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0059 REGATTA DRIVE
Z)r V-9 i i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map = Parc Application # C�d)S av S Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 306• 07) Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address .5q e Village G!rn c.a � 14yotoll"A Owner (� cam, �� , ice Address S(? R )DA Telephone Permit Request I�AVN®u'P. tZ�,s�iye: e��o c e- covuS4o 9x w ,(y) 306so►,l 81 JA) R060, Square feet: 1st floor: existing 7*7 proposed 30? 2nd floor: existing proposed Total new Y P Zoning District R L- I Flood Plain Groundwater Overlay Project Valuation ��boa Construction Typeu3oe.,A Lot Size 0.31 Grandfathered: ❑Yes ® No If yes, attach supporting documentation. Dwelling Type: Single Family �111 Two Family ❑ Multi-Family (# units) Age of Existing Structure 19 9.2 Historic House: ❑Yes W No On Old King's Highway: ❑Yes `d No >Xlq)� Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 9 68" Number of Baths: Full: existing o2 new -- Half: existing / new Number of Bedrooms: .3 existing —new o — Total Room Count (not including baths): existing new / First Floor Room Count Heat Type and Fuel: Ld Gas ❑ Oil ❑ Electric ❑ Other Central Air: H Yes 9,No Fireplaces: Existing / New — Existing wood/coal stove: ❑Yes No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new sib_ Attached garage: Cd(existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: k D Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ •.➢ Commercial ❑Yes m'No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �Jo),J �>/f<S Telephone Number Address /©k,& Aae.2 License # C e Home Improvement Contractor# i3 774/6 Em it �s/m �� >S d>✓t% 4orn P/J� • ��/� Worker's Compensation # IUi�l© S_ ��33 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO h.�. � f..n� • SIGNATURE G/��"J DATE ��. FOR 'OFFICIAL USE ONLY , APPLICATION# DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ��) 'y FRAME r-, G10h INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING s DATE CLOSED OUT ASSOCIATION PLAN NO. f Department ofInd'urtrialAccidents Office of Investigations 500 Washington Street , Boston,MA 02I1I Www.mass gnvl&a Workets CompensationInsiwanceAffidavit BuRders/Contractors/Electricians/Plmnleers Applicant Information Please Print Le�ibl�' Name(Busk=d mq): 'Jam Address: City0ate/Zip: YA Air s yy%,,j 11 S Phone Are you an employer? Check the appropriate bore ' Type ofproject(required): 1.[] I an a employer with 4. &1 am a general contractor and I employees(fiffi and/or part time). * have hired the sub—contractors 6. ❑New constractinn 2.❑ I am a sole proprietor or partner- listed on the attached sbeet 7. ❑Remodeling ship and have no employees 'These sob-coairactors have 8. E]Demolition. working for me iii any capacity. employees and have workers' j ,,,� [No workers'.com rrr_a p.msnc a CAInp.inmlanl# 9. u""`� add�110n required] 5. We are a corporation and its IIEl Electdcalrepami or additions 3.❑ I am a homeowner doing all worm , officers have exercised their 11.❑Plmnbing repairs or additions Myself [No workers'comp. right of exemption per MGL 12 Q Roof repairs insurance required.I t c.152,§1(4),and we have no employees.[No workers' 13.❑Other coraP.insmance required-I *Any applicant that checks box#1 mnst also fiU out the section below showing tbx.*workaa'compcnsdion policy fi fnmrziiom. t Homeowners who submit this affidavit indicating they am doing all work and thm hue outside comtactors amst snbmit anew affidavit indicating such_ $Contractors that check this box most attached an additional shed showing the name ofthe sab-eo atraamrs and state whether or not those entities have employees. If tho sub-contractors have employees,they must provide their worIma'comp,policy m®ber. a I am an employer thnf is providing workers'compensation bu amtce for my employees. Blow is the policy and job site information. Insurance Company Name: t,►. !?�.f-4 a,,,�.• Policy#or Self-ins.Lic.#:. Gcj C-eA 15 :;f Expiration Date: y 3,0 —>,b' Job Site Address: ���* I'C c� n Cify/State/ CA �P_•- ,,,� itilG., Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). FafIrre to sector a coverage as requited tnader Sectim25A of MGL c.152 can lead to the imposition of criminal penalties of a fine'up to$1,50-0.00 and/or one-year imprisomnent;as well as aivR penalties in the foma of a STOP WORK ORDER and a'f me of i3p to$250.00 a day against the violator. Be advised that a copy of this state nmt may be forwarded to the Office of Investigations of the DIA for insurance coverage veEfficafion. I do hereby pains and penalties ofpmjwy that the information provided above is true and correct., Si r Date: Phone# 11 O use ortl}: Do not write in this area to be coa.pkted by city or town o flMaL City or Town• Permit/Licease# Tssag 9.uth� ority(circle one): 1.Board of Health 2,Building Department 3.CityiTowu Clerk 4.Mec$ical Inspector S.Plumbing.Inspector 6.Other Contact Person: Phone#; t -Information and Instructions Massachusetfs General Laws chapter 152 regoites all employers to provide workers'compensation for their euip1r7yees. Pursuantto this shdi tc,an employee is defined as"_.every person in the service of another under any contract ofbire, express or implied,oral or wuf 2m" An mployer is defined as"an individnA 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 - dwellmg house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also state 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 k the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any ofits political subdivisions shall _.. enter into any contract for the performance ofpublic work until acceptable evidence,of compliance with the inan-ancd.. requirements of this chapter have h beecontractingpresented to the contracting authority." Applicants Please fill out the woiicers'compensation affidavit completely,by ch=ki g the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation ofinsur nce coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,Please call the Department at the number listed below. Self-insured companies should eater their self-insurance license number on the appropriate lime. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to hill in the pens i license number which will be used as a reference number. In addition,an applicant that must submit multiple permMicense applitations in any given year,need only submit one affidavit indicating cimreat policy information(if necessary)and imder;`Job Site Address"the applicant should write "all locations in (city or town)-"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or Incenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to.complete this affidavit: The Office of Investigations would lake to thank you in.advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Dep tmenfs address,telephone and fax number. 'fie CGmmc wealth of Massachusetts ` Depa d ment of lkusr al Accidents Office of jtvesfigatious - EQ��ashingtan Street 8astan:MA��1 ll TeL#617-727-4900 cxt 4€6 or 1-977 IASSAFE . Fax#617-727-7744 Revised 4-24-07 .mas5_gav/din ' A TYC-Ghirle8m Woo&ConstructiouinHigh Wind Areas:110uooh WindZooe Massachusetts Checklist for Co' -"�Y ance(70Wcm0 ��3U�� i./)| ' ' . Chcok . . . . . . ' ~^=e"a=" 1.1 SCOPE . Wind110 mph ' � Wind Exposure --- Engineering ' 1'� �P�����BlL[�� . '' ' ' Project . ---- Number mf Stories(a roof which ezzemdmQkl12o3opeahoDb000nmidomdo�nm4 � ob�em �2abzdam � - Roof Pitch ' ' ' --�- HeightMean Roof ........` ..� Building "= gp^ ^ .............................................................. ' ' Building Aspect Ratio '___-.-_. ;�� ' 1- . --- . . Nmm�aHo�btcfToUmn -_--_--nr�'-'�_'' - '---�-'--''-'------'-----�oG�" --�� . . ^ . . . . 1.3 FRAMING CONNECTIONS . Gena�dcmmp�nouv� framing 2.1 FOUNDATION Foundation cf78OCMR 54041 Conorste�-.--------'�.-'�'_---_--_.-�.-'---------'�------'------_'--------- ~° . Concrete Masnn�__-___'-_--_---_______'-._''__'_�____-'-~�_-'--_-�'-'--_' --�� ~ .^ 22 ANCHORAGE TQBJUNDATN]0i,3 ' . 5/8"Anchor BoKoimbeddador5/8^Proprietary Mechanlcjl Anchors aoan alternative in concrete only Bolt S n. . Bolt ---- ' . -from en.--- plate ` ' Bolt Embedment concrete^ pg Bo�Embadmon . Embedment:- --'�'_'/_-----^--_---' |n'�16~ ' ~^ Plate Washer................................................................ (Fig 5).............................................. 3^zIK" ---- 3.1 FLOORS F Maximu!m Floor Opening Dimension....... -___�_ .................................................. ft�12,' ' ' _-.'-- -�� --_- Fum 8�doatF�orOpen�Qo�so than 2`h�mE�ehorVVaUO�gG)-.-----_.'_--_----' rwbAmum Floor Joist Setbacks ' . Maximum Cantilevered Floor joists - Floor pe Floor 'Sheathing - ......... p- '-- --'--,-- -- F�u�w�ng----_-'__-'__-_--_.�-_ a2)_�" d Chapter Fk»orSheathingat � �edge/ -�r- ' 4.1 WALLS V��Height `~ ' ~.�~~. g ................... _ .~",L~""b="".g walls.................................................... and Table cy........................... o ��� . Wall Stud Spacing ....................................................... and Table 5)................... i(P n�z24^o� ~~ ' V�a8Story O�m�s .......................................................-U�gaJ&8A____'.--_- --- � sd � ---- ' . . --_ ~ ----' 4.2 nnA`,S» VVbodSbuds LoadbeahngWalls........................................................(Table .......................... k_ft_j_in, . Gab�End VVaU8�dnQ` --' --- �-- ' ---- � r"o � muSr-Atou Floor Length . ' -_-- - . ` �_--' or 1 x 3 ceiling funing strips @ 16'spacing min.With 2 x 4 blDcking @ 4� �e���cv'truss baysDouble Top Pate G1............................. �� ft Splice Connection(no.of 16d common nu:s)_-'_-( ao�:)__�___-_-'�______._�__^�� � � _�°�' . . . ` AH,C Guide to Wood Construcdou in High Wind Areas: 110 srph 1Yind Zotke Massachusetts Checklist for Compliance (790 03V1R5301.Z.1.0 Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(fables')..................................................... _ Non-Loadbearing Wall Connections Lateral(no.of 16d common nails) ..(Table B) Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(Table 9)..................................-3 ft_in. 11' Siff Plate Spans .......................................................(Table 9)...---........................... ft_in.511, 7:� Full Height Studs (no. of studs)....................................(Table 9).................... 2" Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans. ..................................... ................(fable 9)................................ Y ft � in.512' .. Sill Plate Spans...........................................................(Table 9)................. ............... & ft�fn.512- _ Full Height Studs(no.of studs)....................................(Table 9)......_.._.......... _ Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4. Minimum Building Dimension,W Nominal Height of Tallest Opening Z .............................................................. SheathingType..............................................(note 4)::........--......................C ;K Edge Nail Spacing.........................................(fable 10 or note 4 if less)......................... _in. Field Nail Spacing..........................................(Table 10)....................................................jZ-in. y. Shear Connection(no.of 16d common nails)(Table 10)....................................................... 3 h Percent Full-Height Sheathing......_:..........:...(Table 10).................................................... G�°l° 5%Additional Sheathing for Wall with Opening>6V(Design Concepts).................... Maximum Building Dimension,L Nominal Height of Tallest Openfng2.......................................................... ....... <6'8 �► SheathingType.............................. .....(note 4)..................................... ............. a� Edge Nail Spacing........................................(Table i 1 or note 4 if less)......................_q in. "- FieldNail.Spacing........................................(fable 11)................, ...............................(_zfn. Li Shear Connection(no. of 16d common nails)(Table 11).......... . ................_...... ......._.... 2 Percent Full-Height Sheathing.......................(Table 11)............................................_.......ham% & 5%Additional Sheathing for Wall with'Opening>6'8"(Design Concepts)..................... Wall-Cladding Ratedfor Wind Speed?............................................................. ............................................................... 5.1 fZOOFS. Roof framing member spans checked?.........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19)............. V ft 5 smaller of 2'-or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift...................................... . ......(Table 12).......................................... ...U plf -Zr— Lateral.............................................(Table 12).............................................L- pf Shear............................:..................(Table 12)............................................. plf Ridge Strap Connections,if collar ties not fised per page 21... (Table 13)...............................T=�plf Z- Gable Rake Oudooker..........................................(Figure 20)............. ft 5 smaller of 2'or L/2 ' Truss or Rafter Connections at Non-Loadbeaflng Walls Proprietary Connectors Uplift................................................(Table 14)...........................................U '�_Ib. Lateral(no.of 16d common nails)...(Table 14).......................................L= Ib. Roof Sheathing Type...................................................(per 780 CMR Chapters 56 ana 59)............ �• Roof Sheathing Thickness........................................ ............................................. in.>_7/16'WSP Roof Sheathing Fastening............................................(Table 2).....................:................................... � y Notes: -1. . This checklist shall be met in its entirety, excluding the specific exception noted in 2,to comply with the requirements of 780 CMR•5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs ara not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b.•. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1Ba and Figure 18b 2. Exception:Opening heights of up to 8 fL shall be permitted when 5%is added to the percent full-height sheathing - requ'uer ents shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. ' AWC Guide to Wood Corvarnctiort itt High 1+ ndAreas: II0 mp/r Wind Zone Massachusetts Checklist for Compliance(790 Ch1R 5361.2.1:1)' 4 - a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nall Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: I. Panels shall be installed with strength axis parallel to studs. I All horizontal joints shall occur over and be nailed to framing. lil. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top.member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at'double top plates, band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5. Glazing protection:a)new house or horizontal addition—required if project is 1 mile or closer to shore(generally,south of Rte.28 or north of Rte.6) b)vertical addition—not required unless there is extensive renovation to the first'floor c)replacement windows—needs energy conservation compliance only(chap 93) . ' 6.Wood Frame Construction Manual(WFCM)for 110 MPH, Exposure B may be obtained from the American Wood Council (AWC)website. WHQITHE EDGERES'r5 DN FRAMING USEsd NAILS AT G"= 11 1 1 to 11 I1 t ' • t i' {1 it 11 , � � t 11 I / 1 SC 1 i' � ¢ N e '1 ► t a� i 11 I 1 , 1 ll 11 1 1 1 11 c iti I�r-F 1 t li It m' I ; %6d" . i' i { 1r MR 4 I 1 ►1 1L . t iI 1EDGEMFAMEQLQEL1, k ► 111 1 �d u u g 1.1 11 11 1 1 I r ' p {i it w i 1 e ; i ►a \ t 1 t STAGGEFED 3'MYtI, NA1LiSPACJlVt3 WVL PATTERN pig • PANES,— — 1 �, . FANS EDGE DOUBLE NAIL EDGE SPAAYG DETAL See Detall on Next.Page Detall Vertical and Hoyt ontal Nailing Vertical and Horizontal Nailing for Panel Attachment for Panel Attachment Town of Barnstable o� Regulatory Services ' MASS '� Richard V.Scali,Director 619. A.,� 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, L R --J u1�7k e- 0x-)Al d ,as Owner of the subject property hereby authorize T/ //mot to act on my behalf, in all matters relative to work authorized by this building permit application for. '(Addfess of Job) Pool fences and alas are the responsibility of the applicant.Pools alarms are not to be filled or utilized before fence is installed and all final inspections are performed and accepted �ignature of Owner S* of plicant 10-117-14 A4-c.bolua /,� �I Print Name Print Name . QTORMS:OWNERPERMISSIONPOOLS Town of Barnstable,-- Regulatory Services , Richard V.ScaIi,Director Balding Division r atANci•AAT�A « Tom Perry,Building Commissioner MASS �Eb.19. �� 200 Main Street; Hyannis,MA 02601 www town.barnstable.ma.us Office: 568-862-4038 Fax: 508-790-6230 HOMEOWNER UCEN01iiMMON ---- • PleasePrint� '�,� - DATE: : JOB IACATIOM number street village "HOMEOWNER" - name home phone# work phone# CURRENT MAU-WG ADDRESS: cityAown 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 OFHOMEOWNER 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 4 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 HOMEOVMR'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 Iicensed 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:\WPFII ES\FORMS\buiIdmg permit hrmsMTRESS.doc Revised 061313 Ri.ghtfax N3-1 4/16/2015 6: 23 : 42 AM PAGE 2/002 Fax Server DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE T_ TIFICATE 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 PR UCE ND T E C ll IC E O IMPORTANT:if the certificate holder Is an ADDITIONAL INSURED,the poiicy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the erms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: SULLIVAN GARRITY&DONNE PHONE FAX 1046 MAIN ST (A/C,No,Ezt): (A/C,No): OSVILLE,MA 02655 E-MAIL TER ADDRESS: 78G2N INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA SILVA PROPERTY IMPROVEMENT INC INSURER B: INSURER C: 1046 MAIN ST STE 13 INSURER D: OSTERV)ZLE INSURER E:MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS O CERTIFY THAT THE POLICIESOF 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 6 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R ADD SUB LT POLICY EFF DATE POLICY EXP DATE LT TYPE OF INSURANCE L R POLICY NUMBER (M"DIYYYY) (MM MD\YYYY) LIMITS GENERAL UABILIT1f ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE [:]OCCUR. AMAGETO RENTED $ REMISES(Ea occurrence) ED EXP(Anyone person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ ENERAL AGGREGATE $ POLICY �PROJECT LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YINUB-2E817112-15 03/2"015 03/28/2016 LIMITS ANY PROPERITORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? NIA /M E.L.EACH ACCIDENT $ 100,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 I yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONSILOCATIONS/VEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION J.GILLIS INC. SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED l0 LEDA ROSE LANE BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT VE MARSTONS MILLS,MA 02655 ; ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. ` a ro cense or re tration vafi for diiktfsn Office of Consumer Affairs&Business Regulation indivi 1 OME IMPROVEMENT CONTRACTOR �iefore the expiration date If found return`-f zg egistration. 746 Type office ol`tonsumerffairs and Business Regulation 'Expiration Individual iiO Park Plaza=Smte 5170 7 x Boston,MA 02116 JOHN F.GILLIS i JOHN GILLIS v 10 LEDA ROSE LN. MARSTONSMILLS,MA 026 8 Undersecretary ?Notvalid w' out signature Unrestricted-Buildings of any use group which Massachusetts -Department of Public Safety contain less than 35,000 cubic feet(99I'm of Board of Building Regulations and Standards enclosed space. twistruction Supervisor License: CS-051497 ' JOHN F GILLIS 10 LEDA-ROSE ICI MARSTONS MARLS Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. v-' �1 Expiration J For DPS Licensing information visit: www.Mass.Gov/DP5 .�w•_ �F" 11113/2016 Commissioner L I .. nn C3�Q SY Y/4Y ® D tT ZMtO 'g w cue.. 1p 2 x t ors S Aar + s �ts8► 4-'7 - Pz-'cc 45 7 '� L Le o► �'F L--0o7 1%F Z� st + rb r- z �c+s•�"e��r�(`4 s��creG`) = 3 t © SJ `gym c � -3 4 •'3 O 'pt,ri. ?,', 3� � 'p V '� 4SS G ��,� a Y:,�cc<-:s•ca�ry 7�o Cat� a TAYLOR RES16N `/.�- LAl�.i1L u 4� 31�{F DATE tKz-Cx1ED SY t or t t..l> 0-0 t V t C,a.--z`LcW-1 r- t Qv.- o r't or.7 'PA-le 5 5,104:5 V.5 r ! 4 �`3t P� F �. ���dp g-F co ter,. `yam �®6 Ca r. �� 7o Z 94. 3ro Eo a sF� = 345$®�✓ C 1 ��G�P�� � lot 87 7 en �5ess o✓ChL r-r41 T v s i Al _ opus SPAS I 73,321 N • �p plea'S`�'' � � rD0/J0AT/off 34f �5 31 0i, iVG 3 RICHAP. c� BAXTER 3 ha24V* o-• U }R XIifTi/✓G T/--/A1T T//T ,Z-oc,VD,ar)aAl CEIlrE rzvlu e 11YAA1 jv S.�ioLtiN yE�2Eo.C/ c0�-1.��YS WiT.�.� -5CA L.c fES IZ 7, A NCB S -7 9A Cif EQl//,G�E�/Eit/TS off" Tf-/,!g 7oWit/a,� P,C .gAl OCA T,E',f D Lt//Ty/mot/ Tye .c�aQDP1.�1/.S -73 ^- /3A XT,C �f//S P.Cfliv/S �/oT' BASE"O Gig/ ,4it% i2EG/STE.�EQ L.•�t/�p S'U.el/L., %SEA 7-� OE 7 S..E /GDiC;� �� - . GRIBALANC Company Name _ y ' Phone Number :: a .Applicator Name Installation Date 2 Jobsite Address :��. �� A-Side Lot #'s � � � Permit Number • B-Side Lot # s e o tt�JJU o �© am 0400 • 0 0 0 ,o U'�o Walls '. C./ % � 10 { Attic JQ� , 1 6/ I - DEMILEC YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Ir-OV /.I— Fill in please: APPLICANT'S YOUR NAME/S: a, BUSINESS YOUR HOME ADD ESS: his 4c.& ,r "t TELEPHONE # Home Telephone Number 97k- 3 e NAME OF CORPORATION: Cr/. NAME OF NEW BUSINESS .lJ TYPE OF BUSINESS,6, i '.��t.p - ?-� IS THIS A HOME OCCUPATION? NO .� / ADDRESS OF BUSINESS - 7. MAP/PARCEL NUMBER C�Q >I" X /O (Assessing) �/if�/T X 0 R When starting a new business there are several things you mu t do-in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in t is town. 1. BUILDING COMMISSIONER'S OFF (� 6'b This individual has been informe�ony ermit requirements that pertain to this type of business. Authorized Signature*.* COMMENTS: 2. BOARD OF HEALTH This individual ha infor a of e p it Feguirements that pertain to this type of business. Authorized Wafure** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) / 3�X� This individual has b en ' f e the icensi g ements that pertain to this type of business. Au orized Signat;ur COMMENTS: M' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 5 C� I Application # Health Division Date Issued AD Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village /4--/,4 iv 1v i S Owner L,4 Address Telephone Permit Requesty "� d�D tl-(— �k �� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning trict Flood Plain Groundwater Overlay S Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach lsupportind:documentation. Dwelling Type: Single Family, ❑ wo Family ❑ Multi-Family (# units) Age of Existing Structure oric House: ❑Yes ❑ No On Old King'sHighways ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other =` Basement Finished Area(sq.ft.) asement 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 rst Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing w /coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑e ' ting ❑ 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 d Telephone Number I) Address -yb 3tf License # ,/ IJA- YgE Home Improvement Contractor# � i Worker's Compensation # U ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE A DATE '�y I� FOR OFFICIAL USE ONLY APPLICATION# 4 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE 1 �y ELECTRICAL: ROUGH FINAL = PLUMBING: ROUGH ' FINAL r. GAS: ROUGH FINAL FINAL-BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. C cn The Commonwealth of Massachusetts Deparbnent 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 Lesibly Name(Business/Omwzaaomndividual)' fl dye Il?A-Aj I _ Address:_ City/State/Zip: .S /GL D�� � Phone#:_ 'Ltd c) —6L/ Are yo n employer?Check the appropriate box: T of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I Type P J ( employees(fall and/or part-time)_* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These subcontractors have g, ❑Demolition working for me in any capacity, employees and have workers' 9. []Building addition ' [No workers'comp.insurance comp.insuranceJ ❑ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp, right of exemption per MGL 12.❑Roofrepairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.Fk er comp.insurance required.] sArry applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. that cheek this box must attached an additional sheet showing the name of the sub-obutractors and slate whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy number. I am on employer that is providfng workers'compensation insurance for my employees. Below is the P �1' 1 o ' and'ob site informadom pp� Insurance Company Name: • D�• t) Policy#or Self-ins.Lic.# Expiration Date: Job Site Address: g t� d `Illy Cin,/Stip4VA)Js Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP-WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the paLw and penalties of perjury that the information provided above is true and correct Si Date: Phone#: Off dal use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• .--*typ HDSIfi�St391®ff1�lA�dDAfTf6g71lO�OtlYSI7H0013SOd� ' IMVTBDM • �ataa+�...,,,as��anx aaa3s¢or - ®—�-srsa ua�ue-ram�ew�s��t��au� � c ` •' , tMrmiauca3a��rs�Ma3os3e�rni¢- aw��+nrvrs� � • - aar womm"m J% P*ems atsb aa.-APO Pwdjo JWW 808PWWs1 ML sAoliu W 13ABOMM 1tD6VAl10LL 10�M tea al00 0 UABOA PPSM win WOW OUR" MUM omxmz o quo V IMAWIDd- 00 -T3 4 oom �S -&mvs-esv�en-5 `S JiB@�rteaF3T3 AUV Mt i saw X ONLTJW MHO 600L8ABLIi17C a11/M+ouMStD7sN 9 WE fi s i S ' S 3ltl9�lk]OM 30YIISnWx1 wow . S DtC)w3 Ail�llS�J)Ca ;A'a1 o" S xurv9 moulamo OI MAM7 S �f3'Ai�OlM � AJI7atlR36MtlV8 S 35OIIdClAIZ6! 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Yf Using A.Sn ' der W Owner of the n,oject hmby '�y av� c� ..r f , u)aet mcy bed, is ail noapam:eve tw woxk awhodud by this bang peanit ap*Woo,fo (ass Gf jo) owna Date print Name .• If e r is app�g forpenn.please i,G the Homeowners License EXemption Form on the v rverse ide. . _ r:;- °:" ,y�, xri*. ..yy ;re";".' h,m .ri up m a t� '• ,n s:` x,NO i,• .qr� ( ;,•c,,.,,?,£"A».^'�i''�' ;n'!•" x-,^-i �°a' t"ti 5'` f;S,�,k a'.tTi 4ta. "c�aFA`a,."''- .,x G'4 v4 •.•, ;Pu ` 7 '�" � `'k�s'. .. yu,,, }' �5 ..z r:;N�° ,'"u`y�}},�"'�FS.a r,rav ; A � � � F� ¢.�+ ' ,,�":� c "tit . �'. xis a�a,�s,.�Wd.�>�. „ ,t ' f�`k� "`�; a� � '�i�. �' �t,'� �inh'- Y �L.r5, ` � `s35E1j1�`z� =-t - .__ —_ — .. .-. .—�. _� _.____^ — -- Q1,101ertitt"rajejflaMe eat e REGISTERED AZTEC TENTS °age treaW or i N APPLICATION manufactured 2665 COLUMBIA ST CONCERN NO. }> TORRANCE CA 90503 0412009 .. CAL COMB F-419.01 (800)226-3687 fi ' This is to certify the materials described below hereof have been flame reftrdarrt treated(or are wherry n nmable; W ' FOR vai AMERICAN TENT& TABLE ®st WIS ATTN.-ALLEN SYLVESTER 381 OLD FALMOUTH ROAD UNIT 41 � MARSTONS MILLS, MA 02648 € A Certification is hereby made that: (check a or b ) Q�h a) The articles described below this certificate have been treated with a flame retardant chemical approved and registered by the State Fire Marshal and that the applicationof said chemical was done in confor- mance f them chemical ush the laws odth the Reg.e State of California and Rules d Regulations of the State Fire Marshal. Name o ` x Meathod of application.................. ......... ............................................... ........... (b) The articles described below hereof are made from aflame-resistant fabric or material registered and ® approved be the State Fire Marshal for such use; Fabric has been tested and passes NFPA701-96. pze Trade name of flame-resistant fabric or material used LamhwwFabrk Reg.No....... ?101...... The Flame Retardant Process Used .!N!LL.NOT .. Be Removed by Washing ` (will or will rot) David Bradley Chuck Miller - President �s= ! Name oFApptiptor or Production ¢ntendera Tice ���f d�F1: ,1 w ,.�'Y` .,,1 „ ,. a`�M'�x�v, t,...s .J,��> A. .. ',,� p •:: �: ,i ;: ;� 1, ash +r} t, t i�ru�, �' �-,r �, �... � .1 r`�Y �. +`� t ,.. ,+.. �✓ � +` �r'Iti, ;.,<z � .�:� ;a3'" a-..§3.. � ,,.....r i ,�`b, �k-z. ,.a �a ��i' � , �, � ..t: , z�r ;fib a�. }� r � ,i `�"... },a �..,t� s+ .•r,�fl s �_.. 4, ,?x... �„ .,F ;;.��nn,,..�, �?•s ,�,� r,�� t v .r,« nv W, .��4 � '� L��.�-V�a,3€�+�^�� �� „k�,��'��t wn ti :� t .�, ,q�r i�.,;�7SrF� k r.,� k pn•Mt,. 1 ,1 � ,d, .+•� .. }d v 1. ;.e 5.;,.`a.� 2'',0 ',�', *. .� - °:.,,7 � ,,A.'. r k��`7:`4cs,r`w;: +.. .s.:., r x.�(,,1 }1 2,k•iiuY3'a 2.� xt ?v �F� Y�4At� e,., x '�w ..• CUSTOMER ORDER NO. R174664 ITEMS MANUFACTURED: 8-10x101PC TOP ONLY-UW 2-20x20 2PC STD TOP ONLY-UW 3-20x10 STD MIDDLE TOP ONLY-UW 2-30x30 2PC STD TOP ONLY-UW 3-30x10 STD MIDDLE TOP ONLY-UW i Al opcu SPac� zq 7 3'321 � Q V\ c N �T VG NJAu�`�r N. RIGHARD BARTER No.24040 N SVat,IV f S1�l�I S.�/4Gv'N Gov c/D ATlt�nl CE N re¢✓,, /�yA Nip /lE.2E0.C/COtiI.dL YS �/j�y SC,q L G— '� 1Z 9 5 �C,Q TELL WiTh�/�✓ Tye .�LoavoG4/�f! ZOO �S •,n �, ail. ,Sp� XT.E,2E /NST,eU�/Eit/T S'U,21/EY� 7-y� O��S-ETS Syow.y Sh%UG a ,t/pT /✓`EIS 7-� OET��i1l/�t/E ,G >7" lAlez., /C,Qjt/?' .w.,rkr,we. ::-..V,•. .r.n 1_•y,.._ `r.. . ..•,...• r +.r.•.+s^wA�,yy:� • .sl r s.. aT'1.n '.�++: • ^ :i.. .i^'"1w . _ -a M f 7F V�[ r r TOWN OF BARNSTABLE Permit . BUILDING DEPARTMENT 1 s..�n I TOWN OFFICE BUILDING Cash Ma •9'�ta6jv ` 'HYANNIS.MASS.02601 Bond .....X........... CERTIFICATE OF USE AND OCCUPANCY Issued to Robert O'Shaughnessy Address 99 RpoAtta (T nt55) HvAnniA_ MA USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE.BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. April 14 ..., l9.95............ :..... . . .................... ... Building Inspector TOWN OF B4RNSTABLE, MASSACHUSETTS lLDI . PE �b IT .__ DATE 19 ✓ PERMIT NO. NQ �7402 APPLICANT / �Gr ' /`(- /� L j .f ADDRESS 'T y .'�'�� t-, A ' l 7 (NO.) (�TRE TJ (CONT R'S LICENSE! NUBER OF PERMIT TO A,),, ��� �/[i���/ �'" ( �G.) STORY li � DWELLING UNITS TYPE Of IMPROVEMENT)' N0. IPROPOSED USE) ZONING AT (LOCAT 1 0 ISTR ICT ` NO.) (S REETV BETWEEN AND (CROSS STREET) (CROSS STREET) LOT - - SUBDIVISION LOT BLOCK SIZE f BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR VOLUME P�-� J ` � '�_. �, / G6iTIMATED COST � /L��, �2, FEE $ (CUBIC/SQUARE FEET) OWNER BUIL ADDRESS BY PTH ERZ �N�PERtNCR O RIGHT OTO OCCUPY N PUBLIC ANY STREET, NOT ORC SIDEWA PLK RO ANY PART THEREOF. EITHER TEMPORARILY OR E MIT TED UNDER THE BUILDING CODE, MUST BE AP PROVED 9YVVHE�JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PF.,.,•. . _ _ERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE - OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 16U 6 o �1 a;3�s 2 1- 2 3 HEATING INSPECTION APPROVALS ENGINEERING DE ARTMENT 0,4s- gs BOARD Qj HEALILI OTHER SITE PLAN V W APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION.. I PERMIT iS ISSUED AS NOTED ABOVE. NOTIFICATION. Assessor's Office 1st floor Ma �J� Loti R1 't4i'� Permit# . ] Conservation,Office 4th floor Date Issued Board of Health f3rd floor /*S'p�i��°� C��� " �� 000 OFI "4 Engineering Dept. Ord floor House# '� Pwocml Planning Dept. Ost floor/School Admin.Bldg.): MAW . !S�� Definitive Plan Approved by Planning Board O 19 ® ® ��46.9 (Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.) TOWN OF BARNSTABLE Building Permit Application Pro'ect Street Address 5' Village Fire District (hvncr � Address J Telephone 7-7/` 16 Perm/it Rc uest: Af>kt GL2 LL ' Zoning District /\ c `- Flood Plain Water Protection Lot.Size A 3 P d)'2-/ Grandfathered Zoning Board of Appeals Authoriza 'on Recorded Current Use Propgsed Use Construction T _ Eaistinz Information Dwelling Type: Single Family V/ Two family Multi-family Age of structure Imi-) cyX4,t/— YI Basement tW(11,(/L-�/� Historic House /UO Finished Old Kings Highway A10 Unfinished Number of Baths No.of Bedrooms 3 Total Room Count not includin baths First Floor Heat Type and Fuel 55 w Central Air /0 U Fireplaces Garage: Detached Other Detached Structures: Pool Attached 1 Barn None Sheds Other Builder Information Names Telephone number 7 71 — 1 Q Address Q License# Ila 56/-/S OqU 3,2 Home Improvement Contractor# Worker's Compensation # W C f 5/a -r.Z--2 6 /71F tW8 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 0jt'Nn1�Gt „c�z Pro'ect Cost /413 ,M Fee SIGNATURE /` DATE BUILDING PERMI THE FOLLOWING REASON(S) BPERM T 1/27/95 3740.2 � . FOR OFFICE USE ONLY -2-5-2-6-5-1-$0" 0 �'J00. CAL( z ti 4 ADDRESS 59 Regatta Drive ' VILLAGE w OWNER Bayside Building Inc. DATE OF INSPECTION: FOUNDATION FRAME 499 INSULATION FIREPLACE vZ :Z3 �. ELECTRICAL: 'ROUGH FINAL d" PLUMBING- tl ROUGH FINAL >s J .. NTH • .` . r 'GAS: R FINAL, , } FINAL BUII DING "< /_ DATE CLOSED OUT. a ASSOCIATE PLAN NO. Al COMMONWEALTH OF MASSACHUSETTS !� DErA]C;vDE 7 OF LNDUSTRIAL ACCIDUq S 600 WASHINGTON STREET ,lames.: Can'Doel; BOSTON, MASSACHUS= 02111 ;or•m ss,one WORKERS' COMPENSATION INSURANCE AFFIDAVIT Paz 666y (licensee/perminee) . ` with a principal place of business/residence at: 6 3 a (City/Stxtemp) do hereby comfy, under the puns and penalties of perjury,this.. (J 1 am an employer providing the following workers' compensation coverage for my employees working on this job. 17 D/ Insurance Company Policy Number (� I am a sole proprieror and have no one working for me., ( J 1 am a sole prooricror, 2. io�mpc=r�ion r homeowner (circle one) and have hired the contractors listed below who have the following wor insurance policies: - Name of Conrraaor Insurance Company/Policy Number ► M... . Nime of Contracor Insurance Company/Policy Number Jame of Contnaor Insurance Company/Policy Number 0 1 am a homeowner performing all the work mvself. NOTE Please be aware tsar wbilc bomeowocrs wbo emoiov persons to do maintenance, construction or repair..ork on a dwriiinc of not more 6&n three un,u ,n which the homeo..wner ciao resides or on we prounas appurtemaxit tbercto arc not teaer%U%' considered to be eroiovtn under the Q'ori en' Comoensauoa An (CL C 152,sect. 1(5)), appiieatioa by a homeowner forF a lieettu or txrm,t may mdrncc tat ieE21 sums of an empiover under the Woricen' Compensation Act 1 undcztand mat a cno% of this statc:ent will be forwarded ro the Deoar r-nt of Industri;d Aeadenn' Ofnee to lnsurantz for mac wn;i;::,on ant :hv:.hurt to iccure tryerarc as rccuircc undo Secoon=5A of.MCi" 15 can lead to the itttonsition of Q-=in3i persalues Mnstsone of; tint of uC to S1 500.00 and/or impruon=.e.:t of up to one yea and avii per:aiues in the form of a Stop Wo-k Ordcr ane a fine of S 100.C-v a day a€uns: mc. c: -._ :7;. '�' ��1( �-.• of �/.�2� 1 c, �f � .37 �o�- SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W) COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID'S REMODELING: (L) COMMERCIAL UNION - NB F821442 DAVID BIK: (L) MERCHANTS INS GRP- 8CM0278579150 (W) TRAVELERS - 176K337-8-94 OAK INSTALLER: ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652 PAINTING: CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF (W) AMERICAN POLICY - WCC 186604 ROUSSEAU, AL (L) MERCHANTS MUTUAL - 8CM0278570179 (W) EASTERN CASUALTY - ??? GARAGE DOORS: ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301 (W) COMMERCIAL UNION - CBH573757 STORMS & GUTTERS: ALUMINUM PRODUCTS: (L) AETNA - MP0021014146 (W) AETNA - JC89258880 OAK FINISHER: AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0 CARPET, VINYL & TILE: CARPET BARN: (L) VERMONT MUTUAL - SBP6507393 (W) PHOENIX INS. - 6NUB476J652794 WIRE SHELVING: CAPE COD CLOSETS: (L) U S F & G - BSC146983441 APPLIANCES: KITCHEN APPL MART: (L) FIREMENS FUND - AZC80453098 (W) HARTFORD INS CO - 77WZNB1603 MIRRORS & SHOWER DOORS: L & M GLASS: (L) COMMERCIAL UNION - CBR409003 (W) U S F & G - 0071439933 LANDSCAPE & SPRINKLER: COY'S BROOK: (L) COMMERCIAL UNION - ABR345850 (W) CIGNA COMPANIES - C41138178 DRIVEWAYS: NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945 (W) THE PHOENIX - UB387K530 J�` SUBCONTRACTOR'S INSURANCE ENGINEEER: BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866 (W) LIBERTY MUTUAL - WC1312595563023 EXCAVATION & SEPTIC: DRISCOLL, JJ: (L) U S F & G - HGL 1100.93 (W) U S F & G - 7708711936 FOUNDATION: BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267 (W) LIBERTY MUTUAL - WC1312201785044 WELLS: DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92 (W) WAUSAU - 151300062926 CELLAR/GARAGE FLOORS: MICHAEL BROWN: (L) AETNA - MP0023672849 FRAMERS: ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9 -(W) AETNA - 006C0023972416C MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 ROOFER & SIDEWALL: JOHN MEE: (L) AMERICAN STATES - 01CD1486783 (W) TRAVELERS - 6NUB44BK275894 MASON: SHERMAN, WAYNE: (L) COMMERCE INS CO - N60689 (W) WAUSAU INS - TO BE ASSIGNED ELECTRICIAN: CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649 (W) MISCELLANEOUS INS CO. - 0708878 91 1 PLUMB & HEAT: WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9 (W) EASTERN CASUALTY - POLICY IN MAIL ALARM SYSTEM: BALTIC SECURITY: (L) FIRST FINANCIAL - FF0131 G400831 (W) COMMERCIAL UNION - CB0743379 CENTRAL VAC: VACUUM' HOUSE: MERRIMACK MUTUAL - SBP1608045 INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 (W) U S F & G - 7711099932 . • I, 1 I ❑;�.-I �.�tC� � I II 1 �-j 7177 I 1 I , �I 17 it : ► I Alm i I . 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FINE LINEARCHITF-CrURALDESIGN n rcENTERVILLE, MA 02632 8 WEST BAY ROAD 0517ERVILLE, MA 026555 f o PLAN PHONE: 508-420-1296 A V N� ADDITION 22'-0" W p (6) TW 2446 A 30 1/8'x66 7/80 446 NEW (3) TW 2 30 n o — 0 o SUN ROOM 1�x56 Ire t- rn Q c VI —� 6Q O -- DECK -- 11 - -- EXISTING'RESIDENCE EXISTING GARAG.:E 17'_0. U m pQo cn Q W W-1 J aZW; Q J Q�W U�Z Q W U A � w NEW FIRST FLOOR - I OF 4 SCALE: 1/4" Al JOB: 1410 DRAWN BY: KW DATE: q/26/14