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Home My WebLink About0213 HINCKLEY ROAD �3 ��o nckl �GLD. � e A ,Op , 0 ;t= 10.0' h� —�. Lot 135C 759± S F. 74.7' \`\ 000.. Off.\\`�?4) �Exist.Fdn. �\ TOF=102.0 , 10.9 r . 20.0' 0 , 10 0 d 0 C) STREET ADDRESS: #213 HINCKLEY ROAD ASSESSORS' MAP 310 PARCEL 81 OWNER: CHRIS71NA RUSSELL DEED REF.: CTF# 161858 PLAN REF.: L.C.C. 11519-B LOT 135C TOWN OF BARNSTABLE ZONING BY-LAW ZONE RB I CERTIFY THAT TO THE BEST OF MY PROFESSIONAL SETBACKS : KNOWLEDGE, INFORMATION AND BELIEF THE FOUNDATION FRONT = .20' SHOWN HEREON CONFORMS TO THE HORIZONTAL SETBACKS SIDE = 10' OF THE ZONING BY-LAW FOR THE TOWN OF BARNSTABLE. REAR = 10' PROPERTY LINES SHOWN HEREON WERE COMPILED FROM AVAILABLE -iN0fMAS,2 PLANS OF RECORD AND VERIFIED o=� TERRY_ -ON THE GROUND. o 'ANN v, WARNER No.38721 "AS—BUILT" THE FOUNDATION DEPICTED ON THIS �� 'N©JQ n PLOT PLAN PLAN WAS LOCATED ON THE GROUND 'I IN BY SURVEY ON JUNE 15, 2010 AND BARNSTABLE, MASS. EXISTS AS SHOWN AS OF THE DATE f / OF LOCATION. V SCALE. 1"=40' JUNE 16, 2010 THIS PLAN IS FOR PLOT PLAN TERRY A. WARNER, P.L.S. PURPOSES ONLY. 22 LONG ROAD HARWICH, MA. 02645 (508) 432-8309 THIS PLAN IS VOID IF NOT STAMPED AND SIGNED IN RED. 0 20 40 SO PROJECT N0. 10-150AS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,.; ! Map Parcel d� Application # �7� Health Division Date Issued <It 1 f t Consery tin iv'a o D ision A plicatio n F pp o ee Planning Dept. ' `.x. Permit Fee Date Definitive Plan Approved Eby Planning Board Historic- OKH Preservation/Hyannis Project Street'A/ddress ' Village h' yRN/V/ S Owner (�h r-I s; i tv Q f?v s S eL rt Address' a 6Erl 1's , 2gA- GU. Y,# Y►ovf4 Telephone ;<_0 5' Z 5-8 0633 ' Perm' 11h Square feet: 1 st floor: existing 70 proposed &S3 2nd,floor: existing proposed 9S'Total new Zoning District Flood Plain - Groundwater Overlay 3S3 Project Valuation Construction Type 1. 06 b Lot Size 0 2- Grandfathered: Zr`�Y_es ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: Z'Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) 95746 Number of Baths: Full: existing new 7— Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor(Room Count Heat Type and Fuel: aGas ❑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:-M existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: o `Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ � •--+ o Commercial ❑Yes ❑ No If yes, site plan review# 00 r Current Use Proposed Use 2 W APPLICANT INFORMATION rn�'`� (BUILDER OR HOMEOWNER) �i •bit °c� a f b(� Name 7ARK -R Telephone Number Address 177 5emts yt LCe 12 6 License# C 5 353 2 8 Q. 6C2W yi S M14, 0?-6�O Home Improvement Contractor# /6/ �1' Worker's Compensation #VWC 4?00(10'S6 l 2!t?n ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ' x .®/I 50, t)f-;OUrVI S SIGNATURE // /2 DATE R ti FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED j MAP PARCEL NO. 1 ADDRESS VILLAGE 7 OWNER t DATE OF INSPECTION: r FOUNDATION FRAME INSULATION FIREPLACE . r Q ELECTRICAL: ROUGH FINAL I; PLUMBING: ROUGH FINAL GAS: ROUGH 'FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION. PLAN NO. K , 5 ' j The Cominonwealth of Massachusetts Department of.Industrial Accidents Office of Investigations • 600 Washington Street Boston, MA OZIII www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lep_ibly NaMe (Business/Organization/Individual): Ins !) ..CAPjig iZP-sdpe,yTt4L ��0P—C,,- •Address: /',7 7 5eat/4S11LUe t, City/State/Zip: . 1! e. Dgyotyi s Phone.#: Are you an employer:' Check the appropriate box: -Type of project(required):, 1.❑ I am a e 4. [] I am a general contractor and I employer with 6, [?New construction employees (full and/or part-time).s have hired the sub contractors 2.[] I am a'sole proprietor or partner- listed on.the'attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have g, .0 Demolition working forme employees and have workers'in any capacity. 9. []Building addition_ [No workers' comp. insurance comp. insurance.$ ` required.]. 5. �e are a corporation and its ME]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 uire xe q ]d. t c. 152, §1(4), and we have no employees, [No workers' 13.❑ Other comp. insurance required.] . 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who subrpit this affidavit indicating they are doing all work and then hire outside contractors must submit,a now affidavit indicating such. tL6ntractors 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 providb their workers'comp.policy number. I am an employer.that is providing workers compensation insurance for my employees. ,below is`the policy and fob 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 lip 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification npains-and penalties of perjury that the information provided above is true and correct: I do hereby certify.tinder the Signature;' C Date a Phone# _<0q 2 3 7 -1'!YZ(n Official use only..Po not write in this area,'to be completed by city ar to o�cciaL City or Town. Permit/License# Issuing Authority(circle one): 1.Board of lIealtli;2.Building Department 3•City/Towu CIerk 4. Electrical Inspector S.Plumbing Inspector 6. Other Contact Person:. Phone.#: ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) ApP licant Name: Site Address: 4rt f� 2 �v3o ��:v print Town: N,<fhV//w S Applicant Phone: j b i ,Z 37 - 5-Y74, Applicant Signature: /7, Date of Application: NEW CONSTRUCTION: choose ONE of the ollowingg two options)- 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Basement Slab Option 1: Fenestration exposed Wall Floor Perimeter Wall. AFUE HSPF SEER U-factor floors R-Value R-Value R-Value R-Value R-Value and Depth National Appliance Energy R-10, Conservation Act(NAECA)of .35 R-38 R-19 R-19 R-10 4 ft. 1987 as amended,minimums or : reater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2) 4 REScheck=Web which can be accessed at http://www.ener cy_odes.gov/rescheck/ ADDITIONS OR ALTERATIONS,TO EXISTING BUILDINGS OVER:5 YEARS OLD *Buildings under 5 years old must use option#1 or#2 in New Construction section above.. Complete the following formula to`determin.e the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b. a) -P ! S� 100 x - _ % of glazing (b) Glazing area equals SF b a If glazing is:<_40% use the chart below. If glazing is >40.%o roceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter Fenestration Exposed floors Wall Floor Basement Wall R-Value U-factor R-Value R-Value R-value R-Value and Depth 39. R-37 a R-13 R-19 R-10 R-10, 4 feet a ' R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the:full R-value over the entire ceiling area(i.e. not compressed over exterior walls, and including any access openings). SUNROOM-An addition or alteration to an existing building/dwelling unit where the total El glazing area of said addition exceeds 40% of the combined gross wall-and ceiling area of the addition: Note. Owner.fo.fill out Consumer Information Form (found in Appendix 120.P) I AhYC Grlide to Wood Corlstl"llCtloll ill Hilill 6Yilld Ai-eels: 110 fliph Wh-idZolle massadiusetts Checklist for colup.liance (78o (AMR 5301.2.1.1)' Check Compliance 1.1 SCOPE WindSpeed (3-sec. gust).:.......:......:..... . .................................... ........:..........................:............: 110 mph WindExposure Category.....................................:............................. ..................:.:.:........................:.............8 Wind Exposure-Cat.e.gory................Engineering Required For Entire Project ......,..................................0 IVA 1.2 APPLICABILITY Number-of Stories (a roof which exceeds 8 in 12 slope shall be considered a story)_2 stories s 2 stories Roof Pitch ..................:.:....:........................:::................:.....(Fig 2) ..................... /Z 5 12:12 ! �i. MeanRoof Height .....................................................:....... (Fig 2).....:......................................:.:• ft 533 Building Width, W .........:............. ...:............(Fig 3) ....................I...................: .. ft s 80' ✓ Building Length, L .............. ............. .... : .....................(Fig 3) ........................................ ::3 ft.<80, Building Aspect Ratio (L/W) ........:......................................(Fig 4)................................................./_2S 3:1 Nominal Height of Tallest O�p.ening2 .........................:.........(Fig 4)................................................�'f 5 6'8" 1.3 FRAMING CONNECTIONS General compliance with framing connections....................(Table 2).............. ........................:.. 2.1 FOUNDATION Foundation Walls meeting requirements of 78.0 CMR 5404.1 Concrete............ ..............................:....................................................................,... ConcreteMasonry .................... ..........,. .....................::...:....................:................ 2.2 ANCHORAGE TO FOUNDATION1.3, 5/8"Anchor Bolts,imbedded,or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing—general ......... ...........................:.(Table 4)....... ................................ _251�in. Bolt Spacing from end/joint of plate .........................:...(Fig 5)........... .........:....... ' n. Bolt Embedment-concrete..........................................(Fig 5)...... ......I.............................. in.;7„ -� Fi 5 in.z 15" Bolt Embedment-masonry:.. ( 9 ) ...............:>3"x3"x Y<" PlateWasher..*......:...........:...:....... ..............................(Fig 5)......................... 3.1 .FLOORS ✓ Floor framing member spans checked ..... .... ..(per 780 CMR Chapter 55)............... ........ ...... Maximum Floor Opening Dimension...................................(Fig 6)..................•...............................M Ift_< 12' i Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall (Fig 6)....................................... A/A Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7) ......... ...................................:. ft <d N�I Maximum Cantilevered Floor Joists ft :5d 1V/f1 Supporting Loadbearing Walls or Shearwall......:.........(Fig 8)..................................................... — Floor.Bracing at Endwalls... (Fig 9) ." "• Floor Sheathing Type ................. ............................(per 780 CMR Chapter 55)..........._116I.-0,: .3...... Floor Sheathing Thickness. .: .............(per 780 CMR Chapter 55).....................:.. in. Floor SheathingFastenin ..............................:...(Table 2).. 8 d:nails at to in edge/�2 in field ✓ g................ 4A WALLS : Wall Height; Fi 10 and Table 5 ft s 10' Loadbearing walls........ ........ ............................( g. )..........................7 (Fig 10 and Table 5 Non-Loadbearing walls ( g )..:............ J ft s 20 Wall Stud Spacing .............. ... .... ... ..........................(Fig 10 and Table 5)...............: in. s 24"o.c. .® Wall Story Offsets ' ..........................................................(Figs 7&8)...... 1 ft `d =� 4.2 EXTERIOR WALLS'` Wood Studs U in. Loadbearing walls ........ ................::......(Table 5) .2x�- ft— =T— Non-Loadbearing walls . .....: ....... ....................(Table 5) .... ............ 2x '�ft (/ in. Gable End Wall Bracing' Full Height Endwall Studs........: .(Fig 10)... ................ .:..... WSPAttic,Floor Length. ........ ....... ....................(Fig 11)............. ftZW/3 -N Gypsum Ceiling Length (if WSP not used)....:..............(Fig 11)....J..57 44,,Pf• ft z 0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft. o.c. .. (Fig 11)....... ........... ............................1..4Q.l@. o 1 x 3.ceiling furring strips 16"spacing min. with 2 x 4 blocking @ 4 ft. spacing in end joist or truss bays Double Top Plate ..., Cnlira I annth "...!.(Fig 13 a'nd Table 6):. .:: ....:::. : ft a/ " AP'C Guide to Wood Corlstrrlctiou hi Hr,{Jh 1,11illd Ar•eaS:. 11'0 fill) I-Virrd Zorre fvjassach se is Checklist for C0111PU',111Ce (780 C�1tR5301.2.f.1)' Loadbearing Wall Connections ✓ Lateral (no.of 16d common nails)................................(Tables 7)..................................................... '7— Non-Loadbearing Wall Connections Lateral (no. of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) HeaderSpans ......................................................(Table 9).................................. ft in. Sill Plate Spans ........................................................(Table 9)....................................5_ft in. 5 11' Full Height Studs (no. of studs)....................................(Table 9)......................................................._3 �~ Non-Load Bearing Wall Openings(record largest opening but check all openings,for compliance to Table 9) ` Header Spans.............................................................(Table 9)...................................9_�ft 0 in. _< 12' /. Sill Plate Spans.... .......................................................(Table 9).................................. ft_in.5 12' Full Height Studs (no. of studs)................................,...(Table 9)...............................................I....... 3 Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension, W Nominal Height of Tallest Opening2 `6'8 ✓ ' K Sheathing Type.....::.......................................(note 4).:........................:..........� ......Cn� Edge Nail Spacing ........................ Table 10 or note 4 if less),'....................... G in. .Field Nail Spacing...........:................:.............(Table 10)........................::..............:....:..: 12 Shear Connection (no. of 16d common nails)(Table 10)....................................................... Percent Full-Height SheathingTable 10 .................................................too % 5%Additional Sheathing for Wall with Opening> 6'8"(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Opening..................................................................`:...lP s 6'8 / Sheathing Type..............................................(note 4)...........................:............ •kt6 Edge Nail Spacing .......... Table 11 or note 4 if less)........................ G in. Field Nail S acing .. Table 11 .................................................. rZ. in. Shear Connection (no, of 16d common nails)(Table 11)........................................................ 3 Percent Full-Height Sheathing Table 11 ° . ........................ . : .. 5%Additional Sheathing for Wall with Opening > 6'8"(Design Concepts).................... Wall Cladding Ratedfor Wind Speed?........... .............:................................... ............................................................... 5.1 ROOFS / Roof framing member spans checked?........................(For Rafters use AWC Span Tool, see BBRS Website) Fi r _ Roof Overhang .................. .(Figure 19) ............. r ft<smaller of 2' or L/3 Truss or Rafter Connections at L oadbearing Walls Proprietary Connectors Uplift................................................(Table 12)................... .........................U=Z36 plf Lateral .....,..:;.........:.......................:..(Table 12)..............................................L= z&.plf Shear............................: .......... .......(Table 12)......,.....................................S=--_,LZ pIf .Ridge Strap Connections,.if collar ties not used per page 21... (Table 13)..................I............T=A"plf s ................(Figure 20 ft 5 smaller of 2'or L/2 Gable Rake Outlooker.:..:..................... ( g ) •••••••.•••••.�Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14)............................................U= lb. Lateral(no. of 16d common nails)...(Table 14).......................................L= . lb. Roof Sheathing Type................:......:...........................(per 780 CMR Chapters 58 and 59) ... Roof..Sheathing Thickness........... ............................... . ....................................... in. >_7/16" WSP Roof Sheathing Fastening (Table 2).......................................................... " ►/ Notes: 1. This checklist shall 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 required 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. Corner Stud Hold Downs per Figure,18a and Figure 18b 2. Exception:Opening heights of up to 8 ft. shall be permitted when 5% is added to the percent full-height sheathing requiretnents 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. I E � r Taws of Barastab4e Regulatory Services Thomas F_ Geiler,Director i659- �Q' Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862--4038 Fart: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize <-'S-\QJ .Z to act on my behalf, in all matters relative to work authorized by this building permit application for- (Address of rob) Signature of Owner Date r Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. 3 1 oF Tfu: Town of Barnstable ' � ray . Regulatory Services utWszws Thomas F. Geiler,Director NEARS 1659 .,m�� a Building Division Tom Perry,Building Commissioner 200 Mairi.Street,._Hyannis,MA 026.01 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: 'number street village name home phone# work_phonc# CLrRRbNT MAILING ADDRESS: city/town state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow huneowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HONMONVNER 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 stuctures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form,acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and 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 homeov,mcr engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption an unaware that they are assurrrir.g the responsibilities of a supervisor(see Appendix Q Rules&Regulations for Licensing Constriction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when homeowner hires unlicensed persons. In this cast our Board cannot proceed against the unlicensed crson as it would with a liccnscd the hom o pens p g p 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 bDMCOwneT certify that he/she understands the respansibilitics 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/certifi.cation for use in your community. Q:forms:homccxcmpt Energy Code: 20061ECC Location: Hyannis,Massachusetts Construction Type: Single Family Building Orientation: Bldg.faces 90 deg.from North Conditioned Floor Area: 1353 ft2 Glazing Area Percentage: 6%, Heating Degree Days: 6137 Climate Zone: 5' Construction Site: Owner/Agent: Designer/Contractor: Compliance:0.1%Better Than Code � cam Ceiling 1:Flat Ceiling or Scissor Truss 297 30.0 0.0 10 Ceiling 2:Flat Ceiling or Scissor Truss 610 30.0 0.0 21 Wall 1:Wood Frame, 16"o.c. 264 15.0 0.0 17 Orientation:Front Window 1:Vinyl Frame:Double Pane with Low-E 25 0.300 8 SHGC:0.30 Orientation:Front Door 1:Solid 20 0.300 6 Orientation:Front Wall 2:Wood Frame, 16"o.c. 320 15.0 0.0 22 Orientation:Right Side Window 3:Vinyl Frame:Double Pane with Low-E 15 0.300 5 SHGC:0.30 Orientation:Right Side Door 2:Solid 18 0.300 5 Orientation:Right Side Wall 3:Wood Frame, 16"o.c. 320 15.0 0.0 23 Orientation:Left Side Window 4:Vinyl Frame:Double Pane with Low-E 23 0.300 7 SHGC:0.30 Orientation:Left Side Wall 4:Wood Frame,1 W o.c. 495 15.0 0.0 37 Orientation:Back Window 5:Vinyl Frame:Double Pane with Low-E 20 0.300 6 SHGC:0.30 Orientation:Back Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 858 19.0 0.0 40 Boiler 1:Other(Except Gas-Fired Steam)95 AFUE Compliance Statement. The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2006 IECC requirements in REScheck Version 4.3.0 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name Title Signature Date IVlassachusetts- Department of Ptimic Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 35398 Restricted to: 00 MARK R GUSTAFSON 177 SEARSVILLE RD t S DENNIS, MA 02660 . Expiration: 6/30/2011 (onuliissioner -.- --- Tr#: 6348 �'lxe -V�oryvnio7uuea� a�„/f/�ccaaaclzuaelld - --- -- ---2 Boat. G'uilding Regulations and Standards License or registration valid for individul use only HOW-',-. 161 ROVEMENT CONTRACTOR befas a the expiration date. If found return to: Registra`iion¢z 161892 - Board of Building Regulations and Standards Cx�hrratron 12/91?_010 Tr# 27£?726 One Ashburton Place Rm 1301 Pr� e Corporation 'Boston.,Ma.-02108 j MID CAPE RESIDENIJA! KF�OURCE INC. MARK GUSTAFSiO�N `_ > 177SEARSVILLE SO.,DENNIS, MP,C2660 iinistrator No valid without signature -- .. .; .. .. Liberty The Ohio Casualty Insurance Company MUtUM. 9450 Seward Road,Fairfield,Ohio 4501`4 Bond# '5062830 BOND KNOW ALL MEN BY THESE PRESENTS: That we Mark R.Gustafson,DBA MCRR,Inc. ' 177 Searsville Road South Dennis MA 02660 Street Address City State ZIP Code (Full Name[top line]and Address[bottom line]of Principal) (hereinafter called the Principal) as Principal, and The Ohio Casualty Insurance Company- with principal offices. atR Hamilton, Ohio(hereinafter called the Surety)as Surety,are held and firmly bound unto Town of Barnstable 367 Main Street Hyannis MA 02601 Street Address City State "ZIP Code (Full Name[top line]and Address{bottom line]of Obligee) . (hereinafter called the Obligee),in the penal sum of Two Hundred Thirty Two Dollars and No Cents (Dollars)$ 232.00 for the payment of which well and truly to made;,we do hereby bind ourselves, our heirs. executors, administrators, successors and assigns,jointly and severally,firmly by these presents. i WHEREAS,the Principal has made or is about to make application to the Obligee for a Permit for construction of a single family home at 213 Hinckley Road,Hyannis,MA 02601 for a term beginning on . 10/07/2009 and ending on* 10./07/2010 s *strike out if license or permit is for an indefinite term) NOW,THEREFORE,if the Principal shall indemnify the Obligee against any loss.directly arising by reason of failure of said Principal to comply with the laws or ordinances under which said license or permit is granted, or any,lawful rules or regulations pertaining thereto, then this obligation shall be void;otherwise to remain in;full force and effect. PROVIDED,HOWEVER,AND UPON THE FOLLOWING EXPRESS,CONDITIONS: 1. This bond shall be and remain in full force during the term of said license or permit unless canceled in.accordance with.paragraph 2 below; but if said license or permit was issued for aspecific:term, and is renewed for one.or more specific terms,this bond will be 4 extended.to cover such additional term(s):upon the execution by the Surety of a Continuation Certificate, provided such`certificate is acceptable to the Obligee. In no event , however, shall the liability of the Surety be cumulative from year to year or from period to period,not exceed the penal sum.written in this first paragraph of this bond. 2. The Surety shall have.the right to terminate its liability by notifying the Obligee in writing .ten(10)days in advance of its intention to, do so. SIGNED,SEALED AND DATED 10/07/2009 Mark R.Gustafson,DBA MCRR,Inc. By: Principal The Ohio Casualty Insurance Company By: Martha A.Kenney Attarney-in-Fact S-3853 License or Permit Bond (Unnumbered) Principal: Mark R.Gustafson,DBA MCRR,Inc. POWER OF ATTORNEY POA Number: 40-463 THE OHIO CASUALTY INSURANCE COMPANY Obligee: Town of Barnstable WEST AMERICAN INSURANCE COMPANY Bond Number:5062830 Know All Men by These Presents:THE OHIO CASUALTY INSURANCE COMPANY,an Ohio'Corporation,and WEST.AMERICAN.INSURANCE COMPANY,an Indiana Corporation pursuant to the authority.granted by Article III,Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty.Insurance Company and West American Insurance Company do hereby nominate,constitute and appoint: Mark.McCartin,Robert W.Miller,Kelly C.Bolton or Martha A.Kenney of Hyannis;Massachusetts its true and lawful agent(s) and attorney (s)-in-fact, to make, execute; seal and deliver for and on its behalf as surety, and as its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES, not exceeding in any single instance ONE MILLION ($1,000,000.00) DOLLARS, excluding; however, any bond(s) or undertaking(s)guaranteeing the payment of notes and interest thereon. And the execution of such bonds or undertakings in pursuance of these presents;shall be as binding upon said Companies,as fully and amply;to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of the Companies at their administrative offices in Fairfield,Ohio,in their own proper persons. The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(s)-in-fact. In WITNESS WHEREOF,the undersigned officer of the said The Ohio Casualty Insurance Company and West American Insurance Company . has hereunto subscribed his name and affixed the Corporate Seal of each Company this Zth day of January;2008 JP`ZY INSU� `PN INSU�N _ .. Q - _ o, SEAL I ;! SEAL ;9 �i ;t Sam Lawrence Assistant Secretary STATE OF OHIO, COUNTY OF BUTLER On this 7th day of January,2008 before the subscriber,a Notary Public of the State of Ohio, in and for the County of Butler,duly commissioned and qualified,came Sam Lawrence,Assistant Secretary of The Ohio Casualty Insurance Company and West American Insurance Company,to me personally known to be the individual and officer described in,and who executed the preceding instrument,and he acknowledged the execution.of the same,and being by me duly sworn deposes and says that he is the officer of the Companies aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies,and the said Corporate Seals and his signature as officer were duly affixed and subscribed to the said instrument by.the authority and direction of the said Corporations. IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal at the City of Hamilton,State of Ohio,the day and year first above written. �``yuiuunuppa /f p]1l t! CJtZt yQ q& VA *' * Notary Public in and for County of Butler,State of Ohio My Commission expires August 5,2012 ��irelmnm� This power of attorney is granted under and by authority of Article III,Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company and West American Insurance Company,extracts from which read: Article III,Section 9. Appointment of Attomeys-in-Fact. The Chairman of the Board,the President,any Vice-President,the Secretary or any Assistant Secretary of the corporation shall be and is hereby vested with full power and authority to appoint attomeys-in-fact for the purpose of signing the name,of the corporation as surety to,and to execute,attach the seal of the corporation to,acknowledge and deliver any and all bonds,recognizances,stipulations,undertakings or other instruments of suretyship and policies of insurance to be given in favor of any individual,firm,corporation,partnership,limited liability company or other entity,or the official representative thereof,or to any county or state,or any official board or boards of any county or state,or the United States of America or any agency thereof,or to any other political subdivision thereof This instrument is signed and sealed as authorized by the.following resolution adopted by the Boards of Directors of the Companies on October 21,2004: RESOLVED,That the signature of any officer of the Company authorized under Article III,Section 9 of its Code of Regulations and By-laws and the Company seal may be affixed by facsimile to any power of attorney or copy thereof issued on behalf of the Company to make,execute,seal and deliver for.and on its behalf as surety any and all bonds, undertakings or other written obligations in the nature thereof;to prescribe their respective duties and the respective limits of their authority;and to revoke any such appointment. Such signatures and seal are hereby adopted by the Company as original signatures and seal and shall,with respect to any bond,undertaking or other written obligations in the nature thereof to which it is attached,be valid and binding upon the Company with the same force and effect as though manually affixed. I,the undersigned Assistant Secretary of The Ohio Casualty Insurance Company,American Fire and Casualty Company and West American Insurance Coml5eoy,do hereby certify that the foregoing power of attorney,the referenced By-Laws of the Companies and the above resolution of their Boards of Director;are true and correct copies and are in full force and effect on this date. IN WITNESS WHEREOF,I have hereunto set my hand and the seals of the Companies this 7 day of October TY INS gJP� -fGp INSU{7gh SEAL ,'3 Ni SEAL .' mac° 0;, ;a' W• ? Mark E.Schmidt Assistant Secretary �1• Doci835,224 06-15-2001 2:86 U M 161858 / BARNSTABLE LAND COURT REr'r,I Y ti QUITCLAIM DEED a We,MICHAEL J.SHIPMAN and ELOGY M.SHIPMAN,husband and wife as tenants by the entirety, both of 213 Hinckley Road, Hyannis, Barnstable County, Massachusetts 02601 for consideration paidof. One Hundred Twenty-Four Thousand and 001100 ($124,000.00) Dollars grant to: CHRISTINA R. RUSSELL, individually, of P.O. Box 821, East Wareham, MA 02538 WITH QUITCLAIM COVENANTS F n The land together with the buildings thereon, situated in Barnstable (Hyannis), Barnstable County,-Massachusetts being Lot 135-C (Block B) as shown on Plan 11519-B (Sheet 1). The above-described premises are conveyed subject to and with the benefit of all rights,rights of way,easements,takings,appurtenances,reservations and restrictions insofar as they now are in force and applicable. For my title,see Certificate of Title No. 145143 recorded at the Barnstable Land Court Registry: .r ARDITO.SWEENEY STUSSE,ROBERTSON ". s DUPUY.Pc .PROPERTY ADDRESS: 213 Hinckley Road, Hyannis, MA 02601 ATTORNEYS AT LAW ` WEST YARMOUTH.MASS 02673 c (SUB)775-3433 n / r I . . / 74 WITNESS our hands and seals this day of , 2001. V.,Oa. I A 4- Michael J. hipma o ~' T 'Pt (A rm. p Elogy)VShip a . COMMONWEALTH OF MASSACHUSETTS Barnstable,ss r , 2001 Then personally appeared the above-named Michael J.Shipman and Elogy M. Shipmanand acknowledged the foregoing instrument to be their free act and deed, before me . _ X a . . No ary Publi En TV My Commission Expires. (a� -0 o SEAL N co./V Al N / yC tTi K N L'1:• • � 1 1 .. N W N N N a BETSY NEWELL ARDITO,SWEENEY x Notary Public STUSSE,ROBERTSON MyCOMMMWExplresDeumber6.2002 b DUPUY.PC' ATTORNEYS AT LAW I:10arke0eedslShipman.wpd WEST YARMOUTH,MASS 02673 BARNSTABLE COUNTY (500)775.3433 + ,�1►,�I REGISTRY OF DEEDS REGISTRY OF DEEDS A TRUE COPY,ATTEST JOHN P.MEADE REGISTER. I ( l i " j C. LQ I sF f —t - ;• 11 T.. \ ! ttv 0.hZA%V i` `. --- -- A„ r--=— — '4� �'�s;ti �c;'�' A' CERTIFIED PILOT PLAN! S. CERTIFY Tt-i!`,T THE �="'"_�--sir; R. d' OrHEGRA1.0 PVC., RLS, RS . SHO`NN ON THIS PLAN HAS BEEN 1346 ROUTE 134 LOCATED ON THE GROUND AS I"vDICATED. EAST DENNIS , MASS. 11 DATE: OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to oil the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. `.....%J:.......... .: .a.°......................................... Construction Supervisor's. License ................. .............. .. . P L E*#- Mif 22031 CENSUS TRACT �R AGE IVIIALIAM9,&Q)TU NFIN, Dl h B VAN 9. ELAG77XE! —Russell- 3 ESSOPS PLAN W_3i_0_PjTtl_j8j --I N P L A N F A N_� IM 0 R T C A G h I N S P J,' C T 10 LOCATED AT 213 HINCKLEY ROAD BARNSTABLE, MASSACHUSETTS SCALE_ 1 41=30' P,I'l F-S-T B R,,VL,)F 0 P•D June 7, 2001 58 _":'IT c LOT 1,35 Fs zj t-- I C.K I-Ey R�DAD .77 'I ("ER.71F�lTo Still-LIVAN, WILL'A-MS -IN, IRI WN MORTGAGE.: ("ORPORAINCAN,A�7 i--rS 'ITFLE. , & QLJIN'l NSURANCE C0k4PAN, )', "I TIA-1 J+ff-Rh ARE NO VISIBLE ENCROACHMI-:NTS, OR F.A.qFMENTS EXCEPT A� \'HOWN AND 'I"HAT -THIS PLAN WAS PREPARED UNDER MY IM3AEDIATE SiJPERVISION i' TP'_El.0CATl0N OF '7ffi DWELLING AS SHOWN HEREON IS IN COM!"LIANCE WITH TlfF LOCA.I., A-P PUCARLE A ZONING BY-LAWS, WITH RESPECI TO HORIZONTAL DIMENSIONAL REQUIREMENTS. N I rffF DWF-,',L* tNTG SHOWN liFRE 1)01-'�S NOT FALL W1714IN I �'0 A SPECIALFI-C)OD HAZARD.."'ONE AS DELINEAlTiD ON A- MAP OF C0M_M'iJNI'rY�2500()).0005C DATED 8/19,185 BY 1*1 IE a t1.13 2.1.. —7.�8. 33'.0- ® 01 BATH MASTER BDRId - NIT'HEI! I& ! � BATH BECF.?JI.1 I, BEDRDDI,1 0': _ .°. 7. r I se s® 5® 9 Lovlt'r, Dill,* FRONT ELEVATION 1st. FLOOR PLAN 2nd. FLOOR PLAN. SMOKE DETECTORS REVIEWED �9sscsBoF�'0yk 8A NSTABLE BUILDING DEPT. �oycLry DATE o - OF FIRE DEPARTMENT BOTH SIGNATURES ARE REDUI Fm _ LEFT SIDE ELEVATION REAR ELEVATION ' RIGHT SIDE ELEVATION. Date; 10/5/09 Plans for; Christina Russell Floor Plans & Elevations scale 1/87 111 213 Hinckley Rd.Hyannis, Ma. drawn by; Mark Gustafson —3 8" _.5 47 - =— 24'-0" ridge vent 2 x 12 ridge-- 12 12 5 c 12� vented dripedge . ( r zo:. cdx sheathing( 2x8 c iling joists 16"o.c.w/R-30 f/g insulation I G. asphalt „ O' ' roofing 2 e` 6 R- 15 wall insulatio n(typ) material R-15 II insulation(typ) T4"wall studs zo 2x10 floor joists 16"o.c.w/R-19 f/g insulation exterior wall w/c shingles 5"exposure All to vertically , 1/2"exterior sheathing- ' R-15 wall insulation(ty p) „ .. _1• _ _ _ _ L_ _ _ _ __ _ - i—_�_ _ ___ _ - __ _ _ ., 1.. ____t_I _ ____I, -t___-_ t—._ __ _ - Studs y,4„wall T-0"— -:_—6'-4" —6'-4" E 6'-4" = —T-0 - N i 2x10 floor joists 16"o.c.w/R 19 f/g insulation a ._ 3 2x10 wood girt —� 5/8"Anchor bolts spaced 56".; y Lally columns 3 3 ` .3 1/2" x imbedded 7"w/ "x1Y4"plates w ,. 4. " 3 1/2"poured concrete slab 10" x 16"continuous concrete footing 33'-0" )ate; 10/5/09 Plans for: Christina Russell Foundation & Cross Section Plans le 1/4"_= .1 213.Hinckley Rd.Hyannis, Ma. drawn by; Mark Gustafson TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. ,.;Map P qrce I.' :,,Application, 4 ; t Health Division Date Issue d Conservation Division .,Apolication Fee Planning Dept .,.:Per Dept: Fee' Date Definitive Plan Approved by Planning Board Historic OKH N IC Preservation Hyannis r�ll N . Project Street Address ire k,L G Y Village 73 Owner C H R 1 57p,,, 2 S 5,56 L. Address 77,YS Telephone 50 2-S-8 Permit Request b4mo ® n VC Square feet: 1 st floor: existing lotF proposed /0 Z 8 2nd floor: existing proposed TO 4 tal new Zoning District < Flood Plain Groundwater Overlay Project roject Valuation _6 I Construction Type W O'D PzAmt_ Lot Size Grandfathered: Ll Yes LJ No If yes, attach supporting documentation. Dwelling Type: Single Family N' Two Family L3 Multi-Family(# units) Age of Existing Structure _50.YR-S Historic House: L3 Yes 91 No On Old King's Highway: Q Yes 0 No Basement Type: 0 Full W Crawl LJ Walkout U Other AJ MN Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) 0 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing 3 new Total Room Count (not including baths): existing new 5 First Floor Room ount 3 Heat Type and Fuel: W Gas LJ Oil Q Electric Q Other Central Air: Ll Yes W No Fireplaces: Existing New 0 Existing woocl)�66al stov Ll Y'6,s W No Detached garage: LH existing ❑LJ new size Pool: LJ existing U new size Barn: isting .11 ney:�' size Attached garage: U existing Ll new size —Shed: L3 existing U new size Other: Zoning Board of Appeals Authorization 0 Appeal # Recorded L3 N) C Commercial LJ Yes W No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /n'qZK P, &OSW-5010 Telephone Number 6-eff - 3:24e- .3-7 V-5- Address 5e.4k-svitce- [2-6 License#—C* 5 S53 78 50. N,VU&)i S VAA., 0"40 Home Improvement Contractor# I&LB92. Worker's Compensation # VWC (noo6lo57012-008 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE AMW -'C" DATE Ij E 7 FOR OFFICIAL USE ONLY *:APPLICATION# DATE ISSUED MAP/PARCELNO. - ADDRESS VILLAGE a OWNER c •DATE OF INSPECTION: i 'FOUNDATION FRAME INSULATION i F 'FIREPLACE ELECTRICAL: ROUGH FINAL E PLUMBING: ROUGH FINAL GAS: ROUGH FINAL s FINAL BUILDING ` t � • DATE CLOSED OUT ASSOCIATION PLAN NO. r I . �ie,d Ct�4�'JinotGr nationalgrid A April 14,2009 Barbara Gusta son Via fax. 508430-8058 2U Hinckley Rd Hyannis,MA To Whoi-n it May,CUTIcem: , This is to verify there,is:ao raatarai gas service to the above address. This was confirmed by a representative of l-abc nal Grid. 'If you have any gvestions,please call rrie at(731)466-55066. Mane I Bessette Field Coordinator National 064 52 Second Ave,Waltham.MA 0245" T:78'1-466-5066 a F:781-290.0441 !r�ari�.b esett� us.n�rid.Corn wuvw.nati[,t�algrid.cacn - - f. OFtNE rpk� Department of Public Works ' 47 Old Yarmouth Rd. P.O. Box 326 y�P o,► Water Supply Division Hyannis, MA. * * nY 02601-0326 * BARNSTABLE• * 4, + TEL:568-775-0063 9 MASS. ,, . FAX:508-790-1313 1639. 'Hyannis.WMter System Operations March 13, 2009 Town of Barnstable Building Inspector Town Hall Hyannis, MA 02601 RE: Service@ #213 Hinckley Road-Hyannis—Acct# 605438 Dear Sir: r; i Please be advised that the above water service was shut off.and the meter removed on 10/15/08. The owner has informed us of plans to demolish the building. Sincerely,. .11 ne arck Hyannis Water System'" t . �,Wwp,y r. =. WhiteWater-Pennichuck Operated and Maintained by WhiteWater,Inc.and Penhichuck Water Services Corp.' I7614418721 NS7AR SUM SkA,3024 OR:15:01 a.m. 03•••25-2009ONSTAR 1 ;1 One NS AFC Way ,gL E,0 rR fC Weevlaod,Massachusetts 02090 0A S March 25,2009 Christina Russell RS 213 Hinckley Road, Hyannis Dear Ms. Russell: At NSTAR, we're committed to delivering great service. This letter serves as confirmation that, as of March 25, 2009, the electric service to 213 Hinckley Road, Hyannis, has been removed.. Based on this information, there is no electric power at this address and you may proceed with the demolition. It you have any questions, please contact me at {333 633-3797. Sincerely, MarAlundell Now Customer Connects O3/26/2O00 11:38 FAX 506 '90 6325 WATER POLLT'TION CONTROL Town of Barnstable Department of Public Works Engineering Division .167 Main Street, Hyannis, Ma.ssachuaetts 02601 (508.)862-4088 Fax (508) 862-4711 FAX CUvt:K *HEET, PLEASE FORWARD THE FOLLOWING PAGES TO : Mid Cape Residential Resources So Dennis , Mess Attn Mark & Barbera Gustafson RECEIVER'S FAX : 9 ® � - 5®.� 2�� -�689 FROM e Dave Anderson En i�gering Division Town of Barnstable DPW DATE : arch 2§ . 20L9 NUMBER OF PAGES INCLUDING THIS HEFT . _ 3 _ COMMENTS : Letter concerning sever disconnections at 213 Hinckley Road , Hyannis DJA 03!26/2009 li:3P FAX 508 790 6325 WATER POLLliTION CONTROL 3 Town of Barnstable DePartment of Public Works NARMA=. 230 South Street, Hyminis i�A 02601. 161 www.engineeriaagtatow-n.baimstable.rna.us Mark S. Elis, Director Office : 508 -862 -4090 R. W.`Bud"Brea€It, Jr. ; Assistant Director Fax : 508- 862-4711 March 26 2009 Mid Cape Residential Resources Searsville Road So Dennis , Mass 02660 Subject : Disconnection from municipal.tserer of 213 Hinckley Road a Hyannis'; R'l&P 310 - 81 Dear Sirs ; A Sewer Disconnection Permit application has been issued to Mid Cape Residential resources & Christina Russell for the property at 213 Hinckley Road. This is preparation for the demolition of the existing building on the property. The contractor has been instructed to cut& cap the existing sewer connection, at the property line, and to notify this office when the disconnection is schbduled. The DPW inspector,will irl^apeot End accept the disconnection at the time that time. A sewer compliance record and a record drawing will be completed and filed in the Admin & Tech Support office; At the proper time, a new Connection Permit and inspection will be required for any new construction on the property. If you have any questions, or need additional information, please call pave Anderson at 508 -a 790- 6244. Sincerely ; David J nclersdn ; 'Con,truction Projects -Inspector Town of Barnstable DPW W Admr n & Tech Support Permit TOWN OF BARNSTABLE DEPARTMENT OF PUBLIC WORKS . SEWER PERMIT Connection: Modification: Disconnect: Repair: Assessors Map No. 3/ WATER SUPPLIER: Assessors Parcel No v SEWER ACCOUNT NO.: Street: cg C! C! SEWER ACCOUNT NO.: Village: PERMIT FEE: Septic Abandonment ermit (1)Residential Bldg=$420.00 (each addt'I.bldg.on same service=$200.00) Obtained From Health Department: (1)Commrc'I.Bldg.=$875.00 (each addt'I.bldg.on same service=$200.00) Connections requiring installation of a pump,add$300.00 to base charge. Abandonment Permit Not Required: PROJECT CONTACTS PROPERTY OWNER (Mailing Address BB SEWER INSTAALLERL Name: It ('1 r I`.�'rn�' . L�SS�i Name: i , �S idd!i'1 T1 f Ct S6�t i�C/ Address: Dtf�t 5 �Z�� Address: t "I� Phone: 15b S ' 9 j.0 U ICi!�2 Phone: PROJECT DESCRIPTION REGULATORY REQUIREMENTS The installation of all sewer connections must be done in accordance with FACILITY&LAND USE DATA. the provisions of Article XXXVI,Town of Barnstable,General By-laws and regulations issued by the Department of Public Works. Before excavating NUMBER OF UNITS METER SIZE FIXTURE NO. within a Town Way the sewer installer must also obtain a Road Opening permit and comply with the Construction Standards and Specifications RESIDENTIAL: outlined therein. At least 48 hours prior to the installation, the applicant must notify the Department of Public Works, Engineering Division for the COMMERCIAL: purpose of inspecting the installation. The Inspector will complete the RESTAURANT: Compliance Sketch locating the installed lines and connection. INDUSTRIAL, By signing the Application, the applicant acknowledges and understands the regulatory requirements and understands that failure to comply with STANDARD INDUSTRIAL CLASSIFICATION NO.: them shall be grounds for revocation of the Sewer Connection Permit and the denial of any future application. This sewer connection permit shall be NO.OF BUILDINGS: NO.OF BEDROOMS: valid for 180 calendar days from the date of D.P.W. approval indicated below. The required notice must be given and the installation SIZE OF PARCEL: ACRES: commenced before the end of that period.. Otherwise, the permit shall become invalid. When that occurs,a new permit must be applied for and ESTIMATED DAILY SEWAGE: GALLONS a new fee paid. PIPING: LENGTH DIAMETER Detailed engineering drawings must be submitted with each commercial permit application and be approved prior to acceptance of this permit. EXPECTED INSTALLATION DATE: SIGNATURE(INSTALLER): DATE � /`O C► n SIGNATURE(DPW APPROVAL') Z �� ! DATE , ( /G 7 THIS PERMIT FXPIRES ON: TOWN OF BARNSTABLE SEWER RENTAL RECORD I FIXTURE RATE CARD NAME AND ADDRESS OF SEWER'CONNECTION BILL TO - NAME AND ADDRESS TYPE OF BUILDING - REMARKS Mo are Elaine DwellingPermit 2241 213 Hinckle,yRd Hyannis Map 310-081 • lConn 7/9/87 PLUMBING FIXTURES i YEAR TOTAL CHARGE YEAR TOTAL TOTAL CHARGE I YEAR TOTAL CHARGE YEAR TOTAL CHARGE wic 1 1987 Sink l Tub 1 Shower 1 La Wash TOTAL FIXTURES II II I II b I 10 p � � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Inn C P6_ f2,,r_S1p6A-rr1aL e— Address: 177 S2slor�C� i2>, SQ ��yrv�g f►2� oZG� a . City/State/Zip: Phone.#: S-PS 394/- Y7W Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the stab-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner-' listed on the attached sheet 7.. ❑Remodeling ship and have no employees These sub-contractors have 8. - Demolition working for me in any capacity. employees and have workers 9. ❑Building addition [No workers' comp. insurance comp.insurance. required.) 5. ® We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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 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.M 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 tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si afore: Date: -' O Phone#: 5'69 - 3g4 - 3Wr Official use only. Do not write in this area,to be completed by city or town offu:iaL 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 engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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, PP 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 Investigatim, 600 Washington Street Boston, MA 02111 U. #617--727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia t3o,n d ci'Building Regulations and Standards License or registration valid for individul use only HOME H1,1PROVEMENT CONTRACTOR before the expiration date. If found return to: Regis tra`fion 161892 Board of Building Regulations and Standards it Expiration 12/9/2010 One Ashburton Place Rm 1301 Tr# 278726 t Boston,Ma.02108 P�tvate Corporation MID CAPE RESIDENTIAL RESOURCE INC. MARK GUSTAFS�ONr 177 SEARSV ILL E SO. DENNIS, MA 02660` -- Administrator No valid without signature " Board of w mg egu at�oi(s an ta� .I { Construction Supervisor License I { License: CS 35398 Blrthdat@ ,6/30/1956 I ` Exp tion=6/3012009 Tr# 15419 3 j ��strtction. QO/'r�� MARK R GUSTAFS� PO BOX 635 r DENNISPORT,MA 02630 Commissioner • t, �t►,E, � Town of Barnstable °^ Regulatory Services BARNSTAIS9 MASS.erg` Thomas F.Geiler,Director 16.39. Awe Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, ��`Q-l5`� ��\C� V.�S�� , as'Owner of the subject property hereby authorize MQ,2—9-- to act on my behalf, in all matters relative to work authorized by this building pen-nit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O W NERP ERM IS S ION �j Town of Barnstable F Regulatory Services Thomas F.Geiler,Director �!, ,•� Building Division QED MA'1 a 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: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said 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 constriction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Constriction 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:\YvrPFILES\FORMS\homeexempt.DOC ' l.:SY;'4 r.•i h_...`Oa`..4' Town of Barnstable BARNSTABLE.q• Regulatory Services 9 MASS. 0 s639. `0 Building Division.. 200 Main Street, Hyannis,MA 02601 if Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Ql-� Is Location a/ 14 t rC t t�7-7 Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: C-Ll i UM tJ 4fE Y C — ? 7-" S SFr,2 7- t R o-o r RA ETA&-r-S - 70V s aM d L c FOR- CA IT-4a hpA c c cc y X Co 7v-O rAk- A-PAIZ�r � v E ct�r-f r A-:-V o N _ A b 6 U -rVV i hw � aA PR v PE12 G A SS 1 /`1) M A S I 8&3 6 f2 V-t — 5'PAC ►At/ 0,47 C DL C $1Z :PE!; -raT) j4-bGCd I M uLA 77,0 tr t/6:76 T-r [. rI awe fq 5[co LPI C-r< V&-- It Gy r fL i rf l., ��Prr C_ f= Please call: 508-862-4038 for re-inspection. � � ('It, PLU tit Inspected byuJJ r-, --d 2,0 p Date �-'- � �- 6 � � "� 6� CC ASS Tow n of Barnstable Building Department - 200 Mai Street MASS. Hyannis, MA 02601 9�A 1639. , (5Q 862-4038 rF0 MA'S A Certificate of. Occupancy Application Number: 200904797 CO Number: 20110019 Parcel ID: 310081 CO Issue Date: 02110/11 Location: 213 HINCKLEY ROAD. s Zoning Classification: RESIDENCE B DISTRICT Proposed Use: ACCESSORY LAND WIIMPROVEMNTS Village: HYANNIS Gen Contractor: GUSTAFSON, MARK R. Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: Building Department Signature Date Signed JOWN �� RN S Application Ref: 200994797 BARNSTABLE, Issue Date: 11/10/09 9 MASS �At s639.• Applicant: GUS'�AFSON.MARK R. ` *. Permit Numb°er B 20092 18y J Proposed ACCESSORY. LAND V'I;?P j'? vFn c ;r. _"'t q �I • p O rTI�IT, piration a-., 4YOfif� !r - -- - — , ec�6s� {� Location 2�T3 HINCKLEY ROAD Zoning District RB Pen y t D HOUSE AP ER T':1 DO"i! t Map Parcel j 31008E P�rmrt Eee$ 663.00. ConhaeYc: If SON,MARK R a �< �4 tM f Village• HYANNIS �App Fee$ 100.00, �License I:iam •'!351398 7 � r t : Est Construation;Cost$ 130 006 .� 4 a+ �,, t�,I Remarks Y�ram; APPROVED PLANS MUST BE RETAINIW ON J3B AND x 5'. REB tILD NEW SINGES FAMILY AFTER DEMO THIS CARD MUST BE KEPT POSTED Ui1--TIl F ' W!— €If•P n+" - I INSPECTION HAS BEEN MADE. WHEIRE F �t 'ry CERTIFICATE OF OCCUPANCY IS REQUIRED,'SUCH`� Owner on Record RUSSELI, CHRISTINA R BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL 4 c 'Address:' a ,s ,213`HINCKLEY RD I-� INSPECTION HAS BEEN MADE. T; HYANNIS, MA 0.;601 1` � ! h AP_,.ation,Enteredby PAR r. Building Permit Issued By: — ;* TH1S PERMIT CONVEYS N�O.RIGHT.TO OCCUPY I NY STREET;ALLY.OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPOPAR':.. .; 'SRMAr�NTLY. ' ENCIjtOACH@NIENTS ON A JBLIC PROPERTY;'NOT SPECIFICALLY PERMITTED UNDER`THE BUILDING:CODE,MUST BE APPF ' '`iz ISDICTION. z` STREET RJR ALL•Y,GRADESgAS WELL-AS DEPTH AND:LOCATION OF PUBLIC SEWERS MAY.BE OBTAINED FROM THE DE°� J li [(.WORKS. ' � ., 1 " THE ISSUANCE OF"I I-IISP�FRMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE'$; 1 > r111INIMUM,OF,FOUR CALli INSPECTIONS REQUIRED FOR ALL CONTTTRUCTION WORK: r I'iFOUN'DAT�lON,0i 0'TINGS. x "" 2 ` L FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLF r 3 fN 8i PL�U[vIBING,INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. t 4.PRIQRtiTO COVERING STRUCTURAL MEMBERS(READY TO LATH). I' 5 .INSULATION "y Y tr6''FINAL INSPECTION BEFORE OCCUPANCY.I `I'IWHE E"'APPLICABLE SEPARATE'PERMITS A'RE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. f21w WOR SHAL,EF'NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION,. pERMITfWILL-BECO''ME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE P_+0MIT4S,ISSUED AS'NOTED ABOVE. , Y )'�..y1j .•�•,i 'a;4k JI #" �— RSONS GONTRACTING WITH' NREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTyY1FUND(as set forth in MGL c.I42A). We ULI}ING INSPECTION APPROVAf S ' PLUMBING INSPECTION APP.ROVAIS ELECTRICAL INSPECTION APPROVALS $tY r &,w7 '1 atin Inspectio •Approvals Engineering Dept 2 Board'of II alth, , �x.1J ., TttF t �OWII of �aY"IIstable' *Permit of p� .;. p ; . r Erpir n on s jsenrfssue date Regulatory Services Fe iBAR '13 E, 16yg. Thomas F. Geiler,Director lM � Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town..barns tab le.ma:us. Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT,APPLICATION - RESIDENTIAL ONLY Vol.Valid without Reif X-Press.Imprint Map/parcel Numberi�I Property Address .t 1\el C�wo_ Residential Value of Work ftTQ Minimum fee of$35.00 for work under$6000.00 Owner's Name &Address _C''�Z��Ct�S � Sb r� �' 1 Z��pzrZ �t iE �Sy:v� '. b�K I t YIV► t Contractor's Name �'Zr�< -�uS�'2�Syf1 Telephone Number.5b 9 Home Improvement Contractor License I(if applicable) Construction Supervisor's License 4(if applicable) , OWorkman's Compensation Insurance' Check one: 0 I am a sole proprietor, I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name W.orkman's Comp. Policy# Copy of Insurance.Compliance Certificate must accompany.each permit.` Permit Request(check box) Re-roof(stripping old shingles) All construction,`debris will be taken to S'ECt> r ` 0 Re-roof(not stripping. Going over existing layers of roof) Re-side h r #of doors�1 (gl Replacement Windows/doors/sliders. U-Value (ma imum,4 #of windows . *Where required:•Issuance of this permit d les not.exemptcompliance with other town department regulations,i.e.Historic;Conservation,etc. ***Note:- Property Owner must signTnperty Owner Letter of Permission. A copy of.the Home Improvement Contractors License&Construction Supervisors License,is` required. . SIGNATURE: The Commonwealth of Massachusetts ^� I Department of Industrial Accidents :, Office of Investigations 600 Washington Street --z j, Boston, MA 02111 `mac N www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I . Please Print Legibly Name (Business/Organization/Individual): 2V�-i�Z`C�z�� (e ��S50ri - Address: 13JCLC !2�► , City/State/Zip: Z VI l S I Nt vim® l Phone #: fD 012 6 M• eo�`7 Are you an employer?Check the l ppropriate box: Type of project(required): 1.❑ I am a employer with I' 4. Ell I am' a general contractor and I 6. ❑New construction employees(full and/or part-time).*. have hired the sub-contractors 2.El am a sole proprietor or partner listed.on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capaci! workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3. 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No workers' comp. c. 152, §](4), and we have no 12_&Roof repairs insurance required.] t . employees. [No workers' comp. insurance required.) 13.R Other i D101S t0[tvi *Any applicant that checks box#1 must also fill ouf.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.. tContractors that check this box must attached in additional sheet showing the name of the sub-contractors and their workers'comp.policy information. jam 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.#:. I Expiration Date: Job Site Address: I 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 imprisorunent, 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 ertify under the p 'ns andpenalties of perjury that the information provided above is true and correct. Signature: 'YY Date: Phone#: JrUQ a!7f) Official se only. Do not write in thl is area, to be completed by city or town official City or Town: I Permit/License# Issuing Authority(circle one): ' en it o Clerk 4 Electrical Inspector Plumbing 1.Board of Health 2. Building Departm t 3. C y/T wn C p 5. P g Inspector 6.Other 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 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-contractor(s)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 isTequired. 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,meed only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should.write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each ' year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 1 IHEE Town of Barnstable Regulatory Services. MkxsrAs[.� , rues g Thomas F. Geiler,Director EDµr�� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property OwnerMdst Complete and, Sign This Section If Using A Builder I, , as Owner of the subject"property hereby authorize to act on my behalf, in all matters relative to work authodwd by this building permit application for. (Address of Job) t Y . Signature of Owner: Date i Print Name l . If Property OWInerls applying for perry�tplease complete the Homeowners Liicense Exemption Form on the reverse side: a - r Town of.Barnstable �Of VE rp�y yw� o Regulatory Services" Thomas F. Geiler,Director MAss. Building Division °ren hw�a Tom Perry, Building Commissioner 200 Main Street, Hyannis MA 02601 wwwAown.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 H01)EDY NER LICENSE EXEMPTION Please Print DATE:4 — IL 96(,1 JOB LOCATION: lz�) alV1Cklrlt number �at(n�(2� street village "HOMEOWNER": I�-�zr1� Cam' cJz name QQom�`, p home phone# work phone# / CURRENT MAILING ADDRESS: PO V X I b city/towA state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellin.zs 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 HOMEOWMER Persons) 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.constrgcts more than one home in a two-year period shall not be considered a bomeoRmer. 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 performer)under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,niles and regulations. The undersigned "homeowner"certifies that,he/she.understands the Town of Barnstable Building Department mi„imum inspection p cedures and requirements and that he/she will comply with said procedures and equirements. <= Si attire of Homeownce 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 rcquirrd shall be exempt from the provisions of this section.(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a p=on(s)for hire to do such wofk,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Rcgblations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bfien 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 foruVcerdfication for use in your community. r S Assessor's office(1st Floor): Assessor's map and lot n b �P�o�TNI to`` Conservation /� '� a Surd flo(5r): Z seassr►ntt Sewage Permit number `7 L7��-� 7 MARK Engineering Department(3rd floor): t639•�' House number Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,ie/`LyO 9,-4 TYPE OF CONSTRUCTION _ 7q6P E114�C E SSQ '74 LcJ£C C/A) 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: v N Location /V6k) /R/ !e f3r2 co `5 �e'�Ote� • r Proposed Use 61 e �U Ov L , I Zoning District // Fire District ^^�� Name ofOwnerF-&/tiC (/ O�INFJIQG�6Re6OIRe— Address Name of Builder 2 . (��1�-bl�C Address c2 13 )5/ M/9 Name of Architect Address Number of Rooms Foundation (0, tuoec m 13LC,� C 65—c-o", ,2 i g�f r_ // 5j Exterior -I—efX:L<� Roofing s �T ShlNG)e 5 1"/` b1yC Floors __00(UCR E- Interior .�Usu 14kd�, Heating A 10(1/if Plumbing /Vow>2 Fireplace ti0 A.) �'— Approximate Cost 00J OoO1 Area Diagram of Lot and Building with Dimensions Fee � ICE 0 i . 3� I6 i r, it OCCUPANCY PERMITS REO IRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. z Name Construction Supervisor's License GREGOIRE, ELAINE MOLINARE No 35188 permit For BUILD GARAGE Accessory to Dwelling Location 213 Hinckley Road -Hyann-is Owner -Elaine (Molinare) Gregoire Type of Construction Frame Plot Lot , Permit Granted July 9 , ". 19.J, 92 - Date of Inspection 19;� Date Completed 19, ? C` - ;:� `•may - �. - Fn,n. - 1 C E RT 11 E D PLOT PLAN ;: __;, ��. ► �,` -____ _ ^,SASS. _ CERI-IFY I'll!''.T THE �== ,' '� _-� F;'. J. DlHF,��?�t�, /%VC., RLS, RS SHOWN ON THIS PLAN HAS F3-E- 1346 ROUTE 134 r` T 1� 1 '1 r EAST DENNIS , MASS. LO..ATcD. 0`J H� �ROU�vD A l,,+GICA", �J. �-'-- j' f DATE --=-- -- - - -- I S C A L E '- i' 7 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please printt.. DATE / JOB, LOCATION N�l�leCI n; Number Street Address Section Of Town "HOMEOWNER" Name, ;Home Phone Work Phone PRESENT MAILING ADDRESS - 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 such 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 to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The 'undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet o will be required to comply with State Building Code Section 127gOr�Cons'truction Control. MIScs i } HOME OWNER'S EXEMPTION The code states that: "Any Home Owner 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 . Home Owner engages aperson(s) for hire to do 'isuch work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for Licensing Construction Supervisors, Section 2. 15) . This lack of . awareness often results in serious problems, particularly when the Home Owner hires unlicensed :.persons. In this case our Board cannot proceed against the unlicensed person as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, . many- communities require, as part of the permit application, that the Home Owner 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. Youimay care to amend and adopt such a form/certification for use in your community. i r- z i 4 F 4% E� �. e \ 4i � 7 �y C r FRIEDLINE& CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: ( �uilg Commissioner or Inspector of Buildings ( ) Board of Health or Board of Selectmen ( ) Fire Department TOWN OF BARNSTABLE TOWN HALL HYANNIS, MA RE: Insured: RUSSELL, Christina Property Address: 213 Hinkley Road Hyannis, MA Policy Number: FP2071171 Type of Loss: Fire Date of Loss: 10/15/2008 File#: 108287 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail. G. D. BRIDGE Adjuster 10/16/2008 N0l-SIAI0 g :C Wa - L 1 130 0001 318V].S�4�Vq