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Home My WebLink About0094 OLD CRAIGVILLE ROAD Ya aa ( sd•3 � � 3 oME,� Town of Barnstable *Permit# � Expires 6 months from issue date Regulatory Services . Fee c r BARNSTABLE, • w 039. � Richard V.Scali,Director ' ArED MA'I A Building Division NS PERM � ,Tom Perry,CBO,Building Commissioneg°o 200 Main Street,Hyannis,MA 02601 �UN 2 3 www.town.barnstable.nia.us 2015 Office: 508-862-4038 TOWN F ggA ;RS��8- LE 230 EXPRESS PERMIT APPLICATION - .RESIDENTIAL O G Not Valid without Red X-Press Imprint Map/parcel Number yd Property Address Residential Value of Work Minimum fee of$35.00 for wor under$6000.00° Owner's Name&Address L • Contractor's Name Telephone Numberr��.�dt - 3.l.31i Home Improvement Contractor License#(if applicable) Zl d �'J ZEmail: Construction Supervisor's License#(if applicable) 7 2-0 ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) J ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over ' existing layers of roof) ® Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *.Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro Owner t sign Property Owner Letter of Permission. copy t e Improvement tractors License&Construction Supervisors License is re e SIGNATUR Q:\WPFILES ORMS\building permit fonns\EXPRESS.doa Revised 040215 the Commonwealth ofMassacha seth Departixl'aent ofI`iradrisfrial Accidents J {.e Qfjt+•e of Investagafioris � - 600 Washington street .Boston, AL4 02I11 Y it n�avtvarargov/dira Mrorkers' Compensation Insurance Affidavit Budlders/Conti actorslElectaicians/Plumbers Applicant Information Please Print : . 'b1 Name oktsinessiorgamizatmandmduay Address: City/State/Zip. (/ /�ff1��r%�4 �� Phone# _Iz� — I'-2—JI111' 7 3 2 y� Are you an employer?Check the appropriate box: Type of project{requii�etl): 1.El am a employer vMh 4. ❑ I ann a general contractor and I employees(full and/Ay part-fi.ffie). * have hired the sub-cc tra ctoas 6. New construction I am a sole proprietor or pier- listed An the attached sheet. 7- ❑Remodeling v These sub-contractors have sleep and have no employees These ❑Demolition w,asking for ire in any capacity, employees andhne worfcers' [No workers'comp.insurance comp snsuranee l 9. ❑BBuilding addition required.] 5 ❑ 'tTtFe.are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a horneownzer doing all work officers have exercised their 11.0 Plumbing repairs or additions myself: [No workers'camp. right of exemption per 14ICL 12.❑Rsuof repairs insurance required.]a c..152, §1{4),and we have has employees-[ o workers' 13.0 other . coittp:ins"anm requgire&] • ,a"&mrt&at checks box#1 umst also 5ll on6 the section behave showing their waxlcere compensation policy informatiot2 l Homeowners who submot this of pit indsatml they are doing all wovk and then hone ou=&cm=#orsuvast submit a mew affidavit indicating such- ICanuactmrs that check this box must attached au additional sheet showing the name of the sob-eoniesetors and state whether or not those entities have employees. Ifthe sab<ottitractors have employee%they must.provide their workers'comp.policy number. lam an empZo"r thrat isproi+ia hW n orkers'cottgwmsraiion.iaasrarmce for my enaplo yem Below is thepolicy aaitd job sate iraforrratrtiarn. Insurance,Company Nam: Policy 4 or Self-ins.Lic.#i: Expiration Date: Job Site Address: City/Statet r:" A€tach a copy of the workers'compensation policy declaration page(showing ttte policy number and eap-ation date). Failure to sew coverage as required under Section 25A of MG}L c, 152 can lead to the imposition of criminal penalties of a tine up to$1,500.OD and/or one-year immi Sonmeut.as well as civili�penalties the form of a STOP WORK ORDER and a Fine of up to$250.00 a,day against the vial tor. Be.advised that a copy of this statement maybe forwarded to the Office of Investigations of ale DLAkk f tiros a coverage verification. I do JaeraabUY a:etti µP e s id penrallyes aTf ury that I to infor matron.pr ovided'abova is trace and carrert Date" � 1 Phone#: d).0kial use only o not mite in this area,to be completed by city or flown City or Town.: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Buffding Department.S.City;2own Clerk. 4e Electrical Inspector 5.Plumbing Inspector 6.Other } Contact Persona Phone#s oFtMe r�� . • , . * snxxsrnsi.E, 1 MASS. ,�� Town of Barnstable r- AlFD��A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230. Property Owner Must Complete and Sign This Section. If Using A Builder as Owner of the subjectproperty+ . l hereby authorize to act on my behalf, in all mattets relative to work authorized by this building permit application for: r (Address of Jo ) Signature of Owner Date ,u e� Print Name f If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q MPFILESTORWbuilding permit fonns\EXPRESS.doc Revised 040215 Town of Barnstable y z Regulatory Services �oFtt+E rOtyr Richard V.Scali,Director Building Division BAMSTABM Tom Perry,Building Commissioner MAW 9 1639• 200 Main Street, Hyannis,MA 02601'ArEcw►a�s www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: �/� Inum er street village "HOMEOWNER": 00W_//40� —77 name / home phone# hone# . 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 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:\WPFILES\FORMS\building permit forms\EXPRESS.doe'+ Revised 040215 Parcel Detail Page 1 of 5 A" MANS Logged In As: Parcel Detail Tuesday, June 23 2015 Parcel Lookup Parcel Info Parcel 248-117 ( Developer ID 1LOT 1 Lot -. Pri Location'94 OLD CRAIGVILLE ROAD I Frontage 1117 Sec _.._ . _..__ _ _ _I Sec I Road Frontage Fire............ VIIIage HYANNIS HYANNIS District Town sewer exists at this Road 1145 address No ) Index Asbuilt Septic Scan: p Interactive 248117_1 Map Owner Info Owner JMORIARTY,THOMAS-P I Co-j°IoMORIARTY CATHERINE E TR owner Street!IMOR RAINY FAMILY TRUST I Street2 j94 OLD CRAIGVILLE RD I State City Zjpo26o1 Country( Land Info Acres 10.30 Use Isingle Fam MDL-01 Zoning RB J Nghbd(0705 Topography'Level - _ -I Road Paved Utilities N licWater,Gas,Septic Location.' Construction Info Building 1 of 1 Year 1966 ROOF�GablelHip Ext;Wood Shingle Built' Struct Wall Living i Roof AC._ _..... . Area 11987 I Cover�AsphlF GIs/Cmp Type!None Int Bed, Style Cape Cod Wall Drywall I RoOmS 13 Bedrooms Into. - ............. Bath r Model iResidential ( (Hardwood ;2 Full-0 Half Floor Rooms Heat Total http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=1,7706 6/23/2015 &Xe WOM"?,oauaea`M 1�dacAmdeM Office of Consumer Affairs&Business Regulation License or registration valid for individul use only = OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: •`��gg52 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration:^5LSE20t=_ DBA Boston,MA 02116 THOMAS P DAMELIO15�DG 81�EMODELING THOMAS ��DAMELIO\', + / 16 WHITE BIRCH WAY;:. W.BARNSTABLE,MA 0266B Undersecretary Not v lid without signature I j Restricted-One-and'wo- d accessory building th y dwellings or any. ereto ,irrespective of size. Failure topossess State Building a current edition of the Massachusetts ding Code is cause for revocation,of this license. For DPS Licensing information visit: www;Mass.Gov/DPS Massachusetts Department of Public Safety .Board of Building Regulations.. 9 9 and Standards �.11II1L1 VL.LI II II JL111C1 YI\r11 1 OL L!`AIIIIIV -� License: CSFA-047420 Thomas P Damelio-` '-• 16 White Birch Wly I F West Barnstable 1f�A Expiration , Commissioner 04/07/2017 : L TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel //7 Application # J S pP D Health Division Date Issueds-5, "/s F Conservation Division Application Fee Planning Dept. Permit Fee • 7 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street A dress � �a�l Village . � Owner C/�,�.��P � ��fil Address�� ` Telephone -//r—77.- o4;57,,:?7 Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new D Zoning District Flood Plain Groundwater Overlay Project Valuation 0, 4&ft Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, ppor attach.,suting documentation. ice;k _- Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kin' s'Highway; ❑Ye ❑ No Basement Type: A-Full ❑ Crawl ❑Walkout ❑ OtherZZ 4_.. Basement Finished Area (sq.ft.) 16 Basement Unfinished Area (sq. t) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name l / K 4-J Telephone Number ��'" ��-3..2 Yam" Address /l CC/ License # 101 ell 5/'a2 0 -Z�,Y/ X1610111f -1017 //W Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �- DATE — f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. AetE ref €114e ' 690 �ae� Antw;.MA a2 - aver-w.r .�rr�xrx wurk�& Caropesstf Iusraance kffid.avit ��iier i r�/ �cfr�ci rivsl�ers - Name;gkri� in;r,r1r�, .mess ca ait employer?Cfreckf2m xp1m7upriafg b ITpe,uf FF° jmt 1_❑ I am a ezaglcyzr via 4 I ate a geacosl c=fmcfx-artd I * trafba €zrrs. #. _ I4ie cane employees(Ra andlorFai �)- ❑ I am a sore piupaetQr or., rf of listed on the attacaed sheer - ❑R�odeligg, . shill and bane na employees Z =b-aon#wAnq have $_ ❑Demolifiart Ong forme m any.capa r e�Flayees and have wos�ers' crwaes`comp_rs� rranrg . �o�p_mcrtrwr 4_ ❑Bui}dmgaddifiot� 5_❑ We area carporz6nnand its 10-D Elez-cal repaia m addiEians -3:❑ I am ahem r r&Ding all warm ��e�'�;sed their I 1❑P3nmbing repaiLs ar aldiiims MTSELIE o W=b=s'=Mp- right afe�atpfio�tperT Q 1�❑IZnaf s Mmamt l F c_15Z§1(4),aadwe hava aD . . enploy5es Wu worb--M' other Comp_,msor m mquire }lizip�up afihatche flhmstaL-oSIlouttthe.secdoabglor�shawmgi irwo�es�mmu�sssiio�lpat i ti3 l nmrnwn�ahr,&-ab>a 3ns.KEB& ma=tk'fal'^u dam,- II• =r ti hn-P mtsaL coutre insist subaut a n--W x5 •-7A Mrli a m p tC�hs tist check this bar mast sttarhed sa zrirTifi—i%:b Nlb crmg the nM�CE ffle and sts�uhetaer arrant fansg k fi rnmplaya!s- rftne mT-ca;dmcbumlave rmnTapec meet amide tEir wura�tip-parqymunbeT- -i am an iliczfispratiff-g t�arke,g ccrrTz r fdL4 iirsrtsartc-g far rtzy Lp Ft:pgrs. Hezotp is fhega&c}raid job sd$ fztfarrtesfiraiti< • h-ucnrQ Cowpany:Ma-e' FoEcy9orSelf-ins_UcAk' , - fra�il7ate. Job Sri _ . Attz a_copy-of&t-markers'•campeusatim Policy ded-zm i ru gage(situ iug the poliLy ll r cr zaa t3zpSation Pailnze fu set-rare cuver$ge as aire3uiider SeciiorrSA ofl�IOrL c LSD can Lead iu t mpo ion of ccimiIIal pies of$ . ug ffl L SD0.OD andlar Quayeai ,as well as criv ual�peF in the fD=of a � STOP WORK ORDER- a of up.to$250.00 a clay agaimt the.violater_ Re advised fh2d a cry of f>ri€stated maybe fi)i a ded to fhe 0-EM8 of Ia_re EMt;:orts of the.:DT fur_ `�caF=ge cation I.etrr Foci r tfta s wuf pmaki s pfpejiuY thatfh6,hzfprnta6gn prcn6&d rt&n a-rs b-jw and cvrroct: -FTT Frss rxn£ I7a'ttat tifa i fFrGs u�ecru fu bs car d by ci�p ar tzrwq of cin£ Cif or rowt xrrxf7T Tcenre# I:R021-i oflle.Bft 2.ELmUTnglleartr tit; Clt,ilTa-rsCIcr 4- Iecti�calE s Exefar 'S.P mgF��ctor f Cl&er Ca ctPer�aa : . Monne k- I iassanlms [eaeral Laws chapter 1152 rE gt an epmloyers to provzde workers camms-ion for the;r e Iopees pm�so sr-tn this sfata�,an esr Iapee is dean-ed as Q--�person in tat samct of a-oi�er rmiic any cou��c�ofI , express or implies oral or write." rer is deirm ed as`�a.m&idaaL pa to ashT,association, coiporation or otiier legal eufify, or any two or more offhe fn egnmg engaged in aJour<enterprise,.aadiaaluiingfhe Legal represenfntives of a deceased employer-or the receiver ca-ttasYEe of a a mdivi�partnea�hip,association or other Legal euf;ty,emPl°Ymg employees. Ho�rever the ovtner of a dwelling lhmse havi ig not mare than-ti—e apartments and o rzsides fherem, ar the oc�tpant of e . -O ILS to do mabatma e,c`Mt uLaoa or impair work on such dwtffiag house dwetlmg house of another who employs per or on the grormds or building apPin tenant thereto sHa-U not because of sack employment be deemed to be an errhploye2." MCrL chapter 152, §2SC(6)also stems thA'every sfafe or local lic: r smg.agency shall withhold theissuance or renewal of a Rcce e or permit to operate a bnsiizess or to construct buildings i a the commonwealth for any applicant who has not produced acceptable evidence of comphauce with the insurance coverage required-'. .- Ad Tonally,MCTL chapter 152, §25C 7)sfa�s`Nrifhex the commonwealth nor auy of its political subdivisions shall enter mto any contract for&D perfoi-ance of public Y,ork until acceptable evidence of compli�ice with the in cr�n ce requirements of ads chapter have been presented to the confiactmg anjhority:" B Please fll out the vrokers' compensation affidavit complet�ly,by checking the boxes that apply to yc�r siiurtion and,if necessary,--apply SIr -contractor(--)nam4s),addresses)aad phone i=ber(s)along with their cer�ncatr-(s) of ;,,�rrrance_ Limited Liabihty Comp omits(LLC)or Lia i Liabiay Parinershms.(LT.P)vZr thno employees other_ ihan the members or passers,are not regrlffed to carry workers' compensation m gn-arise_ If an LLC or LLP does have eatployees,-a policy is required_ Be advised that this affidavit may be submitL to the Department o=lndnssial Accidents fnr confimation ofin=rice Coverage_ Also be sure to sign and date the athdavit The af.dairit should be Imt=(—d to the city or town that the application for the permit or license is being requested,aot the Depatineat of Industrial Accidents_ Shouldyon have any gaeStIons rega�a the law or if you�*e equred t°obua a rorlcers' compensation policy,please call the Department at the number listed below, Self-iTlS1 d companies should enter_tbeir. self in er rice Eamse.number on the appropriate at. City or Town Officials i Please be sure that the:affidavit is complete and prntted Legibly. The Department has provided a space at the botiozii of the affidavit far you to�out in the.event the Office of Iuv esti-gations has to contact you regarding tb e applicant, Please b e sue to fill m the pe uit/lieense number which w�71 be used as a reference number: In add=r5 on,an pLcant that must submit multiple pmnitJhmnse applications is any given year;need only submit one affidavit indicating currznt policy infomzatson(if necessary)and lender Job Sit,Address"the applicant should wiite"all focafioas a (city or town)"A copy of the,affidavit that has been officially.stamped or marked by�e city or town may be pro�Zded to the applicaat as proof that a valid affidavit is on fhle for EIt=permits or licenses A new affidavit must be fIled Out each year_Where a home owner or clfiTen is obtaining a license of permit not related to any B ess or commercial Venture (i e,a dog license or permit t bum leaves et_)said person is NOT regahed to complete this affida.)Zt The O$ce of Iavestigaiions would ac to fhank you m-advance foryouz cooperation and shouldyou have any questions, please d9 riot hesibir-to giw,us a call The Depad=mts address-,tr_lephone-and-faxntmmber Thy CDMmaawwtTI of Ml ssachus of luve�&€igatian - ROshOn r . ReTised 4-24-;J i ? Cza A� CERTIFICATE OF LIABILITY INSURANCE ° °°"YY"' 7/31/231/2014 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 pollcy(les)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 COM AOT Kathy Silvia The Fair Insurance Agency Inc. PHONE (508)775-3131 FAx '.(soe)79o-ten 619 Main Street E-MAIL ,kathy@thefairagency.com Suite 7 INSURER AFFORDINO COVERAGE NAIL i Centerville MA 02632 INSURER AAIN 26158 INSURED INSURER B: Thomas P Damelic Building & Remodeleing, DBA: INSURERC: 45 Melbourne Road INSURER D: INSURER E: ,Hyannis MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBERCL1473100806 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 I TYPE OF INSURANCE ADDL SUER - POLICY EFF POLICY EXP LTR POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE . $ COMMERCIAL GENERAL LIABILITY DAMAGE To RERTEIT-- PREMISES Ea oaurrence E CLAIMS-MADE OCCUR MED EXP(Any one person) E PERSONAL&ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY JFTPRO- LOC ! $ AUTOMOBILE LIABILITY COMBINED SINGLE OUT .Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL FOULED BODILY INJURY(Per accident). $ 1� HIRED AUTOS NNION�NMED PROPer ERTY T DAMAGE $ `. .. E { UMBRELLA LIAB OCCUR EACH OCCURRENCE S. EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION - E A WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILRY Y/N LIMITS EEL- ANY PROPRIETORIPARTNER/EXECUTIVEOFFICER/M EL EACH ACCIDENT E 100,000 (Mandatory In ER EXCLUDED? �. N/A WC40070291792014A /25/2014 /25/2015 (Mandatory In NH) - E.L.DISEASE-EA EMPLOYO E 100,000 If yes,tlesttibe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT E 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,ll more space Is required) CERTIFICATE HOLDER CANCELLATION thomasdamelio@comcast.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Jackie Stewart/FAIMCl �� ACORD 25(2010/05) 01988-2010 ACORD CORPORATION.All rights reserved. INS025 mninns ni Th.Annan ...A I..nn j enJ,an CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDNYYY) O1/26/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT .AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE 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 pollcy(les) 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 : PAUL SCHLEGEL NAME SCHLEGEL INSURANCE BROKERS INC PHONE 508-771-83B1s1. Ax 508-771-0663 IA/C,No,Est): I'A Nol• 34 MAIN STREET ADDRESS: SCHLEGELINSURANCE@GMAIL.COM WEST YARMOUTH MA 02673 INSURERS)AFFORDING COVERAGE NAIC0 INSURERA:NGM INSURANCE COMPANY 1478E INSURED Aliandro Nascimento INSURERB:AIM MUTUAL i INSURER C: 77 Buckwood Drive INOURER D: INSURER E: Hyannis, MA 02601 INSURER F: } COVERAGES CERTIFICATE NUMBER: ) REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. - WSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDKYYY) (MMIDD/YYYY) LIMITS A GENERAL LIABILITY MPT5436Q 11/24/201411/24/2015 EACH OCCURRENCE S 2,000,000 x COMMERCIAL GENERAL LIABILITY 1. PREMISES(Ea occurtence) S 500,000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) S 10,000 PERSONAL S ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENT AGGREGATE LIMITAPPLIES PER: PRODUCTS•COMPA)P AGO S 2,000,000 POLICY PR LOC E S AUTOMOBILE LIABILITY " (Ea accident S - ANY AUTO BODILY INJURY(Per person) S ALL O SCHLED AUUTOSS AUTOS EDU BODILY INJURY(Per accident S \� NONOWNED HIRED AUTOS AUTOS (Per acGdeM) S S UMBRELLA LIAR OCCUR - EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DIED RETENTION $ S B WORKERS COMPENSATION WC-0446804 11/25/201411/25/2015 AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE - E.L.EACH ACCIDENT S 100,000 OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandnory In NH) E.L.DISEASE-EA EMPLOYEE S 1DO,OOO 11 yes.describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT S 500,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AHeeh ACORD 101,Additional Remarks Schedule.M mom space is required) ' ALIANDRO NASCIIMENTO HAS ELECTED TO BE COVEREDUNDER HIS CURRENT WORKERS COMPENSATION POLICY I I CERTIFICATE HOLDER CANCELLATION THOMAS DANE= 16 WHITE BIRCH WAY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,_ NOTICE WILL BE DELIVERED IN WEST BARNSTABLE MA 02668 ACCORDANCE WITH THE POLICY PROVISIONS. a, .AUTHORIZED REPRESENTA THOMASDAMELIO@COMCAST.NET (019,88.2010 ACORD CORPORATION. All rights reserved. / ACORD 25(2010105) The ACORD name and logo are registered marks of ORD a 1 ' - i NOTICE-NOTIC�E LEGAL rl 00 1� HEARING NOTICE CAPE COD alb COMMISSION it TOWNS OF BARNSTABLE,BREWSTER, �44 CHATHAM,.EASTHAM,AND PROVINCETOWN . NITROGEN CONTROL BYLAW—FERTILIZER. MA NAGEMENT,D_CPC' DECEMBER 1$;2014 O Pursuant to.Sections 5 and 11 of the Cape Cod C'4. Commission Act,.c.-.716.of the Acts of 1989, as tfY amended,the Cape Cod.Commission will conduct a public hearing on Thursday, December 18, 2014 at 4) .. .. 3:00 p.m.in the First tDbstrict Courthouse,Assembly of 41 Delegates Chambers,3195 Main Street,Barnstable, �., MA 02630 to review -and .determine whether. W implementing.,regulations proposed by the towns of Barnstable;'Brewster, Chatham,.Eastham, and A Provincetown:pursuant to:the Cape-..wide Fertilizer Management,District,of Critical:Planning Concern, (DC.P.C),Barnstable County Ordinance 13-07,conform. to the:Guidelines for,Implementing Regulations set. �.� out in said DCPC Designation: " $ Anyone"wishing.to:.testify.orally.will be welcome to do:so.Written.comments.may also be submitted em at,the hearing-or delivered:.or mailed.to the Cape Cod Commission,,P.O. Box 226" 3225 Main Street, Barnstable, MA 02630 for receipt on or.before the ,p date of the hearing or until the hearing is closed.The relevant documents may be viewed at the Cape Cod.. Commission office between the..hours of 8:30.a.m. and 4:30 p m. For further information or to schedule an appointment,please contact the Commission office at(508)362-3828.If you are deaf or.hard of hearing or are a person with a disability.who requires an accommodation,contact the Cape*Cod Commission of(508)362-3828 or TTY(508)362-5885. The.Barnstable.Patriot December 5,2014 C.OMMONWEALTH.OF MASSACHUSETTS. -` THE TRIAL COURT PROBATE AND FAMILY COURT W BARNSTABLE DIVISION. a 3195 MAIN STREET `P.O.BOX 346 BARNSTABLE,MA 02630 (508)375-6600. DOCKET BA14P1512EA INFORMAL PROBATE PUBLICATION NOTICE Estate.of:,Thomas Moriarty Date of Death:8/13/14. .. 1 To all persons interested 1n the above captioned estate,.by:Petition.of Petitioner Catherine Moriarty of Hyannis,.,MA a Will.has been admitted-to informal .probate.Catherine Moriarty_of Hyannis,,Ma has been informally appointed as the Personal Representative- of the:esfate to serve withoutsurety.onthe bond. The :estate is.being:administered. under.-informal procedure by the Personal. Representative under the..Massachusetts Uniform Probate_Code. without, supervision'by.the.Court. inventory and accounts are not.required 'to be filed .with.the Court, but interested parties;are entitled to;notice.regardingahe- administration from the Personal Representative and ca 1.n petition=the Court in1 any..matter relating to the estate,including distribution of assets and expenses of administration, Interested parties-are entitled to petition.1he Court.to institute formal,proceedings.and to:obtain orders terminating or restricting the powers of Personal:Representatives appointed under informal procedure.A copy of the:Petition:and Will,if any,can be,obtained from-the Petitioner. Docket No. Commonwealth of Massachusetts LETT RS OF AUTHORITY FOR The Trial Court PERSONAL REPRESENTATIVE BA14P1512EA The and Family Court Barnstable Probate and Family Court Estate of: 3195 Main Street Thomas Moriarty PO Box 346 Bamstable, MA 02630 Date of Death: (506)375-6710 08/13/2014 To: Catherine Moriarty 94 Old Craigvllle Road , Hyannis, MA 02601 ts5 You have been appointed and qualified as Personal Representafive In ❑ Supervised ❑x Unsupervised administration of this estate on 'October 02, 2014 a These letters are proof of your authority to act pursuant to G.L:c. 19013, except for the following restrictions if any: ❑ The Personal Representative was appointed before March 31, 2012 as Executor or Administrator of the estate. �. (Do Not Write Bolow This Line-For Court Use Only) CERTIFICATION 1 certify that it appears by the records of this Court that said appointment remains in full force and effect. IN TESTIMONY WHEREOF I have hereunto set my hand and affixed the seal of said Court.Date October 3,2014 VWW,-7 wovv � Anastasia W Perrino,Register of Probate MPC 751 (3/31/12) THE ray 'Town of Barnstable Regulatory Services v STAB �a Richard V.Scali,Director i639 ArEo �" Building Division, Tom Perry,Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Mush Complete and Sign This Section If Using A Bader I,( '1'P `9J£- �D1� �`AQj ; as Owner of the subject property J. hereby authorize , �)*7w/ t5w to act on my behalf, m all matters relative to work authorized by this building:permit application for. (Address o ob) Pool fences.and alarms are the responsibiliiyof the applicant. Pools are not to be filled or utilized before fence is installed'and all final inspections are'-performed and accepted. 4 ° Signature.of Owner " Signa Leo-Applicant Print Name Print Name •''�� —�O%sue_ Date Q:FORMS:O WNERPERMISSIONPOOLS Town:ofarnste . . Regulatory 5emee P�atiE roty,� Richard V_Scali,Director _ { Building Division xnxxsznsr Tom Perry,Building Commissioner 4i Y63s .� 200 Main Street• Hyannis,MA 0260E QED Mpt 6. - - .. . .. • www.town.barnstable-ma.us 0Mc;e: S08-862-4038 pax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Pease 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 notpossess 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 she Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine-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 mat 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 ofasupervisor (see Appendix Q,RuIes&ReguIations for Licensing Construction Supervisors,Section 2.1S) This Iack 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 Iast page of this issue i.s,a form currently used by several towns_ You may care t amend and adopt;suc$a.form7certificatiou for use in your community. Q:\wPFII.ESTORMS\building permit fbnns\EXPRESSSdoc Revised 061313 ,sue cPar�airru»uueal�o�C�aa�cu�eGY i -----, Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 11,8952 Type: Office of Consumer Affairs and Business Regulation ® Expiration 5l8/2019> DBA 10 Park Plaza-Suite 5170 i if Boston,MA 02116 THOMAS P DAMELIO BLDG 4 REMODELING r THOMAS DAMELIO {� ks-t 16 WHITE BIRCH -W. BA RNSTABLE MA 026681 � Undersecretary -- Not va lid without signature `Massachusetts -Department of Public Safety Board.of.Buil ding Regulations and Standards Construction Supery isor I &c 2 Family License: CSFA-.047420 I IN THOMAS P DAM9Y,I 16 WHITE BIRCH W BARNSTABLE f I Expiration Commissioner 04/07/2015 < i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # d. nO Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner Address 4de2! Z Telephone � �_7 7, o O7 Permit Request /31�, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed _Z92 Total new l 9,2 Zoning District a Flood Plain Groundwater Overlay Project Valuation Q 0 oC-Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 79 Two Family ❑ Multi-Family (# units) Age of Existing Structure /17 iZ Historic House: ❑Yes A No On Old King's Highway: ❑Yes .1-srNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing / new Half: existing O new O Number of Bedrooms: existing ;Z new - 02 Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing 4 nevV-isize= Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:� o I w P Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -e Commercial ❑Yes ❑ No If yes, site plan review# "' cry Current Use Proposed Use �O O� rn APPLICANT INFORMATION (BUILDER OR-HOMEOWNER) - Name Gam(. Telephone Number 7:2' Address 4License # 41ol 76 owl Home Improvement Contractor# /Q Worker's Compensation # use e Scdfi7 S_ �,� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE :2 dA01 3 �AP-,7'k0_ 4)-7004 0oA'ro cG� 4 t. FOR OFFICIAL USE ONLY APPLICATION# '¢• DATE ISSUED S MAP/PARCELNO. F' ADDRESS VILLAGE OWNER i DATE OF INSPECTION: xFO.UNDATI.ON} zt�;,3'' i�iUkt w FRAME — =-rINSULATIO.Ni A► ' �_�:, • a ` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH. FINAL FINAL BUILDING. 6 DATE CLOSED OUT ASSOCIATION PLAN NO. j: i' ,per The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations , 600 Washington Street Boston,MA 02111 www.massgov/dia ' Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Le ibl Name(Business/Orgamzation/7ndividnal): •Address: City/State&ip: / / -� � e, Phone.#: �'6 g 3C'z / Are you an employer?Check the appropriate bog: :Type of prof ect(required):, 1.❑ Tam a employer with 4• ❑ I am a general caotrabtor and I * have hired the sub-contractors 6. []New construction . employees(full azad/or part-time)• lisind on tbe'attached sheet 7: Remodeling 2.® Y am a'sole proprietor or partner- These sub-contractors have ship and have no employees 8. ❑Demolition '-working for me in any capacity. employees and have workers' 9• ❑Building addition comp. t (No workers' comp.insurance eo insurance. 10.[0Electrical repairs or additions equired] 5. ❑ We are a corporation and its r 3.❑ qu a homeowner doing a71 work . - officers have exercised their 11.�Plumbing repairs or additions myself.No workers'comp. right df exemption per MGL 12.❑Roof repairs insurance.requiied.]t c• 152, §1(4),and we have no 13.❑Other employees, [No workers' comp,insurance requ iced.] *My applicant that checks box#1•must also fib out the section below showing their workers'compensation policy information. f Homeowners•who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating cvctt. $Contractors that check this box mutt attached an additional sheet showing the name of the Sub-contractors and state whether ornot those entities have employees, lftbe sub-contractors have employees,theymust providb their workers'comp.poHdy number. Xant an employer that isprovid- w�k compensation insurance far my employees. Below is thepolicy andjob site information. Insurance Company NaSme• / \ Policy#or Self-ins.Lic.#- ExpirationDate: O lob Site Address: �� / City/State/Zip: GoIG G�! Attach a copy of the workers'compensation policy declaration page(showing the policy number and eap'iration date).' Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine iip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP.WORK•ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this staternert maybe forwarded to the-Office of' Investi ations of the I)IA for insurance coves a verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si atwre• -• Date• O Phone#: Official use only. Do not write in this area, to be completed by,city or town official �. City or Town: ' Bermit/License# Issuing Authority(circle one): 1.Board of Health 2•Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector' 6. Other ' Department of Pu,90 blic Safety Massachusetts ' ulations and Standards Board of Building Rego r-isor Construction Sun' License:CS-004276 -4 �r t 1 �., ..r AR'�R L - . �GoFf g;DR ,. 19 McCOR1V1 E,MA.02668 W BARNST Expiration 12 j112013 Commissioner �/e �P�'UrraorzcoeaGt�i n Office of Consumer Affairs&Business Regulation �' ME IMPROVEMENT CONTRACTOR Type. egistration: private Corporatio j „ xpirat►o 71 2014 : y o MODELING INC ; ART DOLGOFF BUIL 0 • Arthur Dolgoff 19 McCormick Dr. "__ _ W.Barnstable,MA 02668 Undersecretary y oFE T Town of Barnstable Regulatory Services BARNSTABv IE$ Thomas F.Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, a ,as Owner of the subject property hereby authorize 0to act on my behalf, in all matters relative to work authorized by this building petmit (Address of Jo *Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant �o�as I oh�ah�� Print Name - Print Name A Date QTORM&OWNERPERMISSIONPOOL•S 62012 oFTHE� Town of Barnstable Regulatory Services rBLABS.esr � Thomas F.Geiler,Director q'OrEoy►�0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 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&ReguIations 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. C:\Users\deco]lilt\AppEata\Local\MicrosoMWindows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc Revised 053012 of Yam.row Town of Barnstable *Perrct��0 Cry Expires 6 monthsfrom issue da e Regulatory Services Fee ., RARNS-rnsr.E, Thomas F. Geiler, Director 9�, b 4 ,�� Building Division PrfD MA't h Torn Perry, CBO, Building Comnussioner ^� 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5087790-6230. EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press fmprin.t Map/parcel Number ( � Property Address I 6-A 1. 1b 1.1�' _ ` C � �l�d/✓t� , ��. ��d� �� - VResidential Value of Work 1q, 00 -� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ( (), jV1 � I.q 0 12 1'�{keypv -- V Contractor's Name Telephone..Number 36 Z - 3' Home mprovement Contractor License 14 (if applicable) REorkman's Compensation Insurance k PR S Ch one: I am a sole proprietor SEP ❑ I am the Homeowner ❑ I have Worker's //Compensation Insurance TOWN OF; BA AFI Insurance Company.Name C, f P� 0 e1 r Workrian's Comp. Policy# vC2-- 3 (S — Copy of Insurance Compliance Certificate must be on file. Permit Reque t(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 ❑ Replacement Windows/doors/sliders. 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, A copy of the home Improvement Contractors License is required, y SIGNATURE: Q:\WPF.ILES\FOr 1-MS\building permit forms\EXPRESS.doc Revise020109 s 'f' ✓fie toanvn�ynu ��'°w aC�iuGeGb Board of Building Kegula`ions and Standards License or registration valid for individtil use only before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards , ration 150950 ? One Ashburton Place Rm 1301 Regist Expiration 5l8/2010 Tr# 267093 Boston,Ma.02108 xF� ri s.- LgType DBA PETER J.SMITH HOME IMPROVEMENT PETER SMITHy\�` r I - 3925 MAIN ST b<4� f✓ Not id without signature ' Administrator CUMMAQUID,MA 02637" The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washingfon Street Boston, MA 02111 www.mass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plambers Applicant Information Please Print Le 'bI Name (Business/ • niTation/fndividuan: /� C�� aV+Aq UI p P� City/Statdzip: CUMl L)jjQ 6 Phone.#: f6 2 "7 � Are your an employer? Check the appropriate bow Type of project(required): 1.❑ I a employer with 4. I am a general contractor and I 6. ❑New construction employees (full and/or part-timt).* have hired the shb Gontractars 2. I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These srtb-contractors have g. Demolition employees and have workers' working for nu:in any capacity. 9. ❑Building addition . [No workers' comp.*nrn�e comp.insurance.$ 5. We arc a corporation and its 10.0 Electrical repairs or additions rtquirnl] officers have exercised their 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work m yself: [No workers'.camp_ right of exemption per MGL 12 ❑goof repairs t c. 152, §1(4),and we have no incnranaG r e4�d•] employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that chxks box#1 roust also M out the section below showing their woricrrs'compatsafion policy infomsatim- t Homeowoat who submit this affidavit Mcaf Mg fbCy arc doing all work co and then hire outside ntractars must eubmit a new affidavit find' ng t such --an xaetnrs that chmk this box nnist attached an additional sheet showing the name of the sub-couft-Airs and state whether or not thosb entities have cmployexs. If the sub-eonhurtms have employees,tbey.must providt their worktt-v'comp.policy number. Iam arc employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. �[ Inniranco Comp any Name_ �••/ ` U t1(g Policy#or Self-ins.Lic.#: (�j C 2 ?j S' cK l0 0+d 207 Expiration Date: �' O Job Site Address: l�,- ilk' � � �Gt•; City,StatclZip:_ !iJ Attach a copy of the workers' compensation policy declaration page(showing the policy n er and ex-piration date). Failure to secure coverage as requned under Section 25A of MGL c. 152 can lead.to the imposition of criminal penalties of a fine tip to$1,500.00 andlor one-year iroprisonmrnt, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statrmcrit may be forwarded to the Office of Invcstigalions of the DIA for insurance coverer e vcrificatiom I do hereby certify under the pains-and penalties of perjury that fhe information provided above is true and eorrerl Si c: Daft: Phonc# Official use only. Do not write in this area, fb be cornplzted by cityy or town offx-1aL City or Tower: Permit/License# Issrirng Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other f1-- ua ,.. Phone#: �OFZHETp Town of Barnstable ReguNto>ry Services r r r r H"�'HAS& ` Thomas F. Geiler, Director reotula Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorizetv,,_ to act on my behalf, in all.matters relative to work authorized by this building permit application for: 67 V, l (Address Job) Signature of Owner ate Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. y Town of Barnstable mop THE Tp�� Regulatory Services Thomas F. Geiler,Director • BARNSTABLE, .. . 9 MASS. Building Division TE4 � Tom Perry,.Building Commissioner . 200 Main Street, Hyannis, MA 02501 www.town.barnsiable.ma.us Office: S08-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: !OB 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 o homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as to allow 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 pezmst. (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,I-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, sponsibilitics of a Supervisor. On the last page of this issue is a form currently used by that the homeowner certify that he/she understands there several towns. You may care t amend and adopt such a form/certification for use in your community. Town of Barnstable oF114Et ~�� 13 � Ei ,`�h}o , rRegulatory Services t Thomas F.Geiler,Director Y - ELARN� MAB �° 6 ,.!?) -2 E � Building Division 6 1639. �� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 �Li'y, ;;iOr www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623( Oq PERMIT# FEE: $ C9- SHED REGISTRATION 3r� 120 square feet or less `. 01 e- A1, a-nm► S MA , o a&01 Location of shed(address) Village � O .Sls O 12. -to ` 1.o Property owner's name Telephone number Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 LO A l O F P RO/ 1 N ES' T BE ACCURATE STANDARD LEGEND NOTE:not all symbols will appear on a map ---.:;y GOLF COURSE FAIRWAY rvv EDGE OF DECIDUOUS TREES EDGE OF BRUSH ,. — __ _�__....•--� . /, �___ ,' ORCHARD OR NURSERY i e r v EDGE OF CONIFEROUS TREES \ /J .........:....... . MARSH AREA � ! --•••--- EDGE OF WATER DIRT ROAD DRIVEWAY PARKING LOT / PAVED ROAD •.�\\ —--—- DRAINAGE DITCH i R /� ———— PATH/TRAIL Il AP 24 V 7 PARCELUNE** . J r•we 326 MAP# \ 0 PARCEL NUMBER 0317 367 �_HOUSE NUMBER 2 FOOT CONTOUR LINE 4 Ili) 10 FOOT CONTOUR LINE Elevation based on NGVD29 X 4.9 SPOT ELEVATION r • — �'=`x'� STONE WALL -X—X- FENCE RETAINING WALL ...F...+.._F....... RAIL ROAD TRACK _._._ STONE JETTY SWIMMING POOL PORCH/DECK �j BUILDING/STRUCTURE 2 2 MAP 248 � DOCK/PIER 0 . 2 �? HYDRANT 6 VALVE O MANHOLE 0 POST 0" FLAG POLE T O W N O F 0 A R N S T A R L E O E O O R A P N 1 C 1 N F O R M A T 1 O N S Y S T E M S U N I T o SIGN ® STORMORMN N PRINTEDSWF:INFEET *NOTE:lhbmapisonenlorgementafo **NOTE:ThaparcellinesaraonlyRraphiampmsentations DATASOURCES:Planimehla(man-madefeamresl were interpreted from 1995aedolphotographsbylhelames w } e •` - 1"=100'smle map and may NOT meet of propery bounclorim They are not true lamNam,and W.Small Company.Topography and vegetur ion were interpreted from 1989 aerial plramg phs bs GEOD UNLNY POIE o TOWER. 0 15 30 National Me AuumeyStandardsattha do not mpmsent actual relationships tophyvmlobjects Corporation.Planimouigtappooggmphy,and vegetation were mapped to meet NaBanalMapAttumryStondards e I INCH 30 HET* enlarged ua e. on the map, at a smle of l"=100'.Parml lines were digUi2ed from FY2D04 Town of Bamsiable Assesso(s tm mops. LIGHT POLE o ELECTRIC BOX ...\Desktop\Conservation.dgn 6/2/2006 8:33:44 AM , tt Notes: 2TV All new Anderson 200 Windows Move Bathroom Window All Ceiling joists Raised to 7'6" Cedar Back of Door at Closet All Rough�— sting 4'Il" 4 Ref ame Plumbing cellingheight at is 1 Stairs Std. DBL Window Y 1])1t IMPORTANT- UPGRADE REQUIRED _ STATE BUILDING CODE REQUIRES THE UPGRADING F q SMOKE DETECTORS FOR THE ENTIRE DWELLING WH N Bedroom 1 ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATE 3. Ti NOTE: A SEPARATE PERMIT IS REQUIRED FORT E Storage A Collar INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL r1. R-30 Insulation PERMIT DOES NOT SATISFY THIS REQUIREMENT. {I x8 Ceiling Joists Existing Move Up to new h h New Walls 2 X 8 RO New R-13 Insulation in Walls 1,2 CDX 'SMOKE DETECTOR REVIEWED 16'0" Open length of House _ _ R-30 Insulati 30 3 �� BARNSTABLE BUILDING DEPT. DATE e� 3'4" S" DRIP EDGE 10'0° 1Slb VELT • 2x4 Wall Around P Chimney DEPARTMENT DATE _ 10�0°. - 2x10 Floor Joists Existing Chimney Ec�iAfR@OUIREDFORPERMI NG Walk-In-Closet 3'4' 1 X 3 STRRPING 1/2 SHEETROCK —TYVRK1/2 CDX WRLL OVER 2 X 1 STUDS CEDAR SHINGLES WHITE CEDAR SHINGLES 2x6 wall ;' Correct Ceiling Ileight To 6.8" CARBON ALARMS O O Stairs From Top Of Tr ad Below R 11 INSULATION MUST BE INSTALL PER MASSACHUSETTS BUI DING CODE Move Window Bath 5/8 CDX SUB FLOOR 2 X 10 2X10BOX O� Cedar Closet SILL SEAL PLATE ON R 19 INSULATION O Q, \� r AA "�x a ' s1' AA 6 I L-- 2x6 wall ---_ I ro 4'P 8" CONCRETE POUR .} 3000 lb. MIX, Bedroom 2 TOP 4" CONCRETE k FLOOR rn I m � I 1' X 2' FOOTING ... . # 2.0„ L� 17'8' `I'' Existing Frame Detail Existing I o AA o SCALE 1/4"=1'0" x rn cc Not To Scale 113„ DRAWN BY: 25'S" S.M. LeBARON PLANS FOR'Tom & Kathy Moriarty 508-775-6027 94 Old Craigeville Road Hyannis, Ma. 02601 DATE: " 2nd Floor Layout SCRLE: 1/4"-1 APPROVED BY DRRWN BY:SeM.LEB SCALE 1/4"-1'0" ORTe Sept. 1,2013 REVISED: 1190 sq.ft. STEVEN M. LeBRRON - S PROPOSED: Finish Existing 2nd Floor M • ORRWING NUMBER L �\ Remodel 1st Floor Bath & Study a ,t 5 Existing Kitchen Existing Kitchen 1 �I Living Room f 127 b New Study/Office 0 a� � o ce I m Fir Place Remove Closet Doors Sheetrock Opening 3'1° O = Closet M I Stairs O O Stairs - 6'5• j c - 4r—i New Bathroom Hall Glass Wall/Door 2mx ou Ill�)(I 4"x4" Shower 6 Tile ° Closet _ TF nen 6' 0t 6 Seat ^ 2 Bedroom Sewing Room Lda � 13'll° Existing 1st Floor New Renovations SCRLE 1/4"=1"0" DRAWN BY: SCRLE 1/4"=1"0" S.M. LeBARON PLANS FOR:Tom Moriarty 508-775-6027 #94 Old Craigeville Road a Not To Scale Hyannis, Ma. 02601 DATE. SCALE: 1/4"=1 APPROVED BY: DRAWN BY:S.M.LEB DATE:Sept. 1,2013 REVISED: 385 sq.ft. tSTEVEN M. LeBRRON PROPosEo: 1stFloor Alterations DRAWING NUM R J 1 27'5" ` t f 411" Std. DBL Window y Bedroom 1 Storage Is i c\0 s �e 2x4 Wall Around Chimney Notes: = Walk-In-Closet Chimney All Electrical Placement is Ment to be a Guide 3,4„ All Electrical Shall Be To Mass Code Owner To Determine Lights C— Owner to Specifie Switched Outlets 2x6 wall Stairs Correct Ceiling Height To 6' " Ol From Top Of TrE ad Below i Move Window Bath �o Cedar Closet O a \e A AA A a 0' L2x6 wall 47 0� P Bedroom U� 0 3T rn , L I m I o k W I � CD Is o I tb DRAWN B Y.- S.M. LeBARON -� ll'3" PLANS POR:Tom & Kathy Moriarty 508-775-6027 94 Old Craigeville Road z5,5„ Hyannis, Ma. 02601 DATE: SCALE: 1/4"- ::]1 APPROVED BY: DRAWN BY:S.M.LEB 2nd Floor Layout - DATE:Sept. 1,2013 REviseD: STEVEN M. 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