after stopping you will \ I ✓ continue straight across the Intersection; After the second stop sign, continue r�°moo \\ ' / \\ straight on Scudder Ave. and as the road curves to the right, it becomes Dale Avenue and the house is on the right #44 PLAN VIEW (just after the curve in the road). J/31 Dale Ave. \ \/ � � Scale: I"= ZO Top of Coastal Bank (TOB Definition) / J I Floodzones From FIRM Map Community—Panel No.250001 0008D / ' ( Map Rev;sed July 2, 1992 10 —--_/ — ==— gone C Zone V10 el.14) i / I PROP.PLAN P2oP.t3t.u55Toi`4s, PROP. PORCH F.F. 20.q•7 AREA 'T�RR,p,GG 12'-O" 13'-2u ;� 81DL- pnL_e A�(ENut CL, 20.3U f WALK Nantucket Sound \/IXI�_� ggRM \8'�I�IG13 SITTING 12 9f CONG, EXIST. WAL-L(PROP,) W/ PleRg..LPRoP.) i lU GRAOLI WEGP I.-IOLe.g pcLOP.3o'�-3��NIGH INSTALL F'Rr.NC14 DRAIN STONE RETAINING PER�LZATL= r %PL=-D%5CHAQ-c e WALL. LN L_e.AC.H PIT- SECTION A-A 26-vLSlonl 3�10�0`{ ADDeD ADOtTLONAL DRAINAGE NOTES � Scale: 111= IO' . Title: PREPARED FOR: PREPARED BY. I SITE PLAN Sullivan Engineering, In . CapeSury PR James Patrick Shay � PROPOSED SITE IMPROVEMENTS y Po Box 659 PO Box 718 44 DALE AVENUE 32 Lover's MA Osterville, MA 02655 Hyannis MA 02601-0718 HYANNISPORT, MASS. Southboro MA 01772 (508)428-3344 PSOP28-3115 fox (508)790-7902 (esurv@ cpecod fax � PSuIiPE�oL coin copesurv@ccpecod.net L . I 20 0 10 20 40 60 Comp./Draft: MJD Field: MDH/WHK Date: January 28, 2004 Scale: As Shown — Review: PS Comp./Draft: MDH/RRL - rol. # 23027 Drawing # C605G1