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0093 RIDGEWOOD AVENUE
.� y �� -, �� II y J , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3. `{� Parcel fi S A IT GAF BA R , ,�. lication # � ) �l Health Division Date Issued Conservation Division 17 z 'ri 1'AUlication ' Planning Dept. r) sz-• 2at• YL Permit Fee Date Definitive Plan Approved by Planning Board ��' ��x�x T `�•� ' Historic - OKH N� _ Preservation / Hyannis Project Street Address 1.3 Village Owner lr 6.t4,f;j5,n C?�- r 0 ja n&d44 Address Telephone Permit Request enty OLO C-e_ 4 pe SS QQS-C �Cl t� aa' GUa.I �lLL' Lit �Y-/S S V�� Square feet: 1 st floor: existing407�proposed 2nd floor: existing proposed Total new, Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size _ Grandfathered: ❑Yes 0o If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 6 Historic House: ❑Yes Rr No On Old King's Highway: ❑Yes ®"No Basement Type: Ct`Full ❑ Crawl ❑Walkout ❑ Other P Basement Finished Area (sq.ft.) 40 Basement Unfinished Area(sq.ft) Ct�yo Number of Baths: Full: existing— new Half: existing new _ Number of Bedrooms: existing new Total Room Count (no/Gas in baths): existing ��new First Floor Room Count T n F I: ❑ Oil ❑ Electric ❑ Other Heat ype a d ue Central Air: ❑Yes ZN Fireplaces:.Existing New Existing wood/coal stove: ❑Yes W<0 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 WA No If yes, site plan review # Current Use, ko lilllekvl al --Proposed Use-3OAMAZ APPLICANT INFORMATION sea#^ �o y�rb (BUILDER OR HOMEOWNER) Name (' of /tU'Q�Am, p h l yg4Y S ��7elephone Number / 7 b "b� Address. A4w :,m/ Yh License# 93a8 &�tfv/A/ D 2-� 3 _ Home Improvement Contractor# Worker's Compensation # t�tJCG5010�1�301�O1 f ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � iir- to os SIGNATURE Y4Akr— DATE d 1,TiD lr� II 1 '<FOR,OFFICIAL USE ONLY APPLICATION# F DATE ISSUED : MAP/PARCEL N0. f ADDRESS i VILLAGE r OWNER 1 - 1 .y t DATE OF INSPECTION: i FOUNDATION FRAME x INSULATION FIREPLACE ELECTRICAL: ROUGH ` FINAL a PLUMBING: ROUGH FINAL . GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Cnmamnweatth of H=ach=e t, Department cffidust id Accider,, D,,�ice of1`irr=4,aiwns 600 Washington Street Bastofc, M4 Q2III >�c'►+'►�:aiarsgw/din` Workers' Compensation bmwance A.ffidavk: .Builders/Contracfocrme�ci,:Mmlrunbers A.nn�.cant Inforrnati.on � - Please Pant Leelhly ` Name PusiestJOrgazi�onllndividnai):-_' p�('��' � L. Address City-IStEWZip: phCC}}IIe A.r6 e 7 an employer? Check tine appropriate bo= I. I am a eu�loyer with _ 4. [] I am i general comactor and I TPpe of Project(regtdred): . employeCes(f II and/or part me}.* ban hired the sub-contract ars . 6. []New consfivction 2.❑ I am a sole proprietor or partner listed on the attached sheet 7. de ship and bave no employees These sub-eon tractors have r 8. []De�o3ition W a3cing for me-in any capacity, employers and have Workers' [No workers'Comp,insurance camp,insurance•$ >, 9. ❑Bing addition , required.] 5. ❑ We are a corporation and its 10-n Electrical repairs or additions 3.❑-I am a home*wner doing all work officers have==Li -d they I I. Phmmb' c eI£ ❑ mg repass or additions mys [No warkeis comp. right of exemption pea MGI, msuraace required,]t c. 152, §1(4), and we have no ❑RoofrePa employees• [No workers' 13.[]Othm- ryT� msraaace required] t Azy applicant that checks bar#1 must also f Il out the=um bylaw sbowmg then q ate,prrn ide their wows po =man licy mfuffiatioa that Hameo"=who submit tis h affidavit mffimt ag they an�g eIl wary and then hire onLQidc #Coahactan at eh=k this boa must attached mm d= addial sheet g= cnntrac�mast submit a new affidavit mdimfing mrIL 3plapees• rf d=sob-eant[3 r bane employees,they Est d=of the snb--=tlact7ts and state whethe or not those entities have comp.potter number. I am an ernPlayer that is providing workers compemgfion insurance or infornurfian. > 1` m3'employees Below is thePo&cy and job site InSQranCe Company Name: SD/'//Q M f�fOt/ ✓S �ll 5. Policy#or set ins..I e.# Gl7C�So�D,� s'�O P &`l � F�girston Date:_____ Job Site Address: IJO. Gt-)ya W 04110cny�szip: t�i r�/3, /1�1�DZbD Attach a Copp of the workers' compe=ation policy d=L%ration page(showing idle policy number and erpiration date). l Fade to secure coverage as required'under Section 25A of MGL e. 152 can lead to the ' ositinn of fore up to$1,500.00 and/or one-year kaprisomme� as weIl as civz7 final Penalties of a of up to S250.00 a Penalties in tixe form of a STOP WORK ORDER and a fine �y agsmmst t3ie viola.nr. Be advised that a copy of i}tis sta]�mtmt may be .�d the Office of Investigations of the DIA for insurance coverage verification I do hereby c P Penalties of perjury that tine boom=60rc provided above is true and correct Srenature. Date: al use only. Do not Write is this arsa, to be coarpkted b3'c&y or town o�fj�cid City or Town." PermitUcease# Fsndug A¢thority(circle one): L Berard of Health I BuiildingDepartment 3. Mty/Town Clerk 4.IIecfricaI Inspector S.PlnEIu=sjp=tDr 6. Other Contact Person: Phone#: 'THE TOwy Town of Barnstable 0 Regulatory'Services y WARS �, Thomas F.Geiler,Director ,19. ` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.tQwn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder GOl¢lna*1 , as Owner of the subject property hereby authorize (� to act on my behalf, in all matters relative to work authorized by this binding permit application for. 13 �l�A ooc� le (Address of Job) Wature of Owner Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OV%?kMU R USS10N i r' Massachusetts- Department of Public Safety "Board of Building Re�g,ulations and Stand.u(is- Construction Supervisor License License: CS 83280 SEAN J ROYCROFT 65 EBEN SMITH RD CENTERVILLE, MA 02632 Expiration: 11/29/2012 Commissioner Tr#: 5237 y _.. ('!e Office of Consumer Affairs&Business.Regplation. License or registration valid for inddividul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If founwid return to: Registration: :;-1.4.1225. Type: Office of Consumer Affairs and Bausiness Regulation Expiration: _122f2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,PIA 02116 RO CROFT&KUEHNE BU(LDERS'INC: Sean Roycroft 65 Eben Smith Road Centerville,MA 02632 Undersecretary No lid wi s Town of Barnstable Geographic Information System February 29,2012 328098 #107 /32802'1' #87 #8115 328084 328097 -- k #99 ti 7v �O i1 a 328085 #100 #70 • 328696 w: .� 3- 328227 a a #94 €s 328095 #87 - 4' 32824000M.." #88 328088 y #6g 328094 r r #81w ' 1 0 17 Feet �,,. # 3 0 DIS86 CLAIMERS:This map is for planning purposes only. It is not adequate for legal •i.. Map:328 - Parcel:096 :-, t• _. -boundary determination or-re ulato interpretation. Enlargements beyond a scale of - Selected Parcel ry 9 rY p 9 y Owner GOLDMAN,LAURENCE S& Total Assessed Value:$212200 , 1"=too'may not meet established map accuracy standards. The parcel lines on this map - -�are only graphic representations of Assessors tax parcels.They are not true property Co-Owner:GOLDMAN REALTY TRUST Acreage:0.23'acres Abutters boundaries and do not represent accurate relationships to physical features on the map-, - Location:93RIDGEWOOD AVENUE x such as building locations. - .:,. - Buffer �•` - - ALvi c9• 2012 1 : 1"ATIFICATE OF��LIABILITY INSURANCE N°`-1 240 P. MO�I �, 1. . 02/02/2012 ODUCER SO8.997.6061 FAX S08.990.2731` w THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 'outhsastern Insurance Agency, Inc. ',ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND;EXTEND OR 439 State Rd. k ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW: P.O. Box 79398 North Dartmouth, MA.02747 - INSURERS AFFORDING COVERAGE NAIC# I�R Roycro t & Kuehne Builders, Inc INSURE.RA, .Arbella Protection insurance.-,-, " 41360. . 6S Eben Smith -Road . iNSURERB.' Merchants Insurance Group, Centerville, MA '02632 INSURERC:"Associated Employers Ins: Comp. ,.. > r: INSURER INSURER F.r is <- COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOC'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_AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, '. . ':. POLICY EFFECTIVE POLI T- TION j; :'. ��. : LTRiNSR TYPE OF INSURANCE `v` POLICY NUMBER LIMITS LTR NSR DATE MMIDDIYYYY DATE MMlDD GENERAL LIABILITY 8500022738 °08/01/201'1 08/01/2012 EACH occuRRENCE'.. .,a $' `1 000,00 D h-100 OOO X COMMERCIAL GENERAL UABWTY` PREMISES(Ea_oocurrence t - CLANS MADE I x ,OCCUR MED EXF(Any one person) A q PERSONAL&ADV INJURY $ OOO�O �t GENERAL,AGGREGATE $' :2 000 00 GEN L AGGREGATE LUArr APPLIES PER pRoottcT$-connn/or ncG $ ....2 000, POLICY jE4 LOC v '.• AUTOMOBILE LIABILITY MCA7014095 `10/18/2010 '10/18/2011 COMBINED SINGLE LIMB ANY AUTO (Ea accident) s s1 000 :00 ALL OWNED AUTOS BODILY INJURY Per ereon B X SCHEDULED Autos ( P ) fi X HIRED AUTOS w w DODILY INJURY X NON-OWNEDAU'I'OS (Peraccidcrd) - PROPERTY DAMAGE. $ acclaen4) OARAGELIABItm AUTO ONLY-EAACCIDENT' ANY Auto EA ACC $ OTHER THAN r AUTO ONLY:. AGG S( , EXCESS/UMBRELLA LIABILITY EACI I OCCURRENCE S - OCCUR n CLAIMS MADE ` AGGREGATE - $ DEDUCTIBLE REIE_NTION $ $ WORKERS COMPENSATION WCC5010259012011 09/06/2011 ;08/06/2012 T" AND EMPLOYERS'LIABILITY_ TOitY LIMITS EN ANY PROPRIETORIPARTNEWt1(tCU'fIVE YIN: E.L.EACH ACCIDENT : $ 100 00 C OFFICEWMEMBER FXCLUDED9' (Mandatary in NH) 4•-NA EXCLUSION OF. OFFICERS ; - a E:LDISF_ASE.EAEMPLorE $ -100,•00 Ify�s deamibe under _ ` SPECIAL PROVISIONS belay E.L.DISEASE-POLICY.LIMIT S 500 DD OTHER F 4 DESCRIPTION OF OPERATIONS r LOCATIONS I VEHICLES I EXCLUSIONS'ADDED BY ENDORSEMENT I SPECIAL PROVISIONS #00001; 2004 FORD.. F250 PICK„UP' 1FTNX21L54EA55624 #0000.4 2006 FORD F350 'PU 1FTWW31P66EC79323 CERTIFICATE HOLDER :'_ _d. . CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE;EXPIRAnonl ,. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN , Town Of Barnstable NOTICE TO THE CERTIFICATE'HOLDER NAMED TO THE LEFr,BUT FAILURE TO DO.SO SHALL x ..Attn: Building Department IMPOSE NO OBLIGATION.OR LWBILITy,OF ANY KIND UPON THE INSURER ITS AGENTS OR, 200 Main Street REPRESENTATIVES. Barnstable, MA 02601 ~y' AUTHORIZED REPRESENTATIVE Joanne Bretton ACORD 25(2008/01) FAX: SOB.4.20.1947 01988.4009 ACORD CORPORATION All rights;reserved The ACORD-name'and logo are registered maiks of ACORD wp l 00 So --� o � Tow, 'n orsb *Pernut Ezpires.6 months front issue date . Regulatory Services r Fee. Thomas F.Geiler,Director'. s.. Bll11dlilg P1ViS10II Tom Perry,CBO, Building Commissioner .. P �{ 200 Main Street,Hyannis,MA'02601 *ww.town.barnstable.ma.us" t , , " Office: 508-862-4038` Fax 508-790 6230 EXPRESS PERMIT.APPLI�ATION - RESEDENT AL ONLY .. - Not Valid without Red X Press Imprint '' "- / Map/parcel Number F :. --------- -----= ------- (1 � Property Address J l� - ` [residential Value of work ��� Minimum fee of$25.00 for work under$6000 00 Owner's Name&Address Contr atTu I � elephone Number actor's Name t n , Home Improvement Contractor License#(if applicable).' ' �DD Construction Sup.ervisor's License#*(if applicable). lcmnlme UD;3a Jr IRailwl y, [f lorkn='s Compensation Insurance Check one: :FEB 2 2 2012 e R ❑ I am a sole proprietor ' ❑ I am the Homeowner ,, [gI have Worker's Compensation Insurance 41 ,TQViIN OF BARNSTABLE Insurance Company Name Work man's`comp..Policy.# L 00I32 9011 Copy-of Insurance.Compliance Certificate must be'o.PAIeet =r ; -Peimit Request(check box) Re roof(stripping old shm les All construction debris will be takento ..,�"rn []Re-roof(not strippuig. Going over existing layers"of roof) El Re-side' - G�, [] Replacement Windows/doors/shders, U Value (maX,Tm,m 44). *VJfiere required: Is of this perrmt does not exempt compliance with other Town department regulations,i e.Historic,Conservatiot,'etc ; yt a *.**Note. P petty Owner must sign Property Owner Letter of Permission, k cop;of the"Home Improvemenf Contractors L"icens'e is required.' - SIGNATURE: , Q:Forms:expmtrg; ` r Revise061306 'AC41DRbPCERTIFICATE OF LIABILITY INSURANCE °A�i./25/20112"' 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 endorsemen s). PRODUCER CONTACT NONE: Erica H.O'Connor HART INSURANCE AGENCY,INC. 243 MAIN STREET PHONEQ.Em, (508)759-7326 Fac Ne;(508)759-7366 PO BOX 700 E-MAIL ADDRESS: BUZZARDS BAY,MA 025320700 INSURE 8 AFFORDING COVERAGE NAIC 0 INSURERA: ARBELLA PROTECTION INS CO 41360 INSURED EJ JaXtimer Builder,Inc INSUR_E_R B: ARBELLA PROTECTION INS CO 41360 48 Rosary Lane Hyannis,MA 02601 INSURER CARBELLA PROTECTION INS CO 41360 INS URERD: ARBELLA INDEMNITY INSURANCE COMPANY 10017 I ) INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY 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. I�TR TYPE OF INSURANCE INSR ADDL WVn SUER POLICY NUMBER MMIDDY� PMIDDIYYYV LIMITS A GENERAL LIABILITY 8500042039 01/01/2012 01/01/2013 EACHOCCURRENCE $ 1000000 COMMERCIAL GENERAL LIABILITY DAMAGE TO R NTED 300000 _ PREMISESEa occurrence 8 CLAIMS-MADE FV OCCUR MED EXP(Any one person) $ .5000 PERSONAL&ADV INJURY $ 1000000 k GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 PRO- POLICY LOC 8 B AUTOMOBILE LIABILITY 21662400004 01/01/2012 01/01/2013 COMBINED SINGLE LIMIT , 1000000 (Eaa dent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTO S AUTOS NON-OWNED PROPERTY DAMAGE $ • ICI HIREDAUTOS AUTOS Per accident $ C UMBRELLALUIB Oocu - 4600042040 01/01/2012 01/01/2013 EACH OCCURRENCE $ 2,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 2,000,000 DIED RETENTION$ $ D WORKERS COMPENSATION 0053890111 01/01/2012 01/01/2013 WCSTATU- OTH. AND EMPLOYERS'LIABILITY. YIN - TORY LIMITS I PR ANY PROPRIETORIPARTNEWEXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required). CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HYANNIS,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. \ AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I i a Office-of Consumer Affairs,,and Vusness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 1.10609 Type: Private Corporation Expiration: 11/3/2012 Tr## 205399 E J JAXTIMER, BUILDER, INC �~ ERNEST JAXTIMER >- 48 ROSARY LN. HYANNIS, MA 02601 _yam✓ ``'Update Address and return card.Mark reason for change. -.� Address Renewal R Employment ❑.Lost Card DPS-CA1 0 50M-04/04-G101216 i Off,ce�ko!um r% .M� ine"ss egulano. License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 110609 Type: Office of Consumer Affairs and Business Regulation -,;,• Expiration: `ttC312012 Private Corporation 10 Park Plaza-Suite 5170 — — Boston,MA 02116 E TIMER, B171L 5_Ll t 37 F zi=— u ERNEST JAXTIMER�—�— 48 ROSARY LN HYANNIS; MA`02601 T� Undersecretary Not valid without signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Superli-ur License: CS-003251 ' ERNEST J JAI�IlVIER� { 48 ROSARY SANE { HYANNIS MA 02601 Expiration 1 Commissioner 01/14/2014 1 * BAPNSTABLE, MASS. Town of Barnstable iOrFn ter" . Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Ir, , Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder . ' I, 1 �/� ,as Owner of the subject property ' hereby authorize i5, J. Jk Y-Y71k r, 8u/ /P� P- to act on my behalf, in all matters relative to work authorized by this building permit application for: G 7L s�r.�de r (Address of Job) z��zllZ Signature of Owner Date C a Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street � r Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name,(Business/Organization/Individual): •J• �/a �7�(ylr elm ��( l[iti�/� /�� . Address: g f�Os1� City/State/Zip: N_(Cc.�L"'s 12719 02&0 l Phone#: (5-08) J7'-9 l Are you an employer? eck the appropriate box: ,�,/ 4. I am a general contractor and I Type of project(required): (�1. 1 am a employer with a� ❑ employees(full 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 sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. $ 9. ❑ Building addition d.ire req u 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions ] 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself o workers' com right of exemption per MGL Y � P• 12.❑Roof repairs insurance required.] t - a 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If.the,sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. , Insurance Company Name:—' �66at1,A P47Z-W1W I& tS' CD . Policy#or Self-ins.Lic.#: � �0 6 Expiration Date: O! U! f Job Site Address: 6176 S&uehr- aw_ City/State/Zip: �A�L Attach a copy of the workers'compensation policy declaration page(showing the policy numk4 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 c er the pains and enalties of perjury that the information provided above is true a correct. \ Sianature: Date: /z) Phone#: Offccial 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#: t , r Town of Barnstable *Permit# ` 600000_ •7 Expires 6 months from issue ate • ER MIT Regulatory Services Fee ��, � • sniwsrnecs Thomas F.Geiler,Director (,7 r 2008 Building Division. Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �2� / OC/(, Property Address C4.-�) PiGFqP_WQOd T I Y Er)LA 4Wn/7i Sr MP� 07-6 0 [ Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address I-auren `S': C p 1 d einCL K) G 3 i 2.i�CXx6 }y ev�l.0 ; f4yC(r� Contractor's Name r�(� i� 17 20 ;raj Telephone Number"7-74- 3 2— Home Improvement Contractor License#(if applicable) if 1Z- Vorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name 1 SI,I l�Qn C� Co 1 Y1(�j l Workman's Comp.Policy# msl Lf_4.7— U-3 -- J `T Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ERe-roof(stripping old shingles) All construction debris will be taken to 0__ t ❑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 ekempt 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.. SIGNATURE: i Q:Forms:buildingpennits/express Revised 123107 The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations a 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):' 51 ar) (T. C i� -'J � _ �`�_�� "- fv a Address:loS ��1 S'yjH j PCy l City/State/Zip: ► 02(,3 2 Phone#: Ar you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance. 9. ❑Building addition 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.ZRoof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: — Expiration Date: In , Job Site Addresso' n of cud &,l41 —ua, S City/State/Zip: 1S' ' 6Ge 01 Attach a copy of the workers'compensation policy declaration page(showing the policy num er 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 cerdfr under the pains and penalties ofperjury that the information provided bove is true and correct Date: Si ature: 0 d - Phone Official 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#: GRANITE STATE -INSURANCE COMPANY 71337-0000 WC 447-03-14 13102 --------------------------------------------- 013-66-0807-00 .- . PENNSYLVAN I A ROYCROFT & KUEHNE BUILDERS INC. Member Companies of 65 EBEN SMITH ROAD offt CENTERVI LLE, MA 02632-0000 V If American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D# MA UI : •'�• ��- SOUTHEASTERN INSURANCE AGENCY WORKERS COMPENSATION AND EMPLOYERS 641 MAIN ST LIABILITY POLICY INFORMATION PAGE HYANN I S, MA 026o l-5403 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 004392269 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - wc9go6lo ITEM 2 POLICY PERIOD 12.01 A.M.standard time at the insured's mailing address FROM o8/o6/07 TO o8/o6/o8 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated rat e ion Classifications Code Number Remun $100 OF Re- Premium Annual 3 Year muneration M Annual 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $124 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $284 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $2,f 50 It indicated below, interim adjustments of premium shall be made: ElSemi-Annually Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 08/30/07 ASSIGNED RISK 66 Issue Date Issuing Office Authorized Representhlive wC 00 00 01 M67 INSURED'S COPY of� . * Town of Barnstable + MOM '""SS.&639. Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.harnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 4 ujceh Cc S . Goldman _ ,as Owner of the subject property hereby authorize Sean Off/Gr O� to act on my behalf, in all matters relative to work authorized by this building permit application for: Q,3 R�Ci e u)Ood A-venue, 1AL6 _S; ®ate(0 (Address of Job) Q ignature of Owner ate U11AA11AA Print Name Q:Forms:build ingperm its/express Revised 123107 r . '.1� � ,rr:; i!var.iitG✓rtt�r•trC�+t r,`',, r(.�r Board of Building Regulations and Standards�r Construction Supervisor License A xya_ License: CS 83280 • " Birthdate: 11/29/1964 Expiration: 11/29/2010 Tr# 5313 Restriction: 00 SEAN J ROYCROFT 65 EBEN SMITH RD CENTERVILLE,MA 02632 Commissioner �e Vr ommu»rcaeaCl� o�./ltaucac�auaetla _ . Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR E Registration: 141225 Expiration: 1/22/2010 Tr# 262207 Type: Private Corporation ROYCROFT&KUEHNE BUILDERS, INC. Sean Roycroft 65 Eben Smith Road Administrator Centerville, MA 02632 Assessor's map and lot number ..............., r..............:.:... ...... AA- �� ���� Q�OF TH E T0� Sewage Permit' number !l.Q,n...FG.� t'' 2 33ARNSTADLE, i House number .../.,J.. .. . .L(� Ob.l ...1 ...1:T..... .�K.�. .ANN I $ rooq,tAG& TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO J i.9.?odd.......A....... A.y. TYPE OF CONSTRUCTION ..... .. ..!S s�r...................ka,,.1z,f&A............................................ 0 .19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ...................................................................... Proposed Use ..r ���(. ...V.(. G.CL'... .— .d.4 ...t.v....11 �� .I. ...................................................................... ZoningDistrict .......,..................................................................Fire District ................................................ ...... ry� Name of Owner ... .......ehYO..UI 7.7........Address ...2.3...� ...AK .....1:!.t`p.wN!�r[S. .�I.U+ (� �{ ,! N !! r Name of Builder .It..6bL�,'f...�l.f..�A:b�.........:..............Address ..�.�.f'.��Y.��C�?.�V....I:,IYL�. .��.�:� .1.�.. . S, Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ..................Foundation ... P GG A •r• �'/�/� G 61 ` . .�......(�...................................................Roofing ......./.�<5��..�:�j..................................................... Exterior .............. � Floors .....�.11usooc1.........lr.. � ., ................:.......................0,. /C /Q.,fI. .............................Interior ..... Heating .......CA..7r. ......................................................... ....Plumbing .....CR�jPAA...... +/c .. ... .VG....................... o� Fireplace ..................................................................Approximate Cost ....... � ......., — .................................... Definitive Plan Approved by Planning Board -----------_--------------------19________ . Area d...eft.e .... 011 Diagram of Lot and Building with Dimensions Fee ®9) SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... .............................. 1 show 6C. &P io-avAgf Construction Supervisor's License .. tS ....0,370X6_ CA YOUETTE, HAROLD A. 28312 Add Dormer No ................. Permit for .................................... Single Family Dwelling . ............................................................................... 93 Ridgewood Avenue. Location ................................................................. Hyannis ............................................................................... Harold A. Cayouette Owner .................................................................. Type of Construction Frame.............................. .......................................... Plot ............................ Lot ..................... ............ Permit-Granted .... ............. 85 Date of Inspection ...................................',19 Date (.tomp)eted ......................... .......1�9 Assessor's map and lot number .................................... ....... Bpi TN E p� A n ' Q �� Sewage Permit numberf7XTF. -U.�.. 8�Z J..//C.�. G ?�? .C.1....1.`��.�r (�NNi S ��� Z BABBST/IDLE, House number ... . r rasa Apo,t639• \00 'f0 MA a TOWN OF BARNSTABLE r, a BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....&. .'' '.�C��....... :......t.,.l�.j� ? .. �q TYPE OF CONSTRUCTION .....! r ..../S!LYY .0 ....................J •C'.C.1/�1.��'. .....,....................................., ........... 0 ..9..... .... , .19., ,5 TO THE INSPECTOR OF BUILDINGS: .The undersigned hereby applies for ape�rmit according to the following information: Location ..... ...... R. ... .. ............. . ........ ................................. Proposed Use .. .�5. .1, �...\�.(.�1.�.�L ..�� .�. �1� ...l. .......................r............................................... Zoning District ........................... ..................................Fire District .............................................. Name of Owner . 6 MO.!.I.! . Tr.........Address ...` ,'...Rcr�ctf„W..a�:....../4L� �����.n.J.e�?1..5. .�:✓�4 �}l �( �,•! Name of Builder tS L'.? ."�..V..'..1�a� ...:.....................Address ...is.. '��4 .4!....!:.?�►�'.. . 1�n1i. ..!.! r"rSs. . 4 Nameof Architect ..................:...............................................Address .................................................................................... Number of Rooms .......1 -...............I........................................Foundation .........,,�:,!/C ............................. . Exterior ��iq�)/,FoA2 ...Roofing . ...... .>jG?( ! .1��7 Floors �ycvcca .........� ...........................Interior ........ ,f�. c.1..% .G ........................................ y.............. / Heating ..:....L-A..>..................................................................Plumbing ..... .av� :.4?....... .;:;.� ..... k� 11 ....................... r ';r Faireplace .....X1�.....................................................................Approximate Cost ....... f ............— ...... .. ...... / Definitive Plan Approved by Planning Board ---------------_---------------19________. Area /Ud...ell/.: Diagram of Lot and Building with Dimensions Fee e. r SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .�'�........................................ Construction Supervisor's License �� !.5. ..�s��.� C�s CAYOUETTE, HAROLD A. A=328-96 No ... ... Permit for .:Add Dormer Single Family Dwelling ..... ........................................... Location ....93 Ridgewood Avenue ................................................ ......HY..ann i s............... Owner ......Harold A. Cayouette Type of Construction .....Frame.................�.......:........... Plot ............................ Lot ................................ August 12, 85 Permit'Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 TOWN OF BARNSTABLE BUILDING-PERMIT APPLICATION Map /--'S' Parcel6 Permit# �l Health Division � �� y�� � Date Issued Conservation Divlsi_on Fee Tax Collector Treasurer- - �crn�nC.P�c �J �,Cnzu 1��1 Ju6b A po $AIGNBC�IC$p8 A hi'ER Planning Dept. ° M PROM THR Date Definitive;Plan Approved by Planning Board - Historic-OKH Preservation/Hyannis f Project Street Address 23 Ri'dae-u000 d- R tee_ a Village ` a.nn i s f , Owner avid f ri� 7 FEE P `-c` PN - ,. Telephone 7 Permit Request oA ,.' s� owlio' o .. o� ov v� ..► Square feet: lst floor: esg 5 �pr i rAposed" dotal new 16CK Estimated Project Cos ��"n� �i P ,�G'roD Plain Groundwater Overlay st7. i .,. Construction Type '70 w Lot Size i O�4°70 `3r Grandfathered: ❑Yes A No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 50 4� Historic House: ❑Yes JWLNo On Old King's Highway: ❑Yes *No Basement Type: .I Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing r,2— new 0 Half: existing. new Number of Bedrooms: existing new 3 Total Room Count(not including baths): existing 3 new 6 First Floor Room Count n Heat Type and Fuel: 25 Gas, ❑Oil ❑ Electric ❑Other Central Air: ❑Yes. 4No Fireplaces: Existing 0 New Existing wood/coal stove: ❑Yes (ZfNo Detached garage:❑existing ❑new size Pool: U existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:4existing ❑new size_ Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes,site plan review# Current Use Res de,44_/ Proposed Use A ` y BUILDER INFORMATION Name �/ LJ I t 0L Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE c DATE k FOR OFFICIAL USE ONLY +. PEkMITaNO. - DATE ISSUED - t F - MAP/PARCEL NO. ADDRESS V I yyyLEA��+E ^•i OWNER' IT `,, I , T 14 ci lz .. t " DATE OF INSPECTI4 u a, FOUNDATION O ` a�17 a „ FRAME of INSULATIONf FIREPLACE �b6,.,.�+6- Ai�lY4f. >r ELECTRICAL: ROUGH FINAL+'? tit - _! _,• � ,�, • ; , .. °1 PLUMBING: ROUGH V.w' FINA14.L �r uC�nnT. GAS: ROUGH ':.-. FINAL �`' Q^ r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. -- e' .�F`HE The Town of Barnstable aAR E.ASS. Department of Health Safety and Environmental Services 7 MASS. 0 i639' �0 prEo MAC Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection4 u Location 1 66- Permit Number ` Owner Builder One notice to remain on job site, one notice on file in Building Department. The followi items need correcting: f6 S C4), Please call: 508-862-4038 for re-inspection. Inspected by 2j�� S Date Z 3 r d ci2N"� The Commonwealth of Massachusetts Department of Industrial Accidents .._.. �' �=-� �• 00 Olfrce olloYestigatioos 600 Washington Street v� Boston,Mass. 02111 Workers' :Com`ensatibn Insurance Affidavit WIMMY name location �� �'� e-zx� a-V-e— city H hone 0 7 23- 6 ZF I am a homeowner performing all work myself. ❑ I am a sole P and have no one workin in any capacity for my lovers worian on this 'ob. Iamanem loverprovidmgworkers...compensaizoa............-:.emp.:..,..:::.::..::.:::.< g :..::::.::::,:.«:.;:.;:.;>:<.>:.;:.:;.;<:.:;:>:>:><::<,_„>;::;<>; comoanv name: ...... dre ss..: ..::.::::::::: :: . ...:::... ::::•. .:...... :..:..... . cites ..: ..... phase#: :. . insurance co. :.::::.. ..... :..... ...:.:, . : ,... ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' corrinensation polices: comanvname :::.::....... ::.. ...........::::..:....:....... . address. :•}$�:•:�}i::v::•:i•iii:4ii{ ii:'?:<•:•:•is i sti':iti^:ti4:':ti!i:titi ltitititi::::•::?:'is tV` �•h .... •:•isivri: ....> :':'::•i:•i%:{: •ii:... :i}+:.w>:it ii•'`:::i:::: IN fi iz cc=anv-names ::::<:;:; .:;:.i:: :: :::;::;::::::i:;:;:>:;;'?ir 'r. address: city n$one# :::;:<: ::::i:»:«:; >:<>:;:>:c<::::;>:«:.:::::::::<:»»>:::::::::>«:»< <>':: : ........:... olive#.....:,......::...,:.::.::.:..::..,.... .. ......_ . sarance"co_: .;.:.::,::.:.;.:<..;.:.»:.,..«,,..,.::.::.:::::::.::,,.: :>,,::::..:...::,,:. WOMEN I Failure to secure coverage as required under Section 25A of MGL 1S2 can lead to the imposition of cs6nioal penallin of a Sue nP to S1,S00.00 and/or one vears'imprisonment as well as dva penalties in the form of a STOP WORK ORDER and a Hue of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verincation 1 do hereby certify the pacts and penalties of perjury that the information provided above is trr.and correct signe, Date . F F 6 Print name Phone# -71�0,2,7 -------------------------- otHdal use only. do not write in this area to be completed by city or town oincW city or town: permittlicense# ❑Bttilding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person. phone#,, — 00thzr 9/95 P)A) ra6brsZSb� , Pt n"ipt[re PaeksM for tine and Two-family Rnldan"$oildbW Aeated with Fossil Fuels MA=UM lY1 NMIUM Ong (llaiia$ P.eiiiag wall Boor .Slab agnawyco g Ann_(%) U-valuas R.yai� R•valuo'- &value Wall PC= IP=k=I B.Vabd I &valttet S101 to 690 Heating Deem A)SW Q 12N 0.40 3E 13 19 10 , 6 Normal R 12`S 032 30 19 19 10 6 Normal . S l2!s OJQ . 31 13 19 10 6 B AFUE T 13X 036 3: 13 23 WA WA Normal U tS'sfi OA6 n 19 19 10 6 Normal v Im7i kY+i �e :: Z: WA IA 25 AFUE I w 13yS OSZ 30 19 19 10 . 6 is AFUE I x IE'/. 02 3f 13 y WA WA Normal I v IEY• OA2 3z 19 WA WA Normal I Z lE'/. 0 Z 3= 13 10 6 90AFEIE AA IV/. O30 10 19 10 6 90 AFt1E I 1. ADDRESS OF PROPERTY: iL'�9e Cc�a�e� v2 Z SQUARE FOOTAGE OF ALL IDCrERIOR WALLS.- q qo 3. SQUARE FOOTAGE OF ALL GLAZING: 14 y 4. %GLAZING AREA(#3 DIVIDED BY#2): f 5 0 S. SELECT PACKAGE(Q-AA-set:chart above): `V f NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-030303a °E THE A The Town of Barnstable anstvsT"M *' 9�A MAM p�m� Department of Health Safety and Environmental Services 39 rEo .t Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date - AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors with certain exceptions,along with other requirements. Type of Work: Addy���/� Estimated Cost Address of Work: Owner's Name: Date of Application:- ! rib I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 ,[]Building not owner-occupied Zowner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ` Date Contractor Name Registration No. 1"G Date Owner's Name q:forms:Affidav I d I ESTIMATED PROJECT COST WORKSHEET Value LIVING SPACE '1.2- square feet X $55/sq. foot GARAGE (UNFINISHED) square feet X $25/sq. foot PORCH square feet X $20/sq. foot= DECK � . = square feet X $15/sq. foot OTHER square feet X $??/sq. foot= Total Estimated Project Cost r g990915b »> XD FL N 1 ;;;5 O. 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I_.� �..� T CL- L '' Its o. -� — ; 7 I N D it d — - d •x} .rip-'e '{�� 5� f• � �(r €r / r, 'a3 ! �"y�tL'�''y�x'� '�"� fC'�'!F'.��t k y .6 B• � y�l,A �. � ; +a. p .. � � - �Y rail- _ "Al ,,( .,4 .r tr Hx c 7.aG 3 �. 1 t ✓. f # e�S� �, :7 e 15Fs �,} *v s�ri5.F � ...to 2?.;ts,��.�: ' „�t , ' _�'' _ -- r' ;r•,.. ,,,,,�,.�,: , } / Ot ..........\ 1 i f c nJ u i' f x i r aw OR T GAUGE I1VSPEµCT� is0 x# ; RN ABLEf ? 93 RIDG.E' WOOD AVENUE, N/F GUYER - CONCRETE , " 63.01 CONCRETE BOUND _ BOUND LOT 14 10,070 S.F. f..� Ln N N LOT 13 de�`� c" .LOT 15 LO ECK 1 096 ,X 1 1/2 STOR -. DVEL-L-ING Z� _ . . 63,00' Al - The Town of Barnstable �p SHE l Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Mnss. 059. ,fig �ArED MA'I A Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: YE-1 60 JOB LOCATION: q_3 R, 4 �kJe°d Y number / street village ,.HOMEOWNER":^��1��,� �r�ass 7*7$' t '127 7 Y 222- name home phone# work phone# CURRENT MAILING ADDRESS: '73 /LCca L, d d /?vim �yan n ss PIA 0�vG 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.I.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,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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN The Town of Barnstable Inspection Department Y.Y 1'` 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner June 29, 1993 Mr. Harold A. Cayouette 93 Ridgewood Avenue Hyannis, MA 02601 RE: A=328-096 93 Ridgewood Avenue, Hyanriis J Dear Mr. Cayouettet This office is in receipt of a complaint alleging that you are operating 'a bicycle and lawn mower repair business from the property located at 93 Ridgewood Avenue, Hyannis. Please be advised that the property is located in a Residence B zoning district and the above use would be in violation of the Town of Barnstable Zoning Ordinance. Please contact this office immediately re the above matter. Very truly yours, Ric and R/B-b/a rrs ,.z Building Inspector RRB/gr l CD Le.f,y ro-'re cycZG L'•s�w� owc.� ,�, �r ,�, a si,vcsS Ai; p,e.� zaeldl- 76 TOWN OF BARNSTABLE BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT Dat g3Rec 'd B Assesso 's No. - Last Name_J� G First Name ORIGINATOR Street �7 Village Statd+l (,,I S Zio e �_ Tele hone: Home ►"1 ork Descri Lion: �3 C014PLAINT 1, Pq INQUIRY CA Requestor's Signatur elo COMPLAINT Street Address LOCATIONA', S A= eJ 6 OFFICE USE ONLY INSPECTOR'S Date 6 2,y11-3 Ins Rector ACTION/ COMMENTS FOLLOW-UP Z ACTION ` 0 ADDITIONAL INFO. ATTACHED-- j� COPY DISTRIBUTION: WHITE — DEPARTMENT FILE YELLOW — INSPECTOR PINK — INSPECTOR (RETURN TO OFFICE MGR. ) NIBC1 IG$96- NUT R,VISERG"D AVEN S CTY 07 TDS 400 -44747 F GA 01 It C s 0 C) Y'R 00 PAREMU 0 -G -1 CAYOUETTEI, HARCIED A K.A 11 A R. A 4 AC JV f- 1.1")0 9 3 JR-ihr D G E 0 0 10.0 A V F SF3 U T2 2"3 SQ I'T 114-11. AN NI S, 'MA. 0 xt?'6*1 0 i 150 F."V 1.1, 1 -.*,,1` 0 B 8 GQ'WST P12 P 4 i'?.Y W OT; F R 0000 4,2V 0 -1 1-1—T' WE , RIF A C LA SS.F F 1 l � X . 6 T. R ,S ' . I 111 ,1- • THLA 10 AO LN C GO O 1 41 :5,V 2 0^Sal',Lic,I ICI` 00 L -9'.3K VES 1,FL7F-10N TAX - 6 F '1 "A ! f YiR 1 < Py. t ii 15 LE, J G �g of) j4 I�r I T F! TAX EXEMPT p L 1:102 14 si DJIF N: 0 6.8 0 0 E IN' SP ICE C L,M..tlf C.R C.F AL DUY S 7 RIT Ai F, E. P21 p 5*113 N" SALE 001/00 FRIG'f 2.1.4-3711132 RFD " -p 0-9 22,1 185 PCR Y 7-1-93 TO: THE TOWN OF BARNSTABLE INSPECTION DEPARTMENT 367 MAIN STREET, HYA HIS, MA. 02601 MR. RICHARD Re BEARSE Concering the letter written June 29, 1993. I Harold Am. Cayouette do state that I am not operating a bicycle and ' lawsn mower repair business from spy property at 93 'ridge-wood avenue. i am currently unemployed and am sealing of f my -own personal accumselated things. . THANK YOU, HAROLD A. GAYOUET t E 93 R I DGEit OOD AVE. HYANNIS, MA. _2601- INNER— DEADMEN = t 6„X6"X36" W/ 2'X8"X36" END 6"X6 RETAINING WALL WITH DEADMEN �- I= SPACED AS SHOWN F--1 0'T , , . 6' 4 EXIST, CONC, EDN WALL 10 RETAINING WALL ` PLAN VIEW ELEVATION VIEW �c BARK A. z IvKENZIE ' S IX NOTES: 1. ALL WOOD TO BE PRESSURE TREATED #2 SOUTHERN YELLOW PINE OR BET 2. . CONNECT RETAINING WALL TIMBERS TOGETHER USING 8"X1O" LAG SCREWS OR z TIMBERLOK OF EQUIVALENT LENGTH AND STRENGTH. SPACE SCREWS 8" O/C. ENSURE TWO SCREWS ARE .ATTACHED TO EACH_ DEADMAN 3. DEADMEN BASE LAGGED TO DEADMEN WITH (3) 2"X8" LAG SCREWS OR EQUIVALENT. 4. ALL WALL CORNERS TO BE WOVEN LAPPED. 5. ALL BACKFILL 'TO BE CLEAN SAND PLACED IN 8" LIFTS AND COMPACTED. CARE TO BE TAKEN AROUNDeDEADMEN TO ENSURE ,PROPER COMPACTION t NINE I l _