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Home My WebLink About0013 FOURTH AVENUE (HYANNIS) / w�� I ?i I I I � I I .I 1 f JIB I �I �I i1t A } Town of Barnstable BUlldlri <�PBAIMMA ost Th�s'Card SoTtiat it is-yVislbleFrom<the Street-A roved Plans'IVlustbe Retained onJob and4this Card-Mus bevKe t ar,►ss PostedUntilFinal Inspection Has°Been Made „'�, r 1 s ' % ,bps► ,,,, i. ,- k Permit Where a Cert�ficateof Occupancy is�Required;such�Busldsng shall Not be Occupied�until a Final Inspection,.hasbeen made, ��, Permit NO. B-19-1798 Applicant Name: ROBERT WALSH DBA HARBORSIDE REMODELING Approvals Date issued: 05/31/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration,Date: 11/30/2019 Foundation: Location: 13 FOURTH AVENUE(HYANNIS), HYANNIS Map/Lot 246-185 _ Zoning District: RB Sheathing: Owner on Record: SCURLOCK,JAMES A&PATRICIA A �� Contra o434ame , ROBERT G WALSH Framing: 1 > F Address: 4 DONCASTER DRIVE Contractor License. 'CSfA-057394 2 NATICK, MA 01760 Est�Pro�ect Cost: $4,800.00 Chimney: Description: roofing , Permitlfe $35.00 Insulation: Project Review Req: tree Paid; $35.00 Ai Date •: 5%31/2019 Final: x ,f C�tcVv� G Plumbing/Gas k Rough Plumbing: a. ._ .a . Building Official Final Plumbing: ... ;: This permit shall be deemed abandoned and invalid unless the work authorized�by this permit is commenced within sa monthsafter;issuance. All work authorized by this permit shall conform to the approved application and th approved construction documentskfor which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by law"s„and codes. This permit shall be displayed in a location clearly visible from access street og id and shall be maintained open for public inspect on for the entire duration of the Final Gas: work until the completion of the same. in fR '� w Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the_ il�dmg�and Fire Officials areprovided i this permit. Minimum of Five Call Inspections Required for All Construction Work , Service: 1.Foundation or Footing `e 2.Sheathing Inspection _ .. Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Numbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with 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 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: y� -• Application number i...... Fee.............................. . ........................ MASS Building Inspectors Initials-EAD..... IN� ® � Date Issued.: i 1. MAY 3 0 2019 Map/Parcel. .a�'.� ...:..�� .......... 0 T6 � I14RNSTABLE EXPEDITED PERMIT APPLICATION: . ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 13VV14))�i NUMBER STREET VILLAGE Owner's Name: va w,-e S Phone Number Email Address: Cell Phone Number C �r� �/® ` Project cost$ /� 00 ' Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby ailthorize to make application for bull ' 7a rdance with 780 CMR Owner Signature: Date: TYPE OF WORK Q Siding E3 Windows (no header change)# El Insulation/Weatherization 0 Doors(no header change)# Commercial Doors require an inspector's review CK Roof(not applying more than 1 layer of shingles) Construction Debris will be going to —,rev, CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# .1 LI I (attach copy) Construction Supervisor's License# _ ��-1 (attach copy) a Email of Contractor )D\.k C. '90 RCUMN Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X. X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes. No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval. r *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date C All permit applications are subject to a building official's approval prior to issuance. } The Commonwealth of Massachusetts Department of Industrial Accidents '4 Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): b� Address: Q & City/State/Zip: S Phone#: � �— Are you an employer?Check the appr priate box: Type of project(required): 1.ElI am a employer with 4. ❑ I am a general contractor and I (full and/or part-time).* have hired the sub-contractors 6. ❑New construction2. ,employees 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 workingfor me in an capacity. employees and have workers' Y P t3'• [No workers' comp.insurance comp.insurance.: 9. El Building addition 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 myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c, 152, §1(4),and we have no employees. [No workers' 13;❑,Other .x comp.insurance required.] , *Any applicant that checks box#1-must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :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 is providing workers'compensation insurance for my employees. Below is the policy,and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded.to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties o perjury that the information provided above is true and correct Si afore: ...'� Date: N Phone#: / - Q Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engagediin a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,.supply sub-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 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Reaistration Expiration Offi c 141991- 03/02/2020 a of Consumer Affairs and Business Regulation One Ashburton Place-Suite 1301 ROBERT WALSH Boston,MA 02108 D/B/A HARBORSIDE REMODELING ROBERT G.WALSHVo 250 CAPTAIN CROSBY ROAD CENTERVILLE,MA 02682 Not Valid alid without sig nature Undersecretary ry y Commonwealth of Massachusetts Division of Professional Licensure ` Board of Building Regulations and Standards Construction,S '�Or 1 & 2 Family CSFA-057394 r E.�pires 06/02/2021 ROBERT G W,ALSH P.O.BOX 713y MARSTONS MILLS,`MA 02648 - ,a Commissioner u � Town of Barnstable Regulatory Services , Richard V. Scali,Director MASS. Building Division 1639. Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 PERMIT# S > FEE: $35.00 SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less Location of shed(address) V' lage 4%, Ls-o� S Q Property owner's name Q Telephone number ` 1 ro ®FC' 4F,o ----- , OP Size of Shed e,9� 6 Map/Parcel# !Z!� A4 S gnature Date Hyannis Main Street Waterfront Historic District? - Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE:-IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE. COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE.SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN 1 Q-forms-shedreg REV:06/20/16 NW)S r 7 - 4 caWVA ca u LL z ' t;3V CQ q ti oc y T" o- vr- zi 1 � . co L000 ��- 3. tk� rxrstrr; Qwellin Pra osed She in W. H annis ort MA. 'i= "Pie- aced For: Frederic P. Claussen � I Nye & Holmc�ren, Inc.Assessor's Mar MAP:'246 PARCELS:'185 �QX'�er, Community Panel Number: 250001 0008 D Registered Professional F.I.R.M, Map Zone: C Engineers and Land Surveyors Plan Book: 34/23 (Lots;210 & 212) 350/34 812 Main St. Deed Book: 13,8831314 Osterville, MA 02655 Owner: Frederic P. Claussen Job'No'. 2003-021ab.dwg; Phone - (50e) aze-sus Fax - (50e)-42e-3750 Scale: 1" = 30' Date: 04-01-2003 C R A I G V I L L E BEACH ROtAD ~ S 89'04 30 E 170.51 .x.., BRB FND x BRB FND v M W Ln o T 0 - L PLAN BOOK 350 o O�BP�N,cJ�P a 'C�N1N PAGE ,34 . COONEY 10..5'' N ar29'37" E _ 100-069 �..� 8,005f SO. FT. C 10.5' 0.18t ACRES 38.7' — - PROPOSED h 6 x 8 \ SHED zo N r,4 0 m Z -O 0 n/f Slhr�l1A u o m N _ E p w Zm D m DECK [STONE m w DRIVE _n r m Z M 0 m S 8T29'37" W Z STOCKADE FENCE M u7 C � t f•`� ��' i'� �+�. = ! '• . y �'" � � ';z air 54*�r�, �".r � t ,tr,�;;a ,��'��+'. A,:>,� •, N".�:'� '�'''` '.r�. 'ism �• �'�t. `".'� .A, .` r,. M,'. d'' rr t-f,. ` 8 k # "L'A�"'`'.^ •e�+'Y.sry f uh,..) 'a trt K�ac' y,•fi •F ....'.j -.' ' RICK Aj' S L � f �n/f �'CAMERON �t + p �"�� g ,� t• f >" s � t.� " �°'�`a �t• # r k y +n "e .ffi' M. -✓.•-? sI:,3 '•ti' ,��.2 > . q-x�s '�V,' �yy�,. c�� „� �.aw � �; � -.�TM c�,.�,,t s Y �t' �;;,p2.• s�i+3. *�� '�y,� �' d�,� i � (r•� �° G� a ,r r `k i� d4} -y..- r:+" ° ,s s 4 I'�n'�11°`r ' ,`,,-'+` ya�. Ss'�`�:+, _z •�,xw . '��r�, irk' �"Fd'Y�," l ��CERTIFY�fHA�1#1'dk4'1r�f��6�5�OF�M`Y.�KNO1N� 0 WNLl HEREON 1$ `LQCAT'Lu;f RELATONa ,' fisq 51 RUCTURE�SFiO r I �. { t, , •„ ± 'f •i: ,_, _ , . TtO TF E MAN;'UMEf`7TS SHCYNIN,&AND;IS NOTk�rLOCATAgr v • �;{,°� • :r., �t� WITHINA� SP,ECIALFIOODH4ZARD..AREA` :x � `f a • a,,.T _ ,off }{ ys.y ; . . � 3 _3. `��,-�4 sy. THIS;PLANe IN�NOT� TO BE�RECO aUr-, NOR T�BEz <{ USED:'TO •,ESTABLISHPROP'ER TY LINES 'x Y T s. .''' . t , r r.; f j{ +� t:j�-, ;^s f� S`/� �• QoS�. a e 7>�5 f<Y E}ISTERED{ PROFESSfONAL TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp Parcel A licatiov Health Division BUILDING DEPT Date Issued' 4t'ZZ `(- Conservation Division APR ® 2016 Application Fee Planning Dept. TOWN OF'BARNSTABLE Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 13 11CL us-k-� f/✓1 q Aio ri Sl o_-_90', Village IfuAWA,-, 4 Owner PAP;y +- Ti Address 4f 00(t, {1,J%cK mA Telephone ��$T�pi9 Permit Request �'�' X 12 _J,%Xkb,&j K i�'�!I�v . AJ. i,, 04 &1 Square feet: 1 st floor: existing '976, proposed 190 2nd floor: existing 5 proposed Total new 1,2 U Zoning District Flood Plain Groundwater Overlay Project Valuation A-9),0W 'Construction Type wa A Lot Size 5 Il 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 SfNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) ef> Basement Unfinished Area (sq.ft) 75'0 S-r Number of Baths: Full: existing / new Half: existing 0 new i Number of Bedrooms: existing &new Total Room Count (not including baths): existing �5'—new First Floor Room Count Heat Type and Fuel: )d 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 O new size_ 1 Attached garage: ❑ existing ❑ new sizeU.Xhed:� 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 A&t,)00_VL- Telephone Number Address 7-5-0-ID &d&�bohe to License# 61C7 �14 Home Improvement Contractor# I e.iT M j Email �i,{C: �� ai cwcj"! , {ALP�'" Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO a SIGNATURE DATE FOR OFFICIAL USE ONLY _ APPLICATION # DATE ISSUED x MAP/ PARCEL NO. ADDRESS VILLAGE f OWNER ti DATE OF INSPECTION: R FOUNDATION r FRAME INSULATION j FIREPLACE 4 a ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t Y i I 27ie Comrtiompealth of-Massadiusetts D)epartiffent of rndustrid Actideidr Qfficep Of ImAesdgafiew 600 Washijrgton,street Boston,-414 02M z mptttniasmgavldia '"Furlmre Campensafian.Insurance Affidavit:B•mlderslCanfracturslElec dcians/Plumbers, Applicant Inform:affan Please Frinf del Name Address: :ZZE c fc� l �Y 1;1 ��_, /GO�►►-�u+ , /'I�1<1 Cifftatel 2 _ Phone Q Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑I am a general contractor and I 6_ ❑New consfracii� employees(full andlor part timed* have hire tithe sir&-contractors 2. I am a sale proprietororpartner- listed outhe attached sheet. 7. ❑ReMOde1mg 'ship and have no employees These sub-contractors have g- ❑Demolition working, for one in any capacity_ employees and have workers' � 9. KBuiltitng addition [No wmdaers'comp_insurance comp.insuranml ' required-] 5. ❑ We are a corporation and its 10_❑Electrical repairs cr additions 3.❑ I am homeoramer doing all works officers have exercised their ME]Flumbingrepairs or additions myself[No workers' _ right of exemption per MGL . 12.❑Roofrepairs ; insurance required-]T. C.152,§1{4h and we have no employees.[No wodoere 13_❑Other comp-insurance required.] 'Amyanric ff=tchedm box Rmast also fMont the sectionbeTawsbouingtfieawodcen compensation policyinformadmL, 11�Romemnem wbo subaft dais LM&-nff m&kz .g they Rm doing O wod and. m du ]tire ou=decont mctm=ast mbmA a new afdaeit indicatiq;sadi fCon+r c9m fod rhea tMs bu must attached zu addilional shed shauhg the urine of the sut-caartmctaa xad state whether or not&ose eatitiesbxm artghoyem I€thesahtoat actoesbnm empIcyee%&eymnstpmuide then wwke&romp.palicg number. lam Below is tleepoticy aad jab site informr tom Insurance Company Nam: " policy,4,or self-ins.Lic. Expiration Date: " Job Site Address: Citylstawz� p: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c-152 can lead to the imposition of criminal penalties of a fine up to$1,50aOD andror one-yearimprisonmad as wen as civil penalties the form of a STOP WORK ORDERand a fine of up to WO-00 a dap against the violator. Be ad%ised that a copy of this statemed maybe forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do ero6y CmWfjl �dff tha pains _ dpenalties fhatflee information prm-uW abmw is bare and correct Sitnrature: y pate: Phone C1 0jokial use anl. Do eeot write in thb.area,to be corettpletesd by city ortotcn offi aL City or Town: PermitlLicenrse# Issuing Authority(car,Ie one): 1.Board of Health 2.Building Department 3.City1rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:. Phone#: i Information and lastructions mcsc�setts General Laws chapter 152 requires aII empIoy=to provide workers'compensation for their employees. pM=Mtto this statr3t-$,an mp&5yne is defined as."_.every Person in the sm-vice of another under any contract of bire, express or mrplie-ct oral or written." An wTfayer is defined as"air individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint ,and including the legal representatives of a deceased employer,or the receiver or trastee of an individual,partnership,association or other legal entity,employing employees_ However the owner of a dwelling house hzvi not more than three apartments and who resides therein,or the occQpant of the - dwelling house of sno her who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or budding appurten thereto shall not becanse of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a buskess or to construct bm7diags in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance covexage required-" e comet eahh.nor � f its political subdivisions shall Additionally,MCrL chapter 152,§25C(7)stairs�Ieiihea-th cmvr any o enter into any contract for the performance ofpublic woik until acceptable evidence of compliance with.the insurance._ requirements of-d i chapter have been presented to the contacting authority." A.Pplicants Please fUl out the workers'compensation affidavit completely,by chwYmg the boxes that apply to your situation and,if necessary,supply sob-contractors)nam*), addresses)and phone mmlber(s)along with their cerfificate(s)of sncr„a„ce. Limited LiabEity Compames(LLC)or Limited Liability Partnerships(LLP)withno employees other than th.e members or partners,are not required to cauy workers' compensation i s rrmc-F If an LLC'or LLP does have employees, apolicy isregnired. Be advised that this affidayitmaybe submit�-d to the Department of Industrial Accidents for confnmation of fim=ce coverage. Also be sure to sign and data the affidavit The affidavit should be retm ned to ffie city or town that the application for the permit or Iicense is being requested,not the Department of Ln-drstrial AccidenfE. Should youu have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Depatment at the number listed beIow. Self-insured companies should enter their self-insurance license limber on the appropriate line. City or Town Officials T - Please be sure that the affidavit is complete and prirdedlegibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office oflnvestigafions has to contactyoaregmdmg the applicant Please be sure tD fill in the pe�itllicense number which will be used as a refevnce immber. In addition,an applicant that must submit m11141e penni0cense applications in any given year,need only submit one affidavit indicating cu r=t policy fi fo=ation Cif necessary)and under"Job Site Address"the applicant rho*t1d orate:"all locations in (city or tDwn)."A copy of the.affidavit that has been officially stamped or a mdced bythe city or town May be"provided to the applicant as proof that a valid affidavit is on file for fafm 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 Cie_ a dog license or permit to bum leaves said person is NOT required to complete this affidavit The Office of Ines igaiions would at to thank you in.advance for your cooperation and should you have any questions, please do not hem to give us a call- Me Depa=�enfs address,telephone and fax number: 'I�le C.M oWMME of MasmChMEM , enfi cif 1ud�irial Accld�nts • - - Qffi=of X11v gatio= Bos MA f1�111 TeL 4 617 -49W=t 4.06 or 1-977- a AM Fax 617` 27-7749 Revised 4-24-07 -991dia A WC Guide W» Wood Construction in High Wind Areas: Iy0 mph Wind Zone Mas0achn medtm Checklist for Compliance(780CMR5][1.2.1'1)� Check Compliance�.� ��QP� _ Wind ................................................................. ..................— .......................10 mph Wind Exposure Category...�-----------_--_--_''---��-.__--_--'8 --- , Y'2 .- . __-_'_ . . . Number_ of ........................... ^�-_-_ mpof puoh ' - - --- soanuoo,*night ---' Building Width,~.......................A ..,-.--.----..:. ---_--_-_-___.__=��ft s�Y �. ------- '----`-��---.-_-��jt �0%` u '---- ~ mmm �� -� --- ' mommo neg» ov7�no��punmQ~ -----..�c��--�(F�4>-------.��.��----- ��-sVYr ---' .� . ' 1.3'pRAMING CONNECTIONS General compliance with framing connections....................(Table%)........ .................... v ' 2-1 FOUNDATION Foundation of � -.[on�e�.-'_-- - �� ' ConcreteMasonry......................................................................___.____._____________^_. --- � , . . ` 2.2 ANCHORAGE TO FOUNDATION,' ^ 5/8^Anchor Bolts imbedded or 50^ � ,. � Bolt in. , Bolt �:r�� ---' . Bolt Embedment- ' .........................................' ~ ---- - � 8oVEmbedment-mobon�------.—_--''(FiQ5)........................................... ---' PlateWasher...............................................................(Fig5)...............................................a 3'x 3rxIW --- 3.1 FLOORS Floor framing member spans checked '9K . .. ............ 780 CMR Chapter ._---__--_ ' wammumFk�,Dpon�gDkneno�n_--_--.---.0qgO�-'-----_.' ' fts12'orU2cvVY/2 --- puU Height Wall Studs at Floor Openings less than�hnmEx�dorVVo V�gV�-.'�_--_---.�_-- _-- MammumFko�Jnx�S�bocko - ' � ` --- (Fig 7)..................................................... ft �gd ' Maximum' ` Cantilevered Floor Joists - - - Floor Bracirig at Endwm|ls- ---- ` FloorC�� ................................ --- Fko� ' ` ---- ='=='°'u ""°===" �z Floor aheo�mgFas�n�g---��.._---.'�--.--.pah�21' dn��ar � in edge 4.1 WALLS Wall Height (Fig 1V and Table ft _5Vy walls� ' .--__-_y�g1O and Tab��-.�---- ft �2� Wall Stud . .--'^. o*_��._—''__'(Fig 1]and Table 5)...................__in._5 24"o.c. Wall Story Offsets ........................................................(Figs 7&8)........................................... ft :5d 4.2 EXTERIOR WALLS" ' Wood Studs � LnodbemrinQw��--------- .......(Table � �� | ' --- | Gob�EndVVoUO�c�n, (Table --`--.---'--�-- ---- in---^^ --�- Full VVSP Attic Floor Length.......................-'-_.--.�-(�g11 '--'--'---_.--- *�v� ---- Gypsum VVGP ---.--�lg11>'---'----.r-'_—_ --�aD�VY ---' 2x4 Con UnunuoLo��|B�na��Gflo.�..��11>---- ............ --- uouule top plate ---' Splice ........................................................(Fig 13 and Table O)- .................................. It Splice Connection(no.cf18d common nails)..............(Table 6)............. .......... . ---- ` - . �� C~ 1 AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)' Loadbearing Wall Connections o Lateral(no.of endnailed 16d common nails)..............(Table 7).. . ' .....................•. :.. Non-Loadbearing Wall Connections — Lateral(no.of endnailed 16d common nails)...............(Table 8)................... Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans 'r ,g.:7..........................(Table 9).................................._ft_in.511' _ SillPlate Spans .....................................r................(Table 9)......................... ...._ft_in.511' Full Height Studs (no.of studs)...........r...................(Table 9)............................... _— Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans..............................................................(Table 9).................................. ft_in.5 12' . SillPlate Spans............................ (Table 9)............................................................ ft m.s 12' Full Height Studs(no.of studs)....................................(Table 9)...................... .................................. Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously" '— Minimum Building Dimension,W Nominal Height of Tallest Opening2 ........ ...............................................:........................._5 618" Sheathing Type........ Y ,1&i ................(note 4)........................................ —. .............. _ Edge Nail Spacing..... ... .. ..: .(Table 10 or note 4 if less)....... ................. in. Field Nail Spacing -- P 9.......... . ...... .................(Table 10)................................................._ Shear Connection(no.of 16d common nails)(Table 10)..........***.............."* — Percent Full-Height Sheathing.......................(Table 10).........***** ...... *.. %.... ..................... 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).............. ... Maximum Building Dimension,L — Nominal Height of Tallest Opening2........................................................................._5 6V Sheathing Type.........�`�c?r'!".........................(note 4).............................. `.... ....... _ Edge Nail Spacing.........................................(Table 11 or note 4 if less)................:....... in. _ Feld Nail Spacing..........................................(Table,11).............................. _in. ............... Shear Connection(no.of 16d common nails)(Table 11)...::.................... ........ — ......... ............ Percent Full-Height Sheathing....................... able 11 ............................ . _� — 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).............. /� — Wall Cladding .. — Ratedfor Wind Speed?.....................:.....................``............... .............................. 5.1 .ROOFS // Roof framing member spans chefctked?...../�//.!t(For Rafters use AWC Span Tool,see BBRS Website) _ Roof Overhang .............�................................(Figure 19).............._ft 5 smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)......................................•.....U= plf — Lateral......................................... able 12 pif Shear...............................................(Table 12).............:..............................S= Pft Rldge Strap Connections,if collar ties not used per page 21.....(Table 13).............. = plf _ Gable Rake Outlooker.........................................(Figure 20)..............—'ft 5 smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift.......... ... able 14 Lateral(n .of 16d common nails)...(Table 14)...............................4......L lb. _ Roof Sheathing Type............ -a,...�,`h;�...•,••,•••,••(per 780 CMR Chapters 58 and 59)................... _ Roof Sheathing Thickness...... nTm.......................... .........................•..................._•in.a 7/16'WSP Notes: Roof Sheathing Fastening...........g.i �....................(Table 2)............................. `.......................... _ — 1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1.If the checklist is met in its entirety then the following metal straps and hold downs are not raquired per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness.pressure treated#2-grade. w AWC Guide to Wood Construction in High Wind Areas: I10 mph Wind Zone Massachusetts Checklist for.Compliance(780 CVIR 5301.2.1.1)' - q a. From Table 10 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows- !. Panels shall be installed with strength axis parallel to studs. u. All horizontal joints shall occur over and be nailed to framing. fil. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the,top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing, v. Horizontal nail spacing at double to P 9 p plates,band joists,and girders shall be a double row of 8d staggered at 3 inches on center per the Figure, Vertical and Horizontal Nailing for Panel Attachment r AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)' •-V -,THUEDGEorsore FfbkMINGUMIdNAM-$ nTsbr_ 11 11. � 1i 11 1 u la 11 it It 1 11 11 1 11 11 1 11 11 1 1 11 I l p i • 11 It � I Q !1 it 11 /1 / g 1 1 d u /1 o 1 d U W W 1 1 7 Q li i� 121 N � fl f1 � DOUBLE 9D.rE MAILSPACWG i ! v P See Detail on Next-Page Vertical and Horizontal trailing for Parr Attachment of'MET, ToVwn'of Barnstable Regulatory Services $ Richard V.ScA Dn mdmr _ w ~� BIIIZdh3g Y}hWon TomPerry,Bm7dmg Commoner 200 Mam Stet Hy=,*MA 02601 WWW.tD nbarnsfablema.us Office: 508-862-4038 Fz= 508-790-6230 Property Owner Must Complete and Sign Tbis Section If Us ing A Builder / as Owner of the subject prop=tT liemll�Tar�borize ;� C�6 to`art on mybeh2l& _ in.all=tbM Mlai Ve to work auf 0&-Cd bi is buMiag Pew aPPEmticn for. 02� 72 Add s of j`b) Tc)olfences and alarms are the responsIfl yof the applicant Pools are not to be'filled'or i ��'befofe fence is installed and all f na.1 inspections_are peifo=ed and accepted. ,W.Alf S- of $ 1074v W of App fc-U Pzi=Name p aII7E Day . Town of Bamstable " Regulatory Services r � Rickard V.Sa3A Director , ��• - ��IDg bIQISIOIE • t Tom geny,Bwadmg ComMAISMmoner �a 200 Mum Star Hy mi,MA 02601 arm� w�p�owmbarm��i1e_*s-us ' Office: 509-862-4039 - - Fa= 509-790-6230 - Han�aw�LrCs�s�ox JOB LOCAztMZ- s IIIImbC= . . .IIaIDC )=,phm=A :WOIjCPFI®C . 7 CURRENT MAILaTGADDRESS: _T zip Cock The r-*rrrent exemption for`homeowner'was extended to inclpde owner-occupied dwelim�s of six umib;c�Iess and in allow homeownws to �e b d;vi �l for himwho does notpossess a Iiccwcq provided thatAM owner ads as supervisor_ • . DRFIld2IQN ORHOTiDzAw1QF�R ,P essan(s)who ovms a parcel of Iaad on which.helshe resides or intends to reside,on which these is,or is i atmded to be,zone or two- f��y dwelling. aitaebCd or detached siractxses arrrecorY to sick Bse and/or farm et,��rtr�ree_ A person who constricts m=than one home in a two-ycar period shall nitbe mnsida-ed.ahomcownez Smh`homwwnee-shall submitto ffic Bm7dmg Official on a form acceptable iu the BmOrTh Off jA that heshe shall be responsible for an Such work R=ffl3=oed muierihe bmZd nE permit (Section 109.L1) - Tho gacd`,`homeownee-==cs resPmL" IIAY for compliance w&the State BnTldmg Code and o-er applicable codes, b kqn, 16s aadrag-mbiirms - i lilt `homeowner"des thathelshe uidmStands fe Town ofBaznstahIp BmUffiag Department mmmznm msPechon proms m:Ld=qahmm=nts andthat Wsha well comply w1a said procedur=s and rece mecds. Sig¢am¢a of$==vna App=vpal ofBnBdmgOfcial • Note. Three-famtTy dwellings canfammg 35,000 cobic feet ar lazger willbe rimed in comply with the Stain Bm7dmg Coda Section 127.0 Conshvction Ca&cL Honrowr MIS Corr The Code states that: `Any haiiteowner performing work for which a big g is rued shaII be exempt from the provisions of this sec:f=(Section 109_I_1-Liceusmg of coasixudion Supervisors);provided that if the.homeowner g � engages a erso s)for Ise to do such work,that such Homeowner sh2R act as supervisor." Many homeowners who use$cis eXMmp'& n-are uaaware.ffiat$ey are A_wa,;ng ffie responsfiTrtfes of a supervisor (see Appendix Q,RnIes Bc Regulifions for Licensiag Constr.5 n Supervisors,Secfinn 2-125) This lack of awareness often. resalts in Serious problems,pIff=arty when the homeown=hires unlicensed persons In this ras,our Board r: not .proud against the Unlicensed person as it would wn a ficnnsed Supervisor_ The homeowner acting as Supervisor is uIlimately responsible. communities as art of the To ensure tdiat the homeowner is fatly aware of his/her respo='brTdjes,many require, p permit appIi.r--a n,tb t the homeowner certify that helshe understands fe rEspon.sibiTrlies of a Supervisor. On the List page of Bgs issue is a form eurrenfly tsed by,minxal towns Yon may care t amend and adopt such a formlcwtiffmdon.for use in your comsuunity. Pe�fr�Sl�BF�-boo Revised D61313 Parcel Detail Page 2 of 6 2" POLYISO FOR KW BLOWER DOOR &CST TES 9/14/2005 New Siding 86917 $4,000 1/16/2004 3/17/2003 Out Building 67947 $1,000 12:00:00 AM Visit History Date Who Purpose 3/28/2016 12:00:00 AM Robin Benjamin In Office Review 1/8/2016 12:00:00 AM Teresa Wright In Office Review 1/8/2016 12:00:00 AM Teresa Wright In Office Review 1/30/2013 12:00:00 AM Robin Benjamin Cycl Insp Comp 5/20/2010 12:00:00 AM Nancy Finch Change Reinspection Rereview 3/22/2010 12:00:00 AM Paul Talbot Cyclical Inspection 10/10/2007 12:00:00 AM Nancy Finch In Office Review 1/16/2004 12:00:00 AM Martin Flynn Outbuilding Insp Only 6/30/2003 12:00:00 AM Paul Talbot Meas/Est 7/26/1999 12:00:00 AM Donna Dacey Meas/Listed-Interior Access Sales History. ......... ....... Line Sale Date Owner Book/Page Sale Price 1 7/6/2007 SENST, WILLIAM &CARLA 22170/168 $392,700 2 9/12/2005 KUSIAK, KURT S & KATHLEEN J 20249/120 $299,900 3 5/30/2001 CLAUSSEN, FREDERIC P 13883/314 $150,000 4 8/23/1996 KOSTKA, JOHN E & DEBORAH A 10359/171 $1 5 4/15/1994 KOSTKA, JOHN E & DEBORAH A 9149/225 $24,900 6 7/22/1987 KOSTKA, JOHN E & DEBORAH 58.43/254 $1.17,000 7 5/12/1987 DORAN, MARK 5716/52 $125,000 8 1/29/1987 DORAN, MARIE V 5538/148 $110,000 9 1/15/1987 CUTTER, CINDY L 5538/148 $110,000 10 5/23/1986 CUTTER, CINDY L 5094/49 $98,000 11 2/28/1986 NICKULAS, LARRY D 4944/112 $625,000 12 7/13/1964 TELLIER, EDWARD A&JUNE 1 1260/581 $0 13 4/7/2016 SCURLOCK, JAMES A& PATRICIA'A 29562/214 $365,000 Assessment History Save Building Total Parcel Year XF Value OB Value .' Land Value ValueValue 1 2016 $61,400 $17,900 $1,800 $240,400 $321,500 ` 2 2015 $64,600 $18,500 $2,200 $225,100 $310,400 3 2014 $64,600 $18,500 $2,300 $225,100 $3101500 4 2013 $64,600 $18,500 $2,400 $225,100 _ $310,600 5 2012 $64,600 $18,300 $1,900 $225,100 $309,900 6 2011 $85,600 $3,000 $2,600 $225,100 $316„300 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=17267 .4/20/2016 BUILDINGDEPT ' APR 20 2016 T OWN'O Y. " ri } FOI l Page 2 of 3 �. CLAUSSEN, FREDERIC P 2001-05-30 .13893/314 - $150000 KOSTKA, JOHN E & DEBORAH A 1996-08-23 10359/171 $1 KOSTKA,JOHN E& DEBORAH A 1994-04-15 9149/225 $24900 s ' KOSTKA,JOHN E& DEBORAH 1987-07-22 5843/254 $117000 DORAN, MARK 1987-05-12 5716/52 $125000 DORAN, MARIE V 1987-01-29 5538/148 $110000 CUTTER, CINDY L 1987-01-15 5538/148 $110000. CUTTER, CINDY L 1986-05-23 5094/49 $98000 NICKULAS, LARRY D 1986-02-28 4944/112 $625000 TELLIER, EDWARD A &JUNE 1 1964-07-13 1260/581 $0 ' . Photos 246/185/ Use Code: 1010 " r � . Sketches- Map/Block/Lot: 246/ 185/-Use Code:,1010 As Built Cards:Click card#to view: Card#I . Constructions Details-Map/Block/Lot: 246/ 185/-Use Code: 1010 Building Details Land Building value $ 61,400 Bedrooms 3 Bedrooms USE CODE 1010 Replacement Cost $94,430 Bathrooms 1 Full-0 Half Lot Size`(Acres) 0.18 Model Residential Total Rooms 4 Rooms Appraised Value $ 240. n ` r dt F t ' a� �'y��,� ��t , � t �) Ayr�•,. - - - Massachusetts -Department of Public Safety Board of Building Regulations and Standards 111 it\tl li l't11111 [+___'_ '1 T,..._•I_.. JIl1IC1 Yl�lil 1 t�L i1111i1v License: CSFA-057394 ... ��.r r.` ROBERT G WAIJ" �r 4 735 Old Barnstable Raw, ~y East Falmouth MA _ /��•�• Expiration Commissioner 06/0213017 _;jlcr�crc�rr elY.;' \ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only t HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 141991 Type:YP • Office of Consumer Affairs and Business Regulation Expiration: 3/3/20.18_ ` DBA 10 Park Plaza-Suite 5170 HARBORSIDE REMODELING Boston,MA 02116 ROBERT WALSH ` 250 CAPTAIN CROSBY-'ROAD CENTERVILLE,MA 02632 ` 1 .'f �i Undersecretary Not valid without signature y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIOPP Map 3 Parcel 45 Application # f S-D q 16 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee �,� 00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 4[fv'0,f Village H A rs Owner L a.0 IN, W C Atz e, Address Telephone b 14- 5 H 5555 Permit Request Prij R-3 C e,Ilv1 1p sg `f'0 tke, GAI c es11 i�r ►r set, ( ±L adRc P lao an Lasmeq WIA exa apt J�61 - 0 g,in, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes.;❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing 0 new `-size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size —,'Other: µ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes KNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION ——(-BUILDER OR HOMEOWNER) — - — - - � Name W 111 i" m NC,0066/cxte 5 avG .ln t. '-Telephone Number 608 318 03 9� Address 7"b 4o,41ln,44 n &ram.. License #_:1( l 0&?1(, o�►+�. Y�w d n+ , N ft n a 6O Home Improvement Contractor# l ?-13 8 n Email Worker's Compensation # W W C 3 1 3 6 9- '-� q ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO TILCM D W4 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 s DATE CLOSED OUT ASSOCIATION PLAN NO. J a The Commonwealth of Massachusetts ` Department of Industrial Accidents 1 Congress Street,Suite 1.00 Boston, MA 02114-201.7 tr' wwwmassgov/dia NN-orkers'Compensation.insurance Affidavit:Builders/.Contractors/Electricians/Plumbers, TO BE FILED WITH THE PERMITTING.AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cape:SaVe'Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 .. Phone#:508-398'-0398 Are you an employer?Check the appropriate box: Type of project(required).: 1:❑✓ I am a employer with.LO emploYem(full and/orpart-time);* - j, :D New.cOIlStrUChon ; 2. I am a sole.proprietor or partnership and have no employees working:for me:in 8:. Remodeling any capacity.[No workers'comp.insurance required.] , 9. Demolition 3.❑I am a homeowner doing all work:myself.[No workers`comp..insurance required.] - '0 " 4;❑I am:a homeowner and will be hiring contractors to conduct all work on.my property;twill 10[]Building addition ensure that all contractors either.haveworkers'compensation.insurance or are sole 11.n- Electrical repairs Or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I;have hired the sub-contractors listed on the ittache&sheet. 13:QROOf repairs These sub-contractors have employees and have workers'comp.:insurance. 6.FlWe are a cotporation:and its officers have exercised their right of exemption perMGL:c: 14.[2]OtherInsulation l k,§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 policy information; t Homeowners who submit this affidavit indicatingtthey are:doing all work and then hire outside.contractors.must submit a new affidavit indicating such. .Contractors that check this box muscattached 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'xomp.policy number. I am an employer that is providing workers'comp.ensation insurance for my employees. Below is the policy and job sate information. Insurance Company Name:Wesco Insurance Company Policy#or Self-ins.Lid.#:VVWC3136274 -Expiration.Date:04/0,9/2016 Job Site Address: 7 Harvard Street City/State/Zip: Hyannis Attach a copy of the workers'compensation policy'declaration page(showing the'policy number and eapiration:date). Failure to secure coverage as required under NIGL c. 152,§25A is a criminal violation punishable by a:fine up to$1,500:00 and/or one-year i nprisomnent 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 statementmay be forwarded to the Office of Invesfigations.ofxhe DIA for insurance coverage verification. I do hereby certify under th pains and penalties of perjury that the information provided above is true and correct. Si attire:_ .. Date: 4/28/2015 Phone#:508-398-0398 Official use only. Do-not write in this area,to be completed by city or town.offic al. City or.Tovrn; Permit/License# Issuing_Authority(circle one): 1.Board of Health: 2.Building Department. 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing;Inspector 6.Other Contact Persons.. Phone#: 1 act Rc CEi TIF1Cl4T DATE(MMIDDNYY �. ...- E dl! L IAMLITY INSURANiC: . 3/24/2015 . 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 AfFORQED.BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING tNSURER(S) AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE;CER71FICATE HOLDER IMPORTANT. If the certmeate holder:Is an ADDITIONAL INSURED,the poi#cy(ies)must be endorsed: If SUBROGATION;IS WAIVED, subject In the terms and conditions of the policy,certain policies may require an,endorsement. A statement an this csrtiticate does not confer rights to the certificate holder In-lieu otsuch endorsement PRODUCER. NAME: Colleen Cro.WlE'y Risk Strategies' Company PHONE (781)986.-4400 Fs t?81)963-AA20 15 Paeella Park Drive ecrowley@risk-strategies.com Suite 240 - - INSURERS AFFORDING COVERAGE NAIC* adolPh M 02368 wsuRERA:Se7tective "Ins.. , oE' America INSUREDIN8URERs:Allmcrica FiaaACiai7hiliance 10212 Cape Save, Inc INsuRERc-Wesco. Insurance Comany 7 D Huntington Ave. .. . INSURER D: INSUR ERE: st�uth Y� nth ` "I& w9 INSURERF COVERAGES CERTIFICATE NUMBER:CI,1532491501 REVISlON.IVUMBER: THIS'iS TO CfR?IfY SAT THE POLICIES OFINSURANCE LISTED itEtOVVf RAVE-BEEN ISSUED TO THE'INSUREO-NA)4tEU J1B0VE FO"R'TtiE I?OLICY PERIOD INDICATED. NOTiI misrANDING ANY REQUiREMENT,TERM OR CONDIT!04 OF ANY CONTRACT OR OTHER DOCUMENT WTi}i RESPECT TO WHICH TF IS CERTIFICATE MAYBE;ISSUED OR MAY PERTAIN; THE iNSURANCE_AFFORDED BY THE POLICIES DESCRIBED:HEREIN IS SUBJECT TO ALL THE TERMS, . IXCLUSIONS AND CONDTTfONS OF 5UPH';POLICIES.UMtiS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: INSR TR TYPE OF INSURANCE S POLICY NUMSER I ICY EFF M60t�W EXP :: LIMITS GENERAL UASILiTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO HtNj tu PREMISES Ea 20currenw $ 100,000 �+ CLAIMS-MADE co OCCUR 9i9944,80 0/16/2014 0/1;6/2oi5 MED EXP(Any one person) $ 10,000 :PERSONAL:J:rnV INJUP Y x 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PEW PRODUCTS-C4MP(OPAGG $ 2,000,0001 X POLICY PRO1EU X ,LOC AUTOMOBILE LIABILITY COMBIN Ea accident 1 -1 .000 000 B ANY AUTO BODILY INJURY(Per person) $ A�ilro°sED �ToL� ' 46796600 ]1612016 1/6l2ois BODILY INJURY(Per accdent) $ Y`:`HIRED AUTOS } O Q V1SlED QRO T"DAMA34E :c $ -77 X UMBRELLA UAf3..- }L OCCUR ,.. EACH OCCURRENCE $ 1,000,.000 A EXCESSCIAB CLAINISavtADE AGGREGATE $ 1,000,000 DED RETENTION as 39944$Q 9j16j2014 0j16j2035 C RKERSC WI MATION ffitlars Yrrcludecl fo= V�CsrPrLt TH_AND EMPLOYERS LIABILITY X ANY PROPRIETORJPAR•TNERENECUfIVE�YTOP IN overage Y I R OFFICERJMEMSER EXCLLOED? e- t NIA E L.EACH ACCIDENT $. 5OO OOQ (Mandatory in NH} ]3 t.4 /91201'5 %9%'2CY16 " ityyees•describeunder El,Q1SEA$E--EAEMF,fOYE $ 500 00 DESCRIPTION OF OPERAT10NSbeloty El.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OFERATfONSI LOCATIONS I VEHICLES.(AttachACORD 101,Addlonel Remark%$Lheduie,if more spacb is raquined) Issued as evidence of:insurance. Thielsch Engineering, Inc. is listed as additional izsured:.as.respects General Liabil3ty. as :seguired by written contravt.. CERTIFICATE HOLDER CANCELLATION _ SaDA$ c:ap437 f�hteCa aCt,,Grrr� : WIGULB AMY OF THE ABOVE'DESCRiBED P61:1;1ES$E C>•1'FtCELLED'BEFORE. THE ,EXPIRATION DATE THEREOF, NOfiCE WILL f2E', DELIVERED IN Cape Light Contact ACCORDANCE WITH THE POLICY PROVISIONS. Attn:_ Margaret song 0 59Z 427ISCK, auTHORtzEDREPRESENrAnVE 3195 Main Strep-t Barnstable, M� , 02630 ehael Christian/CLC INS025I(2 oos).oi. 5 a ©1999-201.0ACORDCORR eORb nameand OIRATIOAI AI#r?ghtsreserveci. logo are regis#ered marks of ACORD Building Permit Authorization I, David and Laura Wentzel , as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office:508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 7 Harvard Street Hyannis, MA 02601 Signed Date 12, 1 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation 7 Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. IS McCLUSKEY WILLIAM �. 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664WIN4 � Update Address and return card.Mark reason for change. Ej Address [D Renewal 0 Employment Lost Card SCA 1 % 20M-05/11 . _��c lFr rirrritnrttueu.Gt11 t�f�it'�a.tGr[cl,[t�e//' -., Office of Consumer Affairs&Business Regulation License or registration valid for individul use only t OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: j171380 Type: Office of Consumer Affairs and Business Regulation ;` -. 10 Park Plaza-Suite 5170 Expirations 3/14/2016. Corporation Boston,MA 02116 CAPE SAVE INC. WILLIAM MCCLUSKEY � ^ 7-D HUNTINGTON AVENUE; SOUTH YARMOUTH, MA 02664 Undersecretary Not vali ithout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialtt License: CSSL-102776 WILLIAM J MC C-LUSKEN 37 NAUSET ROAD West Yarmouth MA 023�; J,�.. �1 • '� r-s� IJ Expiration Commissioner 06/28/2015 ' S TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION' Map_ '29(� Parcel Application # J 4 Health Division Date Issued S- Conservation Division Application' Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village nn__ S f Owner �-�-I`Gt. �- Address 1 yam' M Telephone J '3 y 4- 7 6 A3 ,1 Permit Request /-!'Ir S�-��q SWP.E/>S Cf- (.y�S Q`71. �J�INS 6hae-01./� f d&iJ'a 8/&P40-0bo— oL CST �''es-ts • Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ifnh#w &JhrATelephone Number Address cl? zz f k License # lyJr� ref er MA lS a 7 0l l Home Improvement Contractor# EmaiI0J1e��VeweR riZ��1 ra�Yh�l dM Worker's Compensation 456dI&"<,446f4��09" ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 1' eS IVP.�fi`� SIGNATU 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. Ri tfax C1-1 4/7/2015 6:23:53 AM PAGE 17/020 Fax Servarr s o P CERTIFICATE OF LIABILITY INSURANCET�Q,S THIS CERTIFICATE IS ISSUED AS A btATTER OF INFORMATION ONLY AND CONFERS NORIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENDS EXTEND OR ALTER THE COVERAGE TAFFORDED By THE HE ISSUING NSURE9(S),AUTHORIZED REPRESENTATIVE LICIES BELOW. IS CERTIFICATE OF INSURANCE DOES NOT OR PRODUCER AND THE ERTIFICATTEE HOLDER �7 BETWEEN IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(es)must be Endorsed. If SUBROGATION tS WAIVED, subject to the terms and condition's of the policy,certain policies may mquiso an endorsement. A statement on this certificate does not corrfer rights to the certlficete holder in lieu of such endorsement(4 CONTACT PROCUCER MkME: IVEIROS INSURANCE AGCY PHONE FAX arc 375 AIRPORT RO E-AWL FALL RIVER MA 02720 INSUREFM AFFCRDNG CCVERAG E + s MSURERA ACE AMERICAN INSURANCE COMPANY NWRED MURER B ALTERNATIVE WEATHERIZATION INC MUMAC: 1446 STAFFORD RD , 24URERD: FALL RIVER,MA 02721 IN.4URER E . MURERF•COVERAGE$ s F BE B 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 REOUIREMENT, 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. AM iNSR TYPE of I)MRANCE wsR w w ICY NU&MER er PoucY ExP LIMITS lTR GENERAL LIABtUTY EACHOCCURRENCE - S COMMERCIAL GENERAL UABILrrY E a m�vr s S AOE OCCUR uK0 EW(Any om an) S PERSONAL&ADY INJURY S GENERAL AGGREGATE 9 GENL AGGREGATE L1.Vr'r APPLHcs PER; PRODUCTS-COMP-VP AGG 9 9 LAC Mg 6EOPINGLE LRAT S BILE LIABliITY ANY AUTO S=Y INJURY(Per pamm) S " ALL SCHEDULED - SC0LY INJURY Oaracadsnt) S AUTOS K NON.OWNED P t�Y AMAGE S E'.IREDAUTOS AUTOS g 1R29JtEL..LA I.lAB OCCUR EACH OCCURRENCE S E)fGEu8 LIAR l W M&arADE AGGREGATE S DEO. RETENTION S a ' WORKM COMPENSATION X WC STATIY Oho ANDEMpLGYEWUA8LFTY - TORY LIMITS ER . ANY PROPRIETORIPAQTNERIF C��UTTTtttVVV��Y t�N NIA El.EACH ACCIDENT $SQO,000 . OFF rCE;;,?auaER 6S62UB 04.05-2015 04-05-2018 E.L.oISEASE-FA EMPLOYEE $500'000 - INendatm in NH) 5B918901 if Ym aesrrmc � E.L DISEASE-POLICY UMtT 3500,000 DESCRIPr*N CF OPERATXM bdow DESCWT10N OF OFEtArM I LOCATIONS I YB9CL.ES{Atboh ACM 101,Adaldenal Sww to Sdadule.If We apace IS reWreco C O NATIONAL GRID SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B 44 WASHINGTON ST., CANCELLED BEFORE THE EXPIRATION DATE THEREOF, WESTBOROUGH,MA01581 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORM REPRFSBfrATP1E 01988-2010IfACORD CORPORATION.All rights reserved. ACORD 25(2010f05) The ACORD name and logo are registered marks of ACORD ,� �, �i•• 22 �Q�2:�2��L112�v�� C��;y,1��iLL:1.2L�• Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 175683 Type: Corporation Expiration: 5/29/2015 Trlf 241009 ALTERNATIVE WEATHERIZATION, INC. TIMOTHY CABRAL 1440 STAFFORD RD. FALL RIVER, MA 02721 Update Address and return card.Mark reaso for change. Address r Renewal J EmpIoyment 1-1 Lost Card Sr:A1 G 20M-W1i r `- n License or registration� ,_ Office of Consumer Affairs&Business Regulation grstrati0n valid for individul use only E �" OME:IMPROVEMENT CONTRACTOR before the expiration date. If found return to: �tZegistration• t756g3 Type; office of Consumer Affairs and Business Regulation Il a a Expiration: •5/29/2015 Corporation 10 Park Plaza-Suite 5170 ' � Boston,MA 02116 If ALTERNATIVE WEATHERI2ATION,INC. TIMOTHY CABRAL ' 1440 STAFFORD PD. FALL RIVER,MA 02721 ---'�--- Undersecretarq N� t vali _ out signature :.j' , mrrurtit n su11cn i+1! CS40544 TIMOTHY CABRAL 58 DICK EMSO ST I±all River MA 02721 :. 0=8/2095 The Commonwealth of Massachusetts Department of Industrial Accidents o I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lezibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC. Address:2 LARK STREET ' City/State/Zip: FALL RIVER, MA 02721 Phone #:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): I.Q I am a employer with 14 employees(full and/or part-time).* 7. New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.[]l am a homeowner doing all work myself.[No workers'comp.insurance required.]' • 10 ❑Building addition 4.❑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 or are sole 11.❑Electrical repairs Or additions proprietors with no employees. 12. Plumbing repairs or additions 5.r7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14.�✓ Other INSULATION 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 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 policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ♦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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:ACE AMERICAN INSURANCE CO. Policy#or Self-ins.Lic.#:6S62UB5B918901 Expiration Date: J c Job Site Address:`3 _ Ave, City/State/Zip: JOL Attach a copy of the workers'compensation policy declaration page(showing the policy nu er and �iration te). 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 certify under h ,n/s an al sop jury that the information provided above is true and correct. Signature: v Date: Phone#:508-567-424 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: :.r f,M�� ks mass save ° R moo.t,,raergh�,�r.ltidu+cy _ - � PERMIT AUTHORIZATION FORM i, CARLA SENST ,owner of the property located at: {Owners Name,printed) 13 4th Ave HYANNISPORT (Property Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X Owners Signature Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date For Oif ce Use Only Rev.12132011 �1ALTERNATIVE POW W EATH ERIZATION Date ` Town of Barnstable Building Division ' 200 Main St. Hyannis, MA 02601 The insulation work at ��J �' has been completed in accor4 me vu'tfa".. OCMR.,,, •n othy Ca taj President CSL 105454 58 DICKINSON STREET I FALL RIVER,MA 02721 I (508)567-4240 I ALTERNATIVEWEA KERl7.AT10N�GMAIL.COM •� o�tHE � Town of Barnstable *Permit# Tres 6 monthsf rom issue date Regulatory Services Fee sauvsTaste, y Mass Richard V.Scali,Directo �p 039. �0 44 '✓ l/ TE0 fA°'`°' Building Division� $ Paul Roma,Building Commissioner 200 Main Street,Hyannis MA 02600Cr 18 2 016 www.town.barnstablp8VV I Office: 508-862-4038 ®FBARAI'�c Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTI RTA SLY Not Valid without Red X-Press Imprint -- - `�... .. Property Address Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address S ol76o Contractor's Name® t94!�V,-�S.h Telephone Numbers Home Improvement Contractor License#(if applicable) Email:_b L4 G Construction Supervisor's License#(if applicable) C,5jrn —0 67 7 3CY L] ❑Workman's Compensation Insurance' Chec one: am a sole proprietor,, ❑ I am the Homeowner, ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy,# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) , x ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. ` *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property.Owner must sign Property Owner Letter of Permission: A copy of the Home Improvement Contractors License&Construction Supervisors License is required: SIGNATURE: QAWPFILESTORMS\buil ing permit forms\EXPRESS.doc 06/20/16 - v is • Z. i 37ie Corr mamvealth of-Massachusetts Depcartwerrt c�frndus-&ialAccrderds Of ce of 1m figations 600 F adzirrgto:it,street Boston MA 02111 Wark-ers' Campensaficn Insurance Affidavit 130ders/ContradursJEIec dcians Phunbers Applicant Infarmafian Please Print Ida=(Snsineessf ran ionlFnrT dua11.= 6e-,t k— Cti Ad&,ess' P0, _ d. Z City-ISta,tdZig 4-S �, �!�y�Ihant-, Are you an employer?Checkthe appropriate bow. Y 4Tppe of graject(required': I am"a general confractar a rta I I.❑ I am a empla�,*er with °' . 0 6. ❑New ct3nsf=Asctiou employees(fish andforpart-timed* 'have hired the sub- contractors listed the attached sheet 'I. �Remodeling :. 2.® I am a sole propzietor orpertner ou""' ship and bane no employees A These sob-condrac ors have 8_ Demolition _ w g for,ne in any T employees and have wo&ers' a[�IIb Y � ,-. - M '9. .0 BIItl�g additton _ [Na l Tdxrs'Comp_insurra=e comp-insitranv req u -d] -5_ ElWe area corporation audits ' 10-0 Electrical repairsor additions E. 3.❑ 1 am a bomeauer doing allariey< officers have ese�rcised(heir 1L0 Plumbing repairs or additions o vuorScecs, ri�of exemption per 1GiGI: 12 Rflofr inM==e:egnired-j i p x '' .•c.I52,`§1(4);andwe have no ' ., employees.[No workers'.. -13-� ffQO�• yt.I • • caIIzp_msoranve requtred_) • . ; �., 'A.y appficzutdmt checks box#1 mast also ot fffothe sectiaabekwslxu s g dmirworkere aampensa&itpo&cyinfot�aumi #Homeowners wbo submit this affidacii in n tiwp axe dais;ag wC*and d=h¢e outside contmctarsnmst submit a new afdx&frdicariag sacfi. TCaamictnisYfist the lr this box must attadsed in additicm sheet showing the amneof dw sub-caatwbDa sind state whalh4 or nut thnse en�b.n P- employees. workixe comp.policy aum,}scr_ .. I arts apt eliiplayer t7tat isprat dint;,itarkers'compertsrttioit irtsrirartce f or m}s encpFia}+�es $elo�v is tl�e�poficy�curd joys 4 Insurance Cotupauy Nrame: Pa-Rcy 44 or self-ins-Li-6_. ,i ; a.ExpsFatraa Bate:n y :.r Y a . Job Site Address~ Citylst#dzip .` Attach a-apy of the workers'campensationpolicp declaration page(showing the policy number wind expi anon date). Fa l=to secum coverage as required.uuder Section 25A of MO-c_1572 can lead to the imiposifi=of criminal penalties of a fine up(o$UDD OD arrd+for as �earimpaisonment,as wel as riv l peualtiesia the fans of a STOP WORK ORDER and a fine of up to$250,0O a tag against the violator_ Be adsdsed:tbat a copy of this statement inayba faiwuded to the Office of Investi-gations ofthe DIA for insurance coverage v-e€i$cation. I rta ftzreTiy cgrhfj,ander th pruris andpsrialxies o fpeej?}'thatdie informa€mi ptmi&d abm•e rs true and cirrrect: M r - s Date J - S'i.�ture: Lo ' Phone ®-`t � Of lw' iat use*79j, Do not write in this area,to be Compreted by city artopm afoiciat ' f. City or Town: PermiffLicense Issuing A &ority(Melt=one): L Baard of$e lth I Bui[ ing Department 3. LI`owa Clerk 4 Electrical Inspector S.PIunxbing Ins*tor 6.06-ar a. Confact Person: :hone#- -- ---- -- - - 6 Information and Instructions Macachmctfs General Laws cbapira ISZ req=s all employers to provide workers'compensation for their employeesPurm . �this sty,an mipLUyne is defined as."_.evezy person m the service of another under any contract ofhire, express or implied,oral or wiitmn An Moyer is defined as-an mdxvi partnersbip,association,corporation or of aer Iegal au.#iy, or any two or more of the foregoing engaged is a joi at enf$rptise,and including the Iega1 representatives of a deceased employer,or the receiver or trnstee of an mdividaal,par[netship,association or otherlegal entity,employing employees. HOwever the owner of a.dwelling house having not more ffian three apadments and who resides therein,or the occupant ofthe - dwelTmg house of another who employs persons to do mainfenan-ce,conshv�i on or repair work on such&welting]mouse or on.the grounds or other appurfenanttiiereto shall not because of sash employmeaitbe,de:=Ddfn be an employer." MGL chapter I52,§25C(6)also stators that"every state or local licensing agency shall withhold the issuance or renewal of a hcease or permit ermit toop erate a business or to construct bmiitdmgs in the commnonwealth for any n applicant who has not produced acceptable evidence of cdmpfianm with the;ncm-ance covexage reqairecL Additionally,MGI,ehapitr 152,§25C(7)states-Iei$ier the commaawr2M nor any of its political subdivisions shalt enter into any contract for time perfmmaneo ofpublio work unh7 acceptable evidence of compli.au=71ith the n1sUra ce._ requirements of tlz chapter have l een press to the contra anthoatt 71 Apple f PIease fill out the workers' compensation affidavit completely,by che6 the boxes that apply to your sitnation and,if necessary,supply sob-contractor(s)nare(s), address(es)andphonenumber(s) aIongvvithihe=r certdicate(s) of i„crn-ance. LimnitrdLiability Companies(LLC)orLmnitedLiabi-ityPertammILips(LLP)withno employees other thanthe f or LLP does have arm not in womjrers ensafron igsn'ance. If an LLC members or parfneas, rid can•Y �P employees,a policy is rmpired. Be advised that this affidayif maybe snbraith--d to the Department of Indn trial Accidents for confrrmafioa of m since coverage. Also be sure to sign and date the afn-davit---The affidavit should be m etamed to time city or tDwn that the application for the permit or license is being reque not the Department of Ldr sirial A-=dents..Should you have any qn estions regarding the lave or ifyou are req=u to obtain a woik=' compensation policy,please call the Department at the n=.ber listed below Self-insrned comxgmarmies should enure their s Hcease number on time appropriate line. City or Town Of i ials Please be sore that the affidavit is complete and piintedlegibly. The Department has provided a space at the bottom of the affidavit for you to fM out in the event the Office of Investigati ons has to cou act you regarding the applicant P leas e b e sure tD fill in the pemmitllicense nwnbes which will be used as a reference number. Iu addidon,an applicant that must submit mu14le pemsWHcense applit*dons in any given year,need only submit one affidavit indicating=ent policy in:E6 a-tion.(if necessary)and under"Job Site Address"the applicant should write"ail locatiLns L (may or- town)_"A copy of the-affidavit that has been officially stamped or ma&Dd by the city or town may be provided to tine applicant as-proof that a valid affidavit is on file for fatal 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 tQ any business or commercial veufzrre (Le. a dog license orpemnit to btun leaves etc-)said person is NOT regn¢ed to complete ffmis affidavit The Office o f Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesha±r to givens a call. The Dep:R 6nenfs address,telephone and fax rmmber_ ' w�alt3E of Mauch . e�of�ud�za�Accidents - ��of�esfrg�fiap� � - �4 Stan S�ee� - - �Q IvfA E�11� Te,1 4 617' -49W=t 4-06 or 1-977 MA Sfi� Fax 9617` 27'749 Revised 4-24-07 g�� Town of Barnstable Regulatory Services r KAB& ' Richard V. Scali,Director. 1639. Building Division.- ' Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us --Office: 508-862=4038--— _... -- ___._:__.. Fax:-508-790-6230 — f Property Owner Must Complete and Sign This Section If Using A Builder I '16 vwe ��IJ� as Owner of the subject property herebyauthorize �'=1 Y to act on ray behalf, - y �z in all matters relative to work authorized by this building permit application for: , r � , 7 -L , /J / (Address of Job **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspectio erformed and accepted. S' atute-of Owner Siknature of Applicant �.waa¢1 GliFr ,. to 6 p aj'" Print Name Print Name: .4 �� ✓�� . Vie. y , i .. � < f{ �� -R • Date ' QTORMS:OWNERPERMISSIONPOOLS 4° Town of Barnstable 0 Regulatory Services oFtHE Richard V.Scali,Director Building Division Paul Roma,Building Commissioner MAsa 1639. �� 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: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: r•. 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 f6r compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 person(s)for hire to do such work,that such Homeowner shall-act as supervisor." ;i Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner,is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 { Y r Massachusetts Department of Public Safety Board of Building'Regulations and Standards License; CSFA-057394 ROBERT G WADI 735 Old Barnstab*R4MF East Falmouth MA J 1'141 Expiration Commissioner 06102J2017 - - " License or registration valid for indi return use only Rice of Consumer Affairs&Business Regulation before the expiration date. If found return to: ="--0 Office of Consumer Affairs and Business Regulation,' _r HOME IMPROVEMENT CONTRACTOR' 10 Park Plaza-Suite 5170 Re gist 141991 9 DBA. Boston,MA 02116 -' Expiratlon: .31312018 HARBORSIDE REMODELING ROBERT WALSH 250 CAPTAIN CRO$BY.ROAD : ; I Not valid without signature CENTERVILLE,MA 02632 Undersecretary t i 14 Town of Barnstable FtHe T°`'�o Regulatory Services Thomas F.Geiler,Director BAMSTABM MASS.. �� Building Division y _ �ptFD MA'S s` Tom Perry,Building Commissioner 200 Main Street, Hyannis,'MA 02601 Office: 508-862-4038 Fax: 508-790-6230 � vu PERMIT# � FEE: $ -S 6 SHED REGISTRATION 120 square feet or less Location of shed(address) V llage. yam- 4 6 o 64 Property owner's name Telephone number Size of Shed ° Map/Parcel# H X 4Sig4riae Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) 3 )171o3 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN I� Q-forms-shedreg REV:121901 3 It.andard Shed penis ZP fur most popular design, a cl� sic peaked t - roof with�2 pitch is p elvingTV �J an`d hanging space on-walls hale k, epiitg floor spice at a maxi�ium .Traditi`i�nal functional ) r - die � Pricing f - J y $960 00, 10X1Q $1630 00 ` 6x10 $1080 00 1Ox12- {1.0 f - a? 8�c8 $J 040 00 A-14 $2170 0.0 j �:. 8xla $1280 00 1Ox16 $24400 ' 8xL $1500 00 12x12 $2�00 00 $1650 00 12x14' $�bZ6: 12 ern x16 $2980 , ' � .r t= ;, _ � � � `` Pnceis subject to'c�ange �ithout,nottce-rAnce does'r�ottnclude��D sales tax } f'• You will loge=the cute load-;of these sheds , Ozi tradiuonal:,sliort�Tront roo keep'sxhe r-bfile of the buildin smeller and:c terLot " g ' is.not a r ilable on t i e m6deY fie _r�cin 6x$ $880 00 8x 14. $1550 Q0 1Ox10 $1580 00 $9$0 00 1Ox12 $165000 :I ljii;i � 8x1"0 $i21000 1Ox14MEMO y $197000 = o s a r 8xi2 $1410 00 - 1Ox16 $, 4.6.00 >- Pnce is subject to change wtt}tout notice. Vince does not mcluIJe 5%spj�s.tax , .. 'Exist, Dwelhno Proposed Shed in W. H onnis ort MA fl . Pre o�ed For:: Frederic. P. Claussen P Assessor's Mal): MAP: 246"— PARCELS: 185 Baxter, Nye & I-IOlmgren, Inc. Community Panel Nlumbe•r:-250001'0008 D " a Registered Professional F.I.R.M. Map Zone:. C Engineers and Land Surveyors Plan Book:,34123 (Lots ',210 & 212)'- 350/34 ; 812 .Moir St Deed Book: 13,853,/314 '_ „ Osterville, PEA 02655 Owner: Frederic P. Claussen Job No:°t2003-021ob dga, Phone- (508) 428-9131 Foz - w (508)-428-3750.' t Scale: 1" = 30' Date: 04701-2003 CRAIGVILLE BEACH Rp ,Ap: S 89'04'30" E 170.51' BRB FND BRB FND �I m L 0 T 1 U z » PLAN BOOR 350 g .ti:►,��,.�;, •�w. . ,-T*. M,zz.-f,..f •r�. ,._��., ;�,, PAGE •34 E..:.•} .. ..., --+I � a A; +,C11�/, 1Z'l1R w .cll (� tG' §��-5 i•„ .k�tir R '*. J a ; .,# T e _L �-Y raisyt ;.1rt t;' qd 8T29'37" Eft 10.5" i, 9 1.00.06 T N y 8,005f SQ. FT. . C 10.5' a' 0.18± ACRES 38.7' PROPOSED . \ .. 6SHED o X QD n} n o t,a m Z O n/f SIL�i ► o mN Wm �. o . m DECK STONE _ m w DRIVE Z' rn O 100.06' N . -� S ST29'37" W Z < STOCKADE FENCE I N C bt^!'Za�.I.✓.s.r:,cc4h.fitly .>'x:.'.tY•:-Y✓fit.."-. -r. ".L:�,R•�"^...t..n.f:. t.:}:h*. .."T,.'�`.- -.f.,:•..;i:. .. .� '-., {`iI �"a'.z m.:.'^",-.t..} x:Y... .. - .._:w.:av,n:.,ar+a:.•F...:ze.t: :'4>3';.Faa •...a.. .,.:: +4a:»...r,iz.^.. ,a,L;...:�A -_ , . .,.:a ,...�ttss` h ;�r¢v;%'n'ta:.r . CD ' ,-y Y. ':. i_`"'„ .:�,s,� '-).itir+• t;A?' 7'a c,i'v'€1 n/f Fli'ZPATROCK n/f . CAM 0' 13RB FND- (' CERTIFY-THAT.TO THE BEST OF MY KNOWLEDGE THE '.-STRUCTURE SHOWN HEREON .IS LOCATED IN RELATON 3� ✓ r � TO THE: MONUMENTS SHOWN, AND IS NOT`.LOCATED u 11A +' WITHIN A SPECIAL FLOOD HAZARD AREA h� THIS PLAN IN' NOT TO'BE RECORDED NOR.. IS IT.TO BE E 15 TO `ESTABLISH'PROPERTY=LINES F ' USED _ •' •� � • 4- y RE ISTERED PROFESSIONAL LAND SURVEYOR DATE Town of Barnstable *Permit# %011ni Expires 6 months from issue date Regulatory Services Fee d� Thomas F.Geiler,Director Building Division X-PRESS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 S E P 14 2005 /Z www.town.barnstable.ma.us Office: 508-862-4038 _ TOWN of Ba� $� _ 6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address P-00A C 4 11 ,'(Oj(A 1 Q J 4 7 ,;' [Residential Value of Work 4 U C, Minimum fee of$25.00�for work under$6000.00 Owner's Name&Address Com ,,:e ( oy c e A. �' �Y 4-., � f Contractor's Name ' lO M C c4-n -P r J� Telephone Number--? 7 y" a?8 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: t. ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. rry Permit Request(check box) CC] ❑ Re-roof(stripping old shingles) All construction debris will be taken to F ❑Re-roof(not stripping. Going over existing layers of roof) co g Re-side Replacement Windows. U-Value (maximum.44) •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must 'gn P operty Owner Letter of Permission. om Improvement ontt tors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 I , The Commonwealth of Massachusetts Department ofIridustrialAccidents ' q. Office .f g i e.oInvesti ations ' . : 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers • n Please Print Legibly Anuhcant Inform � Naine(Businessiorpnization/Individuat)' Can C' _• /c -C �4Address• > > d� v cam.. . . ® � 6'Z . Phone#:' ?� 3}- City/State/Zip: , Are you an employer? Check the appropriate box:. Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full'and/or part-time).* have hired the sub-contractors 2.El I am a sole proprietor or parEner- listed on the attached sheet $ y?• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g• ❑ Building•addition workers' comp.insurance 5. ❑ We are a corporation and its [Noofficers have exercised their 10.❑ Electrical repairs or.additions required.] 11.❑ Plumb repairs or additions.. 3.L,Zg,I am a homeowner doing allwork right of exemption per MGL g ep (( ``myself.-(No workers' comp. c. 152,§1(4), and we have no 12.❑ Roof repairs insurance required.]t employees. (No workers- 13.0 Other ca=p.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 $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'coup.policy information. I am an employer that isproviding workers compensation insurance for my_employ ees.'Below is the policy and job site. information. ' Insurance•Company Name: Policy#or Self-ins.Lic. #: Expiration Date:• Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Fafiure to.secure coverage as required under Section 25A of MGL c. 152 cau lead to the imposition of criminal penalties of a fine up to$.1,500,.00 and/or one-year imprisomnent, as well as,civil penalties in the form of a 8TOP'yVORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maye forwarded to.the Office of . Investigations of the DIA for insurance coverage verification. and r the p ns and penafties of perjury that the information provided above is true and correct I do hereby c Signature: Dater �� •�/' 0� Phone#: �- Official use only. Do not write in this area,to be completed by city,or town official City'or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: n and Instructions. •• �;. Massachusetts General Laws chapter 152 requires all employers to Provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." , association,Fgrporation or other legal emtity,or any t}vo.or more An employer is defined a$':'P4 1p;divi4A.Tartcierslnp : . .lo er,or the' of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased emp y ,association or other legal entity, employing employees. Howovpr:*he' receiver or trus.4 ee of an individual,partnership,ershiP erein,or. eoc owner of a dwelling hous a having not more o maintenance,�v' o oho resides rrepair wo x on such dweIlinB house dwelling house of another who employs persons or on the grounds or building appurtenant thereto.shall not because of such employment be deemed to be an employer" MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable e 15225C -dence of compliance with the insurance coverage required.". . P ter , states"Neither the commonwealth nor any of its'political subdivisions shall Additionally,MGL chap .. § (� enter into any contract for the performance of public work until acceptable.'evidence of compliance with the insurance ieq#emeats of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking thealboonxesttat apply ca e(s our situation t n and, if necessary,supply sub-contractors)name(s), address(es) and phone n ( ) g insurance. Limited Liability Companies(LLC)or Limited Liability Partaerships(LLP)with no employees other than the or LLP does have members or partners, are not required to carry workers' comp s be submitted to the Deption insurance. If an artment of Industrial employees, apolicy is required. Be advised that this affdavi y it Accidents for confirnnation of insurance c Also be sure to-sip license requested,nd date the is being ue� ,�not the Deparfineat of shouldThe affidavit be returned to the city or town that the application for the Permit or Industrial Accidents. Shouid you have any questions regarding the law or if you are required to obtain.a workers' at the number listed below.. Self-insured companies should enter their compensation.policy,please call the Department self-insurance license number on the appropriate line. city"Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the btm of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicanttion, an applicant Please be sure'to fill in the permit/license number which will beused ars need only submit on affier. In davit indicating current that must submit multiple permit/license applications m any giveny mY policy information(if necessary)and under"Job Site Address"'the applicant should write"all locations in (city or A copy of*Le.affidavit that has been officially stamped or marked by the city or town may be provided to the of that.a valid affidavit is on file for;future permits•or'licenses..Anew affidavit must be filled out.each applicant as proof . g a license or permit not related to any business or commerce venture year,Where a home owner or citizen is obtainin (i.e. a dog license or permit to bum 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 o:�Investigations .600'Washingfon$MetV . BOAOn,MA 02.111, Tel. #617-727-4900 ext 406 or'1-877-MASSAFE Fax#617-727-7749 Revised 5-26705 www,mass.gov/did Town of Barnstable �pftME T�O Regulatory Services snaxsTeBiae. Thomas F.Geiler,Director M"M Building Division i639. ,0� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / Please Print DATE' 1y. v JOB LOCATIvly O�/ ' �✓ number f � street !! l village "HOMEOWNEW' ZC P 7�t 0"name home p �^-- p o e ph e# work hone# CURRENT MAUING ADDRESS: r y n C'<l , D 14 c ty/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. t(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"ho eowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection rocedures and requirements and that he/she will comply with said procedures and req ' ements. SiKu n of Ao4or V/ 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$tares that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption we 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 fomi/certification for use in your community. rl•Fnrrnc•l.mmoovmm�t