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�/ „ems/���/ ��-�r/ ��C-- `� .� _�1 -�- ��� GAL � � cz.�") L(UWu-Q1�- � � �,�-- - � � ��P�� � � °J 9 a I I I i I Town of Barnstable *Permit - P_e�? S Regulatory Services Fee 6'"° hom issue date Krz ' Richard V.Scali,Director / A Fo 3g6 Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press I►*rint Map/parcel Number Property Address ]Residential Value of Work$ "T 00,9 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 92,tg �"�/�f'i✓� Contractor's Name / / t Telephone Number ro$^ -qsy� Home Improvement Contractor License#(if applicable) 7 l Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance . -Rol) Check one: ❑ I am a sole.proprietor AUG.0 3. 2017 ❑ I.am the Homeowner I have Worker's Compensation Insurance Insurance Company Name ,S' it Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going_over existing layers of roof) Re-side '❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where'required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc. ***Note: Prope wner m t Prope wner Letter of Permission. . A co e r vemea Contractors License&Construction Supervisors License is. f re SIGNATURE: r Q:\WPFILESTORNIftuilding permit forms\EXPRESS.doc 01/25/17 - ,o Rik CER TIFICAT R CICATE ATF ,s ►ssuED qS A E OF LIABILITY RT1FICgTE DOES NOT AFFIRN►gnVELY O FLOW. �S CE�NOT A AFFIRM INS TTE11 OF INFO REPRESENTATIVE ORpRODLIC nON ONLY NSU�NCE �TE(N�VI/DDYyyY) ` IMPORTANT ►f ER,AN C DO SAT TLCO END, EXV7END OR R3 NO RIGHIS UPON 7 the to the certificate holder NST►T�iTE A CONTRACTOR THE COVE niE E THE CERTIFCATE C RTIF►CgTE �26/1 mis and conditions ofthe HOER. BE RAGE qFF HOLDER THIS certifica ►s an gpDInONAI INSURED, the TwEEN THE ISSUING FOR THE PO to holder in Lieu Policy,certain INSURER POLICIES PRODUCER of such e►Idors policies policy(►es).must be (S), AUI HpR►ZED Schlegel ,� Sc �nent{s). �Y require an endorsement q staleme orsed• If SUBROGATION IS 34 Main Street legal Ins Broker CONTACT nt on this certificate d WAIVED,subject to ces not confer rights to the West Yarmouth, NAME: JIM gINDMAN r$Ou 02 673 PHONE EMAIL (508) 772-838.1 FAX INSURED ADDRESS: SchlegelinS I / No: 1508 ) 771-0663 INSURE urance@gmail•c0M RICIiARD -- - S AFFORDING COVERAGE Fj -�--- --- INSURER A GARDNER pHEONIX MUTUAL INSURER B':7•'RA�.''L�,'RS NAIC# MARAOARD1`TER 92 PART{ pjACE WAY INSURERc: MASHPEE, MA 02649-2725 INSURERD. COVERAGES INSURERE____ THIS IS TO CERTIFY T CERTIFICATE N UMBER: INSURER F INDICATED HAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BE NOTWITHSTANDWG CERTIFICATE Y IT I ANY REQUIREMENT REVISION NUMBER: EXCLUSIONS EN ISSUED TO THE INS NSR AND CONDITIONS OR MAY PERTAIN, THE INRM OR CONDITION OF ANY'CONTRACT QED NAMED ABOVE FOR TUE POLICY P OF SUCH SURANCE AFFORDED av RACT OR OTI)61a oocuMcrvT yVRH RESPECT TO POLCIES.LIMITS Srypy�MAY I�POLICIES DESCRIBED H WHICH THIS A ENERAL�B'uTMFINsuRAN� NDD`RTs ------- ____HAVEBEENREDU_CEDByP EREINISSUBJECTTO G I - �D CLAIMS ALL THE TERMS, POLICY NUMBER POLICY EFF �dflao- DMhtERCIAL GENE CPP0709341 rMM/DO/Y -u�mTs ---- - - ' CLAIMS-MADE �L�IA8IUTY 8/20/16 8/20/17 - MADE a OCCUR NCH OCCURRENCE $ 1 000_00 DAM4GETo RENTED 0 �' Ea �urzenc s 5 0,0 0 0 MED EXP(Arty are Person) $ - _1 PERSONAL BAOVINJURY 5 000 I GEN'LAGGREGATELMITAPPLIESPER $ 1 000 000 ' GENERAL AGGREGA I P ICY PRO TE $ 2 000 000 OL n T- LOC PRODUCTS-COMP/OP A GG $AUTOMOBILE LIABILITY 2,000 000 I$ ANYAUTO COMBINED SINGLE LIMrr Ea accident $ ALL O WNED SCHEDULED BODILY person) $INJURY(Per AUTOS AUTOS NON-OWNED BODILY INJURY(Per accident) S _ HIRED AUTOS _AUTOS PROP E El DAM AGE GE Per accident $ UMBRELLA LIAB $ OCCUR EXCESS LIAB I MADE EACH OCCURRENCE $ CLAIMS- I — AGGREGATE $ DED RETENTION$ WORKERS COMPENSAMON $ AND EMPLOYERTLIABILITY WC-0179798 6/3/17 6/3/18 WCSTATU- OTH- ANY PROPRIEIOR/PARTNERlEXECUTIVE Y 1 N OFFICERMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ 100,000 Ify..,d-crinNH) E.L-DISEASE-EA EMPLOYEE S 100,000 M os,deacibe under DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICYLIMrr s 500,000 SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 1p1,Addltional Remarks Schedule,if more space is required) CHARD GARDNER HAS ELECTED NOT-TO BE COVERED UNDER HIS CURRENT WORKERS COMP POLICY ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, Npx4eg WILL BE DELIVERED IN TOWN OF BARNSTABLE ACC"WITH THE POLICY P ISIONS. IN HAND, AUTH R2E SENTATNE I l ©1 8-2010 ACORD CORPORATION. All rights reserved. ,CORD 25(2010105) The ACORD name and logo are registered marks of ACORD .._:r. 27m CornrtxmmeaM gjfAassachmsetts Depar&ffmt&f1ruhrs&idAcdde7ds office afIM-W-1kgadmu 600 WashhWtoF:,ngtreet Basta a,CIA 02111 fmim asngorldia Workers' Campem3fidn.InsM2.-Uce Affidavi�BOders/Cu.ntraciMrS/Mecfrician hM3Lhers AppUcanf1nfm=fiuu Please Print Eye Name Address: VA V �.....f3 1 F_ Fle.1 AAA -7 Are you an emplUer?CIffecktheappropriateban Type of reject r 1_ I am a 1 wffi 4. ❑I am a genecnl contractor and 1 e ] ( coon �•P� 6. ❑New oansf�ctiorE employ-ees(fullandforp Time * I=ehiredthe sub-contcactos 2. lam a sale proprietor arparbwr- listed aathe.attached sheet. 7 ❑Remodeling Time;sub-ccinfrac#ars hafie ship and Lsat*e as employees • $_ Demnlifioa waddn„ forme i a any capacity employees andhace wo&ers' 9. ❑Building addition LNo xUpd3a ' conIIp.fimu rnm comp-immrarm-# • . required-] 5. E We area corporafionand ifs 1aD Etechical repairs cr adds 3.❑ lama hnmeo-vm-er doing aI work ofFc=have esescssed their 1L E]Plumbingrepaim ar additions. self right of emmWfion per MGL y �' �o warke& C.1521 �F . , // have no Roafrepaiis frtatr=e required-]i L�aadwe ha employees-(No workers' 13.❑Other camp_inserasice xequired.) `$-aYaPFfics��accheds'Ews�l�elsafll«attheseeBoabeIowshntvngdie�wo3cea'cvmpeasa5aupoTcpir�armsae� • I Snmeamerswho mbmft ff is rf5davu oduzfmg tLvy gm&3iag RUwc*=4d mbfm outsidervntmrtors a sorb ` rCautatlaistTzZtehecYi sboxmmtattar1, saaddid—A shed showingthenmneofthesab-ca==to-mxmdstKiewhetherarnaftseend*slxm employees.Ifthesuh caatradaes5a�ee�giafers,tFieyx�stpmr-ide-ttair warkms'c=p.parmynumben lam art workers'compem Tian i><tsrtranm f or my emplv}�ees Below is the poficy arrd job spa irif Orrrra6m TnsmanreCampauyNams: Poficy,or^�fmsIic_ G' r'7 �� / �pifatiosDafe: Job S"afe.AA&=:d. ��� ' /(a e� c yrs r : ' cam PIX Attach a copy of the warkere compensatienpoay�dect�ara dm page-(showing the policy er and�e.=pn-ation date). FaAme to secure coverage as required under Section 25A of MGL c.1572 can lead to the imposition of rAminal penalties of a fine up to$150D OG awYor arse year imprison as we11 as civil penalties in fire form of a STOP WORK ORDERand.a free of up to$MOt1 a day against the violaicr. Be advW Brat a copy of this statement.maybe fxwarded to the Office of Inresfigahons.o€dse DIA for ihs nce ge -1*hercefiy c. _.._ F th&tlie iu fbrma€rmtprotulrrlaboi .7saud correct Siffiatnre _ Date: Pfmae A. t? aL use wiry. Do not wrke in f ds axea,fit be cmmpTetad by cfty ortomu vj rciat City or`om= •`PermitUcense# Issuing Auihor€ty*(ch-cie oz►e).: L Board of Health Building Pepartm:ent 3.Cftylrovin Clerk 4:Electrical Inspector S.Phimbmg Lupecter 6.Other Con-fact Person: Phone#: — —. — --- 6 ormatian aia' d has colas ` Ma e��cebeaal Laws di pia 152 rDga=all eEDIIoyzrg n Provide V=kMe=33P=S3fton for flier CWPIoyeM P=MM3tto this fie,as e7VkY=is defiled as¢:eveaypersonm.f a service of another ceder aQy,co�rart ofbae, erP Mss or implierL.and or Viate ." Aa Moyer is derfined as-au indrvidval,Pa:r nMsbT,association,c MPMa a ion or other legal Mt ty,or any two or more . ofthe e:�gageaimaJoint ,andincmdingthelegalrepres�-aiivesofadeceasede�ployra,ou13ie �� 1D However•isle receiM or trastee of an mdiyidnal,pMtneasbiP,asociatim or otherIegal entity',employing� 9�- ownr-r of a dweniiag bows having IIOt me io titan three apartments m dwho resides therein,or the;occapant of thee-- dweMag house of an other who employs pem=to do maims ce,conskuc on or repair wolk on such dwelling house or on the grounds or bmIdmg appurfenar¢fhereto sballnotbecanse of such employmedbe deemedto be an employ=m7 MGL cdaapie-t 152,§25C(G)also states that¢every state or local Hc=kmff agency shall withhold•fie imance ar renewal of a Ticease or permitto operate a bvshiess or to construct buildings is the commonwealth for any applicant who bas not produced acceptable evidence of cdmplrance vI tIM ftmvxance.C0verage raquirecb AdLEtionally.MCA cbaptrr 152,§25C(7)states'Neitb=the:carom aweal&nor any of its political subdivisions SBRU ear intD any contract fart epmfonumc c ofpublio wmk nag acceptable:evidence of compliancewn$ie;ncm-ance.. r mf�oftiais chaPICE have been.presentrdto the a nErar .ffalh ity." A-PFIiCZn7b-. ' Please El 0-at the woi='compensation affidavit completely,by d=Ymg the boxes thatapply to your sitnafion and,if necessary,apply sob- s)n=e(s), addresses)andPhon Im= er(s)alongwiththMr CC[tEoate(s)of Lmati-dLbbiUy Companies(LLQ orL=aiFedLiabMtyPaxineships(LIP)'wathno eo:[Ployces ogres than the members or partners,are not rbgaired to cagy wo13ceis' compensation TnevraT,ce If an LLC or LLP does hate employees,a.policy is rtqaiM& Be adyisedthatthis affidayitmaybe sabmittt-,d to the Deparfra=t of r5adosfrial Accideats mr con£amatic n of insurance rzveragE Also be sin a to sign and date a affidavit; The affidavit should be•retrrmed to 1he city or town that the appliccation for the permit or license is being rrg1PsbA not the Dpparfineat of LhAustrial A e:o_t- ToX you have any qmcstLons regarding tire-law or ifyon are recpr¢ed to obtm.a workers' compensation policy,please call the Dep arfineat at the amber listed below. Self-h0nEd companies should enter their s eif-in sruance Iic mD number on the appmpaaf m Imo. City or Town Offi als . t Please be Mare that the affidavit is complete and priofecilegibly. The:Departlnenthasprovidedaspaceatthebottom of the affidavit for you to fill out in.the event the Office of1mvmstigations has to comtartyon regarding sae applicant Please be sure to fill.in the pezm3 ti cease mraber which wiII be used as a rsfr_=ce monber. In.addition,an kTlicant flla±must sabmit m_vb�ple pe.IInitllicense aPPl>cations in ray aver year,need.only sQbmit one affidavit indicating Cau=t p olicy fi fo=ation(if necessary)and reader°Tob Site.AA�re&*tie applic�shor]A write°aU lot stions is . - or town)-"A copy ofthe-affidavitlhathas been.officially stampe d or marled by the cny or to maybe Provided to the applicant as proof that a valid affidavit is on file for futm epemlits or licenses_ A new affidavit rmist be tMed.out each year.Where a home owner or citizen is obfai ling a license or pew not i@ated to any business or commercial venfro btualeaYes eb--)said is NOT req�edto wmpIete this affidavit Cie.a dog license orpem3rt to The Office of IMVCSdgaiinns wouldNM to thank yonin.advance,for your cooperation and shovld you have any 4IIcsl'ms• please do not hesitate to give us a call -Me I)Lepartmemfs add,telephone and fax mmmb=a. . 'T! Ct)�nM,0nWatiiI of Massazb_UREft9 , Degadmmt of AAwUaa s GMWn St f- B IB Oil11 -Tf,-L 617- -49OG Q� t 406 ar 1477 MA SAS Fax#617 727 7M Kevised424-07 �tr�� �IHE Town of Barnstable Regulatory Services + � f ` Richard V.Sca14 Director Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject property lei / to act on m b rite ehal� hereby authorize her y y in all matters relative to work authorized by this building permit application for. m� (A.ddress of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not t be filled or utilized before fence is installed all final pe ns are performed and accep -/ /'ell lyll� " tore of Owner S. o A li t xzc & le- e riot Name Print Name �P l e Dal t QTORMS:OWNEUERMISSIONPOOI:S Town of Barnstable Regulatory Services oF ,y Richard V.Scali,Director Building Division t Paul Roma,Building Commissioner MAM 1639. 200 Main Street Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: 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 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 supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack-of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor..The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fonnsTXPRESS.doc 06/20/16 � Cjf peraaac/ucaeC j (�/iie �y�moauuea z License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR �I Office of Consumer Affairs and Business Regulation Registration:;;`1'43074 . Type: 10 Park Plaza-Suite 5170 Expiration 15I201;8 DBA Boston,MA 02116 OF _ GARDNER CONST RICHARD GARDNER�', M •' I 92 PARK PLACE WAY _ -y - I of va►d witho ignatur MASHPEE,ma 02649 Undersecretary e Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-100471 Construction Supervisor Specialty a RICHARD H GARDNER 92 PARK PLACE WAY MASHPEE MA 02649 Expiration:' commissioner 01/29/2018 i �vGaaoccc�iw�e �/e�po�rurnoauuea�C/z o� License or registration valid for individual use only i; Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Type: office of Consumer Affairs and Business Regulation Registration::;%:14307410Zt k Plaza-Suite 5170 Expiration -6/�6L2Q1;8 •DBA B6 =-�---=3 GARDNER CONST ,t RICHARD GARDNER' �_ r I t 92 PARK PLACE WAY r :r•..--•.._ MASHPEE,ma 02649 Undersecretary ►d witho ignatur =Construction Supervisor.Specialty ti Restricted to: CSSL-RF-Roofing CSSL-WS-Windows and Siding Failure to possess a current edition of the Massachusetts State Building Code is cafise for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS • r r " l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 041, Map 5" Parcel 16 7 /tip Application # I qto Health Division Ot q�v �, � Date Issued. Conservation Division 'dam/ p o,?OJ� Application Fee Planning Dept. 04110 Permit Fee71 Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address ;?l . _S lgn V etj �Ogj Village gS4Q„„dS Owner /l✓r � � Address 874S Qq 1�wg, S+. L' kg je_y v1 ,191A Telephone_ j6/7 ';6 7 -WY/ Permit Request Wecb;c! (104fd ekAe��1r1,,r Yip cry- Vetrjo,.s. /®rt 007 use. -LhS4 l i Alew PVC b eckj;,r, evn sle-w is ova PXI' 4 %r-C Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District RR Flood Plain Groundwater Overlay Project Valuation 6 I( 000 Construction Type V Lot Size 6•2 Aare-s Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes gNo Basement Type: ;A Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) 728 Basement Unfinished Area (sq.ft) 1/0� Number of Baths: Full: existing Z new Half: existing / new Number of Bedrooms: _7 existing _new Total Room Count (not including baths): existing 7 new First Floor Room Count Heat Type and Fuel: ❑ Gas A Oil ❑ Electric ❑Other ` Central Air: ❑Yes ;J 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 Q No If yes, site plan review# Current Use =S �e ,/u Proposed Use _s�e V!�a 11.4 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Ccv me eur- Telephone Number 77`a'23S5-936 y Address t License# 5 - U!-t294,I A Home Improvement Contractor# U00 N 7- Email MlV El cv-e @ a o I , eorr7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �L)rp� L-4" %11 SIGNATURE 7/`% DATE I } FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED i MAP/PARCEL NO. » { " ADDRESS VILLAGE '. OWNER r + 1 t DATE OF INSPECTION: t `Z w FOUNDATION h FRAME ;. INSULATION M` f FIREPLACE ELECTRICAL:. ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 'I DATE CLOSED OUT ASSOCIATION PLAN NO. y Massachusetts-Department of Public Safety Board of Building Regulations and Standards V 1111sL1 U1.11111 Suite s'1111r License: CS-092961 �.�.�.s MARK E MEJEXW ' PO BOX 682 EAST FALMOUTH �.•�L,, ,11 ,AA Expiration Commissioner W0912017 C Xe et"nvtonevea lt �ic6JCr:c�U�ef1, (" y Office of Consumer Affairs&Busi ess Regulation License or registration valid for individul use only = OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration 160102 Type: Office of Consumer Affairs and Business Regulation 7 xpiration 71212015 DBA 10 Park Plaza-Suite 5170 - 1368ton,MA 02116 MARK MEJEUR CONSTRU,GTION MARK MEJEUR 20 PARKER RD. FAST FALMOUTH,MA 0253611- • Undersecretary Not vali thout.signature ' A 1 TTze CtmurtaInrrenMi gjfMassadiztset s v s .vepm-imerrt&fun-du 1n'd Acdderzt x O,-ce ofLn..w#gadam ... ' 600 Washinglon Street Bostono AMA 02,111 - um'1 unasngorldia -- Wm-- mr-s'—CGinpemafinaIus c-e-Affidavit=B•nil:�ders/Coatr-aetm-s/EIeet cans/Plumbers -----P_lease Fn'nt..Leei�y- — Nsme IBanaa4ioIIlFncT�idnal} i,lCe�fi ��l�u Address: C�2 city/state/ ,Aj InA-0 2,531, Phone tr / 7 y-2��- Areyou an employer?flherkthe appropriate bow , Type of project(required): I_❑ I am a employer with. 4. ❑I a:n a general contractor and I 6_ ❑New consizucfii employees(fish andfor part-time).* have hired.the sub-contractors 2.)4 I am a sole proprietor or partner- listed on.the attached sheet. ?- $RernodeHng , slip and have no employees. These sob-contractors have g- ❑Demolition working- foe main any capacity: employees and have wodcers 9. ❑Building additions [No W03 mrs' camp.insurance comp.insuraaml required-] 5. ❑ We ae a-corporaion and its 10: Electrical repairs or adfitaas 3.❑ 1 am a homeoumer doing all work officers have exercised their 1L❑Flumbingrepairs or additions myself-[No wad:ecs'comp_ right of exemption per MGL 12.❑Roofrepairs inSsrance required,]i c.152,§1{4y and we have no employees-[NI o worYers' 131:1 0' then corup-insurance required-) *flay appBLuttbat cbedsbos#1 nmsi dw iM oraithe swdoabciowdovdng&&wo3cme c=pmm&npo&cginfnrmauoa �Hameo�vaersarho sabm%t e�is af5data in�ting tlwy azedning sllwad:sa�tbeahiie o�de2oatm_�+*�amst snitmit anewaffidaBt indieati¢g scccfi_, , � , , rCentmactoasYHst clnjCtL¢s boat must attached su additi-sl sheet sb ndngthe x,-neof the sub-cant=toss and statewhether oraot*wL-eafftiubive employees.T€tbesub-=bxctwshsve emplayee-%they=ustgmuide thin=rke&mmp.poliy number. I am an srrtp�}�ar fltatus prataditrg tt�orkers'toatpertsafiaa insrirarccs,vr arc}*catpiny�e¢s $eZo�v it fJts palic9 algid jaL sere _ iic�armtrtiatr, n 1 _n Ius�cecogrpaayNa= 1V A - Poficy or Sf-ins.I.ic. E�cpirat ion Date: Job%,Mdres- 21 rs1.00A ttw citylStatelTg: ) rni Bch a copy of the work-ere compensaiionpclicy decl2ration page(showing the policy number and respiration date). Failure to secure coverage as.required.un der Section 25A of MGL c.15 can lead to the imposition of a irl im I penalties of a ' fine up to$1500 00 andfor one year imprisonment,as well as civil penalties ini ihe fa=of a STOP WORK ORDERand a f of up to$251DO a clap against the violator. ge adsdsed that a copy of this statement may be forwarded to the Office of c Investigations o€the DIAL for insuraum coverage veriffication_ 1'aFa Hereby c¢rhf rrardar pains artd nal&s o�fgerply.f7iatfPte irtfansiafiartprot rT€rlaba��// b�rE arnd caarrect Simatum Date: Phone 9: 7 7'- '2 — to ` 0j jkid use anly. Do scat awke in thin area b be ctrtnplet¢d by ciiy aura wn afficfat CR or'I'own: Perini f icense:9 Issuing Auflmrfty(circIe floe): L Soard•of.Healffi ButtTffing Department 3,Cityf rown.Clerk 4�Electrical Inspector S.Plumbing Inspector 6.0a Coact Person: Phone ft Laformation and Mstructions ' Massachme is General Laws chapter I52 req=m aII=TIoy=IM provide Workers'compensation for flier empIoyees. parsuantto this sib,an employee is defined as .every person i3i flie service of another under any contract ofhire, express or impHMA oral or writf rM" An errrplQy r is defined as"aa i>idrv%daaI,partner ship,association,corporation or other Iegal e�iy,or any two or more of the foregoing engaged in a Joint cubmTrise,and.including th.e Legal representatives of a deceased employes,or the _ receiver or trustee of an indiviffioal,parfnmsb-ip,association or other legal entity,employing earPloyees. HOwever the owner of a dweIling house having not more than free aparfineats and who resides therein,or tine occupant of tite- air work on such dwelling house use of ano�er who essons to do mat�ce,consfxucfion or rep � dweIIing house ��P „ e tads orb fhercb sbaIlnotbecanse of such cuiploymeutbe deemed to be an employer. or on tit pro un7dmg aPP�-� MM cbaptrr 152,§25C(6)also stars that every state or local B.=2 mg agency shah withhold the issuance or renewal of a license or permit to operate a business or to construct buildings is the commonwealth for any applicant Who has not prockmd acceptable evidence of cumpIrance with time rsm coverage required." Additionally,MCrZ chapter 152,§25C(7)sinus-Ieitherthe cominamwcala nor a'ay of its political subdivisions shall enter min any contract forthe perfarmanct ofpublic wmicumtil acceptable evidence of comphance7affi the insmsnce raquirprrients oftlsis diapter have,S-,=presented to the coziract-mg ardhozityf APPHC=-b Please fiIl do t the Wodrars'compensation affidavit completely,by checkiag-flie;boxes ffia±apply to your situation and,if nmessarY,supply sub-contractor(s)name(s), (es)and phone ntnnber(s) along with their certrEicste(s)of ftsrtrarce. Lir itedLiabiIity Compames(LLC)or Limited LiabilityPartnesbips(LLP)wrihno employees Other fl=the members or paitne%rs,are not required to cagy vtrarke&compensation insurance. Y an LLC or LLP does have empIoyees,apolicyisrequntd. Be advised that this affdaykmaybesubmfit--dto the Depa-tmentofIndustrial Accidents for coufsmatioa of i osm-,nce coverage. Also he sure to sign and date the afro-davit The affidavit should be retained to-ae city or tnwnthat the application for the pemrit or license is being requeste(L not the Department of Lnj±astdaI,A-ccid=JM Shouldyou have any questions regarding the Iaw or ifyou.are required to obtain a work=' coup a nsation poli ey,please caIl the Department at the n=b ea listed below. Self-insured companies should enter their self-i surer ce Iic use mm3ber am the appropmaty Eno. City or Town Officials Please be sore that the affidavit is complete and primed legibly. The Department has provided a space at the bottom of tho affidavit for you to EIl out inthe event the Office oflnvestig moons has 1n contactyouregmTagthe applicant Please be sure to f M in the pev�niOicense namber which wM be used as a reference number. In addition,an applicant: at mast submit multiple pmmat;sense applications in any given year,need only submit me affidavit indi- current $t policy ink im ation-Cif nec;mssaiy)and under"lob Site Address"the applicant should write"a]I ID cat in (may or town)-"A copy of-the•affidavitthathas been,officially stamped or marked bythe city or town any be provided to the applicant as pmof that a valid affidavit is on file for fvtare pemits or licenses A new affidavitmvst be filed Oi t to eh year,gTi here a borne owned or citizen is obtaining a license or p= not im afed to any business or COmmrrGial 4=tn'e (ie.a dog license orpermit to bra leaves etc.)saidpersou is NOT reqahedto complete this affidavit The Office ofInvestigations would luretothankyouiaadvance for your cocpera(ionand sbouldyouhave any,questions, please do not hesitate to give us a caI L The DepFtrneat's ,telephone and-fax Mmal;a: . 'fie an .t�of leach - . rnfi t�f lad�tcialAcci�i.�nis - �4t1 - Basto-n,MA Edl 11 Fax9 617 727 7749 Rzvised4-24-D7 �vum • ,�arsznar�:.: of.Ba�ra�stable; Regulatory Services Richard V.'Scali;Director JBirald�ng Division; Thomas Perry,CBQ Building Commissioner ZOO IVlain Street, Hyannis,-MA-02.60j- www.town b'arnstable.ma i s Office: :5:08-862403$ Fax: 508-790-62.H - . COmpleie:and Sign This Section If Using A Builder Nicolas Encina _ ,as Ovwiaer;of the subject prop, heeby authorize, !z°us' to act on my behalf,. y , m aR-matters relative,o wwF k authorized by th building p�t`application for. i (G UdtZ'Al -204 (Address of;Job} t Signa eo£ et Date; Nicolas Encina Phut,Name:, _ Tf;Properfy,Owner.is applymg. or permit;please.completerhe Homeowners License EgemptonF.orin on tle ,mverse_side. Q.\WPFII:ESIFORMS biulding pernut fo ros\EXF'T2ESS:doc Revised 04DZ5` .44 r ExI5� rn5 d.�rsCire G -op flew Q, P\/C. �ec /�rc� on :4rssvre. .5_6 t Tle,4- . sleeppers C.Svr � � M 4 ,, Ex+�1'h5 fG vS �.`++.-..+.ter..+i+Vv M�."./1�•�- /��IT'.^r7�'�.^�..+^.w�+�.Yr`6rl^r�'+-v'-.� -,--+^-.-.i+...`^-+.....-rti-�++�.rN °`�•.w^�.^'�.^y`�1- /F Assessor's map and lot number ..... ..............................,.... yo q tpj T CON,%ECT To TOWN SEWER € Sewage ;Permit number :................:.'t "� GApd ........... ` !. 7A yFTHEt��� TOWN OF BARNSTABLE BAUST"LE, i 9� 0 aY00. BUILDING ' INSPECTOR APPLICATION FOR PERMIT TO ...................................................... ................................. :......................... TYPEOF CONSTRUCTION ........................w.'�.��....................................................................................... ............/!.7...�d...................19. /• TO THE INSPECTOR OF BUILDINGS: The undersi neddh hereby /applies for a permit according to the following information: Location V T.�.. :. . S IG/✓�> &-,v� l`L/ ProposedUse .....�r.1.. �� . ............................................................................................................................... Zoning District ............. ................................................Fire District ............... .. . a .............................:.. Name of Owner .1.J.fi�. .!Y!........I.. r.lr'. .17.. ,1'1.v..Address �.�..��...��?. .!'!............. .I.I QY �. Gd.SS.. Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..........1;/............................................. ........ ..,?hl ................................................. Exterior .......... ....�X�:. .I�.S........7....................................Roofing ............ 5 Jt. U............................................... Floors � .a .o�.....................................................Interior ......:............. ............ ........ ....................................................... Heating ............... ............. ........ ...................Plumbing J.�...�J.�..: . .. ....................................................... .........................................................Approximate Cost ...� G[ 1/ Fireplace /.. . ....... .. .. Definitive Plan Approved by Planning Board ________________________________19 ___--- Area ..............v..... ..... ......... Diagram of Lot and Building with Dimensions ee �`� SUBJECT TO APPROVAL OF BOARD OF HE A TH �o 0 I hereby agree to conform to all the Rules and Regulations of the T n Bar table regarding the above ;A construction. s` Terracciano, John r. sJ No 17452 permit for 1 stor y�............. .'.... single family dwell g .�.�.• ...••....Island View Road•..•..•.......•,•.•.. Locatio ............................................................ E .......................H►annis......... ................................ Owner .......,,John Terracciano • ...................................................... Type of Construction frame .......................................... ................................................................................ Plot ............................ Lot .........#41A.............. ; i November 20 74 Permit Granted ......... .........19 Date of Inspection 2.......................19 Date Completed .51� ��.J..)...7.5 ......19 r PERMIT REFUSED ................................................................ 19 ............................................................................... ............................................................................... t ............................................................................... 1 ............................................................................... Approved ................................................ 19 s ............................................................................... ..................... ......................................................... Assessor's map and lot number .. � . :.•.:. ...::........... `*n' *. MUST CONNECT 70 TOWN SEWER Sewage Permit number ...................WHM4-&-V 7:Wrv4.Df. •;/Qk j,0 y0F7MErQ�y TOWN OF BARNSTABLE Z BARNSTABLE, i mum 'DUILDI,HG ' INSPECTOR war a• . 1 � * APPLICATION FOR 'PERMIT TO ......................... ............................ .. ....................:............ ......................... " j TYPEOF CONSTRUCTION .......................... ? /. .... .................................................................................................. ..............'... ...................19.7� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location t ! l.. <. �h�17C F ....�. '_ ............. .. .............. .......... .:� ....... ...... ProposedUse ................ -................................................................................................................................. Zoning District ... ..... l s? ...........5�.................................... ... ....�.. Fire District ... Name of,-Owner ;%,n• ".ir- �.GG f.• a+ () Address t ..: 4 4A ly Name of Builder ..................... ' ..Address ......:............ .................... Name of Architect .................. :.Address ...............`....... ..................... ..........t'� J .Foundation. r�. ...... , Number of Rooms ..•....................................:................ .,............_..,:................................................................ E Exterior - ............. ........:...................... '`."'. 1t .�.........:.......:...........................Roofing ..::......:. 5. :�'! : �!... FloorstrJ i Interior ........:............................................ .....•. ........... ............. ` . .... .......... .. .. .:.. Heating .. "......' IP t ...!: ....` •....Plumbing J. e ....................... Fireplacepp �� � /..................................................................................A roximate. Cost ........:.................�......................................... f .q . jl f Definitive Plan Approved by Planning Board -----_--------------------------19----- . Area l ff f'•r ' ....................... Diagram of Lot and Building with Dimensions Fee —' ,-; .. • . ............................... ,r SUBJECT TO APPROVAL OF BOARD OF HEALTH i \ 1 1 1 t I hereby agree to conform to all the Rules and''. Regulations of the Town of Barnstable regarding the above construction. kName........ ................ .... .`� ............ .:A:. Terracciano, John _ 7 17452 1 1/2 story, No ................. Permit for .................................... single family dwelling ............................................................................... 2_lIsland View Road Location ................................................................ Hyannis John Terracciano Owner .................................................................. frame Type of Construction ......:................................... ................................................................................ Plot ............................ Lot ..........#41A............. Permit Granted ,,,:,Novem.ber...20. 19 74 .. ...... . .. Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... ��FTHE r Town of Barnstable Regulatory Services sn ASS.�e' Mass. Thomas F.Geiler,Director y M g �A s63q. �E039.�a Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 February 14, 2007 Ms. Annette Dequattro 21 Island View Road Hyannis MA 02601 Re: Illegal Apartment: 21 Island View Road Hyannis, MA 02601 Map: 325 Parcel: 167 Our records indicate that your house at the above-referenced location is currently being used as a multi-family home, which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. Sincerely a Edson Amnesty Zoning Enforcement Officer Building Department gforms:zoning3 TOWN >OF BARNSTABLE BUILDING PERMIT 4PLICATION Map ` Parcel Uyf r„� Permit � ABL Health Division 5� (� ���(`1 2��r10� 'U # UAi?t'�aTABLE 6a Issued Conservation Division V0-3 d4 r ^ � ii�1 J �j ll: 5SM ication Fee Tax Collector P mit Fee Treasurer - i?i�`iSILr Planning Dept. APPUCAWNWOBTAW ASR M Date Definitive Plan ENGINEERING DIVI9JONN PRIOR To -Approved by Planning Board CONSTRUCTION. Historic-OKH Preservation/Hyannis rl -euz Project Street Address P-I TSIJ�� , Village O Owner Ail n Address ��1-4 La-1-1 Telephone -- 77 1— Y=L7LZ—� Permit RequestP_ Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Oda.D° Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family O Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No e� Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _ Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes Cl 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-0 Yes-- ❑No---If yes,sit e'plan-review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU ,6_2 DATE `��TO 5� FOR OFFICIAL USE ONLY 4 PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ~ t DATE OF INSPECTION: L FOUNDATION 6 1"7a 0 f O FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH r: FINAL FINAL BUILDING •m is; S. ,07 ' DATE CLOSED OUT o ASSOCIATION PLAN NO. --� Town of Barnstable °Y E R.egulatou Services. ' -�" ThomasF.Geiler,Director, Bunaug Division , l D MAC , Tom P erry,Building Commissioner ' 200 Main Street, Hyannis,MA 02601 , Fax; 508-790-6230 Office: 508-852.¢038 , permit no ' Data . ,Ak'RTD.A.YfT . HOjyM UORo'VENI NT CONTRACTOR LAW SUPPL,NMNT To PERM(T APPLICATIONenDvati ' MGL c.142A requires that the"recoWb=tiou, neof an additiontoomy pie-existing n. oo w4er o�ccapied conversion, •improvement removal,demolition,or constru bu0�g containizig at least one.but not more than four dwelling units or to structures q{hich are adjacent to sucb residence or building be done by registered contractozs,with certain exceptions,along with other requirements, Estimated Cost Type of Work: Address of Work: Owner s NameS Date of Application: ' I hereby certify that: ge#stsation is not required for the following reason(s): , ❑Work excluded bylaw []Iob Under$1,000 . []Building not owner-occupied $'Owner paing own permit Notice 14 hereby giYen that; ' OWNERS p-rjLLTNG THEIR OWN ieFI MIT OIlRNDPROYEMENT W ORKD 0 N EkYZ CONfg.koTORSFORAYPLICAB„'LE ROYM PRO OR GUARANTY ACCESS TO THE ARI3ITRATXON PRO GRAM FUND UNDER'MGL c. 1.42A, SIGNED LTNDERP ErIALTIES OF PERJURY Ihereby apply for a' ermit as the age pt of the owner: ' ' Contractor Name RegisErationNo. Date • OR The Commonwealth of Massachusetts - — Department of Industrial Accidents - — ; . �16e sfl�rraa�aU�s • 600 Washington Street Boston,Mass. 02111 Workers'-; Com ensation.Insurance Affidavit-General Businesses . ':� .fr,.:. 'k;•:`pt. ':s�aU.n. • .p,,, �� .ia® .- � .t y � nti:Adh1 �:•�:'>ti•;.•,� Uaf1 TVA IIIDI ame: address: city �' state: I �1 . ziv� J.,D uhone# � work site location(full address): ❑ I am.a sole proprietor and have no one Business Type: 0 Retail ElRestaurant/Bar/EatingEstablishment working in any capacity. Office❑ Sales(mcluding.Real Estate,Autos etc.), ❑I am an employer with ere to es(full& art time. Other / %/ % I am an employer providing workers, comuensation for my employees working on this job.. sddr'esss •y"`•� •a' •' city` OI1C, #' c .insiirarice.cur'` •{^ `°k ' I am a sole proprietor and have hired the independent contractors listed below who have the following workers' . comp ensation polices: comnenyname= -- - - - - - cityV one insurance co. - %%%%/%///%%//%/ address•-- - ---1- - - ----- --- - - : ..: 1{1 city ..• . t: ' -.. :-. •• . . O�1C' insiirsac_so }f , . :. %%i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal Penalties of a Ste 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$100.00 a day against me. I understand that it copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ce under the pains and penaiti o erju the information provided above is true and correct. Sipature Date Print name Phone# official use only do not write in this area to be completed by city or town official city or town: -- permitlliceuse# OBuilding Department OLicensing Board ❑check if immediate response is required ❑Selectmen's Office O$ealth Department . contact person: phone#; CIO (revived Sept 2003) I ' oF� r Town of Barnstable Regulatory Services BAMSTABM : Thomas F.Geiler,Director MAss. 9�b 1639. 0 b Buildinga Division pTFO ry1p`t 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: � 30B LOCATION:_ number street village f6�"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 requ'mements. a 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 performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Lj � Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons.-In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt NOT A RSOORD, t0 N — GfAs ,tO ' dr$ 401 for Me reproduction of property.lines :. . ,peciol Floodd Bvihr� Arev MA) is A&liCohle ZO ar �) 1' 71,Z.s' o 6) r 4 i J C l�f J4. . a'ccond"Move a+Ilb �J�► ��iaeb�r fiv hyy r �»►: j�fy � Oprtp)pyp PLOT" PLAN OF LAND /N /�°1C,✓'��/.^'d[7 L✓� MY�i7 71I1+R�7 QdifAl'd®d/'{OV� � � / _ FRANK � SG`�1 L,�` . feet to on Inch R., IRs� I.IO, rat. F , D, �E"' .'CMG ' , ' ?d 1. . $ 27074 sut-I RI E'RE AND ��, H,�B'L NON INC V » A �� ENGINEERING AND LAND SURVEYING MIL FORD—MILL IS—WHI7'INSVILLE - FRAM'LIN 4 PX12 DF(W w/RRILS FOOTING DEUTAI FRAME SuPPo :r- Fog DECK. FRAME LAyovTl?o 6,xtsrtNG Af6usir, .STRt1CTulL SCALE AT �/ . _ �° SCA LX At Vy I ° SCALf FOR :'86LovJ IS: rX""!STING HouSt NO 2WAY . Pr BEAM a /�OCRfi`tJotSTJ, m p, EXISTING GRADE I3RGK To 13CR FRDM Posts (,Y& Pr 3 SoN PAS NEE SPEC w y t3�low Gx� vfvASfp i CORAPE t. 2Y8 3ais i 2. 2-24 SEVI. . 2x g rr HOUSE MErtC R Att.16"oc , PEL IFtCR71O $ L• - ;J S/4AtPer- 1. 1'wo FoeTtnrGs kr SpPPorr 1AD inito EXisrlN6 �. Alt LtxatB ' ftu#1 GR D 13RUZ"y 30tSTS; , :` .�€� > h Z y � A E � 3. CoNc rtTc F t ijEp $„SonA ' }. LA45,.AT►ISF TUBES y. S PAN SETV6>;]#/ Posts t'F IDNS € ©. V1tu'tL f l9� . S)ST$+r PST' Arm CRERTSR-}RN 2 X8 PT VAK F* 76urs(rr # 2. 24 Pr 7vls-p I&"off• , $>;ti SSE j.JO1SrAT HOUSE 011293 HAA601 . 3#i"1A65'FOR HOUSE MEfi 2X$SyP . S. &XG PT PaSn ro rwVIV&S I38oft.6 Fort vaX Sufte-' ' PAN brijTI/ ' All NAILS r0 13C 6ALV. F Z�1lS SPAY 8;x12, AROPOSEP DI:tM +6k RE$iDtNCE.A'r MRS,ANNFiTE E4l�TR'OsfZ1 ZStAlv©y1Ea( Ro'1(. 21 ZStANDuIE►,#/ J�pf►D p L1Y41VNIS MA 02-&01 Cape Save Inc. r0 , r 7-D Huntington Avenue ' ARN T3°C South Yarmouth, MA 0* Tel: 508-398-0398 Fax: 508-398-039� t Tij 3/17/12 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 21 Island View Road,Hyannis has been inspected by a certified Building Performance Institute(BPI) Inspector. Ceiling: R-11 cellulose All work performed meets or exceeds Federal and State Requirements. Sincerely, = William McCluskey a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 'M.ap Parcel /4 - Permit# �d 0 � 1��t;:i nr• Cy Health Division 6'-Ibo '� _2 02�'3 �,, r ar,r F?Ia�t,DaV lasued l .of 0 3 , " 1� 00 Conservation Division 0� 77 ®�©T� _ App�iation Fee So L 4 3 . Tax Collector 00 `,O� k M � — �� Permit Fee 3 S • ` 1 Treasurer Cy_ �� �. � �� _.�. .rJ-, _ Planning Dept. EOftc p �Brq�A Date Definitive Plan Approved by Planning Board �oNsU pN�Yls oN pM�T o� Historic-OKH Preservation/Hyannis Project Street Address o2 Villagev,c3.�1C1� Owner A r('Y*� Address at 71 sV" Telephone 5Q1 — 17`7 1 _.J-1 J DC-5 1 Permit Request x '? �k Square feet: 1 st floor: existing proposed 11 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 5 A Lot Size c6 9 9 1�� Grandfathered: ❑Yes A No If yes, attach supporting documentation. Dwelling Type: Single Family M Two Family ❑ Multi-Family(#units) Age of Existing Structure ag 4X'S, Historic House: ❑Yes 1A No On Old King's Highway: ❑Yes No Basement Type: A Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) l0 1`t Basement Unfinished Area(sq.ft) NIA Number of Baths: Full: existing a new Half:existing 1 new Number of Bedrooms: existing new Total Room Count(not including baths): existing i O new First Floor Room Count Heat Type and Fuel: ❑Gas ;@ Oil ❑Electric ❑Other Central Air: ❑Yes A No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes [H No �f Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size .Attached garage:❑existing ❑new size ShedA existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use _-z S uJ^\M iA, BUILDER INFORMATION Telephone Number 5 g7o I I �� Address 7'i�' 1v_frn License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Vim, SAS t4A 6N 5e ATURE DATE a e FOR OFFICIAL USE ONLY 5 PERMIT NO. DA4E ISSUED MAP/PARCELf NO. -ADDRESS:: y' 5 VILLAGE OWNER DATE OF INSPECTION: _ FOUNDATION /� �a/Cl�a0 3 SeWiog�S �,✓5, FRAME y 2 71e 3 (% INSULATION FIREPLACE ' I ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL "FINAL BUILDING �L°i I w /L /Q A 7/0 3 AW A�DATE CLOSED OUT ASSOCIATION PLAN NO. t p i r INE rqy� Town of Barnstable Regulatory Services BAMSrABLE, Thomas F.Geiler,Director 9j1 A i `�� _ "°rE 639. a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: �`�`s1��M aa�� � Estimated Cost Address of Work: Owner's Name: R CZ fl-Z�n� Date of Application: _ sZa- �3 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded bylaw ❑Job Under$1,000 Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: A� Date Contractor Nam Registration No. OR Date Owner's Name Q:fortm:homeaffidav RESIDENTIAL BUILDING PERMIT FEES . APPLICATION FEE New Buildings,Additions $50.00 S'Q° o Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE � 01 square feet x$96/sq.foot=f 7 2 x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF ERISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ftC >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS - Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocadon/Moving $150.00 (plus above if applicable) permit Fee projcost O�TIT a n =1��G`? ::.t�'�. Oil acc:o ?SScC_il!a2tJ S State �iilding Coc=, 1 C2��i-'_r 3= al C1.�.9:n2 rBSaj znter -r off 'vlor aSSoci atad- wiEh Pa=l4 Y w li be. properly dis-0cse oz at -y .:5 bV ure Of Pa.MM uailGa LL C i L LuSS1..,,�/.1 i ES ? •.S:lU 3(J�L 5 = ��1~.i. +-L Vi _ 1 } a - _ n L♦.F i iJ�J i �` c t !y� 'rs1 .�`�_��J[ !r:l//L kri. 1�.`` f k, S:1Y .�� . r S"f�-l.��Vai...i—_._ ~c\-� _.- 1.J`._. _,"u_S:e�^ i� :i�i='.� ..Y.,-.•-•"' � `". Y25u :. C) ~� - peilijt T'lc� iOO_ sh8I1 he r?> S� ad _ _ c1'�L zrrti? t�� Z LCj~S� ' ..]_SQSal TctCill Vy CGu`ci"-=. g C'1 Of the vtc1.,+rla, i 'c W=ig_'C �:ld `v`C7l 1c b Lr_v L'L-,o l O s=C.Gt7 of.. Fna aispQ�a.1_ _c C1i1,__y _ _royc�r� .7tL5� also have >'S .c �?II'� Of, th-e the d13posa .S zac?l _t _ Pnl�11 �. 0 CCi1.TJ1 y 'N? r L_`c Z'�Gll1r?�1l°*1�S Of GAS Oi^^J_`1�rCE W 411 _en-u T, 1_^_ =*?_Q"r�arnar�� action by t_}i= CltyjT. TDTAL. P.On ------ v�1n, t!nmt-ntoottrerc�/� r�. Ir7.adiur•�uae/td BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 078016 Birthdate: 11/08/2000 Ll Expires: 11/013/2004 ' Tr.no: 78016 . Restricted To: 00 JAMES F RINGER 44 CANDICE STREET "-'. % CLINTON, MA 01510 Administrator lsusru of Building L-j--c,se ar rebg str',,than va.;.ict ir:divi `sal us-.an:•;; i41+ q HOME IMPROVEMENT GOP i C F oefare the expiration date. ):; Dur.o.retnr fc; 6fr DuHdinz FCecrift-tiont 1:;,^'. Registration:.. 125168 E� it a.tior11 i` 10/21/03 One Ashhert-lln Piave R-:1? s_in,i:f2. 121 GE :.`...Typer'.:.Private C�rp-affirm PATIO ROOMS OF B.OSTON INC ANDPEWS MALONc 100 O T IS ST NO-TH30ROU3H. MIA 0153� - 6.cin:ir.i- -< ::w :'' r,t Liia ovlthow:SiE-'Kare 03/18/03 TI1E 12:37 FAX 734 487 8922 Personal & Confidential 1O003 DrM ACORP. EE TIFICA`�E F LIABILITY INSURANCE 03/18/2003 PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Joseph MGKeone HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JP MCKeone Insurance Agency, Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 INSURERS AFFORDING COVERAGE. { Ann Arbor, M1 48106-0333. .. .�. .--- INSURED - Patio Roorns 0f America INSURER A: H.aj{tfDT,:i' - John ESIer INSURER B: Ar.bella 78 Turnpike Rd INSURER C _. Westboro MA 01591 INSURER D: INSURER E: - I COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENY, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T14E TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. —•• •—• --. ..—_. - "— POLZI`Y$FFEG7lvE P."!;V EJ(P1ftAT�F1• -ACHOCCURRCNC ltgR 'TYPE OF INrURANCE POLICV NUMHER DAT MMIDD I DATE MMIDD/YY I LIMITS A �(GENERAL LIABILITY 35 SBW KM63521IQ1I2QQ1 11/Q1/2QQ3 C:. --E .. Z,000`000 Ili (COMMCRCIAL GE NFRAL LIABILITY _ FIRE DAMAGE(Any one 6A) ,�- _ 100,0,00 I CLAIMS MADE. I�)OCCUR I 4 MED EXH(Any one aarsonk-_I j ._ 10,000 _._ _ r ry PERSONAL&ADV INJURY- s _ 1 QOQ,000 x tr EtUally _I GENERALAGGREGAT@ 5 " 2,000,000.. IrN'L AGGREGATO LIMIT APPLIES PER _ _ ODUCT$ CCMPIOP AGG 3 2,000,000 7 pro- POLICY JEC IX7 LOC AUTOMOBILE LIABILITY ]9957400001;- 12/15/2001 12/15/2003 COMBINCO$INCI,F LIMIT �•S 1,000,000 ((Ea=dent) _ ANY AUTO - — ��ALL OVrN[D AUTOS BODILY INJURY SCHEDUI FD AUTOS �(Pa'Pef60f11 in I HIRED AUTOS BODILY INJURY IX NON-OWNED AUTOS MA PROPERTY OA GE t S GARAGE LIABILITY AUTO ONLY.-E ACCIDENT S _ _ 4 _� . -- `. OTHER THAN , EA ACC 5 •,. ANY AUTO ` „— - AUTO ONLY: 'AGG S---- ExcessrlaBiuTY 35 vl3 l{4M6352. i.1110.1/2001 11101/2003 EACH.OCCURRENCE D 2,G00.000 A �-.,, I ACCUR L. J CLAIMS MAD; AGGRtGATE ,,. S _ 2,000.000 I I DEDUCTIBLE IRLTENTtON ,. - I WC 5TAIJ• OIH• WORKER5 COMPENSATION AND r ;TORY LIMITS_ ER A 1 3D WBG JJ9353 08/01/2002 : 08/01/2003 - w .. EMPLOYERS'LIABILITY E.L.EACH ACCIDENT As required by the laws „ I E.L.O jt;ASE•EA EMPLOYEE b___ 100000 1 of the State Of New York _ .I E.L.DISEASE-POLICY LIMIT 8 500 000 . OTHER - DESCRIPTION OP OPERA-nofgSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENOORSEmENTi8PECIAL PROVISIONS CERTIFICATE OO!_DER ADDITIONAL'INSUI%rD;INSURER LETTER: CANCELLATION r _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DAME THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN INSURED COPY NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE IXFT,®UT FAILURE TO DO SO SHALL IMPOSE NO OSUGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS Oft _ „, ° -• i REPRESENTATIVES. - . AUTHORIZED REPRESENT IA V� I ACOR 3 25.5(i197};. ACORD CORPORATION 1988 ,...��.-vao.�...+una..�...�:s�......., �:......r._I ..,:.ti,....._•.an... 3:►tutu.....:".-... _.,� _ , ',� t�ssac uet `Tui T Grode 8 MRA p 2 ate daltl �, 7 U C t o__... _.._.C:. ...._.� .....� ��.P eny5 i�url The Massachusetts State Building Code (780 CMI) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroorn" additions to an existing house (780 CMR, Appendix J, Section J1.1.2.3.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom" of any size, configuration, orientation, form of construction or percent glazing, but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year= round comfort considerations involved in selecting and utilizing a "sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installatiofi of"sunroonis", included below is a non-required,.open-ended Iist of product and design considerations that a homeowner may wish to consider before actually constructing/installing a "sunroom". It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO "SUNROOMS" o Solar Orientation and Natural Shading • Type of Glazing • Insulating value Solar heat gain • Frame materials ® Glazing to frame sealing and gasketing materials/seal durability and/or weather tightness of the sunroom • Adequate ventilation - Operable windows and fans ® Applied Shading Systems Insulation level in floors,walls, and ceilings ' • Possible Suurooni isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment 'The Massachusetts State Building Code, Section J1.1.2.3.1, requires that the actual property owner..(not the owner's agent or representative) acknowledge receipt of this CONSUMER INFORMATION FOR14 prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the information in this docurn t 01 ing sunroom comfort and energy conservation. F ignatureofActualBuilding wrier Date Print Name Address of Permitted Project Z.1'7 � Owner Ad d ess (if different than project location) Owner's telephone number TIt �I1C IIyt4ik�1��" i Gr 4 "4r;> �¢J I�gA)�a tL'PSSSLIITT'(iUInS�? ' : ' Eaceptiou: Sunroorn Additions/ Consumer Notification:..:. unrooms, as defined in 780,CMR . Appendix.ix:o I nrij �1IION 9, s i(i tsa exci. i it 1�ci.ry tl2o cc�iiYpllance:rcqu'ttements set forth in 780 CMR J 1.11-1.I and J 1.1.3 provided that the actual.property owner(not.the owner's agent or representative) of the'structure onto which the sunroom addition is being made, provides a signed copy of the Sunroom "CONSUMER INFORMATION FORM" (found in 780 CMR, Appendix B) to the Building Department. This signed "CONSUMER INFORMATION FORM" shall be submitted to the building official as a requirement of building permit issuance, and shall remain as part of the construction documents. If such sunroom additions are separated from the main house by a wall and are conditioned spaces, then a readily accessible manual or automatic means shall be provided to partially restrict or shut off the lieating and/or cooling input to the sunroom addition space. That portion of a wall that separates the sunroom addition from the existing building/dwelling unit, if an existing exterior wall, shall be allowed to remain and.either that portion of said wall or any fenestration within said portion and common to the sunroom addition, need comply with the thermal envelope requirements of Appendix J. cfio� el��' 2 en 1 J2 U�JiJ IN I`IOI'�S 't orov� e:arVef ho w$ : !-, c .+.irn +Nti act'. �- ir } 3s' r3 tiYt�r ' pr y� r^ 780 CMR J2.0 DEFINITIONS SUNROOAI: An addition to an existing building/dwelling unit where the total area (rough opening or unit dimensions) of glazed fenestration products of said additiotr exceeds 40% of the combined gross wall and ceiling area of the addition. oae �n faoaz3 Step 6' ' cid a� �e�+ .V S.TM[EIt €I1I +'CI O� see eIl6 r . r.Y,r S tcrrx� Tttih ?. p rt� j ��pv [1 ?J34nft)rse ocl.e, ncf;><o t�e,I�cated rffinnned are �, mtfaaf� h Q ,'2'IONSn;alsooundE' 4Ppeaid � �ry� �_ f Property Owner Must Complete and Sign This Section If Using A Builder I �J, Owner of the subject property hereby authorize Betterliving P io R oIn (d.b.a.—Patio Rooms of America) to act on my behalf, in all matters relative to work authorized by this building permit application for (address o job) r ®� 4 Signature of Owner Date' Owner or Builder (as Agent of Owner) Must Complete and Sign This Section as Owner/Authorized Agent hereby declare that the stateme is and informatio�n,,\\on the foregoing application for (address of job) al �S� �X 4� 1� , are true and accurate, to the best of my knowledge and belief Signed under the pains and penalties of perjury. 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[1S11FAIlCe:COt:>: .r..:r.no akb•n ,,,. ob and/or' Faitme to secure coverage as required under Section 25A atMGL 15Z csalead to the imp III, osition of crbninal penalties of a ffne up to 51,500. one years,secure cove agas$re tie dvil penalties in the form of a STOP WORK ORDF�t"�a$tie of S100.00 a day against ma Iundetstand that a copy thisstatementprisoemd be forwarded to the Office of Investigations of the DIA for coverage verldcatiom I do hereby certify the p ' 77 of erjruy that the information provided above is true and correct Date Signature �a g - V /'900 Phone# Print name of M me only do not write in this area to be completed by city or town official cid nt peradt/l(cen_se# (]Building Depa� ❑I,icesnjngBoard, �Y city or to`vn: C3Sd ectn en!%Office i] check if immediate response is required ❑Health Department ❑olher phone#; contact person' Ucyised 9/95 PJ/a Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An'employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint'enterprise, and including the legal•representatives of a deceased employer, or the receiver or trustee of an individual, Partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or'renewal of a license or permit to operate a business or to construct.buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate-of fimu-ance 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 ret amed 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 Me of fnYestlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 nhone#: (617) 727-4900 ext. 406, 409 or 375 NOTE: NO ACCE55 PROVIPE7 INTO ROOM, OWNER fO INSTALL POOR Af FUTURE PAS PROP05W NEW PECK 8'XI9'(APPPDX) I,2X8 Pf FRAME @ 16"O.C, 2.LEDGER DOLfEl71/2"X5"LAG5 32"O.C. 3.J015f HANGER5"END5 8' A 4.2X8 Pf TRIPLE ENI7 DEAM(HII717EN) 5,W!,5117E J015T5 6.(5) 12V X 48"19EEP FIC45 W/ANCHOR5 I 7,5/4"f86 PLY OVERLAY 8.6X6 P05f5W/ KNEE DRACE5 9' PROP05E17 3 5EA50N PORCH 8'X 19'(APPROX) 5TU1710 5TYLE ENCL05UIT 3"EP5+ H POOP 5Y5TEM (8'5PAN) =1 I=1I I-1I I Ell I-a EI-1I1=1I IT =1 f-1_I I FI 1=1I1=a I1=_I I1=1I I=_i I I: _ 11=11 PI 1-1I L=1 11=1I I- I I�i I I- I I F-9I I—I I I I I�I I I- I I I-I 11=1 I FEI I r_ -1 I1=1 11=1 11=1 I1=1 I1=1I 1=1I , =1 I FEI I I-1 I F1 I EI i f=1 I�1 f=1 I�I i I� t-j 1 1 1 EI I�I�(=y I-1 I I-1 I I-1 I1=1 4 �_ I I I I II I I I I I I III 111 I I LI 1Ii-1I�II1=II�II� =1It=Iq III-1I�l fill '1=J)� f=1I-1IL II�II�Iif-llis — �I E— I I �I I "1 I Ell�" I I I H EI I I Ii I�I I EI II II I i=1 t_I IF _ - —' I'`— LJ LJ LJ - LJ LJ LJ Project: 5cale:1/8" I'-0" 17rawj# Betterl IVI ng nau��r�o ��sin�Nc� SUNROOMS 2115LANP VIEW ROAD A-1 Turnpike Road Westboro,MA 01581 HYANNI5,MA 02601 Phone(508)870 1900 Fax(508)870 5756 Pate:8/12105 Sheet I of I ' LAYOUT FLAN5 WALL SECTIONS EXISTING BUILDING , U+ vi ° (MAX z r , r b o - i --57"— z V' U+ v DM v I 51-UDIO SIDE WALL(A) STUDIO SIDE WALL(C) 5706"1) 57"x7Fi"D 8 WALL ,' , -...--- -----•-------------- }° A55EM1 LY DETAILS STUDIO fLDOR PLAN ���� � ; (NOT lO'SGALE) ALUM:PANEL I IANGERy �Q+ CONNECTS TO WALL STUDS r, Y { 9G.75" r.' OR ROOF RAFTERS I r , 1 (MAX) - SEE ALLOWABLE I OAD a —57"- 57 TABLE FOR PANEL 51ZES,I:- �` MINIIrIUM SLOPE 1:12-- GUT7ER FASCIA IJ�p 1 I! FIEAI7EK SUPPORT 13EAM STUDIO PROMi WALL(B) I ALUM.SLIDING TRANSOM(OPTIONAL) _ ALLOWABLE= LIVE LOAD-I A13LE FOR,11 FT. I'ANEL W1TI 110 F I OK LE55 51'AN =`' POOP,oKWIN"ll _0 PSF _ 25 I'SF 30 P�f_ 7>5 Par �°rsr V5 PSF 5U I'6F 55 P5F 6U P6� 3'I IG i'l IC 3 NC f 3 1IC 3"I IC }IC �'I IC 3 hICF11 3'HG+H -- E}+IPEP.CD GLASS T G -- L3 EP5+11— YEP5+I 1 ,3 LPS+hi _. ?i'EI'S+11 YEP5 o-i 'i'EP5;1 I YEV5+H_ 4.5"EPSi I I I:5 EPS r}I,S ± SLIDING POOP,°N SILT' SECTION WITH.DOOK NOTGS FOP,STUDIO CON5TPUCTION t FLOOR Cl t 5TKUGfUPAL MEMBERS 51!ALL COMPKI5E 4.WIND LOADS=20 PSF 10.ABBP.EVIALIONa` ; - ?'W 6063 TO ALUMINUM Lxl I;U510N5 PKOVIDL--D FOR,L30 MPH EXP05UP.E A,I3,G U=DOOR F '% DECKISLAB ---� ° z BY CRAFT BILT,MANUFACTURING COMPANY. 5.DL•AD LOADS=5 F51: DM DOOR b LION I IUL 1014 4V WIIJDOW ' 2 ALLOWABLC LOADS ARE 13A5EDUPON" 6.DOOK AND WINDOW LOCATIOIJS P/M `WINI70W IvUL a+unauaor� TYPICAL..JTUDIO SECTION ARE INTERCHANGEABLE. U U'cr 1ANNEL � of rtE�hy�n.,! � NOT TO.SCALE ThIE I_E SSOK:OF THE ULTIMATE LOAU/2.r� OK TNL LOAD Al"5PAN/120. 7.GLASS KNEE WALLS ARE FIC=h.IONEYCOIA PANELSc;r, P ri 3.hIC/EPS f�l FERS TO Ci;AF'(-BIT:f STRUG'I'UP.AI_ IN'fERCI InIJGEABLE 4VI11 I PANELS. EP5=POLYSTYRENE PANELS r' t..• P[?Qj1GCT: �'� CONTRACTOR: PANELS WI'1'I-I ALUMINUM SKINS DONDED TO r,,! d df Joss {m = 8.4JID'fJ-I OF B-WALL MAYVAP,`(PER I-1=THERMALLY-BP,OKEN �:�cgo5��_"f"'��" JOSS I-IONEYCOMB/POLY5TYILENE COKES('�',4r'/z" ''~ `'"`"'` "°'n" ' = 10'-0"X 10'-2" I DOOR!WINDOW LAYOUT UPTO 24f-T. ALUM li-S'fiFFENEP ;:,;\ ca,•�c J. -o AND 6"71 IICKNIc55E5.). 9.AUTI-IOKIZED FOR BETTERLWING 0/I I=OVEP,NADIG 5TU DIO EN CL05URE ADJAGL"NT PANELS AP.I.COIJNL(1tU USING OCALEP USE ONLY. P5F=POUIJD5/5a FOor r,'•;;a P-PAIJEL t t9az-0 I1P.AN7iSI�1o(3 filE' DWG NO.: VINYL CLEATS OP 115 F'f=FEET 3iv�rrgf; B° "'rnr;u,r+u+-"' em50 iOxlO.lwg GENCRALLAYOUT j ALUM.=ALUMINUM ) ?,g;;h_1`:'c1 ' SCALE PATE:1112'712000 `, �.�.��r��:• ��.1 1' 1�I1:1 1y Rm�>a, WIN� 1 Town of Building Department Complaint nquiry Report a, Date: 6 I l �7 Rec'd by: IA Assessor's No.: Complaint Name: Location � Address: S tvur l 6 7 Originator Name: v Street: State: Zip: Telephone: D/E Complaint Description: - a� UA 1 Inquiry Description: For OI ce Use Only Inspector's Action/Comments Dale! 6 1.2 4 jq Inspector. QL(� - Follow-up Action /II O 4 .S Gt� 44/�� 16e- 4; Adclitionai Info. Attached twatp.nenartment Me _ • N Mord not for the reproduollon of property l/nes Spa�ial Flood Hay r A rig a (FIA) is Applicoble x U i y V Z. 7X 0i 1 von y thole" th+l haue Js Mwod then !a# 'c�� �lf�wu► old � t1��r �� arccor*fi�v with -thw Ding by h7ws Or tho . wit Ot PLOT PLAN OF LAND IN 'me,$$. WM9 WMMUCt'O.a F►dtN "�, -a SCALE .* -�O Yost to an Ine1! DAM. fit; /9961) G f IRRELLb, JR, +' 27B74 , Grl'ERPIERE ,AND HAL NON INC. OT ENGINEERING AND LAND SURVEYING r f/ : Mf L FOR - -MIL L/S—WHI rINSVIL LE FRA.NKL IN . .8041#w0d 'Town of Barnstable *Permit# 3 •�p�THE� Expires ti,months from ism date� •^-• : . ulatOry ServiLes .... _ Fee v sntuvsrest.E; . • �'"rr..;:�:- .9 ,Thomas F.-Geiler,Director �o i +p,---• _ _ _ V Building Division _. - '"Tom Perry, Building Commissioner - p •200 Main-street,-Hyannis,MA 02601 ; Office: 508-962-4038 APR. . .7, 200.5 Fax:'50$-790-6230 :... w :.. RE5IDNTI� BRR :. -• EXp S : ERIGII' 'I�EIOA"Y'TON - �J NSTALLE Not Vai:d without Red X Press Imprint Map/parcel Number Property Address Residential Value of Work "7© 0,C>D Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address � c i Telephone Number f " 7 71 Contractor's Name Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: �y am a sole proprietor amthe Homeowner ❑ I have Worker's Compensation Insurance Insurance CompanyName Worlanan's Comp.Policy " Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑. Re-side eplacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with _other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home lmprov)n4eut Contractors License is required. Signa 44 Q:Fo :expmtrg Revise063004 • .,i -----_ The Commonwealth of Massachusetts Department of Industrial Accidents office oflnuestigadons 600 Washington Street, a Floor ---- Boston,Mass. 02111 Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors ame:- address: , i state: phone# r w site location full address): , am a homeowner performing all work myself Project Type: ❑New Construction[]Remodel Al I am a sole pro rietor and have no one working m* any capacity. _ ❑Building Addition • ❑ I am an em Toyer Providin workers'compensation for my employees working on this job. ' - . rat•: �J I' is r.:• S9 �.. p 1.g.,. ,•�'. .r:+> =,L cH�!F.•t: .tit, ::vy. .x... .,;. J'1:•: ,,,•-�'� .r,N h •� r (�r� t t'Z > L .$..ttlx'. aJ+-h .1i.. 5 p g'. �. .d d' �• 's :%ii'..: i;' !i ''1+,s oc w. 4 .�.?,..1 •dr`'3 c--.,�'.' h4 :`+ f 7 R yc. ':.s,. r { r:J y4,G{p, s v �z. +� a•�,i �'�G`'.i:x «"�i'��"�1, ..•k*.'i•.':^�' 'R:..r�«�et.a ,,,44�.r f y .i :A�dl•eS�' - ;'+t-F +.2.ti> Yyt�reerFi� GY:X�m*'r, Iru: � �»- r a` r 3 i �p',4� a ly>, y 9 w' 1 y w:3.rry+�.. �,,x ;. h \1 f y ➢ a. t L. 3 i _ r r r•r .. t : •7':lr+,� r� �N ; -+ir.�i w1-.g r<�n'�,,r,.%��'??•• t,c i yd��i�"�if.: FS.ae mTt' t."A�.'^•tx �",i''?'�'af+e�a mPi r y. z' te_ �'`r %• r f�,v•� 4.f',�•'��`'w71`'"tir. i+)7'* �.,F`W,11, �% �J' a�� #FdR'�.;s+wt. 3u. 9'y�� i9 z ••.i � -v { �LK.;�::: O:ne�T>�„x ,�lw�>.Si '@F.`}a N . . 7 i'" r �� e ?^; �� ""y`xci "�r` r'� W`" tYfi f�..�';�ir 7 9+,�. ?F 7 C�•a rGt +J'7 f-tip _ r,:. a+ G..is?� d .5+'y`'••G+' h t"'c x5:�r«�• �>� �•�iT y e. es ? �tlS.tlk8nee?Cfl.'w..,r g_;'4jx .,'!:� ..k�"!,•s r.t'Sa •?',�"��� diEp � : .. . .- , w>.,♦. {..N1:...�::14.�'. .+R ICW., 4...-. a ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the followin workers' compensation polices: _ +>'7•.• •T.'+ '1:`" .,:N` •„-4 'tom':': =' , '=z'�== .,y . bmp811VYla2AE.S 4.1 - 1 L r•Lf,•eF:j, d 1,? t 2 T �,. } � A � ),)f •q H <�.1+,�:5J x��'f`•'t �lI'C -� . ansur:&t2ct~,eon:....::,_,..::F•,�,!>.cr.,;a�,:.�..,,;_`�: ..,.r.•,....r.. . _. , ,�: ; i:. �o0m an.:1t _ S 1• r r :, r• ,:; r i. '� _ ;Dl10nC`#i f :. .9 .rnr "{ ! ✓;q t 1 )7 r✓i ry f L f i\, FY "` ..._... .�.....•4.5. :>., ....,. .. . _. ...<...< ._.,x._ :.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 hereb under the pains and es of e ' ry that the information provided above is true and correct Sign 2� Date Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised Sept 2003) _ t 1 Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of.such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance.coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is is Should you have an questions regarding the. law or if being requested, not the Department of Industrial Acciden y y q g g 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 °F1ME Tay, Town of Barnstable E A,� ;;t, ,Regulatory Services saxiaAS& Thomas F.Geiler,Director Ft 22 Aa l ! C �Q �ECMa+ I• �� Building Division Thomas Perry,Building Commissioner /Q' -�- • 200 Main Street, Hyannis,MA 02601 ( —r''www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 February 14, 2007 Ms. Annette Dequattro 21 Island View Road Hyannis MA 02601 Re: Illegal Apartment: 21 Island View Road Hyannis,MA 02601 Map: 325 Parcel: 167 Our records indicate that your house at the above-referenced location is currently being used as a multi-family home,which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home, • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. Sincerely da Edson Amnesty Zoning Enforcement Officer Building Department gforms:zoning3 i t_ s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. I INS Map 3 5 Parcel 6 Application # 1 iZ :.7 A#f At5%sued i Z Health Division CIA Conservation Division Application Fe' Planning Dept. a P9rmit Fee Date Definitive Plan Approved by Planning Board - Hist Historic '- OKH o c _Preservation/Hyannis Project Street Address 1 S I au Y i e uj 0 a Village V A,A n Owner �nnP p � &-aJ+ o Address `erne Telephone y g a 5 1 Permit Request �,►r seal A41 c A I pang, IAl I'f'h o&M p se -t-o e 1 l i n a , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuationli Q 0 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure _ 114 Y Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) ' Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: )d Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes )I(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 XNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name iI iaA M rz G 1&3 6 wkkne, Savt Telephone Number S h- 3 48 ' 03 90 Address 4tkn iV__e License # 7:r, �S o►,h yo_ m0l 0�.�p N Home Improvement Contractor# 6 q 43 . Worker's Compensation # -IN G�M'MfVA 3 9 /'� 7 T ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE ,� S r , FOR OFFICIAL USE ONLY APPLICATION# ,. DATE ISSUED r" tMAP/PARCEL NO.,.,- ADDRESS VILLAGE OWNER.. F DATE OF INSPECTION: s . `FOUNDATION FRAME INSULATION,';.1"(�N' FIREPLACE v ELECTRICAL: ROUGH FINAL 'S PLUMBING: ROUGH FINAL J, GAS:- z. . ROUGH FINAL - .FINAL BUILDING' { c DATE CLOSED OUT r ASSOCIATION PLAN NO. --- -� T� t�l} est �S��u-L Street .�4 �s�S"�'r Hyannis, A1A 0260I._3698 ENERGY & HOME R;A PALR " T " ' TTY on. all. lines 'a€ttd1. 1Cc€kFEcfjecQt .Gig HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. hereby consent to and agree that weatherization work maybe done by the Weatheriza ion Program of Housing Assistance Corporation ( herein after referred as "Agency") on the property located at: J The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: , Weather-stripping & caulking of windows and doors,insulation of attics, sidewalls &basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows.In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as maybe necessary to perform weatherization work on said property. - 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the, weatherized unit on an ongoing basis for no more than five (S) years after the weatherization e , work is completed. I.have read the provisions of this agreement as listed and freely give my consent. _, ; Home Owner: (Signature Date: �1 Y (signature) Agent: `�. g • Date: /' rr . HAC approved Weatherization Company: Cw�� Sat �d, Caliber Building&Remodeling Cape Cod Insulation a' Creswell Construction Frontier.Energy Solutions Lohr& Sons Peter Smith Resolution Energy Rock Solid Construction All Cape Insulation ;'460fl11lYLC�shuaI all wt!rl_Pe__ai__kz� :dU-c-Juc �,' The Commonwealth of Massachusetts' Department of IndunWWAccidents Off ce of.Investigations 600 Washington Street 4 t Boston,MA 02111 LL www.mass.gov1dia: Workers' Cc mpeflsation Insurance-Affidavit: Builders/Contractors/Electricians/Plumbers Aaulicant Information Please PriintLeaiblw. Name:(Business/Organization/Individual): Mir eke .Address: *q>C... ' t,A u rt�t nic��nf , City/State/Zip YA-i'LM0S:!x Ma UURone±q# - 3 gr 3 Are you an employer?Check the appropriate box: Type of.project:(required.). 1. I am a employer with. ] �' Q l ant a:general.contractora<id i 6 a:Ncw construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 atn a sole proprietor or.parn�cr listed on'dte attached sheet: 7, {] Remodeling and have no employees These.sub-,contractors have. 8; 0.Dcmol tion working for me in any.caP tY aci employees and have workers' 9. Building addition (No workers' cotiip. insurance comp.insurance:* required.] 5 Q We area corporation and.its. 1.0.❑ Electrical repairs or additions 3.❑ l am a homeowner doing all work officers have exercised their I L0 Plumbing repairs or additions m self:. No workers'com . right of exemption,per MG L y [ p - 12.[]Roof repairs y insurance required]+ c. 152,j 1O.,and we ha'va no k employees [No workers' 13.E]Other•�naud x4IQfi comp.insurance required.]. Any applicantthatchecks box#1 must also fi71 out the section below showing their'workers'compensation policy information *Homeowners who submit this affidavit indicating they are'doing-aU work and then hire outside contractors must submit a new affidavit indicating such.. tEontiactors that check this box must attached an additional sheet showing",the frame of the sub-contractors and state whether or not those entities have employees. ifthe.sub-coattactim have employees,they.must provide their workers'comp.policy number. ram an employer.that is providing workers'compensation insurance for my employees. Below is the po&cy and job site information. Insurance Company Name: I L • -.B ra(1 OM f 1 Policy'#or Self4ns.Lic;:#: T(,�C 3�, 9 "M / d� Expiration Date: 1 0 /a i 01 Job Site.Address: a`'I 0.n Y I Cul City/StaterLip--11 { 's Q Attach a copy.ofthe workers compensation.policy declaration page-(showiing the policy number and expu'atton date).. _ Failure to secure coverage as required under Section 2SA of MGL c. 152 can dead,to the imposition of criminal penalties of a fine up'to$1,500.00 an one-year.imprisomment,as well as civil penalties:in the form of a STOP WORK'ORDER and a finer of up to$250.00 a day against.the violator.I 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 herebycerltfy under thepains=enallie��erjury that the in formad6n provided above is true and correct Signature:_ YAMley Date: Phone.#: _. - , Offcial'use an/p. Dn not'w,.rite it this area,to.be completed by city or totvp offciaL City or Town:'. Permit/License#' Issuing Authority(cirtle one): 1.Board of Health 2.:Building Department- 3.Cityfl'own Clerk a;Electrical Inspector 5.Plumbing.Inspector 6.Other ' Contact Person: '. Phone#: ... A0Q, CERTIFICATE OF LIABILITY?'INSURANCE io/20/2o111i' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A'CONTRACT BETWEEN THE ISSUING.INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the.policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 PAX (761)963-4420 IAJ 15 Pacella Park Drive ED Re :ssperrazza@risk-strategies..com Sua to 240 INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURER B:Safety Insurance Company 33618 Michael McCluskey, DBA: Cape Save INSURER C.Technolocry Insurance Company 7 C Huntington Ave INSURERD: INSURER E: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL11102041451 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS," EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY M /DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ al,000,000 DAMAGE TO RENTEff X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 100,000 A CLAIMS-MADE FxI OCCUR PPS1994480 t. i" 10/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 rt PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGRE GATE LIMIT APPLIES PER: -,x F, _ PRODUCTS-comp/op AGG $ 2,000,006 X POLICY PRO-JECT LOC $ COMBINED TINGLE LIMIT AUTOMOBILE LIABILITY SI Ea accident s 1,000, 000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED- 6208200 ; 1/6/2011 1/6/2012 BODILY INJURY(Per accident) $ ` AUTOS AUTOS . HIRED AUTOS NOTOSWNED b. ' PROPERTY DAMAGE $ X X Per accident X Underinsured motorist BI split $100000 300000 X UMBRELLA LIAB X OCCUR PPS1994480 0/16/2011 0/16/2012 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS MADE AGGREGATE $ 1,000,000 (' WORKERS COMPENSATION executive excluded X ,W - $ RED RETENTION$ C STATU OTH ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN from coverage E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? a NIA C3297972. ~ 0/21/2011 0/21/2012 (Mandatory in NH) E.L.DISEASE-EA E I MPLOYEE $ 500,000 11 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additlonal Remarks Schedule,if more space Is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a"NationalGrid, d/b/a Boston ',, Gas Company, d/b/a Essex Gas Company, Action Inc. , ,and Housing.Assistance Corporation are lis'ted•as additional insureds as, respects-General Liability as required by written-contract. . x CERTIFICATE HOLDER "' +fti`'. y +� CANCELLATION " - a SHOULD ANY OF THE ABOVE DESCRIBED,.. y (508)790-2425 , � �. � � CRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED,;,IN ACCORDANCE WITH THE POLICY PROVISIONS. Housing Assistance Corp 484 Main Street - AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 .... Michael Christian/SMS' ACORD 25(2010106) • 01988-2010 ACORD CORPORATION: All.rights reserved., INStl2goninnstrri a< AThn Ar_ pn nomn onrl Innn oro rcnictcrnri m2r4c of Ar_r1Rr1 J/W O ice onsu �er �faiVano-d Business egulation s' 10 Park.Plaza - Suite 5170 Boston, Massachusetts 02116 ' Home Improvement:Contractor Registration Registration: 164432 Type: Supplement Card CAPE SAVE Expiration: 10/6/2013 WILLIAM MCCLUSKEY , 8201 S. HOURD CT 4 CHAPEL HILL, NC 27516 — t Update Address and return card.Mark reason for change. sa , ❑ Address �] Renewal Employment ❑ Lost Card DPS-CA1 50M-04/04-G101216 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only Z HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to- Office of Consumer Affairs and Business Regulation WIN Registration tsg432 Type: 10 Park Plaza-Suite 5170 Expiration 10I6l2U13 Supplement Card. Boston,MA 02116 CAPE SAVE WILLIAM McCLUS,KEY 7C HUNTING AVE.S.YARMOUTH,MA 02664' .Undersecretary, Not valid without ' nature . 4 e - '1wssachusetts- Department of Public Safety Board of Building Regulations and Standards Construction.Supervisor Specialty License License CS SL 102776 Restricted,to ICAW , WILLIAM MG CLUSKY. " 37 NAUSET ROAD ' WEST YARMOUTH,'MA 02673 Expiration: 6/28/2013 T ('nnmrisvi�,ncr Tr#: 102776 r • 4 Clts!„L'i LFJ1✓J ny:'_,i yl��'G2"GJ7a • �' y, k-'.ACit �1�b1 CAPit. ISAVE poll Weatherizatiun 5 8-3 - 398 August 22, 2010 To Whom It May Concern: William J. McClusk+ey is an empioyee.p#Cape..Same. He is authorized to negotiate contracts and.building permits for our.company. Michael McCloskey Cape Save—owner 319-59 39 cell f.3 59 b r w JC Huntington.Avenup,.South Yarmouth, MA 02664 To Date Time W LE V U WERE OUT � r M of Phone Area Code Nu m Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message r Operator` dh''`1 AMPAD 23-021-200 SETS EFFICIENCY® 23-421-400 SETS CARBONLESS 14 r- lei t �I AW AM X t � 4 reµ .�. � � • � ti.,o �� � .,.�� •C ,� �,,, � �� ���� c �� - � � � � �a i:.. / !�.�: "- . C �� ... <� � r �� + vV � l A \ a'h �'� 4 / / �� i \ i �� a Parcel Detail Page 1 of 3 VO 5 <z r rp H y� Logged In As: Parcel Detail Wednesday, Februa Parcel Lookup Parcellnfo ............ Developer Parcel ID,325-167 Lot Location 21 ISLAND VIEW ROAD Pri Frontage'87 ____._.................._ .__._._. .._.._. _r ...___._. __"__.. . ,...,.__.. ___...._....._ _....___._ Sec Sec Road IYANOUGH ROAD Frontage 80 ............... ..................................... _ .. ...................................... .............. .......................__. ........... village HYANNIS Fire District'HYANNIS ........ .. ......... _ ......... __ ..................................... ................................... ............ Sewer Acct'0460 Road Index 0777 Interactive Ma Owner Info ......................................-- ....... ...... ........... Owner`DEQUATTRO, ANNETTE Co-Owner ................. ......... Streetl =21 ISLAND VIEW RD Street2 C€ty HYANNIS State;MA Zip;02601 Country;US Land Info ... ........... ......... Acres 10.20 Use'Single Fam MDL-01 Zon€ng :RB Nghbd .0113 _.... .:.:...._ ... .::.. Topography Level Road Paved .m...m....._._ ..... ..... _ . Utilities 1AII Public Location Construction Info Building Year` Roof Ext€ Built i 1974 struct=Gable/Hip wall€Wood Shingle Effect'_ _ Roof E ,__ AC Area 1403 Cover iAsph/F GIs/Cmp Type°None rY i Style;Raised Ranch weu Drywall Roome 3 Bedrooms Int Bath Model Residential Floor= Rooms`2 Full + 1 H --_,-.W... ., _ ... Tota Grade;Average Plus Type Hot Water Rooms 7Rooms http://issgl/intranet/propdata/ParcelDetail.aspx?ID=27118 2/14/2007 Ak Parcel Detail Page 2 of 3 n " e 3j 33 j t"`j ..... ....... ' Heat _........ Found- Stories!1 Story Gas Poured Conc. 3 Fuel .. ation - J r I Permit History Issue Date Purpose Permit# Amount Insp Date Comrr 4/7/2005 New Windows 83251 $1,700 8/6/2004 Wood Deck 78400 $1,000 3/10/2005 12:00:00 AM 7/18/2004 New Addition 70204 $11,000 6/21/2004 12:00:00 AM 11/1/1974 B17452 $0 HY 11� ......... ......... ......... Visit History Date Who Purpose 3/10/2005 12:00:00 AM Martin Flynn Mea./List Bldg Permit Only 6/21/2004 12:00:00 AM Martin Flynn Mea./List Bldg Permit Only 4/12/2002 12:00:00 AM Paul Talbot Meas/Listed 8/15/1988 12:00:00 AM ML Sales History Line Sale Date Owner Book/Page Sale P 1 DEQUATTRO, ANNETTE C73372 2 DEQUATTRO, ANDIMO C73372 Assessment History _... .... _ _ . .. ..................................... Save# Year Building Value XF Value OB Value Land Value Total Parce 1 2006 $135,100 $20,400 $400 $283,800 2 2005 $125,900 $20,200 $400 $252,400 3 2004 $94,800 $20,200 $500 $189,300 4 2003 $87,600 $20,200 $500 $80,600 5 2002 $87,100 $20,200 $500 $80,600 6 2001 $87,100 $20,200 $500 $80,600 7 2000 $63,900 $18,400 $300 $51,000 8 1999 $63,900 $18,400 $300 $51,000 9 1998 $63,900 $18,400 $300 $51,000 ; 10 1997 $95,900 $0 $0 $33,600 http://issgl/Intranet/propdata/ParcelDetail.aspx?ID=27118 2/14/2007 a Parcel Detail Page 3 of 3 11 1996 $95,900 $0 $0 $33,600 12 1995 $95,900 $0 $0 $33,600 13 1994 $88,900 $0 $0 $60,500 14 1993 $88,900 $0 $0 $60,500 15 1992 $101,400 $0 $0 $67,200 16 1991 $105,100 $0 $0 $75,600 17 1990 $105,100 $0 $0 $75,600 18 1989 $105,100 $0 $0 $75,600 19 1988 $67,700 $0 $0 $21,200 20 1987 $67,700 $0 $0 $21,200 21 1986 $67,700 $0 $0 $21,200 Photos http://issql/intranet/propdata/ParcelDetail.aspx?ID=27118 2/14/2007