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Home My WebLink About0067 DELTA STREET (07 1�1f4 �Sh-ee-f� J I uj F �- C� r Town of Barnstable able Building BAX Post'Th�s Ca d So�That a is'Uisible Fromahe Street Approved Plans Must be Retained on Job and this Card Must be Kept - VA 3 ' . :'� e . - ' Posted Until Final Inspection Has.Been Made 63W ♦ r Permit ea Certificate of Occupancy is Require tl;such Building shalLNot be Occupied until a Final Inspection has been made Permit NO. B-20-1086 Applicant Name: Steve J Spengler Approvals Date Issued: 05/15/2020 Current Use: Structure PermitType: Building-Solar Panel- Residential Expiration Date: 11/15/2020 Foundation: Location: 67 DELTA STREET, HYANNIS Map/Lot 292-003-001 Zoning District: RB Sheathing: Owner on Record: CARDOSO,GERALDO F-&.MARLY Contractor Name: ..VIVINTSOLAR DEVELOPER LLC. Framing: 1 Address: 67 DELTA ST ( Contractor License: 17,0848 2 HYANNIS,MA 02601 " - Est Protect Cost: $ 1,522.00 Chimney: Description: Installation of.roof mounted photovoltaic solar systems 3.46kw 11 Permit Fdle: $85.00 r . Insulation: Panels ' Fee Paid: $85.00 Project Review Req: Daate 5/15/2020 Final: Plumbing/Gas Rough Plumbing:. UffIcIaI This permit shall be deemed abandoned and invalid unless the work authorized by•this permit is commenced within six months•after issuan Final Plumbing: All work authorized by this permit shall conform.to the approved application'and_the,approved construction.documents-for wFiich this permit has been granted. , All construction,alterations and changes of use of any building and`structures shall be in compliance with the local zoni b, laws and codes. Rough Gas: , This permit shall be displayed in a location clearly visible from access street or:road and shall be maintained open for public inspetion for the entire duration of the T c work until the completion of the same. Final Gas: �: ,,� = , The Certificate of Occupancy will not'be issued until all applicable signatures by the Building and Fire Officials are pr6vided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing . Service_: r ' 2.Sheathing Inspection = - 3.All Fireplaces must-be inspected at the throat level before firest flue hnmg is installed Rough: 4.Wiring&Plumbing Inspections to be completed prior to FrameInspection final' 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation. = 7.Final Inspection before Occupancy Low Voltage Rough: ; 1. Low Voltage Final. 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. Health "Persons contracting with unregistered contractoes!do not have access to the guaranty.fund (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: lz -V Cape Save Inc. 7=1) Huntington Avenue South Yarmouth, MA 02664 I' Tel: 508-398-0398 Fax: 508-398-0399 12/7/15 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 201506350 Dear Mr. Perry This affidavit is to certify that all work completed for 67 Delta Street, Hyannis has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey t .t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a 9 a` Parcel 0 0 3 Application #Z, ✓56 Health Division Date Issued 1.0 AS Conservation Division Application Fee •V Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �. Historic - OKH _ Preservation/ Hyannis Project Street Address Village A r�S Owner G ca 0 C&�`�osn Address �olfrk;P, Telephone got S Permit Request � � J cell#1I u 4.o +i e_ a4 i c � M Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total newer Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documer%tion. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Higbway: ❑'TYes 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 U new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )<No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _-- _ — - (BUILDER OR HOMEOWNER) - - Name ve, c. Telephone Number 031 Address !T-D t"T 11 n f`{�n iA License # TC I ookl]6 Ya,rrnd u �P1 d�b �[ Home Improvement Contractor# Email Worker's Compensation # [ d UJ C 313 6 A I L!' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO�a�rLtij SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER 4 DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. dr ' r The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 -Boston,MA 02114-2017 www massgovldia Workers'Compensation.Insurance Affidavit:Builders/Contractors/Electriciahil Plumbers, TO BE FILED WITH THE.PERMITTING AUTHORITY. Applicant Information Please Print.Leg blv Name (Business/Organization/Individual);Cape Save Inc Address:7-1) Huntington Avenue " City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398 0398 ' Are you.an employer?Check the appropriate box: 5 Type Of project(required): - 1. ✓ 1 am a employer with Z�. employees(full andlorpam-time)° -- 0 7 Q New construction 2. I am a sole proprietor or partnership and have no employees working forme in M1 - any capacity.[No workers'co insurance, 8: 0 Remodeling comp. rep fired.] .. , ., � .• � .u 3.[D I am a homeowner doing all work myself.[No workers'comp.tnsurance'required]t "° ` 9. ❑Demolition r ` 10 Q Building addition 4.Q 1 am a homeowner and will be hiring contractors to conduct all work on my property..I will " ensure that all contractors either have workers'compensation:insurance.of are sole 11:0 Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑lam a general contractor and I have hiredthe sub-contractors listed on the attached sheet. 13:aRoof repairs These sub-contractorshave employees and have workers'comp.insurance.; . 6.❑We are a corporation and its officers have exercised their right of.exemption per MGI cL 14.[ Other Insulation. 152,§1(4),and we have no employees.[No workers'comp.insurance required,] *Any applicant that checks box#1 must also:.fill out the section below showing their workers'compensation:policyinformation_ t Homeowners who submit this affidavit indicating.they are doing a]I work and then hire outside contractors musi submit a.new affrdavii 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. E I, ant an employer that is providing workers'com ensadon insurance or m employees. Below is the policy and•ob.site P f y _P eJ' . J information. + Insurance Company Name:Wesco Insurance Company ' r Policy#or Self=ins.tic:#:WWC31.36274 Expiration Date:04/0912.016 Job Site Address: 67 Delta Street City/State/7_1p: Hyannis Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date): , Failure to secure coverage as required under.MGL.c. 152,§25A is a criminal violation punishable by 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.A copy of this statement:may.be.forwarded to the Office of Investigations of the DIA for insurance coverage verification. , . I do hereby eertT u.nder ihopqins and.Penalties T erJu�Ghat the informationprovided above is true and correct' Si.. ature: Date: 9/24/2015 Phone#:508.-398 0398 r �cial use only, Do not.write in this area,to be completed by city or town oity or Towp, PermitfUcensesuing Authority(circie ones a , 1.Board of Health 2,Building_Department 3.City/Town Clerk 4.Electrical Inspector 5.Plummbing Inspector 6.Other Contact Person: Phone#: .: ...a /�C l DATE(MMmonrwvy . - CERTIFICATE 01P LIA�ILITl(;INSIJR�►NCE /z i2o15 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 AfHEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THtS CERTIFICATE OF.INSURANCE DOES NOT C6. sw r A CONTRACT BETWEEN THE ISSUING INSURER(S),,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE MOLDER. MPORTANT: If the certificate holder Is An ADDITIONAL INSURED,the PONCY(tes)Must be eT)d9rsed, It SUBROGATION-_15 WAIVED;subject to the terms and conditions of the policy,certain poNcias may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In fieu of such egduitement s. PRODUCER k NAME:' Colleen Crowley R1SIG 8trAteJies Company '; PHONE: (781)986-4400 ' FAX IN C No:;(781)963-4420 25 Pacella Park Drive .ecrowley. risk-strategies.com. Suite 240 . . INS URE S AFFORDING COVERAGE Baada2pb MA fJ2358 ., NAIL� aNsuRED INSURERA:Sel�eCtive 'IIIS,.. . oS "Amer9.[sa . Cape save, Inc iN8URERdA11=zica Financial Alliance 10212, ` INSURERc Wesco Insurance:.. a 7 D Huntington Ave • INSURER[): , iL �{q� �y ��a INSURERE: o9OUth i'IM1V4tII WK 0,994 INsuRERF: COVERAGES CERTIFICATE NUMB ER:CL1532491501 REVISION NUMBER: THIS IS T0,CEiRTW-Y THAT T+[E f+ouCtES OF(NSiJfiANCE`tiSTED`BEiCi�i fiRcUE BEEN 15SUED TO THE'fN5I3#€tEE61V71tifED AE�E FCYR"1Kr POLICY PERIOD IttIiICATED. iVOTUUfEHSTANDiNG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DQCUMETIT:WITH RESPECT TO WHICH'"t]i(S CERTIFICATE MAY$E ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY_ E POLICIES DESCRIBED:HEREIN IS SUBJECT TO.ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LtM{TS SHOWN M4Y HAVE BEEN REDUCED BY PAID CLAIMS. INSR. 00L L iYPE9F INSURANCE $ POLICY NUMBER O�ICY EFF POMUCY EXP LIMITS GENERAL:LIABIIJTY EACH OCCURRENCE: $ 1,000,000 X COMMERCAL GENERAL LIABILITY N PR ISES Eaocwrcence' $ 100,000 A' CLAIMS-10ADE Q OCCUR 10116120141 D/16/2015 MED , (Any one person) $ 10 000 , PERSONAL 8 ADu w.u?Y s 1,do D,4dDD GENERAL AGGREGATE' $ 2',000,OOO " GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP'AGG $ 2,000,000 POLICY X PRO X LOC Au I UMOBILE LIABILITY Ea M13INED SINGANY A�UTO.r- d B. . 1,00010 00 BODILY INJURY(Per person} $ AU O'NNED SCHEDULED -4b796600_ .,, 1/6/2019 l/6/2019 AUTOS AUTOS BODILY INJURY(Per accidMED ent} $: x HIRED AUTOS '� .AUTO Th''T3AMt1GE X UMBRELLA LIAR- X ' OCCUR EACH OCCURRENCE $ 1,000,000 .� EXCESS LIAB .CLAIMS�dADE. AGGREGATE $ 1,00.0,000 Dffl RETENTION 8I 1924480 O/16/2014 0/16/,2015 (; WORKEIiMM? MATl4N AND EMPLOYERS'LIA�fLITY Y'N fiCA� If1CLLL .for X. • STATU- OTH- ANY PROPRIETORrPARTWRIENECUTIVE OV92aCJ9 OFFICERlMEMBffi EXiv!LIL1ECn7 NIA . E.L.EACH ACCIDENT $: 5O0 0OO I andatory In NH} 1.6274 /9/2iYl`5 j9/201'S If yyees,dssaibe Lander E.OrD SFASE-EA EIAELOYE $ 500 GOO DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 5O0 000 DESCRiPT10N OF OPERA770NSf LOCA710NS t VEHICLES(Attach ACORD 901,Additional RemarksSchadule,if mare space is regal Issued as evidence of insurance_ Thielsch k6g rnee ing Inc. is listed as. additional insured as respects; General F.isbilat written.contract. ` . y'as.required bjr CERTIFICATE HOLDER CANCELLATION p SFtOUILD ANY'Ff1 THE A13OVEDESCR'IBED PQI.;{CIES SE CANCElLBD BEFORE. THE EXPIrtAnoN DATE THEREOF, NOTICE WILL BE OEUVERED {N Cape bight Compact ACCORDANCE WITH THE POLICY PRObI$tONS. Attae Margaret Sang.. p,O .Box 427isQK ALnMPJZM REPRESENTATIVE - - - - 3185 Main :Street: Barnstable, t49 02f330% chael Christian/CLC ^'' AGOYtD 25(ZU t01f)5}. @ 1988,Z01Q ADD t:OldRG1RAT7#Mp All rights reserved. tNS025(zotoosfot The ACORD name and logo ere registered marks.of ACORD I , • fi f { � Town.o Barnstable { sei�►isr ItiChar<i'�.$caii Ihireeior. } Tom ferry3nilding'Comtnfssioner 200.main SQreet-,Iiyt msR3.k6601. tofvnbarnstabte�ia.us ; y Office: 508=862 4038 Fax_ .50&=700-6230 r©p xty C} vner T Is't r fete aid S s tioll z gas Q��eroftlie snb`ect xo .. lebpauthanze: . CO 2tCC on inybelra�# c lh all, n mis,relativc to-work.a4ffionied:by-his bugd}ngpei=application.for. 5 . . �Adi�res�s o��ofi "',Pbol fences and;mar s the iespons i ltry''0 e app i t are not t4 be fX pr utec before fenes11 'and alb f uial` ix�specnos As- are:pezai�med and a�ceprerL *. Of*- er�-�/ Srgn %ure:af Applicant . -naze F �re o ��2a>2, clecr �2 0- C' � 1jua eg J Office of Consumer Affairs and Business Regulation d 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 r4 Type: Corporation • Expiration: 3/1 412 0 1 6 Tr# 249649 CAPE SAVE INC. WILLIAM MCCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 - --- - - ----- of , Update Address and return card.Mark reason for change. Address Renewal [A Employment .Lost Card SCA 1 C- 20M-05/11 - - �T r��-rierturrureu"lG�n��l�runr�neN,</' `. ' • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: -'171380 Type: Office of Consumer Affairs and Business Regulation Expiration 3Lt4/20a_6 Corporation 10 Park Plaza-Suite 5170 _ Boston,MA 02116 I CAPE SAVE INC. _. T WILLIAM McCLUSKEY 7-0 HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664 Undersecretary Not vali rthout signature i Massachusetts Department of Public Safety Board of Suiiding Reguiations and.Standards - r - - a ♦.an+u.ut`uriir..�ufiiir=vrSirTou�i.inre�' :License: CSSL 102776 WILLIAM J MC ctusj= 37 NAUSET ROMP IF West Yarimouth 113A J,.� .�1l/ •.��t?� Expiration Commissioner 06/2812017 t • t�ti-•, tti .� --± � "�"",.aar, YX.... ^� +- t"�y- �. x .r�.?�h '_ ��-•V 1Gy+. �T;+;�6 .� �,• .f' .•.`f'. kx`^r,r, t' y .,�„�s ►, - , � ^rya, ,1^`Fr t •, ,- "'-'--• �#�« ��'.. i- *;i- �,.�'",`�= •,."�r i,«^-� ti.e_:�! `° �F�'.`.` +�rq'`` i J� "y}`•'� "0°r.i":"'�5�'� .'K' ••'7e, �..`Y• ^y..�'.�►',1.• .`�. - _ s .. .�'+�. �~ -_,k Yr n 1 «.,.•., � .��.•�. � � r� '�a.. r"4.a�"'+i �' �r .r. i c'` Y •r. - �. ` _ ♦ �' .!' L''� r�''µY ..'„s';I,,. ' _ - - , J, now 44 1e•�° t -� 4 .I -g r .� -". r 'i„ _,-.«.-+"'^"• 91'. 'r + '„ems �, «. ' T..' '.. _ --sue:�- —� - ,�_ - �4� ? 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't• -j -.• r�,�T�.��..� �.b, �,, I' e.�_�,zt:�t� Sg1,s�`c �.1 .f # '.f��a^;v�1r,� r y?,T 'wit • •._ '�` � 7 r i �1,"''w `• y, �'.�'� y'l��.I*_ '' .. `� `y' * •µ .*i.. .M1,1►• ' 4s a - �. fl•,}?�., ��^�e1�=3:y`flJ�.�i7 r s�,. �' ? �-' �7axtJ� ,I ay", ,,�� t, �J' ,+r��:r 4 � �� _ � �••, !d• �a,3 t+a,�� isT•";<�`r�s.r�. 7`i 'F� `� `�'�'T,� 'r "s�y �� a �r f�„ �Y- .1�'' 1 1 � ��- `�.1` 4-Ja.':14r t.- -•,`�',r�= -L�.�z J"?ti;',, 'r :°s +Y .+,'�•_^,.•a �+� ':" /,. 1 � ..,7 ' y; :: � ��+'d-mar..-._ s. FF• ° t Ad r yn } . Ara �Ilw� r V ;i - i+' ,,:. •=� TCY70IA - T 61 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map = Parcel oo-3. , 00 E3#, Permit# '7� 7 Health Division � S 45 Date Issued x s Conservation.Division /.Yr 7- 7 "''4 "� �>>> Application Fee , Tax Collector Permit Fee x, Treasurer SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board WITH TITLE 5 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 6- : 6r,02% S� Village /`� v a ►-� h YS a Owner G c.(J Jo C, d ct e 5 u Address sl�.r�►-e Telephone Permit Request c,s L✓ c, eo,4 a,, M 1 Ya e1 Square feet: 1 st floor: existing proposed 2nd floor: existing 'N'X proposed 3 7- Total newer Zoning District Flood Plain Groundwater Overlay Project Valuation r e e Construction Type 1151 _ Lot Size Grandfathered: '❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family M. Two Family ❑ Multi-Family(#units) Age of Existing Structure _ Historic House: ❑Yes 6-Y'No On Old King's Highway: ❑Yes i�(No J1 Basement Type: ❑Full ❑Crawl Walkout ❑Other ��G ,Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new 6 Half:existing l new C� 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 *o Fireplaces: Existing New Existing wood/coal stove: ❑Yes No JQ Detached garage:Clexisti w sizPoo�existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing gnew size_1-'1''e'1'Z Shed:Alrexisting ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name /7 �_S 1,�, Telephone Number 7 7-1 Q 7 Address G s >c 1-e. License# 6 Q T—7 Home Improvement Contractor# •l 3 6 0/ , Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ile SIGNATURE DATE 7 4 FOR OFFICIAL USE ONLY PERMIT'140 _F DATE ISSUED MAP/PARCEL NO. ADDRESS" VILLAGE y OWNER DATE OF INSPECTION: I "* FOUNDATION kfNOD /I Z /6- FRAME iC7 ,•, !"� A't rS r n INSULATION ti FIREPLACE ELECTRICAL: ROUGH FINAL y , PLUMBING: ROUGH FINAL ra GAS: ROUGHM e _ FINAL FINAL BUILDING tm :E 0 2 DATE CLOSED OUT m T 0 F- co — w5 ~ASSOCIATION PLAN NO. r,,, S The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street . Boston,Mass. 02111 Workers' Comipensation Insurance Affidavit-General Businesses name: F, VC J �7 / -.6��3 address' cites_ -1 !3 state: UU zip: CrLU I phone work site location full address): 'S I am a sole proprietor and have no one Business Type: LJ Retail❑RestaurantBar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an employer with eml loyees(full&part time).-R Other [� I am an employer providing workers' compensation for my employees working on this job. company name: city' pbone#: insurance.eot•: .:,:; .; .. ".:.. olic. .#.:. ❑ I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: comyany name: address:.:: city. Phone# insurance co. olic # / / / company name:: address city.. ` : phone N. 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 well 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 un ai and p aiti6 e ' that the information provided above is true and cor. cL Signature Date ', �7 Print name s747 0-9� O.Ja/!S a Cam, Phone#-_ -7-7 I' 0 fici2l 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 w ❑check if immediate response is required ❑Selectmen's Office i ❑Health Department contact person: phone#; ❑Other (ievind SepL 2003) I Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in,a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, lease do not hesitate to give us a call. P � The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents 89we of Inlles"gadons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 r RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Jr D Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE q � s I square feet x$96/sq. foot I7` x.0031= Vo oq plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) S square feet x$32/sq.ft.= t 'Cx.0031= 7 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.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 f (plus above if applicable) �L Permit Fee = 0 11 projcost r np C2r{R r1PP�a! , Tlb1e JS.Ub(contl=4 tb gcsxf[Fuelx er1 tiYe Pseksgd far Qna and Txo-Ftsciti'Aeslrleat3sl HaildInp ge"ad wi P'rci P MIMIMU-F PZelsf=tabr �1 $catin�wJ g/Coaling NfAXfMUM Ceiling Waii floor 8 � Equipment F:t1'ioirnry� Glaung Glazin8 Am'('/.) Li-vafue= R-vsiuj R.value{ R.value! W� & ter R-value Pie 3101 to 6500 Hating DICIT"Di?'' 6 Normal 38 13 19 10 6 Normal Q I2Y. 0.40 19 19 10 15 A€UE 0.57 30 6 R 10 0,50 3s 13 19 Normat 5 12/. 13 NIA IA N Nam-W T , 15% 0. 4 3 19 19 8 15 A t0 U 15V, 04 33 3s 13 15 AFVE 4 29 NIA NIA Y 15Y. 0.4 ti '. 30 19 19 10 Nornsal W 15'h 0 13 25 NIA NIA Piomtal X 19% 0.32 31 19 25 NIA NIA Y Is'/. 0.42 38 8 90AFtfE 19 10 x is"A 0.42 3A T9 19 I0 6 QO AFVE 30 1, ADDRESS OF PROPERTY: \ S gQUARE FOOTAGE OF ALL EX'IERLOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4, 0/1GLAZING AREA(#3 DNIDED BY#Z): [ 5, SELECT PACKAGE(Q�- A.p,•see chart above): ' G ETtERGY REQUIREMENTS p : OTMR MORE INVOLVED QR THIS II E p T�Ov ARE AVAu,ABLE, ASK ��,DING INSPECTOR APPROVAL: ' YES, N0: q-forms•f950303 a r �F t Town of Barnstable Regulatory Services 3 BAMSWL4 ' Thomas F.Geiler,Director nsAM 9qj s6JQ, �� Building Division prEo r�<' g - Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as..0uinet..of the subject ptopetty- ....,..._... .: hereby authorize ��c. �." a i d_ • -act on my.behalf,. in all matters relative to work authorized-by.this building.pezmit.application for: (Address of Job) , Sere of Owner Date Print Name r __....i.eer�.r-nt.nr*rrnnrn�t -; hoard of �uildin a ulations One As 1301 Pace,- 18 n Ma 02108 16 Boston, —� t Birthdate: 02/04/1967 License: CONSTRUCTION Restricted To: 00 - Number: CS 058 87 Expires: 02104?2006 STEPHEN E BOBOLA x 24 S"r FRANCIS C1R --- «, A 02601 w i Board of Building Regulations and Standards One A shburton Place - Room 1301 Boston. INNksachusetts 02108 Home Improvement ntractor Regi ration egistration: 130611 Type: ,Individual ' Expiration: 3/31/2004 CAROLYN BOBOLA CAROLYN BOBOLA 24 ST. FRANCIS CIRCLE HYANNIS, MA 02601 „ Update Address and return c d.Mark reason t'or change. P r .. .� LOT I �' 1' OVER— �� — — —__— HANG DECK S�8 225 41,E 1 �1 43 B8, � LOT RES. ZONE.- "RB" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.- "C" Bank Use Only TOWN: _HYJYYZS__ ____________ REGISTRY OWNER: RESOLUTION TRUST CO._____________ DEED REF: -6QYOj O-----------BUYER: DATE: _3130194_______________ PLAN REF: ____________SCALE:I"= 30'__FT. I HEREBY CERTIFY TO SHA_w��'_________________ YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THETHE GROUND DASG � N OF 9�y CONSULTANTS SHOWN AND THAT ITS POSITION DOES ---- CONFORM g PA 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE A. TOWN OF --_BARNSTABLE --------AND THAT o MERITHEW y INDUSTRY ROAD o IT DOES_ NOT No. 32i MARSTONS MILLS, MA. 02648 _ LIE WITHIN THE SPECIAL FLOOD HAZARD 9 AREA AS SHOWN ON THE H.U.D. MAP DATED 6/�/�2— ��Fs �FGrSTill TEL: 428-0055 LPAUU unit — anel 250001 0005 C s%y s� FAX 420-5553 THIS PLAN NOT MADE FROM., MENT 14507 DPG A ME�2ITH PLS SURVEY NOT TO BE USED FOR FENCES ETC. I _ Town of Barnstable oF,Me ioyy • . o� Regulatory Services ThomasP.Geiler,Director, L aaxt Sz ST' $ DlviSXOTI BuaJ,din.g TamPerrY,Building Commissioner 200 Main Street, Hyannis,MA 02601 • Fax: 508-790-6230 Office: 508-862-4038 ' permit no• . Date � O A�b'IDAVIT_ SUF� pLEMERNT TO ERMIT APPLICATION a 142A requires that the"reconstruction,alterations,renovation,repair,moderniza e=a�ccu ied ion, MGL of construction of an additionto any pre-existing ow.4 P improvement,removal,demolition, unitsOng four dV' containing at least one but not more than ontract zswith ertain ex pitons,alo g with other nt o bud g be done by registered such residence or building req�aments, v S�G�2� • Estimated Cost Type of Work:, f WorkAdes o : 6�- a ' Owaar's Name: 7 © ' pate of Application:_ I hereby certify that: Registration is not required for the following reason(s): [3Work excluded by law []lob Under S 1,000 []Building not owner-occupied COwner pulling own permit Notice is hereby given that: ORDEALTNG WIT,[UNREGjsTERED OWNERS PITLLING THEIR OWN PERMIT CTORS FOR APPLICABLE I30ME Il1OR U�NT y=UnER M L 142A, COV-LMjNT-W0PX])O NO ELM NT YTgATION PRO GRAM ACCESS TO THE ARB SIGNED UNDERPBNALTIES OF PERJURY Iheleby apply for apermit as the agent of the oyr�er: p �, ` �-�ch � gegistrationl�To. Contractor Name Data OR Owner's Name ' 5.4 ........I RG C'A Z!� 7111 Poor p A no-cl Ih a c 0.11 s-e- 6>c 1 C ZZ IN ar'r_�.?" ,........X ........ CY,.rck._nr7.I_3_. . v jam✓ -f��___- U C e a r tn5S-esJ._ ........ r/ c x 5 �n� ►DouS e� /d S. 400 zXy cant ' 7C A/L o z71 Z Zool f h _7 I , i I I i rt lor 10. i Ali Z.of r Results ; Page 1 of 1 Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City, Name, or License number Select Search type: OF,, AND r OR Search - Search Results ` Reg. No. Applicant Street City State ZipI Name Title Expiration CAROLYN 24 ST. BOBOLA 130611 BOBOLA FRANCIS HYANNIS MA 02601 CAROLYN OWNER 3/31/2006 CIRCLE Total of 1 Records matched. Back to Home Page BBRS Privacy Statement http://db.state.ma.us/bbrs/hic.pl 5/3/2004 = no� " Town of Barnstable Regulatory Services s 'I'hoinas F.Geller,birector EARaTAffiZ $tiding Division ArFD► k 'Tom Perry,Building Commissioner 200 Main Sweet,Idya nis,MA 02601 Fax: 508-790-6230 Office: 508-862-4438 � RE UEST''OR ELECT . CAL INSPEC ON ELECTRIC,A.L PERMIT N-00ER (Permit required in order to process inspection) Today"s Date �10 Requested Date of inspection 7 d`� 4� I, hereby request an inspection under Maseaohusetts General ($iLCA'fCtQM� . Law chapter 143, section 3L and 237 CMR 4.02(3), The installation is complete and ready for inspection.at 47 ✓�� (Property Location) Type of inspection requested: ❑ Temporary Service ❑ -Re- cdo ❑ Excavation 0 ou$b ainspechOak ❑ Service loapection ❑ Final Re-inspection iZd Rov,gb Inspection for,,�4 Fvaal Inspection for ❑ C-h Owuer or tenant Licensee's name,address,and phone J � I•,Seecse number Licensee's Signature phis section tv cc coM M. "e ttcstabde nspector of Bras 2 lr�spectiou date JUL 004 proved []Not Approved This work was not approved for violation of the following Articles and Sections of the M.A.Electrical Code: 06/28/2004 08:04 2955792 LEONARDHORSFORD PAGE 01 `.- Town of Barnstable Oi�. r r` 4 Regulatory Services ?�t4 JU 28 0 9: 42 s , Tharnas F.Geiler,Director M -659- Building Division 'i e Tom Perry,Building Cornmissioner -� SION 2o0 Main Street,Hyannis,MIA 02.601 office: 508-862-403 8 Fax: 508'790-6230 QIIES'I'FAR ELECTRICAL RLSFUU-0-N ELIrMUCAL PYFJYM NLNMER (Permit required in order to process inspection) Today's Data O O!9- Requested Date of Inspection_� ` ' C., hereby request aA inspection under Massatbusetts General (Electrictdn Law chapt-u 143,section 31.and 237 C VM 4.02(3). The installation is complete and ready for inspection at r ` (Property Locatic Type of inspection requested: L) Temporary Service S " ice Excavation _ e on service Inspection ❑ Fina1 R inspection [] Rough Inspection for a Final Inspection for Other Owner or tenant Licensee's name,address,and phone_-I- r 5 License number �* Licensee's Stgnature_� This section to be co p arnst le 1'n ector of fires JUN 3 0 200 Inspection date Approved ❑Not Approved This work was not approved for violation of the following Articles and Sections of the MA Electrical Code N Commonwealth of Massachusetts Offici S�Only Department of Fire Services Permit No. ��K-- BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 11/99] eave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(M C),527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town of: Barnstable To the In ector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 6 7 ')e I f,c) SJ-Ce,�,}- - Map Parcel Owner or Tenant -C eXr,J p Sp Telephone No. Owner's Address 6 7 % ei to ct4 'eek Is this permit in conjunction with a building permit? Yes �1 No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service D6 Amps / 9 4olts Overhead[ Undgrd❑ No.of Meters New Service 90n_ Amps /;LU /dz 14c)Volts Overhead❑ Undgrd O No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: (IJAaA ,Ian fir, A--CtM'cQ k, e,,�,�1 Completion of the fiollowing table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil.-Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA f Above In- o.o Emergency Lighting No.of Lighting Fixtures Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Detection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No.of Alerting Devices No.of Waste Dis osers Heat Pump Number„Tons„ KW o.of Self-Contained P Totals: -- Detection/Alerting Devices No.of Dishwashers S ace/Area Heating KW Local ❑ Municipal ❑ Other P g Connection No.of Dryers Dr Heating Appliances KW Security Systems: Y No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent No.H dromassa a Bathtubs No.of Motors Total HP Telecommunications Wiring: Y g No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE W BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work, (f i�/� , (When required by municipal policy.) Work to Start: '6 lay Z,0 Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certify, under the pains an penalties of perjury,that the information on this application is true and complete. FIRM NAME: LIC.NO.: 'TaK Licensee: U Signature LIC.NO.: F3%Q1T (If applicable, enter "exe pt"qi the licei a number line.) LL_ Bus.Tel.No.: �� 4 Address: a/� (5I �d-6 e� t4" ��' Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability.insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one) ❑owner ❑owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Y Map 0,3 dd Application# xb®q J Health Division Conservation Division 3 f Permit# Tax Collector Date Issued LJ Treasurer Application Fee 60100 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �L Historic-OKH Preservation/Hyannis Project Street Address 6/ Z r �2 C 77 Village Owner Address r Y 7- Telephone O - �� 7 7- 7 V 2- Permit Request -P en �. L!l 4(3 l� rJ , Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total+new `' Zoning District Flood Plain Groundwater Overlay ` Project Valuation ,�O0�4� Construction Type - Lot Size 47. 3o O S Grandfathered: ❑Yes ❑ No If yes,attach supporting documentation. 7 Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure o? Historic House: ❑Yes Ao On Old King's Highway: ❑Yes No Basement Type: ❑Full ❑Crawl 4Walkout ❑Other Basement Finished Area(sq.ft.) ?-0'0 Basement Unfinished Area(sq.ft) Number of Baths: Full:existing / 19 new Half:existing / new O Number of Bedrooms: existing new Total..Room Count(not including baths):existing ' new First Floor Room Count 6 Heat Type and Fuel: QGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes �No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes XNo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: existing ❑new size 11APSP Shed:dexisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes �Mo If yes, site plan review# Current Use X. G <- Proposed Use -1 BUILDER INFORMATION Name -0 DS C-) Telephone Number S'o� -S�7 7- 7/V 2 2 Address j 7 S 9 License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE �� /�� FOR OFFICIAL USE ONLY 4. t PERMIT NO. DATE ISSUED MAP/PARCEL NO. r f t - _ ADDRESS VILLAGE OWNER l / DATE OF-INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO.• - ' The Commonwealth ofMassachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organizationth&viduan: Gi2.>9 L-OHO L.c? /.l ?V 05 0 a Address: 6, 7 9 7119- 17— City/State/Zip: Phone#: 5'O - .S' 7 7 - .7 612 2- Are you an employer? Check the•appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(fall and/or part-time).* have hired the sub-contractors. 2.❑ I am a sole proprietor or partner- listed on the attached sheet t ❑ Remodeling ship and have no employees These sub-contractors have ' S. ❑ Demolition working for me in any capacity. workers' comp.insurance. . g, ❑ Building addition (No workers' wmp.insurance, 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.[erequired.] officers have exercised their I am a homeowner doing all work right of exemption per MGL 11•❑ Plumbing repairs or additions myself:(No workers' comp. c. 152, §1(4),and we have no 12.[3 Roof repairs insurance required.] t . •employees. (No workers' -G comp.insurance required.] 13.7 OtherG *Any applicant that checks box#1 rnust also fill out the section below showing their workers'oorapensation polievinfon nation.' t Homeowners who submit this affidavit indicating they are doing all work andtheu hire outside contractors must submit anew affidavit indicating such xContraetns that check Ibis box must attached an additional sheet showing the name ofthe subcontractors and their workers'comp,policy infosxnation. I am an employer that is providing workers compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: - City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to securr.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 fame 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. 1 do hereby certi rid r the ains and penalties ofperjury that the information provided above is true and correct Si=afore: Date: 5 Phone#: 5`Og- �77 7 t- ZZ 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 E1.ealth 2.Building Department 3.City/!owm Clerk e.ElectAcal inspector S.Plumbing lnspcetor 6. Mer Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their empldyees., Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,.offal or written." An employer is defined as-"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and'including the legal representatives of a deceased employer,or the . receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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 ofpublic work until acceptable evidence of compliance with the iur nsance 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 partners, are not required to'carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The-affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of . Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies&omd ewer 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 permitlicense 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 off cially 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. Anew 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 aftidavit. 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. r 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 w-w-w.mass.c,ov/dia Town of Barnstable Regulatory Services ' SARN9PAB ' Thomas F.Geiler,Director a`�� 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 constructfon of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. (> Type of Work: ' Estimated Cost. /I 'I C) Address of Work: 7 c r 4 �S Owner's Name: �� Date of Application: 5 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WIM UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERM-RY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Oate Owner's Name Q; =:homeaffidav r . ;z 03_ s�4�s11 � 145�8, Ily �.� LOT i b, ti \ r LOT 2 RES. ZONE 'RB" This MORTGAGE INSPECTION Ba d v For FLOOD ZONE "C" TOWN.__H dylya-_ -- REGISTRY OWNER jW_0Jjl?d�MLIST-0'o_____________ DEED REF: 0089__L6�_--_-----BUYER O'ERdLO F�.. -MARLY_0 RVO-s0__------ DATE: 313�J,�_94__ __--___ ____ pLAN REF: 34 5�_ _ _____SCALE:1"- _3 I HEREBY CERTIFY To Eff� --- -----THAT - YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED O HETGROUND AS HE G ��EA't��' y: CONSULTANTS SHOWN AND THAT ITS POSITION DOES ____ CONFORM PAW. 40$ (SUITE 1} TO THE ZONING LAW SETBACK REQUIREMENTS OF THE A. �` TOWN OF _BARNS�g$LE AND THAT S MERIT14EW H INDUSTRY ROAD IT DOES_AR LIE WITHIN THE SPECIAL FLOOD HAZARD s No. MAR.4TONS MII1S, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED}/_Q/�_ �,� '�fcrs�f4�° TEL 428-0055 Co u it - a e ,250001 000 C `�o FAX 420-5553 - -• ..rr_ ... ..r .rnm HE Town of Barnstable CF Tp�• ' Regulatory Services S sARwsinsi.>r. ; Thomas F.Geiler,Director 9q, MASS.9 �� Building Division Argo ��s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: /30�/®6 n JOB LOCATION: (ft 7 � number street village "HOMEOWNER": 96/Z�3G�0 � �pSo 50g- �"77- -name home phone# work phone# CURRENT MA UNG ADDRESS: % Jam` C/%/l'�L� �/512'1 <z city/town state zip code .The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,Rrovided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family-dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building-Official,that he/she shall be resQonsible for all such woik performed under the building permit. (Section l09.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,.rules and regulations. The undersigned"homeowner"certifies that he/she understands the To of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and P k-- Signature oner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:fornwhomeexempt I • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel _ 0011 , • Permit# ��( 0 c-w�dc fr+� �� —� /Y Date Issued �/a//J0 0 Health Division — Conservation Division I Li MARI 1 2001 4 lFee — Tax Collector C - N Treasurer —� 0 a SEPTIC SYSTEM M INSTALLED IN COMPLIANCE Planning Dept. WITH I =6 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND f TOWN.REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Co A : � fi SbZ4-e- - Village �I0 Owner (Z a, (7 C'—&JZ tA 0.S C7 Address ( —T S-}- Telephone l_�� —1:3 1—-I$-3 q Permit Request 1 O c x s oZ� P—e- c e, --�'- 1V lZ—a'V/yd s 4-1f �-r e.j �S v k4id�S u �-o M-eJZ P✓L a-v bG cp Square feet: 1st floor: existing proposed� 2nd floor: existing ___ proposed Total new Valuatio Zoning District Flood Plain Groundwater Overlay Construction Type INS 1ZoUNd Lot Size �`� Grandfathered: ❑Yes I No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 1 ,72qHistoric House: ❑Yes *No On Old King's Highway: ❑Yes XNo Basement Type: 41 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Doty 4— 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 15- new First Floor Room Count Heat Type and Fuel: )4Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes >! No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 9 No Detached garage:❑existing ❑new size Pool:Cl existing X new size l6` 3 Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes WNo If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION a /o Name Telephone Number 7 Address rt 3 D t License# V 6� 6 J 61 Home Improvement Contractor# /70 6 6& �1-�—�f Worker's Compensation# F 5 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE I l D I FOR OFFICIAL USE ONLY PERMIT NO. j DATE ISSUED i MAP/PARCEL NO. < ADDRESS VILLAGE r OWNER DATE OF INSPECTION? ( y FOUNDATION FRAME ` INSULATION FIREPLACE ELECTRICAL: ROUGH- FINAL PLUMBING: ROUGH V FINAL GAS: ROUGH ". FINAL FINAL BUILDING _)- s A veE m n DATE CLOSED OUT 5 ASSOCIATION PLAN NO. • 5 • k l : . The Town of Barnstable 16 9. �g .. Regulatory Services Thomas F. Geiler,Director Building Division Elberf Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 E Office: 508-862-4038 t Fax: 508-790-6230 r Permit no. Date J g t 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: � (R TV A3 t1 SW 9 M IN 1 OL Estimated Cost ' /& -6V Address of Work: �1 Owner's Name: Date of Application: 13/ I hereby certify that:. Registration is not required for the following reason(s): ' ❑Work excluded by law ❑Job Under$1,000 '❑Building not owner-occupied []Owner pulling own permit " Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. 4' b T �Sw Ior^/ti�� LDS Zo 66, Date Cdntractor Name Registration No. OR Date Owner's Name q:fomu:Affidav The Commonwealth of Massachusetts ' Department of Industrial,Accidents • � �=`�•'�> . '=_� ; OflICr01/OnCSllAP1lOOS 600 Washington Street i� Boston,Mass 02111 Workers' Cora ensation Insurance Affidavit tee: .3 C location-(, ciN �N k S yhone L/ - 79N ❑ I am a h meowner perfbrminj all work myself: ❑ I am a sole prapnetor and have no one wixidng in any capacitv ❑ I am an emplover praviding workers'co:I:[T= Olo for myemplovees woriang on this 'ob. :. .......:...::...... . ram anv�nstae:: ..�. address.. 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' •::.:;>:•.�:.:�........ .. ........................,.......v.:...x!b»:{ta2..:.. ..r..,a+ed.�..{•}xa4.. .�...�},.,c.}wx:{{.:.}r?;.:,v.Y} xt•:{bU:::;:::•.':;?;a:;:}::i::.:::::,;w::;u:<;::{:. Faibnv to seeo:s coversge ss required Hader Section I5A of MGL 1S2 emisad to thtimposttion of ai-ii—i pemitin of a Due up to S1.600.00 and/or one years'imprisonment as wen u civil penalties in the form of a STOP WORK ORDER ad a fine of S100.00 a day against me.I tmdanmd Chat a copy of this statement may be forwarded to the Otnce of Investigatiow of the DIA for caveraSe ver McdIm I do hareby certify under the paint and paiakier of penury that the inform ion provided above is truce and corrat oinciaa use only do not wade in this area to be completed by city or town oMcha city or town: permit4lcense o OBtti>dlns Department QLtcensin;Bond ❑check ifimmedlate response is required ❑Selectmen's Otiace ❑Health Department contact person: phone tt; _ Omer. 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Title: Rectangle 16'x 32' 2' RC N Forbes Road Newmarket Industrial Park Newmarket,NH 03857 Drafter: JLC 2436.8 PHONE(603)859-4465 FAX (800)595-0222 NO DIVING IN SHOF P OEND File Name: tpd/RECT1632-2 Area: 512 sq. ft. DIVING MAY CAUSE PERMANENT INJURY,PARALYSIS OR DEATH Perimeter: 92'6 314" NOTE.These dig dimernionscem 1_hChaNat!a""S,aendpod"""n"e=°,9°�edm m Template#: 21099 NSPI Type II WA—32" ±3" standards for residerdial pools.W�mino- NOT DIVE IN THE SHALLOW END.8 diving boards or slides are to be used with these pools please consuh the manufacturers instruction and t� — NalionalSpa and Pool IrWdWe5 un'vrimum standards prwrtoaW t!diving beards or sides on -. these pools.E°`"`ermat�n`°n`errung NSPI"'° 'n'sta^°a�s.w<°°°Nattoral spa and P. - - - WE DELIVER POOL KITS FASTER!institute.2/l t EseNmwer Avenue.Aleundria.VA 22314(703)838-0083 c v 3 D` NO 4 I/ It r r CERTIFICATE" F I SURAIV�E o11s o� >r PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Antonio F Alberto Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 420 Stafford Road' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Fall River, MA 02721 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED Steve Senna 411 Waquoit Highway E Falmuth, MA 02536-0000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 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_ II co - LTR I TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY LIMITS HE PROPRIEi OR/ >- ARTNERSiEXECUTIVE OFFICERS ARE: INCL o EXCL❑ 8543460 12/02/2000 12/02/2001 TATUTORY LIMITS THER overage Applies to MA Operations Only. CH ACCIDENT $ 100,000 ISEASE POLICY LIMIT 500,00 ISEASE•EACH EMPLOYEE 100,000 DESCRIPTION OF OPERATIONSNEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ti and of Building Regulations and Standards One Ashburton Place - Room 1301 Boston , Massachusetts 02108 Home Improvement Contractor Registration Registration: 130666 Expiration: 04/06/2002 ",— - TYPe : SBA . •«rou .��G BUMF IMPRaJfM�kT CO1lTRaCIOR Registritioo� 130d66 The Swim Pool Spa Sale & Ser ,, Ma k EKpirition; 0410412002 Steven Serena Type: ' 06a P .O . Box 3612 kit E . Falmouth MA 02536 The Srii pool Spi Sile 15 Steven Senni -7? g iquolt UMy AMINSTRuoR t. Fil�outh ha ats16 r AJ Assessors map and lot number ..................................... 8D` yoF toy♦ (� e` THE ` Sewa a Permit number �1. . > � ... TI6 1YS E 'I � T.g ' INSTALLED 1N C0 P LIA ICE � BARINI9TABL8. House number ..................................�.7039 ....`�,�.....:. WITH TITLE 5 ' rasa ............ ENVIRONMENTAL CO AND ° TOWN OF BARMY � B- " BU�ILDIAG ' INSPECTOR - APPLICATION FOR PERMIT TO .f..! .M. ...�Y. Gl .. .�....1........ TYPE OF CONSTRUCTION D..... l....a..............19-ir' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ,/ Location .�I . ./.......... .. ��......... . ........... l3f� l. ... ...................................... ProposedUse .( !. ..../.: .. �. ........Q. .................................................................................... Zoning District .... ..........................................................Fire District ... .)*-Vy/7-;LA/ .//.� ....................................... Name of Owner .P.97 OA 1..C!rio'%M.1301412ARS'.P I`Niess ... e,/3R.A PP.J.& ......dz.im L-z .....1 6�1 Name of Builder Ilypi.®N�� .SO.rv.aYJ. .P.:jeI1k.Address 11.131 AD.DA&A Name of Architect So.� Ll..PI iit1. /3�-... �! .. ...Address ../.Y/ .. /7. ... ..°.......................... a� y� Number of Rooms ......... ................................................Foundation �Q 1'P .li�i�=.��....0 .I.O.ZarlL...... Exterior ...... .V.11 OO.D......... ............................Roofing .......................................... Floors ..../..,k... ...r Al...... . 'F �...........................Interior ..... ��./...��.GD>f�.................................. Heating .f�.j4.1..�j..1. ............. :............Plumbing ...... /s .f7.117. ...:.............................. Fireplace ........... .A1L9...................................................:........Approximate. Cost .. ...�.......... ..... �LQC,� S Definitive Plan Approved by Planning Board ��_I��___1_��.___19_�_�. Area ........................... ............ Diagram of Lot and Building with Dimensions Fee �� ' SUBJECT TO APPROVAL OF BOARD OF HEALTH Lq 1 4 13 A rN � f?AiveH 0 ®0 `CICCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS e r� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above ..e � . ,G S9�YU - construction. � Name . .... . . . .��f.. ..11-e . Construction Supervisor's License o..0"..,7..e ..� �....... PEI'RONI & SON BUILDERS, INC. - h No ,•26532..,• Permit for ..One Story.•••,•,.•,.•• Single'Fami_ly Dwelli-nc Lot 1, 67 Delta Street Location ......................................... ........... .................Hy ........................ ................ Owner ......etroni & Son Builders, Inc. r Type of Construction Frame „ II . Loti/ ,k Permit"Granted .J ..1,.............. .1"9 84 �j Date:of Inspection .. . '1'9 , • ' Date .Completed . r�..... � /✓r � ��J a �/ / � , t � 1 ,i - +. + � , TOWN"OF,•BARNSTABLE . 26532 `.� 4• t r . Permit No .---- _--- -- tt ' Building Inspector i D�8IfT18L l . Cash OCCUPANCY PERMIT Bond -- -X Xl� Issued to POtroni S-SDTi 'Builders, °Inc.: Address r 7_nr_ #1 67,Delta. Street'. Hvannis Wiring Inspector - -x ✓ ,'� Inspectiondat4 Plumbing Inspector � _ f: x. Inspection datea'� ! Gas Inspector ✓ + u N Inspection date f O. ./ Engineering Department-- 4"` Inspection date- Board of Health ^z`~ j `v �/ Inspection date THIS PERMIT.WILL' NOT-BE VALID,_,AND THE BUILDING6FIALL .NOT-'BE OCCUPIED UNTIL. SIGNED BY-THE BUILDING INSPECTOR UPON SATISFACTORY •COMPLIANCE WITH TOWN i j' REQUIREMENTS:AND IN ACCORDANCE .-WITH SECTION�119:0 OF THE MASSACHUSETTS STATE ._ BUILDING' CODE. . IL .........................(f( „ldig ectoBuinnsprV Is,; .�f TOWN OF BARNSTABLE BUILDING DEPARTMENT ! asaasr � rua TOWN OFFICE BUILDING i6J9.� HYANNIS' MASS. 02601 0 YAY lire MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit 'has been issued for the building authorized by Building Permit ��.-------------------... . ................ _......._. _ _.... » ... _ _. issued to --.'F� ......r Please release the performance bond. y Assessor's map and lot number ..................................... THE r�xrSewoge• Permit number ....�5.....F4!Y.... BAR39 ABLE.- (/I NAG& House number .................................... 7•.....a................... 1639- YAK TOWN OF ,4BARNSTABLE BUILDING INSPECTOR r . ........... APPLICATION FOR PERMIT TO R6. ....R.... .........9...........!3. TYPE OF CONSTRUCTION ....0.67� L ..............19.A.s..... .......... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... ..................................................... r...4............ jl.!55.�............. de ProposedUse %/.........I -K1 .................................................................................... Zoni6g District .....kl.,;l........................................................Fire District ....../yPo4&,4j/�`.r........................................ Name of Owner ..... Name of Builder Name of Architect ...Address ... .......N.14....0-t............:�.............. Number of Rooms ..........I.:............................... 7-tourld. ion 41_4 A.. Exterior . ............................................W.. .........5.!..P. ...........................Roofing ... Floors ....10? .........../ V...........................Interior .....X .................................. ......Heating ........................................Plumbing .......1. .................................. Fireplace .............. ............................................................Approximate Cost ...................................... . 14 y *jp�AS41__j q. 19 Definitive Plan Approved by Planning Board Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 419 z — 14 15 1 44 "N rn 13 A 7�y ew H OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of,Barnstable regarding the above construction. S, Name . i7.....;T .. Construction Supervisor's License ()At ....... j PETRDNI & SON BUILDERS, INC. A---292-3-1 ,.?Ia- -3 26532 One....... Story No ................. Permit for ........ ..................... Sincfle Family Dwell inJ...............•..... Location ... 67„Delta Street.......... ..................Yanni s................................................ Owner Petroni & Son...Builders ...Inc . .. ...... ................... ...... . Type of Construction ..Fri............................... ................................................................................ Plot ............................ Lot ................................ r = Permit Granted .,Zune..1,.........................19 gq Date of Inspection ....................................19 Date Completed ......................................19 r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Parcel Permit# � Health Division 1 .1 �� 3-`�� Date Issued 1 1( LO Z Conservation Division / Z—`/ hoz Fee Tax Collector W r Treasurer �— !� a� SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. 1M'TH TITLE S Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address A ig � Village _M1 ',41-4QC, Owner ,c, ��xJL y0 �/�.R P"rS© Address _Z)r Telephone `� �!��— 7 7/- ,'7�� Permit Request A Square feet: 1st fl . gsttiinng�/!� proposed ./ 2nd floor: existing proposed —,---Total new Valuation - ! !� r Zoning District __Flood Plain �� Groundwater Overlay . Construction Type o&P ,6� - fll,v Lot Size16U 3 9.1>2CiZ6—' Grandfathered: ❑Yes A No If yes, attach supporting documentation. Dwelling Type: Single Family CAI Two Family ❑ Multi-Family(#units) Age of Existing Structure / 7 Historic House: ❑Yes to On Old King's Highway: ❑Yes 4'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 0 Total Room Count (not including baths): existing new 0 First Floor Room Count Heat Type and Fuel: I(Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes C! No Fireplaces: Existing 0 New Existing wood/coal stove: ❑Yes UNo Detached garage:❑existing ❑new size Pool: ❑existing 1 new size/H 43 Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ❑ e, Commercial Yes �I No If yes, site plan review# Current Use Proposed Use A BUILDER INFORMATION Name "' C Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# _ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATUvh, DATE A € FOR OFFICIAL USE ONLY 7 PERMITNO. DATE ISSUED ' or MAP/PARCEL NO. ADDRESS VILLAGE OWNER) ,^ ' t lx� DATE OF INSPECTION: / - 1 FOUNDATION ` r FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH m FINAL PLUMBING: ROUE .KZ FINAL GAS: ROUGH <? - FINAL Y i? r= t.i E r FINAL BUILDING f i cr Co 0 C3 DATE CLOSED OUT -S of i3 titfil ASSOCIATION PLAN NO. I I J :�: _i.•//S;.Ci[S %:% / �.%:. :'ids"L.%%£i% ? 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Ie1• Y. • •.•./ r tl ►•1111• 1 r ' t11 II 11 11 I.• _• 111 w•1 .•Ill • /11 1 .1• 1.1 1 •_w1 • ..11 �• ! /1 •111• ••• • j/MjEEM/jjjjj��jj%jjjjjj��jj//jj��jjj��/��j��j��jjj��jj�jj��j��/�j�j�/�jjj�jj�� 1 l' a 11 11 • /, r•ie el• .• W.1• e11 . •• • . I Yel•/1• 1I e_ .•11 ' s1 I•► /1 .1 .1• e • 11 ela/ .1• •11 .1• • It • *Palo* • / •II II Ile •.1•, •11 • •1 Y./ •IB •.:11- • II OI .11 • I •• • Il 11 if , • •11 till •1 / t11 •• « •..Ill 1.1 rU Ito 1•st •1• •It 01 11 1Is- r. is V :JI t • 1 1 1 1 // * t 1 • 1 1 • *11•a sibs,_ • 1/ MI •1 • •'1 /1 .1 •1 .1. 1 ✓.1• •t1 •1 /1 I .1.1111 el .•1 _• .� 1_• 1 1 11 / • .1 •t1 w11 • Ip of •111,126r.1 « I wtll lI • 1 •• 1 I • 11 • n • • • 1 1 _1 • I 1 •'•111 ••I/.�.• r•1111•we♦`✓.1• •tl 1 • • �• v ✓. 1 /1 w*/. /11 w/l .1 •1 11111/ •.. 1_• WAIN 1 1 1 / /1 /1 .1 1.-1yt :• . 1 •••1111• ..1 .11 I I 1/11_1 w'♦ * 1 . •1*-.It 1 t . I _. . .1 /1 . • . ells • I at • 1 • /11 • 11 11 /1 w11 sl / i• • • 1 .� a •GI• •11 1 U r•111 Y. M •• 1 ...✓. I111 ' 1• I s t•%•11 • all 11 11 •.I1141 lift 1 @'MM.OMIIa• _• wl.l wl 11.111 •.� 1 •s • Il II • *11•• _• • oil..11 • • It •) 11/ • BI .1 • •11 • w1*wlll / VA • _wl 11✓. 1 i• • 1 e •I:1• •II • 1 • II .11 • 11 • • .11 •• • •1 r•• •./ .IB •11 /• 1 • • • • .t* • 1 w • •• •• 1• •..�I I t'.1 • •J ✓- 1 • IU.111 •1 � • loll .11 * s!V 1111/ •.0 1 1 11 11 1 1 1 � 1 1 1 •II 1 1 1 1 / 1 1 t l l ` 1 1 ' • 1 / 1 1 1 I 1 1 1 1 / •• 1 1 1 1 1 1 1 1 °� The Town of Barnstable MAS&URNSMOLL Regulatory Services %6s9. �m Thomas F. Geile. r,Director, Building Division Peter F. DiMatteo,Building Commissioner 367 Main Street.Hyannis MA 02601 3ff ce: 508-862-4038 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. Estimated Cost 1 y �� Type of Work: Address of Work: 4 11117 Owner's Name: w Date of Application: T /�� I hereby certify that: Registration is not required.for the following reason(s): ❑Work excluded by law r1Job Under$1.000 []Building not owner-occupied ffOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED. CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL.c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR Date Owner's Name f �pF THE Tp� The Town of Barnstable �sr"M • b e 9' � Regulatory Services°AIEc +"�� Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 ffice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION T / Please Print DATE: ! � � JOB LOCATION: 6-7 T'>57- .S 7— number street village "HOMEOWNER": ��Q.Q��/lJ G-��%- U S O�— 7 71 name home phone# work phone# CURRENT MAILING ADDRESS:—'7 7 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an.individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said proced an--requir-erne ts. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN i ' LOP y .2 , ~ `� ��/ � �� .2 i�� . �� 3 � �� %�� ` ', LOT i 1 fi ----_ 1' OVER— l� ____ HANG -HSE. - - - - - °' DECK i \ PI) S78 V5141'� LOT 2 RES. ZONE.• "RB" This Plan is For MORTGAGE INSPECTION Bank Use OnlyFLOOD ZONE. C» TOWN: _HYALVYI-S-__ ________- REGISTRY OWNER: RESOLUTION TRUST CO._____________ DEED REF: -60Q�_L69 --BUYER: _G'LL?.9LD0_F s DATE: _31301!94_______________ PLAN REF: A 56 ____________SCALE:1"= 30L FT. I HEREBY CERTIFY TO S'LLrJ_W"_T_________________ .X YANKEE SURVEY -----------------------THAT THE BUILDING OF SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS o� Pq�y, CONSULTANTS SHOWN AND THAT ITS POSITION DOES _—__ CONFORM AUL �, 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE A. INDUSTRY ROAD TOWN OF ___BARNSTABLE_ ________AND THAT MERItHEW IT DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD 0 N0. 32098 a MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. `MAP DATED_V__1�,/_/�85 _ �Fs '�FGISTt Q TEL: 428-0055 Co unit -Panel j 250001 0005 C s%,y ' S� FAX 420-5553 eg_ THIS PLAN NOT MADE FROM MENT 14507 DPG PAUL 1 M—EI2ITH PLS SURVEY NOT TO BE USED FOR FENCES ETC. r err.. •vv ��r.. � '`'�� ^`� Z - L0CAt_L LL, SEiAGE PERMIT NO. qMILLAGE INS LLER'S NAME a ADDRESS jam, d U 1 L D E R OR OWNER DATE PERMIT ISSUED . ® 3 DATE COMPLIANCE ISSUED r " The conunonlrealllt of Massachusetts ` Departtnefrt of Industrial Accidents' z t, ;y -�� Off�cea//m�estl9alloas 600 If irslliir„tnn Street �-' Workers' compensation Insurance AtTidavit _ r. -- locntinn- Cin, yl i (3-1 am a homeowner i6rforming all work myself. I am a sole proprietor and have no one work in_in any capacity I am an employer providin;workers' compensation for my employees working on this job. address: h phone#� y# ' cur�npolic ---------r-•-• G..._. 1 am a sole proprietor,general contracto or homeowner rcie one)and have hired the contractors listed below who} the following workers' compensation polic camniti n•tmc i,s �CD('.-7(2, nddresse cy . phone#� —7 cth•c Go m om•nafne- iddress- city- - phone#• insurance :Atiach additioaal'sh. if neeessa r^ 'M� �"'f "`��'r.�r �� 'z� „•'c f� sa � Fttilure to aeenrc coverage as required wader Section:SA of 111GL 152 can lead to the imposition of criminal penalties of s fine np to SI300.U0 ape une years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a.fine of S100.00 a day against me. I understand tha Copy'of this statement mad•be forwarded to the OlIce of Iavestiptiom of the DIA for coverage verification. I do herehr cetify under me pains and penalties of peduer that the infornmtion pmided above is attic 777,4 Signature Phone# Print name 4 otiiciai•use oniv do not write in this area to be completed by city or tots otUcial. permit/llccum# nfinildlag De city or town: partment up Board Huard • . �Seiectmen's Office ❑check if immediate reiponse is required C311eatth Department contact person: phone#: nOther� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers- compensation for emplo}•ces. As quoted from the"lay+•", an employee is defined as every person in the sen/icc oi'another under atnl 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 n ►, enterprise, and including the legal representatives of a deceased employer, or the the fors_out_enLa_cd in a joint � � _ � J rP rccei%ler or trustee of an individual , partnership, association or other legal entity, employing employees. However Owner of a dweiIing house having not more than three apartments and who resides therein, or the occupant of tite dwclling !rouse of another who employs persons to do maintenance, construction or repair work on such dwclIin�-, or on the ;-you»ds or building appurtenant thereto shall not because of such employment be deemed to bean emplo MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or reneival of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapt: been presented to the contracting authority. 7. ..,q .• - .a�..,rah: 7,777,77M, .-.. Applicants Please rll in the workers' compensation affidavit completely, by checking the box that applies to your situation an supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are requi: to obtain a workers' compensation policy, please call the Department at the number listed below. ...... _ 7-7777E ._.._.... City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottotr the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retume the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any quest: please do not hesitate to Live us a call. The Departments address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents s r, Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 nhone -9- (617) 7274900 est. 406, 409 or 375 HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which�a- bui3 permit is required shall be exempt from the provisions of this sectior. (Section 109. 1.1 - Licensing of Construction Supervisors) ; provided tt. Home Owner engages a persons) for hire to do such work, that such Hon shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assu the responsibilities of a supervisor (see 'Appendix Q, . Rules and Reguia for .licensing Construction Supervisors, -Section 2.15) . This lack of a often results in serious problems, particularly when the Home Owner hi unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home Owne as supervisor is ultimately responsible. ..�. ... To ensure that the Home Owner is fully aware of his/her responsibiliti communities require, as part of- the permit application, that the Home certify that he/she understands the responsibilities of a supervisor. last page of this issue is a form currently used by several towns. Yot care to amend and adopt such a form/certification for use in your commt ' r i a . .— .—. . . .. .... .. ..., S'. i .........v. ...Y ... . .'3•'..i.. ".. .. ..,..... ..'.. 1. .. ,. o .1.•. • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE_ ZA�6 . JOB. LOCATION , Q -4 �-5 "Number Street addres Section of town "HOMEOWNER" K6- f 1 Vj 0 S c� l-7 Name Home phone Work phone PRESENt MAILING ADDRESS o City town State Zip cc The current exemption for "homeowners" was extended to include owner-occ; dwellings of six units or less and to allow such homeowners to engage an dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends tc side, on which there is, or is intended to be, a one to six family dwelli attached or detached structures accessory to such use and/or farm structr A person who constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner"• shall submit to the Building Of on a form acceptable to the Building Official, that he/she shall be resno for all such wor3c performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes ,responsibility for compliance with th( Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requiremE and that he/she will comply with said procedures and requirements. �HOMEOWNER,S SIGNATURE APPROVAL OF BUILDING OFFICIAL .Note: Three family dwellings 35,000 cubic feet, or larger, will be requir to comply with State Building. Code Section 127.0, Construction Control. dt tt�e C - h. � , . . The Town of Barnstab e . ;S Department of Health Safety and Environmental Services �,6 •� • Building Division 367 Main Street,Hyaaais MA 0=1 Ralph C== Off= 508 790-6ZZ7 BuildingCommtssc F= 508-775 3344 For office use only : Permit no. ,i r Date y AFFIDAVIT ' HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERwr APPLICATION that the"reconstmcdon,alterations;reaovadM repair,�Ctn1zadon"apa�/erbTOIt, MQ"c 142A anon of an addition to any pm- •i . improvement,.rentm -4 demolition, or construction units or to are ad' : contaWn at least one but not more than four darelling other building g on art g registered contractors,with certain cac m ons, a. .g residence or building be dons by tegtn. to such rest eats. Type of Work: Est. Cost Address of Work- Date of Permit Application: R`/2- v I hereby certify that: , t rod for the following reaso (s): Registration is not required n_ < § Work acdudedby law x' Job under S1,000 4 —Building not caner pied: �cr P�g�Pit Notice is hereby given that: CONTRACTORS: OWNERS PULLING THEM PERMIT OR DEALING WrM FOR APPLICABLE HOME IMPROVEMDM WORK DO NOT HAVE ACCESS',,TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MQ-c I4ZA SIGNED UNDER PENALTIES OF PERJURY I hcrcby apply for a permit as the agent of the ov�•ner k _ F tin ( / Registration No.- Date Contra=name b OR . T94k I� TyvEk • h fi 4 d I ,� Map. Parcel /Permit# 7 6 Y Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fee ,�.5 Engineering Dept. (3rd floor) House# ltt(g -7 (_=J5 _ -� $EP-nc SY �t �� 'ALL�p 1 ?BE , CE TOWN OF BARNSTABLE- !�R � � � Building Permit Application LOT Project Street Address `+ S`r �'��) Village 9•40L,M S Owner c� o 'n Address Ce_► Telephone Permit Request P=Q�Z L)5-k J - First Floor square feet 1 I"a Second Floor square feet Estimated Project Cost $ S ,E eo Cn Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorizationn Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family �� Two Family Multi-Family Age of Existing Structure I t t rS, Basement Type: Finished Historic House d Unfinished Old King's Highway o Number of Baths l 112- No.of Bedrooms Total Room Count(not including baths) S First Floor Heat Type and Fuel +o Central Air C1 Fireplaces 0 Garage: Detached Other Detached Structures: Pool Attached Barn C� None Sheds 6 Other Builder Information Name © W n Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO / - SIGNATURE ,. DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY f _ PERMIT NO. D TEiISSUED Mr PARCEL NO. M ADDRESS VILLAGE ' OWNER , DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH, FINAL PLUMBING: ;ROUGH FINAL GAS: t ROUGH FINAL ' I;± - 4�,r FINAL BUILDING DATE CLOSED OUT' ASSOCIATION PLAN Ng. r t I Q�CS� , 7� I i f .. I f. t t me 49 : : : i i ► i 1 , 1 � , 1 i : 1 I i 1 I t � i i i I ; + . � ; , Y - - - I : 1. i , f i : - 1 , � I I { , : p E r: -- �✓ t 1 o , t I r Y : 1� : 2 s i 1 y a , 7 : ' `J — S�l g� e PLAN VIEW : SCALE , / Zd i 0t '` ►C.iM aRAr� N�, �'►T -_'°----,.--,� �p 4.*.a.cC).r?'!'r<,a�v' .:.,.✓rs�c...�.s.i �C'+u C3'e�M 1,3.sr..�' x\ +G .�« r �:� ea�s✓ T.�.<ak" ..e±aac��v cx x►N ram. FRANK YM111t4G N,, 248e9 cn i 41 41 AV I s t^r� i RC�3 PLAN VIEW : 41 p r F ` PIT ¢ N F— ol �-, o l m - RA A Rq �� r►T