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0074 HARBOR ROAD
�� %����z��J ��,� ,. VIP Town of Barnstable Building Post Thrs Card So Thatrt rs Visrb(e;From theStreet�y Approved PlansMusi be Retained on Job and thrs Card Must be TKept * Posted Until F ni al Ins action Has Been Made y ib � Nr ,� �'�. s � tee'� � � � �r �,' Permit Where aCertificate of Occupancl/rs Req"ulred,such Burldrng,shalt Not.be Occupied until aFinal Inspect�onhasbeen made v. Permit NO. B-19-2331 Applicant Name: Craig Bishop Approvals Date Issued: 07/19/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 01/19/2020 foundation: Location: 74 HARBOR ROAD, HYANNIS Map/Lot 306 173 004 Zoning District: RB Sheathing: Owner on Record: MCMANUS,JAMES P&NATALIE Contractor Name Craig P Bishop Framing: 1 Address: 7 PLEASANT STREET UNIT#8 Contiactor'license CS 109777 2 CHARLESTOWN, MA 02129 ; Est Protect Cost: $2,024.00 Chimney: Description: Attic Damming,attic flat,install the rmadome,ventilation chutes, Permit Fe"e: $85.00 vent bath fan through soffit,install soffit panels, r ai sealing, ' Insulation: Fee Paid $85.00 Project Review Req: Date 7/19/2019 Final: ¢� Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work autho zed&by this permit is commenced within six months after H an Icia Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction"documentsfor whicfi this permit has been granted. All construction,alterations and changes of use of any building and structures;shall be in compliance with the local zoning by Laws`and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street orroed and shall be maintained open for public inspection for the entire duration of the i l Final Gas: work until the completion of the same. a a The Certificate of Occupancy will not be issued until all_applicable signatures b h euildmg and"Fire Officials are prow ded on this permit. Electrical -- Minimum of Five Call Inspections Required for All Construction Work r g 1.foundation or Footing Service: 2.Sheathing Inspection k 3.All Fireplaces must be inspected at the throat level before firest fluening is,mstalled .� ,.. Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction., Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available.on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: ONE ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ' Parcel'I palGtl .�M1dN 1p `-Application # � � P Health YDivision .Date Issued Z Conservation Division :Application Fee Planning Dept. " Permit Fee. 1 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address '7�. uAlbo! KA1�d Village P VAN ff j.� MA D21o01 Owner JAMb Me. Moau) Address Dew .1 I vkA X0 02W Telephone p Permit Request n pG�GL= /fdx/T G jk,0ool,? q449 a /2002S, a4i f= CA>T' Square feet: 1 st floor: existing proposed 2nd floor: existing. proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation JD D00 .ca . Construction Type Lot Size . 3 Grandfathered: ❑Yes YNo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes YNo On Old King's Highway: ❑Yes Lill'No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 2 new Half: existing new Number of Bedrooms: . 9 existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: YGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes YNo Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes YNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other:- �4 . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ r Commercial ❑Yes LIB No If yes, site plan review# Current Use Proposed Use = '` APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Sgvlys 'Qolqsjluulomi . wG Telephone-Number SOQ • 9Q9 • 23Lo- Y S'n BA6930 Address y �� License # CS ��830 � I�taV�l /Y10 Q2�32 Home Improvement Contractor# i Worker's Compensation # �C 00 D 222N I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Lt-�MbY! 20/0 i SIGNATURE DATE � 7 1 FOR OFFICIAL USE ONLY APPLICATION# ;r DATE ISSUED. " . r MAP PARCEL NO ADDRESS VILLAGE OWNER r ti { DATE OF INSPECTION: FOUNDATION:. r FRAME r INSULATION FIREPLACE op ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS .R ": ROUGH,R:2 f i FINAL ,FINAL B_U'ILDING'_E J5 2" tr ° .r t r. DATE CLOSED OUT F ASSOCIATION PLAN NO. t -J d. The Commonwealth of Massachusetts Department of Industrial Accidents h :'1 !- Office of Investigations I lit11itit 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): S411l4J5 C-yiijalvty UYG Address: 182 QQv Lam,' City/State/Zip: L.;Y1VpuVdIt, AA 02ri32 . Phone #: S6Q . 44� • Z310{ Are you an employer?Check the appropriate box: Type of project(required): 1.[�rI am a employer with *T S 4. ❑,I am a general contractor and I 6..ElNew construction employees (full and/or part-time).*, have hired the sub-contractors 2.❑ Tam a sole proprietor or partner- listed on the attached sheet. t 7• [✓Remodeling ship and have.no employees These'sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. Building addition [No workers' comp. insurance 5: 0 We are a corporation and its required:] '.. officers have exercised their 10.❑Electrical repairs or additions " 3.❑ I am a homeowner doing all work right of exemption per MGL" 11.0 Plumbing repairs or additions myself. [No workers'.comp. c. 152, §1(4),and we have no 12,Q Roof repairs insurance required,]t employees. [No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation.policy information. I 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 their workers'comp.policy information. I am an employer that is providing workers.'compensation insurance for my employees. Below is the policy and job sile info Insurance Company Name: Caw DA q Ucirmation:_._ �Say i Pao PsJ I- _. �. Policy #or Self-ins. Lic.#: We doe 2241 Expiration Date: �1 j10I11 •7+I 9011t>01 60,6d: / •F1 01V►* Mod M Job Site Address: C1ty/State/Zip: y 1[� ZIr 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 certify find e p s and nalties.of perjury that the information provided above is true and correct' Si nature: Dater &C.fL11�►�Y/ 2010 Phone#: 04 2,31 Official use only. Do not write in this.area,•to be completed by city-or town official City or Town: Perm'it/License# ' Issuing Authority(circle.one): 1. Board of Health. 2.Building Department 3. City/.Town.Clerk .4. Electrical Inspector 5. Plumbing Inspector 6. Other. Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employ's per so 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. ce e number which will be used as a reference number. In addition, an applicant Please be sure to fill in the,permit/li ns _ that must submit multiple permit/license applications in any given year, need only--submit one 4affidavit indicating current policy information (if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address-.,telephone'and fax number: . 'The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia ,ep�® CERTIFICATE OF LIABILITY INSURANCE OP DATE(MM/DD/YYYY)ID EM 12/13/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lou INAME: PHONE FAX DGP-Miles Insurance Agency,Inc AIC No Ext: (A/C,No): 3 School Street P.O. Box 1018 ADDRESS: PRODUCER Taunton MA 02780-0957 CUSTOMERID#: SQUIR-1 Phone:508-824-8961 Fax:508-880-2734 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Savers Property 6 Casualty Ins Squier Construction Inc. INSURERB: One Beacon American Ins Group 20621 Michael Squier 582 Bay Lane INSURER C: Centerville MA 02632 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 B X COMMERCIAL GENERAL LIABILITY 7100223870002 03/15/10 03/15/11 PREMISES(Ea occurrence) $ 1000000 CLAIMS-MADE FK OCCUR MED EXP(Any oie person) $5000 PERSONAL BADVINJURY $1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 X I POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) $ ANY AUTO 3900001640001 03/10/10 03/10/11 BODILY INJURY(Per person) $ 500000 ALL OWNED AUTOS - BODILY INJURY(Per accident) $500000 X SCHEDULED AUTOS PROPERTY DAMAGE $ 100000 X HIRED AUTOS (Per accident) X NON-OWNED AUTOS _ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION _ WC0002241 11/10/10 11/10/11 X - - AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIV _ E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA.EMPLOYE $100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) - Proof of coveragqe subject to actual policy terms, conditions, limits, exclusions and defintions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BARNSTA THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable AUTHORIZED REPRESENTATIVE 200 Main St. Hyannis MA 02601 ORFORATION. All rights reserved.. ACORD 25(2009/09) The ACORD name and logo are gis ered arks of ACORD Marianne @ Squier Construction From: Joe Madera Umadera@ShepleyWood.com] Sent: Monday, December 20, 2010 3;41 PM To: Mike Squier(E-mail) Subject: Emailing: M Squier 74 Harbor M Squier_74 , irbor.pdf(36 KB) Hi Mike- . (2) 1-3/4" X 11-7/8" LVL. spanning 11' and 7 ' ,work but the intermediate column would need to be 3-1/2" x 5-1/4" to provide. 5-1/4" of bearing length. Also, a post would be needed in the basement as this same intermediate post is going to have a pretty large load on it. Let me know if you need ,any additional information.. { Joe The message is ready to be sentywith the following file or link attachments: M S.quier 74 Harbor Note: To protect against computer viruses, e-mail programs may prevent sending or receiving certain types of file attachments. Check your e-mail securityjsettings t© a determine how attachments are handled. <<M Squier_74 Harbor.pdf>> ' This Email has been' scanned for all viruses by PAETEC's Hosted E-mail Security Services, utilizing MessageLabs proprietary SkyScan infrastructure.. For more information on a proactive .anti-virus service working around the clock, around the globe, visit http: //www.paetec.com: L , V i ' ,1 , Boise Cascade Double 1-3/4" x 11-7/8" VERSA-LAM@ 2.0 3100 SP Floor Beam\F1301 BC CALCO 3.0 Design Report-US 2 spans No cantilevers 0/12 slope Monday, December 20, 2010 Build 440- File Name: M Squier_74 Harbor, Job Name: Description: F1301 Address: 74 Harbor Road Specifier: Joe Madera City, State,Zip:Hyannis, MA Designer: Customer: Mike Squier Company: Shepley Wood Products, Inc. Code reports: ESR-1040 i Misc: .......... ,, 4-4 r€ _ �'. a hf- ,,�.„�; n, ��7,,„ �,,,,, ;YxF .-: 11-00-00 07-00-00 BO,3-1/2" ( B1,5-1/4" B2,3-1/2" DL 1;612 Ibs ILL1,61 Ibs LL 9,613 Ibs LL 2,762 Ibs DL 4,025 Ibs DL 694 Ibs UP 411 Ibs Total Horizontal Product Length=18-00-00 Live Dead Snow Wind Roof Live Trib.(in.) Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% 1 Standard Load Unf.Area(psf) L 00-00-00 18-00-00 40 - 10 14-00-00 2 Unf. Lin. (plf) L 00-00-00 18-00-00 60 n/a 3 Unf.Area(psf) L 00-00-00 18-00-00 20 10 14-00-00 Controls Summary value %Allowable Duration Case Span Disclosure Pos. Moment 12,056 ft-Ibs 56.7% 100% 14 1 - Internal Completeness and accuracy of input must Neg. Moment -13,247 ft-Ibs 62.3% 100% 1 21 Left be verified by anyone who would rely on End Shear 4,107 Ibs 52.0% 100% 14 1-- Left output as evidence of suitability for Cont. Shear 6,208 Ibs 78.6% 100% 1 1 - Right particular application.Output here based Uplift 411 Ibs n/a 14 2- Right on building code-accepted design, properties and analysis methods. Total Load Defl. U574(0.225") 41.8% 14 1 Installation of BOISE engineered wood Live Load Defl. U781 (0.166") 46.1% 14 1 products must be in accordance with Total Neg. Deft U-1;893 (-0.043") 12.7% 1.4 2 current Installation Guide and applicable Max Defl. 0.225" 22.5% 14 1 building codes.To obtain Installation Guide Span/Depth 10.9 n/a _ 1 or ask questions,please call (800)232-0788 before installation. %Allow %Allow BC CALC@,BC FRAMER@,AJST"^ Bearing Supports Dim.(Lx W) Value Support Member Material ALLJOIST@,BC RIM BOARDTM,BCI@, BO Post 3-1/2"x 3-1/2" 5,634 Ibs n/a 61.3% Unspecified BOISE GLULAMTM,SIMPLE FRAMING' B1 Post 5-1/4"x 3-1/2" ,13,639 Ibs n/a 99.0% Unspecified SYSTEM®,VERSA-LAM@,VERSA-RIM B2. Post 3-1/2",x.3-1/2" 3,456 Ibs n/a 37.6% Unspecified PLUS®,VERSA-RIM@, VERSA-STRAND@,VERSA-STUD@ are Cautions i trademarks of Boise Cascade,L.L.C. Uplift of 411 Ibs found at span 2- Right. Notes , Design meets Code minimum (U240).Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary(1") Maximum.load deflection criteria. Connection Diagram b --d a 1 c r a minimum =2" c=7-7/8" b minimum 3" d = 12" Member has no side loads. , SageelctOrt are: 16d Sinker Nails' f Massachusetts-.Department of Public Safch Board of Building; Regulations and Standards Construction Supervisor License License: CS 51830 Restricted to: 00 MICHAEL K SQUIER a; 582 BAY LN ,; A CENTERVILLE, MA 02632 " Expiration: 2/3/2012 Commissioner Tr#: 19019 At u a wn /consumer a irs smess g Office of CTOR HOME IMPROVEMENT CONTRA Type: Registration: 1,11006 private Corporatio 'fR Expiration:CONSTRzCSI� a MICHAEL SOUIER ?r g 562 BAY LN 2 Undersecretary M CENTERVILLE, , t License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs,and Business Regulation n 10 Park Plaza-Suite 5170 Bostofi,MA 02116 Not valid w' t signature i r. i HE Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 ww w.town.b arnstab I e,m a,us Office; 508-862-4038 Fax; 508-790-6230 Property Owner bust Complete and Sign This Section If Using A Builder L a c;,�,zS (101 CIN � S , as Owner of the subject property hereby authorize _ s{UiyA corwruu lbg Li a to act on my behalf, in all matters relative to work authorized bythis building permit application for: 14 ampol Qooa , 4wyau m u`o) (Address of job) la- IL l Sign. of Owner D e Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:O WNERPERMiSSION Z 'd ti�S 'ON N0I10AMN00 N3I00S MSS:L 0l N 'E l '030 .. �;n;r..�:,;es+ai!.mnsx-zvmtan5�+samwtra�zrm�vR..rme.��vecvwmvuxw.aennMay...,a�«r:�p,aa.mr.�...�.. � �. 'q. 1 ' t - v { TOWN OF BARNSTABLE BUILDING PERMIT'APPLICATION Map GC� Parcel, �7-� . GO s - Permit# APPLICANT MUST OBTAIN A SEWER, Health Division '' - q9 CONNEC r , r';,'.2IT FROM THE Date Issued ENGINF.'� I .1 DIVISION PRIOR TO — CONSTRUCTION. i Conservation Division Fee `, G Tax Collector Air Treasurer Planning Dept; t , t Date Definitive Plan Approved by.Planning Board N t Historic-OKH Preservation/Hyannis Project Street Address. '2 ,f��oefi�Gr' 2,6 Village Owner C 0 N r�£t,-, Address C'.Oma'J�- Telephone `7 °IO ° J d` q Permit Request �� v F•• ,17 Square feet: 1st floor: existing propose CO3 And floor: existing_ pro osed Total new Estimated Project Cost 2560 Zoning District Flood. Groundwater Overlay . � Y Construction Type L,,-00�9 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 ANo On Old King's Highway: ❑Yes 4No Basement Type: ,Full ❑Crawl ,*alkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) SJ, IVuber of Baths: Full: existing new Half:existing new i ' Number of Bedroo existing new 'Total Room Count(not including s) existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ectri ❑Other Central Air: ❑Yes ❑ Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached gar :❑existing O new size Pool:❑existing ❑n size Barn:❑existing ❑new...size Aft d garage:❑existing ❑new size Slied:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ ' Commercial ❑Yes >(No If yes, site plan review# ' Current Use Proposed Use BUILDER INFORMATION 1 Name_ Ac; of Telephone Number Address .'S ,�L f1 �.a� � License# �I © l � l ��/ ,6,9W1r /22.4 Sfr (j;C e0 Home Improvement Contractor# /�ZQ 7-cl Worker's Compensation# Ftc� =ZL1 - ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO191 i3 U SIGNATURE DATE 14 FOR OFFICIAL USE ONLY _ PERMIT NO.y DATE ISSUED i f v` , -� •': ' . - .: - ,,:_ ,. � � .. ; MAP/PARCEL NO. ra ADDRESS + ,, VILLAGE r* OWNER. �. t DATE OF INSPECTIQ ' '"" e'Tj C'3. _ , ; , A ' , L � S ' ' ' T t a r k • ..7 �a � ' i. FOUNDATION FRAME INSULATION • _ = r, t i._ ". + FIREPLACE." .. ELECTRICAL" ROUGH FINAL ,' • / I � ' � _ ` PLUMBING:``'"� ROUGH FINAL ' GAS: ROUGH FINAL* '� - � :� '. . `� 1 t': '• i ; �'� ,- t: ' >, , "" 4 t _ • rT t - ,.. .. '.• Y ! , t -' '_ f f t ram. j FINAL BUILDING DATE CLOSED OUT ASSOCIATION-PLAN NO. ' —` -..- - The Commonwea&h of Massachusetts -- - ' Department of Industrial Accidents VAYCR al/�esoffat/eas - 600 Washington Street . . -'—. Boston,Mass 02111 Workers' Compensation Insurance Affidavit name: , 4/'.btu L � (�1 a F-�/� location �S � ' ci O .}hone# —" GG ❑ I am a h meowner performing all work myself. . . . ❑ I am a sole rietor and have no one worlds ' ca acity ///%//O///////% % ///%%%%//O/////GO/%///%%zl/%%%/////%�%%�//%% /////%/////%//%%%%%/G%//////O/////��////%//%/%%%/%%%/%/%%///O%//%//%/�. y////%j /� %%//li, ;.. I am an employer providing workers compensation for my employees wox.rking on this 'ob. :::::..:::::::::::.:.:::.:.::.::::::::. ..:.. ......:::::::::.::..:::...::::.:::::::::::::::.:::::::,.:::.:: :.:.:.. ..................................:.:::.::,:::::--:,:::::::::::..:::::::.:.::::::::::::.::._::.:::::..::::::.::::..:::::::::.: iii :::,::..::::::.:,:::::::::::.:.:. .. :.: :: t.::::::::::: man';name...:. ... ................... ... . .......... .. .i.......E°................ ::: . ::::«:: ::>:_>:>:«:><:<::<::>::<;::::::<:::»>:«<::::«;:::::.>:::.:<_: .F:iii::'i::"::i...'.:Lii:.::4?i:;. /� '::: .. ...:.:n� :::: ::::•::..::::...........:ii.•?�:::::::::: :•::::::::::::::..:::::::-:•::.:..............:::::::::: :.:.�:::.::::.f..::..n........... 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':..:.........:.... .........................................................:...:................................::...:.....:.:::.:::.::::..:.::..:.:::................. ..........-.......................�................a.......... 'hi S>•,• ::::::::::.::.::::.:..::.::.:.::::..::.:::. .:::::.:::::::::::::::::::::::::::.::::::::::::...::::.................;i s i;. :.:-.'... :»>:i is>.:::'>:>::: :.... .. ::::::.;;::::::. urance a _ . .. :,i':;.i:>.»;' o1i:::..#; :; ::.: Fafim to coverage as required under Section 25A of MGL 152 can lead to the hnposition of crhninai penalties of a fine up to 00 and/or one y T' rtsomnent as wen as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I man copy of this statement may be forwarded to the Otflce of Investigations of the DIA for coverage verification. I do hereby certify a pains and aloes ury that the information provided above i4 tr/w.and correct Signature Date [�—� -- 9� _ Print name Phone# official use only do not write in this area to be completed by city or town ofildal city or town- . permuffleense# ❑Badlding Depar4nent ❑checkif immediate response is required I OSele tote soars ❑Srlcc6nen's O®ee OHealth Department contact person• phone#; _ ❑Other Umsed 9/95 PJl) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any cqn ract of hire, express or implied, oral or written. An employer is defined as an individual partnership, association, corporation or other legal entity, or ari two or more of �P P� � rp g Y the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold.the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peiinitllicense number which will be used as a reference number. The affidavits may be retomed 10 the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. MEN The Department's address,telephone and fax number: ` The Commonwealth Of Massachusetts Department of Industrial Accidents Imce of Imlesugadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �"E The Town of Barnstable enatvsrnai.E, '+6 Department of Health Safety and Environmental Services " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME HAPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. — Type of Work: L �ni. e r£„ �/!1 Estimated Cost SOO t Address of Work: r� Owner's Name: Date of Application: I I hereby certify that: Registration is not required for the following reason(s): 0 Work excluded by law ❑Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: r OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: rJ 7S 7 Date Contractor Name Registration No. OR Date Owner's Name } q:forms:Affidav ..r s f TIM d DEPART ENT OFPUBLIC-SAFETY' d CONNTRUCTYION'SUPERVISOR LICENSE �F r o Na�ie Ezpires � �estFu edx 11 't "95~�AINCE 5 Fib z Y: YAa1IS,xK �4 - � i F w; 1 ti - 47.E �' -N. 7 .� �,-. �r1r r a.� -`�-�" �24 �sSr �.`rX� � �•. - ��'i�--�� � ra � '-'.��(�T' v''-�P n.. .`:��' � �q 'y �'9a;:: x e s�Y v `€� ��. � �t n�"/` �%ti?�`a:a,.�+•t�,�+i`Y.h �' �'1�k t �:�`C.�.>< x: z t` eta ' m /�f�, - "`Ag, : n� : Mr • • MANI ._`'>ax.S ,. .+,9t` i' e x z4'.t.�`F+�'` ^.... ice`•„� ..d�'r` ,� v *�. - �. .- '-x Y 3y\ fr ► � -�. F,> ���.•y. '� T - �i� E'�: °Z eh g {' t. '- Y°# °"s-', ;,"a' ,.,,.5 -�`,,r t e�«.•,�., -%`�d "w" ` ,4 •F,fi-.i- r d r f�y.,a�{'°a - ',xP :* ae`r sarc`.?fi .M'F.,""�aa hh`'° :m „.`*'xY''ri'?'.� � >(l,j - yr 'C* e I' e ^„.r. g v., ..,�.k:✓�.v ti f 3•.;i'r* *+� ' ;.�.•-`''' a - � `�.s z .�` '- a sy;3.'a" Iry'3 ? s., �••.'• E fb ' �"�"-"� t'�. y ,�'�T•, y ^a _ "'r a,a"t,.�, 4 a %';. 4r`•r e i- �, Y, '-1 ,e 3 •fi Ma n+.Li, t.. 'a ir^ f•4`l'� 3 z� a w- 01 }} 7 4"�, -�� ,� „a ,� �, • ® -sue "a. r,-Ya f? 'b-e tk.•. • h e �' � .� � • ��a� a��} Alp °s ,�,,�� ��� L ,�€ �1,�",t,. ��` • • "'Ern ,�` � ir '� x,f�. �® "`�>:•.,�� ��,.`� �TaL.�ri� s '� � �"•"` * �•� •.� � r' � `{�k[�r "- ems. *' g� yg •�6y�� T ae••'"'� �w '4'„ '?2 �r ���f� t ye + `s • • • E&V7.0 IV5 n� Dio�eriber 5 ,,,; t f l CANT(' PPLI 1 OiPt1@Y' .:DATE ;t 19 85 PERMIT NO wt16` ADDRESS e 4 r Build Dwell in 1 $ (NO (STREET) (CONTR S LIGE NSE) ? PERMIT TO g 1?1 STORY, .Sillgle. Falri�l D.w 1;�Ag . . NUMBER OF ' ...:(TYPE OF,IMPROVEMENT) - NO. DWELLING UNITS - - (PROP SEO USE) - I AT�LOCAT�ONf 74 Harbor Road, .Hyannis ZONING (N0.! (STREEY) 01.STRICT U j or H(EEN i r '•�� (CR038 8TREET) 'AND STREET) :'SUBDIVISION LOT LOT - BLOCK SIZE ,.� 6UILDING I$TO BE FT.'WIDE BY FT LONG BY t FT• IN HEIGHT,AND SHALL CONFdItr(,N CIONST U4�Ok I TO TYPE \ t f(0 � tit�r/�r t�yt7'f f USE'GROUP I BASEMENT'WALLS dR FOUNDATION f s8W8 e. J`` r (TTher i ` '_ r e REM7iRKSi A85 362 J+�:^a i�n r � Iwoe:8�i� o � C$400:S�d) 1008 8 g r AREA OR ` Q• ft'. r83n �rea,, l�R, 4 • ��1 r 1{ arc, VOLUME ��yy yy�� z• h4 , n?Rq��y( 'BARE FEET) ' .ESTIMATED,COST $ `501o4;Q10�✓J,•. s.: hFEE"'ib i, �0•7 '..ti y:Bugene-,J. 1Yf�fiR. OWNER Wgshinetan G't-r„�t� Rrat,&ap: FROM.THE DEPARTMENT OF PUBLIC WORKS. TFiE ISSUANCE OF H '`�'' 'BY. •- r..,n•:t�4 Y,.si 1 f �...�: c.�s�. OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. INISPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTRICA' PLUMBING I. FOUNDATIONS OR FOOTINGS. MADE. WHERE.A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL�INSTALLATIONS.D •2. MEMY TO LATH). PRIOR TO COVERING STRUCTURAL QUIRED.SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL 3. FINAL NSPEC TION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET+ BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 • . 3 S HEATING INSPECTION APPROVALS ENGINEERING DEPAR ENT OTHER n/ � ma BO U OF I IEALIH y.�-9a�,� .�.� c�•�- t �t WORK SHALL NOT PROCEED UNTIL THE INSPEC• PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF LATE THE INSPECTIONS INDICATED ON THIS CARD CAN BE CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR�WRITTEN NOTIFICATION. — THE TOWN OF BARNSTABLE permit No. ..2H.2..7..... r BUILDING DEPARTMENT I -- I Cash (.$AQ0...00).. /4?0 TOWN OFFICE BUILDING .6,39 ��au+ HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to 1♦igene J. Mahnnex� � r Address Lot 47 . 7 4- Ha ncor Road Hyannis. Mafia_ USE GROUP FIRE GRADING =OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ......A:pri.l..9......... 19..9 Q.......... Building Inspector SrPTIC SYSTEV I IN `Assessor's map and lot number .. .��..-'.� ....o. yJa - SI) CO3 IT3-I�iT . �oF THE roe Sewage Permit number ..... ..: .. ... `.... ENVIRONMENTAL CODE ' 'e`vQ TOW XIO, . TOW � Z BARNSTABLE, i House number .......................:T. ....................................... 9O NAG& s639. ^...................... p m O MIN Ar TOWN OF BARNSTABL• E BUILDING ' INSPECTOR • APPLICATION FOR PERMIT TO ..........................................t ..... :...'...`,. I ® � TYPE OF. CONSTRUCTION .......... ............................................� ....... . `! �............. . 9 , ..... .....•...p.......... ............... L.1)................t 91 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 7— ��-2.30 d 171 .......................................... Proposed Use L �j I L/ t1 .......................................... Zoning District .................. ... ............................................Fire District .�� Name of Owner .. ��.. tr/�.......`.. :'.:/..".......... ......Address . S Name of Builder . ..Address � .....,...13............ !..`..-r!�1� Name of Architect .... ......... .............�/.fi'f.V1\ 'L.Address .......... ......... ............................�{........ Number of Rooms 4a�............................................Found ation ..... ® ��£'o ��Ce2 ...................................................... .... ..... Exterior ��9 ...... Roofing ............. �`� .. ..................................................................... Floors </�...�.r�..��� �'�...................... ................Interior ..........fix y Lu .................................... Heating .."... "�` ' F'',c ..........Plumbing, � :.a?`�6�8d.!1.................................. Fireplace . .�C.............Approximate. Cost ........ ,— ..s``�C.....�= -jL....... .. .r�....... Definitive Plan Approved by Planning Board -------__�_________L_--------19 ___. �rl Area ........ ..../..... Diagram of Lot and Building with Dimensions �I Fee f SUBJECT TO APPROVAL OF BOARD OF HEALTH 160 Aq OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 8 I e Wd Z I 80 Name ................ .... .. . .. ......... Construction Supervisor's License �. ........................ t� ��0 j 'MAHONEY, EUGENE J. • r ,Ni 28627 Permit for 12 Story ' ................. . Single Family Dwelling ....}...................................................... ................. F .�Location . Lot 7, 74 Harbor Road .. .......................................................... Hyannis -� ...................................................... ti r Owner Eugene J. Mahoney ' `o ....�c....... ..�.!.............................................. ......'.................. t Type of Construction .......................................... i .........................,.................................................. Plot ....................... ... Lot ................................ 85 - Permit Granted .......Nov....5.r...................19 _ i Date of,Inspection f Date Completed 9 ..........19 Af r . t - Le Town of Barnstable *Permit# v 3 E T Fxp{res 6 months from issue date -e - :._. ulator - Services Fee-• 8ARN aM^ss ,m ,,,Thomas F.Geller Director u Building Division" -' ' -'TomPerry, Building Commissioner . ...200MainStree - Hyannis,MA02601-•-•• -• Office: 508-862-4038 Fax: 508-790-6230. . .. :...:....,.. ... PERIGIIT-AXPLIOATION ''-RESIDENTIAL ONLY. . Not Valid w#houtRedxPressImprint TOWN OF BARNSTABLE ` Number dap/parcel _ 'roperty Address Residential Value of Work Minimum fee of 25.00 for work under$6000.00 Owner's Name&Address b Telephone Number6 D` "I2 4'l'D Contractor's Name Home Improvement Contractor License#(if applicable) ♦ ,t e �� �"l 10�� Construction supervisor's License#(if applicable) • �Workman's Compensation Insurance Check one: Y ❑ I am a sole proprietor_ ❑ I amthe Homeowner .: [�I have Worker's Compensation Insurance ~. Insurance Company Name Worlonan's comp.Policy# Copy of insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All constriction debris will be taken to ❑Re-roof(not stripping. Going over ` ' existing layers of roof) Rf Re-side m VI m(yl u m I Y I ( l_ t' ❑ 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 sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature �i Q:Forns:expmtrg Revise063004 Ifs °fTos, Town of Barnstable Regulatory Services T,homas F.Geller Director � �, ��•� Building Division '�6nMA� Tom Perry, Building Commissioner 200 Main street, $yannis.MA 02601 wwwAown.barnstable;ma.us Fax: 508 790-6230 Office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property r to act on wbeha hereby authorize:'• ' lf; rriatters relative to work authorized by thisbuilding pemut application for; (Address of Job) Signature of Owner Date Print Name a . � F —3 The Commonwealth of Massachusetts _ Department of Industrial Accidents Office oflnuesd adons 600 Washington Street, 7"`Floor .R'af Boston,Mass. 02111 Workers' Compensation Insurance Affidavit: Buildin /Plumbin /Electrical Contractors name: f MMA V i address: lX W city state: zi : hone it work site location full address): rl A u l ❑ I am a homeowner performing all work myself. Proj ct Type: ❑New Construction od 1 ❑ I am a sole proprietor and have no one workin in an ca aci BuildingAddition 71 mom I am an ejUjger pr vg- iiworkers' com ensation for my employees working on thi 'ob. CUBtI f Yt18t2YE. _j }ter av ✓ k.>w r rti c.) � '� �c,r i toy" °✓' _dj ou 3. r `rsi e <y F d �`L 4Z. i � "r S"„ ��"�w*��-i�X_a'�,."�N.".-,,«,,..3 Y�°`�"�'.. r•,R �y�',e�i.rA'� �r ���v� "( �� '?rt �Yy .�•+s.kti� _ � � �- }r�r:� .c-><}it.. "�'*a. .: hr,..:w.,.... ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices g� .: "' '✓: lq st Z � f �* j��-�v4!''dye.3.^,�'�".��'S.� 3ir��'z� r.._wx'r� J C ,-a°S' z'. _i - Y 46dTeiiS' h rq cemtaanv�3ate� k C tV k 4t M G v r { Y Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cerfify under thepains andgo,lties ofprerjury that the information provided above is true corr ct Signature �1 Date Print name r 1 Phone# ` (official useonly do not write in this area to be completed by city or town officialy or town: permit/license# ❑Building Departmentt ❑Licensing Boardcheck if immediate response is required ' ❑Selectmen's Officel ❑Health Department ntact person: phone#; ❑Other ised Sept.2003) , - i Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire,express or implied, oral or written. An employer is defined ajoned as an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in int enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, 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,7`h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext. 406 CAPIZZI HOME IMPROVEMENT INC . SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, 1M1)M OWN THE PROPERTY LOCATED AT I1I Y Y,/�/I �`��► IN �4AM� MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN CORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: C OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 NEWTOWN RD- COTUIT, MA 02635 APPLICANT'S TELEPHONE: 5081428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BY DATE THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL # �• `�rE-lib 03:57prr From-AIG , 4i8�310-G9U3 7-1'l4 I'.UU[/UUL t^I[C .i. ' �� L., .h•• fir,..'• .fd r �f' n3 �,.� ^•:.: •, ,:. .. :'.. •� Ui� .. I. ti � ,•'i;';f � ...t tiI P !, 3I„.,. C PyTtI�ICA�` t : ht Ran!` r l.; :,i ,a ;,.: i,: ,' �_i_�--�-'[_ ' i.a iit4�"i.• r.%•;r, ,• ! ...',• ;..�m:rl':�a _:,•.':t•.•'•.. •• '•�I •I,i � • _ PRODUCffk 1 HIS CERTIFICATE 1S ISSUED AS A MATTED OF IN[-OftMATION ONLY AND CONFERS NO RIGHTS UPON l HE CERTIFICATE Lmployem Ins Group Inc HOLDER.THIS CERI IFICATE DOES NOT AMEND,201 Main S>,>>aRl,quite I11 EXTEND OR FledTburg, MA 01,120 I ERTHE COVERAGE AFFORDED BY THE POLICIES BELOW COMPANIES AFFORDING INSI••IqANCE COMPANY A GRANITE STATE INSURANCE'COMPANY IIaSURED ReWU(L a IVlarlapament(;Inc j f 281 Main Street,Stlr'te#5 Fitchburg, MA 01.820 � THIS IS TO CERTIFI'THAT IHE POLICIES OF INSURANCE USTAD SELOW HAVE BEEN ISSUEL)TO THE INSURED NAt •FOR ''I•:4}': THE POLICY PERIOD INDICATED,NOT WITHSTANDING ANY REQUITEMENT^TERM OR CONDITJQN Of-ANY CONTRA T OR O HEROR DOCUMENT WITH RESPECT TO WHICH THIS C[R7IFICATE MAY HE ISSL)El)OR MAY PERTAIN,THE INSURANCE AFFOf�DED THE POLICIES DESCRIBED HEREIN is Sl!)A,IECT 70 ALL'f1-iE TERMS.DCGLV510No AND COND1710NS OF SUCH POLICIES.LIMITS SNOWN MAY HAVE SEEN REDUCED BY PAID CLAIf�1S, + CT IN3lfR11NC� PaL}C7 NUMBER i'DLICY EMEC'MT DATE, FOUCY mm RA-rm DATE, A COMPF.PISI1TiOI� . ND SMrl-0Yi378-LIABILTTY HF-PROPrufimra i LIMITS PmErzA INC +;'.A ;.i�N 'f x,•n L o i7�CL t� C Group 12/252004 12125/2005 ST'ATUTOF{YLIW8 192 ACH ACCIDENT 5 100,D 19LA96 POLICY LTIdIT' • - _ S 5D0,0 E ORIPI ION OF OPIERAT]ION �[5 $ 100.0 RE:COVERS THE EMPLOYI^ES OF THE NAMED INSURED LEASED TQ CAPIZ7J HOME IMPROV)_MEN s INC,1645 NEWTON ROAD, OTUIT MA V;Z535. CERTI�r1CATE NOkD>�R ANCELLATION CAPIZZI HOME IMPROVEMENTS INC aHomt)Aw OF THP A"V F-D nertl"D POL'cl�s p>i cANc�L>So esPaR�rr�e 1645 NEWTON ROAD EXPIMTION DATE MEREOF,THE MU NC COMPANY WiLL ENDEAVOR W MATl.12 COTU IT, MA 02630 DAYS►vRinEN NO)7CE TO THE CERTIFICATE HOLDER NAM®TO THF=LEFT.BUT FAILURE TO MAIL SUCH NOTICE smLL lnarOm No OMM'nON OR LK8lLrrY OF ANY KIND UPON 7}j�WMPArNY,ITS AGENTS OR REPR0WTAT;VeS, AUTHQRIZED REPRESENTATIVE ,C/ -'� , , -9?7, 4!�1oaT o jr Reu' gh )11 aj)d Standards lo One AshbuT "T41ce Roon') 1301 50 Boston. M.as'�41)uselts 02108 lionle 13)3j)T0VCJllCj)t 6 _91raUOT RegiI strati Repistralioll: 100740 Type: Private Corporation CAPIZZI HOME IMPROVEMENT, INC. Expiration: 6/23/2006 Thomas Capizzi, jr. 1645 Newton Rd. COtuit, MA 02635 Update Address and return card.A1,qr1c reason for change Address E] Renewal Employment Lost C2 Board of Building egul2lions and Standards HOME IMPROVEMENT.CONTP-ACTOR License or registration valid for individul use only before the expiration date. If found return to: Registration: 100740 Board Of B-ui)dil)g Regulations and Standards Expiration: 6123/206 One Ashburton Place lZm 1301 Type: Private CorpoTation Boston,Al2.02108 CAPIZZI HOME IMPROVEMENT,I Y�-1cmas Capiz2i,jr. 1645 NeMon Rd. COtuit, I%qA 02635 Administr2l slid without aatnr BOARD OF BUILDING REGULATIONS to License: CONSTRUCTION SUPERVISOR Number: CS 057032 Expires: 09/26/20.05 Tr. no: 7171.0 Restricted: 00 THOMAS X CAPIZZI JR 12 1645 NEWTOWN RD COTUIT- MA 02635 Administrator v TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map &3 O'� Parcel 036 Permit# Q Health Division Date Issued 2 /-s- 6 Conservation Division Z S 0-4 Application Fee Tax Collector_ Permit Fee o • Treasurer Planning Dept. . APPLICANT'";T"T ORTAIN A SEWER CONNI` 'ROM THE Date Definitive Plan Approved by Planning Board ENGIN d 1.Ion TO Historic-OKH Preservation/Hyannis CONS. Project Street Address 77 I7 Ae!3 ar P 0 AP Village %Y yA !'I f• Owner a Cr /-/C/ r ,may Address V 171p1C 130'1z lC dP d Telephone �"4 790 /0 S 7 Permit Request 0?f p1AG8 RAIi z!L�N ,- rLada-/r✓� • S T�� y�PjJ' — �A'>�Titi� Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay �A Project Valuation Construction Type Lot Size Crandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes f�1 No On Old King's Highway: ❑Yes A 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: O 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 BUILDER INFORMATION G� Name (!Z- /w"41—y Telephone Number eJ Address may` �/14I�3� ,�� License# f'Ly7LC ' Y4wn11'f /IL4 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ✓�uh'J'S�f� �'�` ,5e�7J' ltwe"Ploe, SIGNATURE c DATE FOR OFFICIAL USE ONLY it PERMIT NO. k J r � DATE ISSUED ti MAP/PARCEL NO. i ADDRESS VILLAGE OWNER 1 DATE OF INSPECTION: FOUNDATION FRAME Ll INSULATION l FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINALf GAS: ROUGH FINAL = r * FINAL BUILDING �✓ k 3 o �? DATE CLOSED OUT " ASSOCIATION PLAN NO. r P The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit-General Businesses address: -7T city Al IS state: 79 zip: 09 CO/ phone# See-7 Qe work site location(full address): ❑ I am a sole proprietor and have no one Business Type: 0 Retail❑Restaurant/Bar/Bating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an employer with employees(full&part time). ❑Other [5 I am an employer providing workers' compensation for my employees working on this job. company name: _ ,. address: city: Phone#:`. ansurance.cor:: ...:: .; Ilia.#.: : _. //// ❑ I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: address:.: .' ON: phone# insurance co. olic # comoanv name: address 4. city::. phone# insurance so.: olicv or Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that it copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certi nde the pains andpelaltigs of perju that the information provided above is true and correct Signature Date Print name ��/J N Woe j'e,Y,/ Phone# S official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department s ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office t []Health Department contact person: phone#; ❑Other e (mvised Sept 2003) r I� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such.employment be deemed to be an erTloyer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, 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 WIN of I8Ve098dens 600 Washington Street Boston,M 02111 fax#: (617)727-7749 P #: � � hone 61 727-4900 ext. 406 oF•txe rosy Town of Barnstable Regulatory Servides 8 ram, t Thomas F.Geiler,Director qq, sbgq. ,m� Building Division ''lFD µP't A • Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 • Fax: 508-790-6230 Permit no. Date 2v AFFIDAVIT HOME ny2ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: � ' Estimated Cost Ct�1 yP �vs®r� Address of Work: 7�`f �"4 Owner's Name: r'�'�"' C /I r Date of Application: r I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law nJob Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDERPENALTIES OF PERTURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR er's Name Date f VKKE Town of Barnstable Regulatory Services BARN67ABM Thomas F.Geiler,Director 9 MAW. $ i639• p.• Building Division lEc � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: /V JOB LOCATION: �L number Ystreet / Village "HOMEOWNER : 2G'L'L ` g�,` �� G� �D.� / name ho phone# work phone,# CURRENT MAILING ADDRESS: city/town state zzip 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 buil&g_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. C Si re 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 perfomang work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a superviscr(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt P`ppfHE� � The Town of.Barnstable HW 0� BARNSTABLE. Department of Health Safety and Environmental Services 7 MASS. 0a i639. �0 PTFO MAC Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: To 14AI —1& Map/Parcel: go �6 1 7 2 Q a 5/ Project Address: 7 X Builder: The following items were noted on reviewing: lei :'0V S 7- s S a e- .G' .-u . C'0.vr Reviewed by. Date: q:buitding:forms:review Assessor's map and lot number 0 €, �'.j.?- ."::0.'................ . �pF 1M E t0 Sewage Permit number �...... ' g :...........:.... Z BABBSTADLE. House number ........................................................................ ro rasa 1639- C P TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO a /1.1 � E ° � ...................... ............. ................................. ................. TYPE OF CONSTRUCTION ............kj d.��......r n°.-.f..�:........�::�t V .:�"�.:'�.....�� ����� .� .�°�........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:,, / Location .................. `. .......... ................"!... �� l�Q.nS>:......... /7"y�.......�!..� •C//L1/A.�,�................. 6 L e Fi"/`1 I L 1f .171' c� � ProposedUse ........................../.....It...................................................;............. .. ...............................................,......................... _ f Zoning District , f Fire District .......... �........ w.:................................ S Name of Owner .............................,E,)6 ttf /�G•f�l//� / �—�� /� ��i���/(��a c !/�f• 4/,j .-- .- ................................ ......Address ............. .................................. �.a` t� .!,.......,f• t} f� �tf Name of Builder .................. ........�....................f..Address ....................................... .. .................. .. k�.r" , • Name of Architect f t �.... � r.� ....Address ...... :j .....G� .". '`� '`................................... Numberof Rooms ...............:............................... ../........l...�....Foundation .............................................. /.,........... Exterior L ,� ..... ` °r ^? Y ° Roofing �. r ''r- � ...:�f. '�.�.. ......... Floors �, er "' �,/� �" t�...'r�..`.....��........................................Interior ............... .y.............................................................. t ... Heating ......�" , x £, s � .:'.1................Plumbing .. �1,c� .�.,�............. .................... ............................. ... ..... ............... . . AZC eye Fireplace .... ...............Approximate. Cost ... ....... e.............................................. ..... 1, Definitive Plan Approved by Planning Board _______ _" --------19 7-__7 Area .... ... !.al..1.;.>.:; = ........ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH PTO OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to ,conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................ Construction Supervisor's License .................................... 1 MAHONEY, EUGENE J. A=306-173 No 28627 Permit fo 1 z Story l ................. .................................... .. . Single...Family. . . ..Dwell. .....ing ........................ ...... . . .. ...... .... Location L.ot. ....7....... ... 74 Harbor. . ..Road. . ....... . . . . .... ........ . .. .... . .. Hyannis ............................................................................... Owner ,,,Eugene J.. ... Mahoney ..... ......................................... Type of Construction Frame .......................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ...........Nomember...5......19 85 Date of Inspection ....................................19 Date Completed ......................................19 /'Oh 11116 -7 i I E i f . t � l E a N N N ' e,c 00 0 � ; M E i i c7 O O C- P_T Y THAT THE C)VA OH TF+IS PLAN lc:. 4-C)GArs—p OW THE. 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