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0015 SHOREY ROAD
i Town of Barnstable *,Permit# 6 F�tres months from issue date ' Regulatory,Services Fee snxxsrnsi.E Mass. Richard V.Scali;Director° i6;9. �FDMA`� Building Division f ARE Paul Roma,Building Commissioner nu ° 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us CEP 21 Office: 508-862-4038 TAI.� _ Fax: 508-790-6230 W 'c EXPRESS PERMIT APPLICATION - RESIDEN'TIA fO!NI r ON Not Valid without Red X-Press Imprint Map/parcel Number -olb:77-A 7b A"- Property Address Residential Value of Work$ 3 o�/4 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 8f` EA/-,K e-CfPLL/i9�f }" Contractor's Name Telephone Number: ,*Y O/Z! ' f Home Improvement Contractor License#(if applicable)/0 0 0 Email: Construction Supervisor's License#-(if applicable) ❑Workman's Compensation Insurance Check one: �am a sole proprietor ❑ I am the Homeowner; ❑ I have Worker's.Compensation Insurance Insurance Company Name t _ Workman's Comp.Policy# Y Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ ,Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-foof(hurricane nailed)(not stripping. Going over, existing layers of roof) EJ Re-side P-11replacement Windows/doors/sliders.U-Value v (maximum-M)#of windows #of doors: Smoke/Carbon Monoxide detectors 4'floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance'of this permit does not,exempt compliance with other town department regulations;i.e.Historic,Conservation,etc. i ***Note: Property Owner must sign Property Owner`Letter of Permission.` A copy of the Home Improvement Contractors License&Construction Supervisors License.is required. t SIGNATURE: QAWPFILESTORMSUilding permit formsEXPRESS.doc` 06/20/16 . The ColnmarnreaM o,f sadrusd& Deparanent afI ebidtAcrderrts f},f ke of fit gations 600 Washfiwsa&reef Boston,MA 021I1 . knrvt�r�ras���iiia -. - y Warlmrs' Con3pensa Lion Insurance Af RdaviL Bc.ilders/Contracturs/Elecfrkian&Tlumbers AppHcan#Informs atiII Please Print fie 1lY Flame ra i--/ 0,9 T Ad&esrgO ����� �o� 14�6 Are you an employer?Check the applopriate bom Type of project{retl�eal}: I.❑ I am a 1 with. 4. ❑I am a general contractor and I P * have hired the sub"cofactors 6- ❑New co cti� employees(fall andfor part iime)- 2.E�T6 a sole proprietor orpart=r- listed onthe attached sheet, 7. ❑Remodeling. sb�p and have no employees, , These sob-confmctars hate $. ❑Demolition andhave wodoers' warring foiine in any cagas�4y: � employees 9..❑B.ui1dmg addition [No�va6ers'Camp'-i ce camp_;,, �, f S. ❑ We are a corpomtica and its 10-❑Electric ,d�al repairs or as required] officers have eseressed their 1L F repairs or ad&fions . . all svorli ❑ �� eP 3.❑ I area hQmeoumer daurg myself[No Workers,comp- right of exemption per 1ST GL 13.❑Roofrepairs � {� c_I52, I sndwe have no. inc+rra4arer d„]t j�.�tF1E,C employees.[No iod=- '}.tap RMHCastaat Ckeasbana#1 mast also i�ai�the sectia�ahelaaysh�iag�e¢iaodaexs*camp��+++�++�peTiayiafo�saFianL Haa7eas{�aers who sah�t obis si�da� srep e�dasi�a]f wad sad } amsid�en�cmrsmnst snhmit a nem affida�t mdiesbng mcb IC.a�mat checicthis b=n=x t rh ffi additional street sh�the a—of the sad=UP whether area thane e=ddesha-e em huees.IfthesvTzcantactacshmLpigy ,&e}' gxauidet it sra&-&a-P•PwkF- !- " lam as inatraaw far my emprDiwaL $erviv is trie pa cy and job site infarmaliats. _ ' Insurance Company Dame: ¢ Policy,41-or Self--ins.Lis--&IL Fxpir-atian Date: Job Site Address: CitylStatelz p: Attach a4vpy of the worlters'compensationp.oHcy declaration page(showing the policy,number and expiration date). Failure to secure coverage as m4uirednudes Sutton 25A of MO-c�1572 can lead to the fimpositioa of criminal pamalties of a fine up to$UOG 00 iuWar oni-e--ye-a-rimpiisorsment,as well as rivil peaalEies in 1he fore of a STOP jb ORK ORDER and a frme of up to -00 a clap ag-ainst the vio]a nr. Be z&ased fiat a copy of Ns statement mgybe forwarded to the Office of Invegabons of the DL4 for msmmnce coverage verfficahmm- I ti`a kerehy tlrs ' s afgee�cr}� atfhs infbrwa€=ptmmicied abm a is l=and cvmrd iffiature: Date_ C3 •''�� PhMM;rr-�5-tp j 2, 7010 Ojokiad um only, Do jwt smite in This mva,to be caimpieted by dip arbim offidat City or Toga: PermofUcense O Issue Auflmr4(carIe true): L Board of Health I Builffing Dgmtne nt 3.Otp Taws Clerk 4.Electrical Fnsp tDr S.Plumbing Fnspeecter b.Other Contact Person: Phan#' 6 i Information and l struefions A/jacear3rrT cft Gc=asl Laws chVtcr 152 requ=all=1pl07=to XMCIe workers'compensation for fhen'employees. Pors�to this sib,an Mnrplape�Is dctroed as¢_every peasdn in the Service of aaothrr�dPz any co�ract ofbi% t =sparse or implied,oral or vxith " An ernPlvyF is defmcd as�`aa m3ivir7IIat,parinexsbzp,assocraiioa,c mp anon or afhrr legal enE$y,or any two or mote of the foregoing engaged is a Joint eMtaprise,and inclndmg the'legal repre�es of EL deceased employer,ar fha receiver or trustee of an individual,per,association or otherlegal mfity,employing employees- However fbp owner of a.dwellinghonse havmgnotmore than fbree apadm=ts and who reszdesfferem,orrthe occ¢pant ofth.e - dwellmg house of anDd=who maploys persons to do mah teronce,consUnct on or repair woi.on such dwelling house or on the grounds or but-Id g.apptsfinant thereto span not because of such emplayment be deemed be an empployer." MM chaptez 152,§25C(6)also SAPS that"every sfaf a or local licensing agency shall withhold the issaance or renewal of a license or permit to operate a busutess or to construct bm2dings in the corumortwealf3i for any applicantwho has notproduced acceptable evidence of comphancewith the instu-Ance.covexageregaiz'eci" AdditionaUy,MGL chapter 152,§25CM sfstes-Teaher the commortWmM nor my of its political subdivisions shall ester into°any contract for th.e perfmmma a ofpnblio wow uoifl acceptable evidence of compliance with the ins�aozce.. MTm-amens of tide&Vtez bane been preset ied in the mntm�anilaol*-7 Applicants please fiIl oid fb a worIa°as' compensation affidavit cc)mpletely,by g the boxes&A apply to your sifnation and,if nee weary,s-oPPly sob-contractor(s)n3inc(s),- s(es)and phone numbers) along with their certffir.�(s) of in Limited LmbflrLy Companies(LL<C)or LmntedIaabi&yPmtaessbips(LLP)withno =ploy=other than the meambers or partners,al a not reed to cauy worice&compensation igso==- If an LLC or LLP does have employees,apolicy is requn-ed. Be advised that this affidavit may be;sabmitied to the;Department of Industrial Accidents for confirmation ofmsmm=coverage: Also be sure to sign and datEiffie affidavit The affidavit should be mtmned to the city or town that the apPlicafion for the pennit or license is being requestA not the Deparmmemt of ; hadast ill.4=dentg- Smuld you have any questions regatdmg the law or ifyou are requasd to obtain a wormers' c mpensat ion policy,please call the Departiaeat at fbe number limed below: Self-funned crnupanies shonId ent rr their s elf m�n ca license nmmber an the approve line City or Town OfEl aLs Please be sore that the affidavit is complete and pri nrd.legibly. 'Ihe Department has provided a space at the bottom of the affidavit for you to fill out is the event the Office of Investigations has to contact youregzrding the applicant Please:be sure in fllmih pe�t/h,e, -cease munber which will be used as a mfrre m nomber. In addition,an applicant that must submit multiple p=itlIicense applitaiions in.any given year,need only submit one affidavit mdicai cat p olicv information(if necessary)and Tder'job Site A-d&ess"the applicant should w=h--"all locations n (cry Or town:' PY A co ofthe-affidavit that has beers officially stamped or maimed by the city or town maybe provided to the -applicant as rmafthat a valid affidavit is on Me for future permits or licenses A new affidavthmust be filled out each year. Where a home owner or citizen is obt iir i a license or permit not related to any bn sine:ss or commm cial (ie.a dog licen=orpeunit to bum leaves etc.)said penm is KpTreq>medto =mplete this affidavit: The Office of Ihvmstigations would like to ffonk you in advance for your cooperation and should you have any questions, please do not hesifatm to give us a call The Department's address,tDlephone and fax giber: 1 of 1 . - • � De �c>f1ad .lAacid�nt� - . - _ Ta 4 617 -4950 cft4fl6 or 1477-MASS� Fax 617-727 7M Revised 4-24-07 f , wmass�a[21Tf wa i Town of Barnstable Regulatory Services ' Richard V.Scal4 Director sb Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section ' If Using A Builder I V)z� fas Owner of the subject property hereby authorize IA` to act on my behalf in.all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be`filled or utilized before fence is installed and all final inspections are performed and accepted. Stature-of Owner Signature f Applicant All M r 1V k, AdetLyll)�l Print Name Print Dame Date QYORMS:OWNEUERMISSIONPOOLS . 4 Town of Barnstable Regulatory Services p1F Richard V.Scali,Director y Building Division > . = Paul Roma,Building Commissioner MAM e39. ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038, - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityhown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building'Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Ru-les&Regulations for Licensing-Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a-licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the .permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 „ ” a Massachusetts Department of Public Safety I Board of Building Regulations and Standards vy)� License:.CS-000998 - construction Supervis6r Ij VICTOR J WIINIKAINEN PO BOX 69 r WEST BARNSTABLE 8 1 n - �,,,�,� 1`/A`�� _ Expiration: Commissioner - 09/29/2017 r _ r• � Vhe�ayrurnaruaea�Cli a�v/�Ga4actc�cuaeL�a I• ' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR k Registration:';`T00053 Type: Expiratiori_-=6t>3 2M1 Individual VICTOR J.WIINIKAkr. -- } - Victor Wiinikainen 58 CAPE COD LN BARNSTABLE,MA 02630 Undersecretary Construction Supervisor -Restricted to use group which contain Unrestricted-Buildings of any of enclosed 'less tha n 36,000 cubic feet(991 cubic meters) space. - Failure to possess a current edition of the Massachusetts for revocation of this license. State Building Code is cause DPS Licensing information visit: W"•MASS.GOVIDPS - License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation ,I 10 Park Plaza-Suite 5170 Boston,MA 02116 � It L L I No valid without signature I TOWN OF BARNS' R I S E Division of Thielsch Engineering,Inc. MAY ss 1: 19 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 ®1V1S1f � May 1, 2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street (r`r Hyannis, MA 02601 Re: Insulation permits Dear Mr. Perry, This affidavit is to certify that all insulation work completed for 15 Shorey Road has been inspected by a Building Performance Institute (BPI) certified Professional. All work performed meets or exceeds Federal and State requirement. Sincerely, Erik Nerstheimer Supervisor of Installations, BPI certified Building Analyst Professional and Envelope Professional, RISE Engineering, a division of Thielsch Engineering, Inc. 1341 Elmwood Avenue Cranston, RI 02910 y 401-784-3700 •800-422-5365 •Fax 401-784-3710 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel °:'Application # Health Division 'Date Issued a �� Conservation-Division Application Fee J Planning Dept. r Permit Fee. ✓S Date Definitive Plan.Approved by Planning Board Historic - OKH Preservation / Hyannis 10 h . Project Street Address 41-L Village Owner X �'�l l /��1• AddressC Telephone Permit Request Square feet: 1.st floor: existing 11koproposed 2nd floor: existing proposed Total new Q Zoning District Flood Plain Groundwater Overlay Project Valuation ; ' 690 Construction Type Lot Size' 9 "mil Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structur#1 6YACIM� �� Historic House: ❑Yes 64o On Old King's Highway: ❑Yes ❑ No Basement Type: Vull ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft. Basement Unfinished Area (sq.ft) ' Number of Baths: Full: existing_ new 0' Half: existing new Number of Bedrooms: 3 existing 4 new � Total Room Count (not including baths): existing new o First Floor Room Count Heat Type and Fuel: & as' ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes A'No Fireplaces: Existing/New Existing wood/coal stove: ❑Yes 41No Detached garage: ❑ existing ❑ new size Pool: ❑existing ❑ new size _ Barn;d existingw ❑ new size_ Attached garage: ❑existing 0 new size _Shed:ffe"xisting ❑ new sizetXLa Other:J: -, .Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w Commercial ❑Yes 6lo If yes, site plan review # Current Usea 6 1 f Proposed Use APPLICANT INFORMATION —T (BUILDER OR HOMEOWNER) � oiz •-Name G ✓ V T lephone Number�6� Address�� C� �-�/ License # L16S1 l Home Improvement Contractor# ,. Workers Compensation # /`��>bi&CC__� _ ALL CONSTRUCTION DEBRIS RESULTIN FROM THIS PROJECT WILL BE TAKEN TO Y D SIGNATURE ! DATE FOR OFFICIAL USE ONLY APPLICATION# - DATE ISSUED ,;3 3-u D: . �MAPJ PARCEL NO;:,,.:n:- c S -ADDRESS. . - VILLAGE OWNER _ DATE OF INSPECTION: DFOUNDATION . ,•-. FRAME 3)17)Il INSULATION! FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL } ` ` GAS: �? ROUGH 1KRical-i ��- FINAL A _ - � _DATE CLOSED:°OUT ' ASSOCIATION PLAN NO. . Th. onwerrlth ofMassacht/setts. Depdrtnlent'bfIndustnril,4ccideliIs , offCe Of r1lYestLgati0J1S ' � q' tr"eet 600 lYd'shircgta�� S c Boston r�1,4'02111 - y � ri�ww:mccss.gov/dia Workers' Compensation_I.n ra-nee"A'ffidavit:.Builders/Confractors/Electricians/Flumbers. Applicant Informatione - Please Print Le ibl _q� _ Name: (Business/Organization/Individual): V 1�e5.A , Address: 0 C i City/State/Zip` Sri , ® Phone Are you an employer?`Check,the appropriafe box: Type of pro)ect^.(required): ]:❑`I-am a employer with 4. Ej-T am a general contractor<and I 6y f New construction e -p7oyees (full andlor'pai -tLMr),t have hired the sub-contractors —Z listed`on the attached sheet 7 '0 Remodeling 2. & 1 am a sole propnetor.or partner- ub These s contractors have ` g, Demohtton" ship and have no employees employees and.have workers working for me in any capaclly. 9 Building'addition POMP insui-ance.� •: . [No"workers' comp..insurance Electrical repairs or additions" required.) 5•.El fc`are z corporation and its , 3. I am a homeowner:doing all work a officers have exercised their - 1 l [] Plumbing repairs or additions myself o'workers co`m` ` right of.exerripfion`per MGL of,rep'airs< Y [ p: 12.[]Ro , and we have no insurance required.) t 13. the>� 1 '� emp)oyees:.[No workers' r 'Any applicAl that ehC6F box'#],must also fill out the section below showing I, ,workers compensation policy infonnat on: t rneowncrs.who submit this affidavit indicating they are,doing.al):w'ork and then hire outside confraetofs must Ell a New zfdavil indicating such. HD Mr that chcckthis box must attached an sdd'itional shcct_showing the name of the sub-contractors and stair Whcthcr or nbt Ihosc cnliticsYhavc Pemployees. If the sub-contractors have e loyecs,they m workers'ust provide their comp:,policy number;, I am an employer'that is providing workers'compensation insccrarice for my employees. BeLaw is thepolicy:.'andjobsate R . Insurance Company:Name: Policy# or Self ins: Lic. #: a. ion Date: . Job Site.Address: Attach a copy of the workers' cornpensa,tion policy declaration page (showin"g the policy number and expirationidafe). Failure.to secure coverage as:required ander`Section 25A-of MCL c: '152 can lead to the imposition of crtmmaI pen alti_es of a " fine up to $I,SOO.00 and/or one-year isriprisonment as well as civil penalties rn.tbe-form of a STOP'WORK ORDER and a fine of up to $250,00 a nst•the violator. Be advised.that,a copy;of this statement may be forwarded to the Office of day agai Investigations of the DIA for insurance coverage ver"if cation. I do hereby eerti�tinde Che pains and. enalties,ofperje�ry"[lial Che ii7formation pr0Nided above tr trcGe and correct. a Phone #: �vd � ® F£ F=t only. Do not write in Il is area Co be.compfeted by cii orfown offeraLnpermit/Licensehority (circle one):Health .2,_Building Department 3, Cify/Town4 E.lectrc'aInspector SPlumbing In p.ecfor son: 'Phone # n t Information and fnStructions Massachusetts Gcncra) Laws chapter 152 requires a)) crnploycrs to provide 4vorkcrs' compensation for fhc�r cmP)oyecs. Pursuant to this statute, an einployee is de.fincd as "...cvo-ry person in the service of another under any co nUac ot�hi�c, t .express or implied, oral or written. An employer is dcfincd as "an individual, parncrship, association, corporation or other 1cgaJ entity, or any two or more of the foregoing engaged in a joint cn1riprise, and igcluding the legal representatives of a deceased employer, or Lhe receiver or trustee of an individual, partnership, associaliob or other legaJ entity, employing employees, I-Iowevcr the of the owner of a dwelling house having not more than (hrce apartments and who resides therein, or the occupant dwelling house of another who employs persons to do maintenance, constriction or repair work on fo bh dWn ellJ Yo fse e deem cd or on the grounds or building appurienaoi thereto sha11 not because of such employment ti L MGL chapter 152, §25C(6) also stales that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally MGL chaplet 152, §25C(7) stales "Neither the conunonweallh nor any ofils political subdivisjons shall enter into any conlractfor theperforina.nce ofpublJc work until acceptable evidence ofcompliancc with the tnstuanec requirements of this ehapterhave beenpresentcd to the contracting authority." Applicants • Please f 11 out.the workers' compensation affidavit completely, by checking the boxes that apply to your sit2�ation and, if accessary, supply sub-contraetor(s) narne(s), addresses)and phone numbcr(s) along With their cerlificaie(s) of insurance, Limilcd Liability Companies (LLC)or Limited Liability Partnerships(LLP) with no emp)0yecs o ther than the members or partners, are not required to carry Workers' compensation insurance, if an LLC tr LLP dots have employees, a policy is required. Be advised that this affidavit may be submitted to the Deparimcni of ]ndustriaJ Accidents for confirmation of insurance coverage: Also be sure to sign and date th-e affidavit, The affidavit should be returned to the city or town thai•the application for the permit or license is being requested,not the Department of Industrial Accidents. Should.you have any questions regarding the 1aW or if you.are required to obtain a,workers' compensation policy,please call the Depaitnocni at the number lJsicd belo}Y, Se)f�nsiired companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be srtro that the affidavit is complete andpnnted legibly, The Deparlmcni has provided a space at Lhe bottom of the affidavit for you to fill out in the event the Office ol. flnYestigations has to contact you regarding the applicl,ni Please be sure to fill in thepermik'ccnse number which will be used as a.referencc number. Lnaddition an app current Thai trust submitmultip]epcnniUlicense applicatJons in any given year, need only submit one affidavit indicating (city or policy information(if necessary)abd under"Job Silo A_ ddress" the applicant should write "all ]oc�t�ons in_�_ toy, copy of the affidavit that has been officially stamped or marked by the city or sown may be provide d to the w applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidaYi tpusf be filed nu l each year. Where any busines or commercial yenlurc a home owner or citizen is obtaining a license orpermit not related to s a dog liccDEc or permit to burn leaves etc.) said person is NOTrcquired to complete this adaYil• rnnfinn Ind should youhaye any questions, The Office of inYesligalions Wou t e o hankyou�rra�v� �O' -r nrra— plcase do not bcsitaie to give us a call. The Departmcnt's'addless, tclephonc and fax number f The.Comrnonwealth of Massachusetts ! Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 021 l l Tel. 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727.-770 Revised 4-24-07 www.mass.gov/dia I , License or registration valid for individul use only before the expiration date. Office of Consumer If found return to: lop Plaza_ Affairs and Busin Boston,MA 02116 VlidNOthout,signature i • 8 sines itegu a on G—f,� - � Office✓i Co��r A airs HOME IMPROVEMENT CONTRACTOR Type: Registration ,t100053 Individual Expiration 61812012 w" yR J.WIINIkiAINEN w - V F . F ��`�. ire - 1�: Victor Wiinikainer�y�\ md- 58 CAPE COD LN BARNSTABLE,MA 021-630 Undersecretary _ Massachusetts Department of Public Safet) Board of Building; Re!-ulations and Standards Construction Supervisor License License: CS 998 Restricted to: 00 ; VICTOR J WIINIKAINEN " r PO BOX 69. . , W BARNSTABLE, MA 02668 Expiration: 9/29/2011 Commissioner Tr#: 2294, r r :To zl 6fBarnsta�Zo eulgtor Serice g v s Y nrAs4 �, Thomas F.,Geileri Director �B:uildil g Divisionki �b Tom Perry, Buildia`g.Corrimissioner 200 Main Street, Hyannis, MA-0260I www:town:6.arnstable.Ma.us office: 508-862-4038 Fax: 508-790-6230 x Propey Ownez Mdst .. :Complete and S gn`Th�s Sec�on F x.If Usz'x-ng A Builder k p At - „ a r v n., I as SOcvner of-tle subject property hereby author,( L �, aet on rr�y beha]f Yin all matters relalsve to`wQrk autho11�rized byt6Ls biulding perriiit ap`nficatcoii for p Tt ` a �j SignatZue of e.r , :Print NaII1e £ u C A y if Property Cywizer s applying forpernzztpleasexcornp1e�e Sze I-Iorrieowriers Zz.cetse Exerrzplzor Fozrn2orz the zeverse side. Q:FORMS:O WNERPEtRMISS,)ON m of rim `Town of Barnstable r� .. 0 Regul'afory Services ; a,txxs-r.�sr�, Thomas R Geiler, Director rctisa t6SQ. , Banding ]division PrEQ htE'i 1. Tom Perry, Building Commissioner 200 Main.Street,_Hyannis HA.02601 x w.town.bzrnYt2ble_ma,us Office: 509-862-4038 Fax: 508-790-6230 ErOTEEOWNER LICENSE EXEMPTION Plcarc Print DATE: JOB LOCAMN: number strcal village "HOME,OWNER name home phonc# work phone# CURRENT MAILING ADDRESS: cityhown state zip code nc 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 SUPCI- lsor_ DEFINMON OF HOASOWN R Pcrsoa(s) who owns a parccI of land on vrhich 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 stzuctures accessory to such use and/or farm structures. A person who consti-pas 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 bcAhe Shall be responsible for all such work performrd 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.hdshc understands the Town of Barnstable Building Department rxn= m insp6C6Dn procedures and requirements and that be/sbe will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Notc: Thrce-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Codc Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Codc states that: "Any hOmeOWner performing work for which a building perrrr t is required shall be exempt from the provisions ).) -Liccnsin of construction Su crvisors);provided tha I if the homcozyncr c tgagcs a pc-son(s)for hire to do such of this section 5cetion )D9 g P ( work, that such HOmcDwnQ shall act as supervisor." Many homcownczs who use this cxerrrption ai-c unawarz that they arc assuming the responstbi)itics of a supervisor(sec Appendix Q Ru)cs&Regulations for Licensing Construction SuperrisorT,Scction 2.I.5) This lack of awarrncss bflcn resulu in serious problems,particularly when the homcowncr hires unliernscd persons- 10 this cast,our Board cannot proceed against the unlicensed person as it would with a bcrnsed 5vpery sot. Tbc hoM_owner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hisAcr responnbi)ities, many'eommunities require, as part of the permil application., d•at the horncowner certify that hrJahe understands the rtsponsibil;tics of a Supervisor. On the)ast page of this issue is a form currently used by several towns. You may cart t amend and adopt such a form/ccrtification for use in your community. Q:fornu:homcezcmpt ®Boise Cascade Double 1-3/4" x 8-1/2" VERSA-LAM® 2.0 3100 SP* Floor Beam1F1301 BC GALC@ 3.0 Design Report- US 1 span No cantilevers 0/12 slope Wednesday, November 10,2010 Build 440 File Name: V Wiinikainen 102210 Job Name: Description: FB01 Address: Specifier: Joe Madera City, State,Zip: Hyannis, MA Designer: Customer: . -Victor Wiinikainen Company: Shepley Wood Products Code reports: ESR-1040 Msc: 2: .. DM 09-03-00 BO,3-1/2" B1,3-1/2" ILL 1,295lbs LL 1,295lbs DL 1,657lbs DL 1657lbs SL 1,943lbs SL 1:9431bs Total Horizontal Product Length=09-03-00 . Live Dead Snow Wind Roof Live Trib.(in.) Load Summary Tag Description Load Type Ref. -Start End 100% 90% 115% 133% 125% 1 Standard Load Unf.Area(psf) L 00-00-00 09-03-00 20 10 14-00-00 2 Unf.Area(psf) L 00-00-00 09-03-00 15 30 14-00-00 Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 10,226 ft-Ibs 78.6% 115% 2 1 -Internal Completeness and accuracy of input must End Shear 3,837 Ibs 59.0% 115% 2 1 -Left be verified by anyone who would rely on Total Load Defl: L/266 (0.397") 90.3% 2 1 output as evidence of suitability for Live Load Defl: L/402 (0.263") 89.6% 2 1 particular application.Output here based. Max Defl. 0.397" 39.7% - 2 1 on building code-accepted design properties and analysis methods. Span Depth 12.4 n/a 1 Installation of BOISE engineered wood` products must be.in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide 8 BO Post 3-1/2"x 3-1/2"� 4,895 Ibs n/a 53.3% Unspecified ( ask questions,please call B1 Post 3-1/2"x 3-1/2" 4,895 Ibs n/a 53.3% Unspecified 00)232-0788 before installation. BC CALC@,BC FRAMER@,AJS-, Notes ALLJOIST@,BC RIM BOARD TM BCI®', Design meets Code minimum(L/240)Total load deflection criteria. BOISE GLULAMTM,SIMPLE FRAMINGSYSTEM@,VERSA-LAM@,VERSA-RIM Design meets Code minimum(L/360)Live load deflection criteria. PLUS@,VERSA-RIM@, Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND@,VERSA-STUD@ are *Cut from: 1-3/4"x 9-1/2"VERSA-LAM®2.0 3100 SP trademarks of Boise Cascade,L.L.C. Connection Diagram f b d a minimum=2" c=4-1/2" b minimum=3" d= 12" Member has no side loads. Connectors are: 16d Common Nails Page 1 of 1 J b TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Zd to. L4o�� Date Issued 1C Health Division t� . Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan'Approved by Planning Board Historic - OKH _ Preservation /Hyannis Project Street Address Village HA o_,n n S Pb} ' Owner Vv I Address SM7 L, Telephone Permit Request E S� V1SU Cfz-30 k Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation - 1 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King0Hig2;r-;way: ❑'Yes ❑ No _n Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ►� Basement Finished Area(sq.ft.) Basement Unfinished Area(sq 3 � Number of Baths: Full: existing new Half: existing p�4new CD r� Number of Bedrooms: existing _new cn r Total Room Count (not including baths): existing new First Floor Room Count l_ Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S(� - Telephone Number �Q)- I N-37 01) Address J 3 N/ E-Jim uif Nt� License # )60415� l_n.n S 1`n , �( ��] t(D Home Improvement Contractor# 1 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1-0) 11 LD hy- FOR OFFICIAL USE ONLY ' APPLICATION# f DATE ISSUED ' i t MAP/PARCEL N0. - ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION- - FRAME INSULATION i , ,R 1.:= i FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL „ GAS - ROUGH " , , FINAL "FI.NAL BUILDING-' °� # . "lr,. Y DATE.CLOSED OUT ASSOCIATION PLAN NO. i r The Commonwealth of Massachusetts ^ 0 0 Department of Industrial Accidents Office of Investigations 600 Washington street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant In Please Print Legibly Name(Business/organization/Individual): RISE Engineering a division of Thiel ch Engineering Address: 1341 Elmwood Avenue .City/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer?Check the appropriate box: Type of project(required): 1. N I am an employer with 4. 0 I am a general contractor and 1 6. 0 New construction ; employees(full and/or part time).* have hired the sub-contractors 2. 0 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance. $ 9. ❑Building addition required] 5.0 We are a'corporation and its 10. 0 Electrical repairs or additions 3. 0 I am a homeowner doing all work officers have exercised_their , myself [No workers' comp. right of exemption perm MGL 11. ❑Plumbing repairs or additions insurance required]f c. 152, § 1(4),and we have no 12. 0 Roof repairs employees._[no workers' 13. Other Insulate comp.insurance required:] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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 isproviding workers'compensation insurance for my employees.Below is thepolicy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Lic.#: 3730961-00 Expiration Date: 1/1/11 Job Site Address: City/state/Zip:.w ; 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 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 $250.00 a.day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certi and the Xins enalties ofperjury-that the information-provided above is true and.correct. Si nature: '` Date: Print Name: -Erik Ne_rstheimer Phone#:(401)784-3700 or 1 -800 422 65 Pxtill Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Jssuing-Authority(circle one): 1.11oard of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: I 6? :_ RD CERTIFICATE OF LIABILITY INSURANCE OP ID 47 DATE(MM/DDlYYYY) PRODUCER THIEL-1 04/13/10 The P THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Preston Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOIq. East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-885-1700 INSURERS AFFORDING COVERAGE NAIC4 INSURED INSURERA: Zurich—American Ins Co, Thielsch Engineering, Inc INSLraERB_ Thielsch Group Inc.g �•:'.io<� Guizont�• S Llabll _ty Hi Tech R6alty Inc. iNSURERC: .'North American Capacity_ 195 Frances Avenue INSURERD! Hartford Insurance -.Company an Cranston RI 0291.0 p y .INSURER E. - COVERAGES - NE 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 DOCUMENIT`NITH RESPE=0 WHICH THIS CERTIFICATE MAY BE ISSUED OR WAY 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 NAVE BEEN REDUCED BY PAID CLAIMS. - LTR INSR TYPE OF INSURANCE POLICY NUMBER POL DATE(MMlDDIY'/) DATE IMMlpp LIMITS GENERAL LIABILITY - EACH OCCURRENCE 1,000,000 TX COMMERCIAL GENERAL LIABILITY 3730962-00 04/01/10 01/01/11 PREMISES(Ea occurencaI $300,000 CLAIMS MADE rX1 OCCUR - ., MED EXP(Any,one person) $10,,000 PERSONAL&ADVINJURY $1;000.,000 GENERAL AGGREGATE $2',0 0 0,0 0 0 GEN'L AGGREGATE OMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,0 O 0,0 0 0 POLICY X JET LOC _ Emp Ben. 1 000,000 AU70MOBILELIg81UTY � - .. - - - k X ANY AUTO 3730963-00 04/01/10 01/01/11 COMBINED D'SINGLELIMIT (Ea cd g2,000.,"-000 - ALL OWNED AUTOS SCHEDULED AUTOS - , BODILY INJURI' (Per,per, on) HIRED AUTOS _ - �- NON•OV.MED AUTOS ' - BODILY INJURY T . (POT aCGda,nl), PROPERTY DAMAGE -- _ (Per accidenl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ - L ANY AUTO - OTHERTHAN EA"'CC $ AUTO-ONLY: AGG $ EXCESSIUMBRELLALIABILITY - - ' .- EACH OCCURRENCE- $ 10,000,000 - A B X occuk CLAIMS MADE UMB 9263637-00 04/O1/i0 (woo/11 AGGREGATE $ 10y000,000 RDEDUCTIBLE -- X RETENTION $10,0 0 0 ti WORKERS COMPENSATION AND X TORY 1.1MIT5 EP. EMPLOYERS'LIABILITY - _ - - A ANY PROPRIETOR/PARTNER/EY.ECUTIVE 3 7 3 0 9 61—0 0 04/01/10, 01./O'1/11. E.L.EACH ACCIDENT $ 1,000,000 OFfICEWMEA4BER EXCLUDED? - E.L.DISEASE-EA EMPLOYEE $1,00 0,00 0 If Yes,describe under - - - - . SPECIAL PROVISIONS below - E.L.DISEASE-PdLICY LIMIT :T 1,000,000 OTHER - - C I Professional Liab DVL00002 6 80 0 „\04/011.1, 04/01/11 Prof Liab 2„000,000 D ILeased/Rented Eqp 02UUNTD5678 04/01/10 04/01/11 " 'Equ.ipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES!EXCLUSIONS-ADDED BY ENDORSEMENT I SPECIAL PROVIZ3IONS _ I CERTIFICATE HOLDER CANCELLATION SHOULOANY,OF-THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL i - IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE V ACORD 25(2001/08) @ACORD CORPORATION'1988 0 NoTEP��[�•l�z � ���1�,, s fi any x.� �, ,�k:�. � „r� r. �� � � � � � � 1 � �, 3 RISE Engineering, a division .of Thielsch Engineering, Inc: , Gaekell_ Associates.; a division of Thielsch Engineering,,. Inc. BAL Laboratory; :a divi"eion of Thielsch Engineering, Znc ESS Laboratory, a division of. Thielsch Engineering, Inc." ' W ALCO Engineering, .a division of Thielsch Engineering, .Inc. Inc.',-Water Management Services, a division o gf Thielsch En in e' erin g, r t .. g1m W O ice o onsumer fairin usmes� on _ g . 10 Park Plaza Suite 5170 Boston, 1 kssachusetts 02116 Home Improveontractor Registration Registration: 120979 Type: Supplement Card z J w Expiration_: 3/25/2012 THIELSCH ENGINEERING C. ERIK NERSTHEIMER ; 1341 ELMWOOD AVE. a a CRANSTON, RI 02910 ��%�•til �v Update Address and return card.Mark reason for change. Address Renewal' Employment Lost Card PPS-CA1 0 50M-04/04-G101216 �/ze TDanvrrco�uuea`!�c o�./�aaeac`uaelta Office of'Consumer Affairs&Bu iness Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registrationz�979 Type: 10 Park Plaza-Suite 5170 r Expira '1122j Supplement Card Boston,MA 02116 THIELSCH EN [ —= # (� ERIK NERSTH � I 1341 ELMWOOD _ !, CRANSTON, RI 029 z :"- Undersecretary Not valid without signature 1 a80 1 Ul 1 / The Official Website of the Executive Office of Public Safety and Security (EOPS) Mass.Gov Home t Public Safety Department Of Public Safety Licensee -Co cnplaints License Type Construction Supervisor License# 100459 Restriction WS,IC Name Erik Nerstheimer City,State, Zip North Scituate, RI, 02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search L ✓J4G.�LY�Y2i i7(�;i:t;({p�C/L OZ i/!!(.O.QaC2[:fLGL(� .. 1. _ -... ... Board of T3ididino Regulations and Standari'ts tkense or registration valid for individol use only HOME IMPROVEMENT CONTRACTOR I. .. before the expiration date. If found return to: Registration,_ 120979 Board of Building Regulations and Standards Ex iraiion 1: One Ashburton Place Rm 1301 k. P 3�.25/2010 - TYPe__SUP:;Plement Card T>a?stc�3i,Wa. 021.0$ _ IELSCH ENGfNE>Ef ING> IK NERSTHEiMER _ 1 ELMWOOD 6E*`�*=� ANSTON, RI 02910 Admmsti:uor Not valid Witbout sign Ire ht-tp://db-state.ma.us/dps/llcdetalls.asp?txtSearcYiLN=CSL 1004 59 t 3 F. �t r ME . l_ 4 • fir+ � r - r NAT 24531 - 1 ry t . f s y RISE ENGINEERING `' Federal lq#05-0405629 RI Contractor Registration No 8186 A division of Thielsch Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI 02910 (401)784-3700 FAX(401)784-3710 CONTRACT Page - 1 .THIS CONTRACT IS ENTERED INTO BETWEEN RISE - - ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER - ...,1 - PHONE ,DATE CIie/MS Beverly M Williams (508)775-0154 07/12/2010 110978. SERVICE STREET I tl _BILLING STREET - 15 Shorey Rd a 15 Shorey Rd SERVICE CITY,STATE,ZIP - { WILLING CITY,STATE,ZIP - HyannispoM MA 02647 �a _._.�__ ___�.__..-- - Hyannisport,MA 02647 JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 12 man hours. $792.00 RISE Engineering will provide labor and materials to seal heating and/or cooling ducts within designated unheated areas. This work will be ^ performed at the rate of$75 per man per hour,which includes materials. 4 man hours. $.300.00 RISE Engineering will provide labor and materials to install a 8"layer of R-30 Class I Cellulose added to 1120 square feet of open attic space. $1,232.00 RISE Engineering will provide labor and materials to install insulation and weatherstripping to 1 attic access hatch(es).' + $25.00 RISE Engineering will provide labor and materials to install 1 insulated exhaust hose w\roof mounted flapper vent to exhaust existing bathroom fan(s $100.00 RISE Engineering will provide labor and materials to install 10 4"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas. 1 , • s 9 RISE ENGINEERING - ' . >' 'Federal ID#06-odo5629 RI Contractor Registration No 8186 A division of Thielseh Engineering ' MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,R102910 } -3700 -3710(401)784 Page Z I : .THIS CONTRACT IS ENTERED INTO.BETWEEN RISE ` �- ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERINGDESCRIBED BELOW CUSTOMER , ,..APHONE, ,,,>. „,.`.. .;.DATE, COeOK# +. Beverly M Williams r (508)775.=0154 07/12/2010 7 110978 SERVICE STREET , - - $ILL,ING STREET ; 15 Shorey Rd 15 Shorey Rd. p P SERVICE CITY,STATE,ZIP - BILLING CITY,STATE,ZIP Hyamusport,MA 02647 *,` 14yannisport,MA 02647 : JOB DESCRIPTION $170.00 RISE Engineering will provide labor and materials to.install R-6 faced fiberglass insulation to'the exposed heating and/or cooling ducts in certain non conditioned areas. Total to be installed is 252.0 square feet. r.t jt $630.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for households where total income is less than or equal to 80%of median income, the Cape Light Compact offers 100%incentive toward eligible measures(not to exceed$2,000 total incentive.), ` 43,092.00 , 1 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM,OF ' '"One Hundred Fifty-seven&00/100.Dollarl.,` . . - '' $1,67.00, UPON FINAL INSPECTION_AND..APPROVAL BY-RISE ENGINEERING.CUSTOMER AOREES TO REMI7.AM0.eY x. .• 'M1 .. . .UNT DUE S1 FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER EO DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON':GUARANTEE%RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. '- DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SIG ENGINEERING . a : -, CUS- .ACCEPT NOTE: IS CT MAY BE WITHDRAWN 9Y US iF NOT EXECUTED WITHIN ' DATE OF ACCEPTANCE L' ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE _x SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO Do THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE + , ' 'ovv ,of�a �sta aorc)b � Barnstable *Permit# Lxpires 6 inon/rs from is•sr{y�tnle Regulatory Ser-vices Fee r d" Thomas F. Geiler, Director UL Building Division Torn Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax; 508-790-6230 . EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid w,'thoul Red.1-Press Imprint Map/parce l,Nunber c; Cy c Property Address XKsidential Value of Wor � 6„ Minimum fee of S35;00 for work under S6000.00 Owner's Name & Address 92 f.. 4 �, eA3 4.1 ! Q Contractor's Name 2714 Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) mg ❑Workman's Compensation Insurance am a sole proprietor S F P ❑ I am the Homeowner TOWN OF 3ARNSTA�L ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany e,ich permit.. Permit Request (check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be tal<en to ❑ Re-roof(hurricanenailed) (not stripping. Going over existing layers of roofj ❑ Re-side #of doors Replacement Windows/doors/sliders. U-Value C�:' _(maximum ,35) i/ of windows_ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.hlistoric,Conservation,etc, ***Note: Property Owner must sign Property Owner Letter of Permission, A copy of the Home ImproVenient Contrgctoz-s License& Construction Supervisors License is require j. � r SIGNATURE: i Q:\WPFII_FST0jZMS\bui1dingp mit forms\FXPRCSS.doc Revised 072110 l i i 9 - '- iIiastiachu set ts- Department of Public Safch Board of Building Rc- �ulations and Standards ' Construction Supervisor License License: CS 998 1 Restricted to: 00 ,w - VICTOR J'WIINIKAINEN PO BOX W BARNSTABLE, MA 02668 � c— J - �y ` Expiration: 9/29/2011 ('unmiissiuner Tr#: 2294 Y Office o ofumer A a-rs BV6-- ss egu of"on" p HOME IMPROVEMENT CONTRACTOR IJ Registration:_x100053 Type: ; Expiration: 46/8/2012 Individual V R J.WIINlKAINEN I _� tNIE � a 1 iij Victor Wiinikainen 58 CAPE COD LN f , BARNSTABLE MA 02630 i. cy " ' Undersecretary e License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 No lid without signature { f The Ctamnioirwea tlr of-Afcrssaclrusetts ............. Deprrrtineni of 1'ndustrinl 4ccidents ,— 09ce o/'Investigalions �• m - 600 Washington Street Boston, AL4 02111 1I•'Jt"'Y1'.rr!!r.£S g0v✓d7A N,Vorkers' Compensation Insurance Affidavit: Builder:s/Conti•4ictoi-s/E.Iectizcians/Plaimbers Applicant Information. Please Print Leobly ,y s Name. (Bu &�sinesOrgauization.'Lvdividtial) �IG� C1Q � - Q % V4 ��/Y�/� Address:;5-!9 /00� 45e.,,#_!2 4-;4,"- 2 citylState.IZipjOA,44/,4,,oVJ94 4, Pli n Are you an employer?Check the appropriate boa.: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I eaVloyees(full and/or part-time).* have hired the stub-contractors 6- ❑New construction 14�t<m a sole proprietor or partner- listed on the attached sheet- 7. ❑Remodeling s1u and have no employees These sub-contractors have p8_ ❑.Detawlition ivorking :for me in any capacity. - employees and have workers' [No workers' comp,i�isusance comp_insurauce.1 �. .Building addition required] i_ ❑ We.are.a corporation.and its 10.❑Electrical repairs or additions 3.0 :I am a.homeowner doing all work af35cers have exercised their I LEJ Plumbing repairs or additions myself. [No workers'comp, right of exemption per MGL 12.❑Roof repairs insurance required.]i c_ 152, §l(4),and use have no employees.{No workers' 13 ' Other coxvp.:insurance requuired.] 'Any appticaut thstchecls box#1.MUSt also fillout the section below sbawingtheirworkers'compensation policy infornrrtiarL t Komeavmers who submit this.affidavit in&i ating they are doing 91 work and then hire outside contractors must submit a new affidavit indicating such_ ' kontractnrs thaf cbeck this:box must attached an additional:she.et showing the:.nsme of the sub-contractars sad stare whether or not Those entities have employees. Ifthe sub-c.ontcactors:hsve empl yEes,.they.must provide their warken'comp.polio,number. Taro arr errtplol rr°tltrrtis prar rd rrg rtrork�rs'corrrperrsrzr on irisrrrrrrrce for.rr�y't�rrplo7 ens. Betow is tftepalir p and job site irformiatioll, Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date.- Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy"declaration page(sholidng the policy number and expii-ation date). Failure to secure coverage as requited under Section 25A of MGL c. 152 can lead to the imposition of criminal pma.l.ties of a fine up to$1.,500.00 anchor one-year imprisonment,as well as ci nl penalties in the form of a STOP WORK DRD:ER and a fine of up to$250.00 a day against the.violator. Be advised that a copy of this statement may be fomrarded to the Office of Investigations of the D.IA for insurance coverage verification. I do lt."veby rd under tP par s andpen:alh'es pedsiry that the itformatiorn protzded above is trite and correct. Si + ('� Date: Phone#: � � � 7r Z�An Official rise vnlV. Do not.tnrite in this area,to be coinpleted by citty:or toivn:offi aL City oi•Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4, Electrical Fnspector 5.Plumbing Inspector 6. Other. Contact Person: Phone M. 6 f f .. 41 °f THE T oy, ti t + BARNSTAHLE, "SS' Town of Barnstable �rFD MA'S A Regulatory Services Thomas F. Geiler, Director Building ]Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.mi.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must - Complete and Sign This Section, If Using A Builder . h , as Owner of the subject property r hereby authorize 1 "40act on my behalf, , in all matters relative to work authorized by thus building permit application for: 4 ' *dress of Job) /d Signature of wner ate Ae Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Forma on the reverse side. QAWPFILEST0RMSlbui1ding permit formsTXPRESS.doC Revised 072110 o ' P�otHET° Town of Barnstable % Regulatory Services BAVS7ABLE, Thomas F. Geiler, Director tars. o;E,. A,� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town,barnstable.ma.us Office: 548-862-4038 Fax: .508-790-6230 ----------------------- HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER" name home phone# work phone# CURRENT MAILNG ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for-all such work performed under the building permit (Section 109,1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirEtnents 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 t HOMEOWNER'S EXEMPTION The Code stales 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 ofconstruction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor:" Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 0721 10 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION •t Map 2=(P7 Parc S Application# Health Division Conservation Division �" `�' Permit# Tax Collector Date Issued Treasurer Application Fee J`' a'o Planning Dept. b �'c '1 �iEPTIC SYSTEM ` Date Definitive Plan Approved by Planning Board LIMITED TOE_#OF BEDROOMS Historic-OKH Preservation/Hyannis f' ���� v�17?eW. ebt- Project Street Address �' `►`�� Village Owner ��� L ���� C ��`( Address f'� -" � � f f try' �iC Telephone Permit Request LI S X���G" d� �� o �exi>CCU AF C i • F Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new- Zoning District Flood Plain Groundwater Overlayco _ . Project Valuation j�"e Construction Type p� -_ a t�� v, �p _4 ' Lot Size .-F 66 l' Grandfathered: ❑Yes XNo If yes, attach supporting documentation. Dwelling- ype: Single Family Two Family ❑ Multi-Family(#units) ''' Age of EAstin Structure � �� Historic House: ❑Yes No On Old Kin 's Hi hwa ❑Yes No 9 9 Y 'Basement Type '4 Full i ;T❑Crawl ❑Walkout ❑Other Basement Fir shed Area'(sq.ft.) Basement Unfinished Area(sq.ft) , Number of Baths: Full:existing Z new Half:existing C�3 new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing J_ new First Floor Room Count Heat Type and Fuel: XGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing New ® Existing wood/coal stove: ❑Yes <No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:4existing ❑new size Other: Zoning Board of Appeals Authorization ❑- Appeal# Recorded❑ Commercial ❑Yes �No If yes,site plan review# Current Use 1'19 ICI I Proposed Use - BUILDER INFORMATION Name !c a W1( % l CT�l�( l' Telephone Number 'K 3 Address C���-S• C�p �. License# Q 92 /9R S `�/t�,4 � Home Improvement Contractor# /C) c3c I - M � 0 2• � ' Worker's Compensation# �69/tL(, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �� � C G SIGNATURE ��1 DATE 4 �� FOR OFFICIAL USE ONLY 4- PERMIT NO. ` DATE ISSUED" MAP/PARCEL NO. "y ADDRESS VILLAGE i OWNER - - - s 1 f•� DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH -, FINAL. PLUMBING: ROUGH r►? m FINAL ' GAS: ROUGH 0 FINAL FINAL BUILDING -6g, � '—�� ��f 0 U DATE CLOSED OUT -� N rn ASSOCIATION PLAN NO. n f � i °FVE►o Town of Barnstable - �' Regulatory Services �'"M r'E� Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: t3z;( P, Estimated Cost 11, Address of Work./ Owner's Name: 1 1�� �` L l ,`1, 41', IA4 S Date of Application: O � l — 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 []Owner pulling own permit r 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�offtthe owner: Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav °FTME 1pyy Town of Barnstable Regulatory Services MAS& � Thomas F.Geiler,Director Eo jg. 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 &14 ,as Owner of the subject property hereby authorize �� ,t/�, � to act on my behalf, in all matters relative to work authorized by this building permit application for. ( ss of Job) Signature of Owner Sate Print Name Q TORMS:OWNERPERMISSION is ulations and Standards t 1 Board of Building Reg TRACTOit _ NIENT CON I HOME IM',ROVE, Reg istratlon,:100053 I ' xPjration .08120Q6 VICTOR J.WIINIKP: t a, 1 _ p Victor 58 CAPE COD LN \\ ~.,,"- Administrator ai BARNSTABLE,MA 02630 BOARD OF BUILDING REGULATIONSa I ;. License: CONSTRUCTION SUPERVISOR s Number.:;CAS, 000998 4' i + Bln�1a0 / 9/�I40 1 a I 1107 Tr. no: 3719.0 VICTOR dPO BOX 69 f '� W BARNSTABLE, MBA' r Commssioner c 1 -l- ,T l G T Advantage Mortpape Corp. ) E INSURERS. MORTGAGE INSPECTION PLAN [AT THE BUILDINGS SHOWN DO ( CDNFORA TO SETBACK REQUIREMENTS L�Tm IN SIDE . 4 REAR SETBACK ONLY) OF Hyannis ROOTED. OR ARE EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. G.L APTER 40A. SECTION 7, UNLESS OTHERWISE NOTED. MASSACHUSMS ERTIFY THAT THIS PROPERTY IS Not, LOCATED IN THE ESTABLISHED FLOOD A. COMMUNITY PANEL NO.: 250001 0008C DATE: 8-19-85 DEED IY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT TO THE RECORDED BOOK LATEST DEED OF RECORD. PAGE UILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE.PROPERTY.UNE IT IS ADVISED CERT. N0. E PRECISE SURVEY BE MADE TO VERIFY THESE MEASUREIAENTS. r ;ATION IS BASED ON THE LOCATION OF SURVEY MARKERS OF"VZIIEf ' gfd �� SNOT PLAN BK. �ln PAGE 57 1 PROPERTY SURVEY. VERIFlCATION OF SURVEY MARKERS:; `-AND: `• SHOWN, OMPU ACCURATE.SHED ONLY BY AN ACRATE. INSTRUMENT SURVEY..QRIVEWAYS AR PICTED PLAN 0 DATED ERTIFICATION TO BE USED FOR MORTGAGE PURPO ESQ ` OFFSETS AS SHOWN ARE NOT. TO •BE �r , .• �; , USED FOR THE ESTABUSHMENT OF PROP RTY.4 NEB, ""S 9�' BRA►®FORD ENGINEERING CO. P.O. BOX 1244 JADES W. BOUGIOUKAS R.L.S. 9529 TEL O L) 37 2396 TEL ('M) 373-2398 � R r � 47 . aia-OS7 Town of Barnstable *Permit# Fxpires 6 months from issue date Regulatory Services _ 00 Thomas F.Geiler,Director t S Building Division OCR j 1 Tom Perry,CBO, Building Commissioner � `� 2005 200 Main Street,Hyannis,MA 02601 -OVVfV Or '1 r www.town.barnstable.ma.us �� '/VSj,�aLL N✓ Office: 508-862-4038 Fax: 508-790-6730 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address : `S Residential Value of Work �� CD Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S E (`/i AA/n 40 S Contractor's NameV f4�%A r t"//'1�6 �r/`¢L -� Telephone Number a?® �4� Home Improvement Contractor License#(if applicable)- ®0 �� Construction Supervisor's License#(if applicable) 0 0 l� ❑Workman's Compensation Insurance Check one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) - p _ eRe-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Horne Improvement Contractors License is required. I SIGNATURE: c QTorms:expmtrg Revise071405 Town of Barnstable ° Regulatory Services ° Thomas F.Geiler,Director s MASS.. �Fcp Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize ��C��' "�/d`<1�P e �ll'`Lr'l� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Ow er Date 0 Print Name Q:FORMS:O WNERPERMIS SIGN . ...P � � • •''�� L/O�YI/I7200t1I/P,p.LG1L O�i/!/GQQ6Q�ALU60�.6 Board of Bujiding Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registratron 100053 :ate ypenaiidual VICTOR J.WIIN(IG41NfF�t __ W Victor Wiinikain z aj 58 CAPE COD BARNSTABLE MA 0206' . Administrator ifr f a k - _ TOWN OF BARNSTABLE A . 3 BUILDING PERMIT PARCEL ID 267 078 GE08ASE ID 16906 ADDRESS 15 SHOREY ROAD. P PHONE W HYANNISPORT ZIP _ 1 i I LOT �11 ' BLOCK LOT SIZE DBA i' DEVELOPMENT DISTRICT HY PERMIT 67476 DESCRIPTION 6 FT. FRENCH DOOR PERMIT TYPE BMISC TITLE MISCELANEOUS PERMIT CONTRACTORS: WIINI-KA.INEN, VICTOR J. Department Of ARCHITECTS: �00 Regulatory Services TOTAL FEES: $�5@ BOND CONSTRUCTION COSTS $2`,200.00 1 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE i O.E., ._.. * s�iuvsraBLc, • Mass. _. 039. 1� FD MPl a � - - BUIL--DI,NG DIVISION � - . BY . 1 . 7 X� G DATE ISSUED 03/14/2003 EXPIRATION DATE ;. .� T WN, OFF ARNSTA:BLE s BUILDING PERMIT BARREL ID 267 078 h GEQRASE ID., 1690,6r` ADDRESS 1.5 SHOREY ROAD ' HYANNISPORTIF . LOT 11 BLOCK fir.; LOT SI GE ., I` DBA DEVELOPMENT DISTRICT.:Hy PERMIT 67476 DESCRIPTION 6 FT- ..FRENCH DOOR PMMIT .TYPE -BMISC TITLE MISCELAN90US PERMIT � CONTRACTORS: WIINIKAINEN, VICTOR J. Department of ARCHITECTS:. 10 Regulatory Services -50 TOTAL FEES: 0 BOND $.00 OF CONSTRUCTION COSTS �$2,200.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE >Knss. BUILDP4G D ISION I BY f r DATE ISSUED 03/14./2003 EXPIRATION DATE -PHIS PERMIT CONVEYS.NO RIGHT30.000UPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY:EN.- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION-STREET OR 1 ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS., MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND� WHERE APPLICABLE, SEPARATE I, 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION 2. PRIOR TO COVERING'STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR I, (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. I 4.FINAL INSPECTION BEFORE OCCUPANCY. I. s ® Tj s BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 2 2 2 II 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH 1 _�I/O O - - OTHER: l SITE PLAN REVIEW APPROVAL 4 WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS j THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY j VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. BUILDING PERMIT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ' ' Parcel On < , Permit# T 7 Health Division .-J, a -I _ag Date Issued VA /� G� r�i t.lf= Fi gr .Conservation Division �' �� R ��`ABLE Application Fee Tax Collectorr� ad Permit Fee CT P't Treasurer STEC SY°' IxosTALLED IN COMPLIANCO Planning Dept. WITH TITLE 5 f S 10 N ENVII�ONIEAERiTAL CODE AIdG Date Definitive Plan Approved by Planning Board TOWN REGULAMNS Historic-OKH Preservation/Hyannis Project Street Address 5- 5C Village Owner 49 te— 1/,e4— ` S Address &5—Aia �1 , tsltEfe` G Telephone 0 Permit Request �< �� ! l CIYEH ��� 41q Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ® Total new �J Zoning District_ Flood Plain Groundwater Overlay Project Valuation �< 2r Construction Type W<s Lot Size Grandfathered: Cl Yes 6IQo If yes, attach supporting documentation. ' Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 44eo On Old King's Highway: ❑Yes Basement Type: , uIl ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) - 10 0Y X Basement Unfinished Area(sq.ft) Ie,; 'rL Number of Baths: Full: existing new Half:existing new Q' Number of Bedrooms: existing new Total Room Count(not including baths):existing _new�_ First Floor Room Count Heat Type and Fuel: 6.Qe ❑Oil O Electric ❑Other Central Air: ❑Yes 121 to Fireplaces: Existing �� 'New O Existing wood/coal stove: ❑Yes 44e--' Detached garage:❑existing ❑new size Pool:❑ex�isting ❑new size Barn:❑exist' g ❑new size Attached garage:❑existing ❑new size Shed:®'existing ❑new size Other: L� Zoning Board of Appeals Authorization- ❑ Appeal# Recorded❑ r Commercial ❑Yes ❑No If yes, site plan review# Current Use c Proposed Use = a BUILDER INFORMATION. / Name / E? Telephone Number Name V1 Address ,r � �' LG� �Pr . License#- C C3 Home Improvement Contractor# /C>0 d �J Worker's Compensation# 161qg _ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �� DATE © � `— FOR OFFICIAL USE ONLY PERMIT NO. J r' DATE ISSUED MAPJ PARCEL NO. -• f - ' s , ADDRESS VILLAGE OWNER DATE OF INSPECTION: t FOUNDATION ,J FRAME 6 f/eh'I 03 ,g l o I-, , - n INSULATION FIREPLACE `• ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH-i ` FINALn + FINAL BUILDING /�7 ��;�' n�F3 �d 3 C% �• DATE CLOSED OUT ::; • 'r c t ASSOCIATION PLAN NO. _ t The Commonwealth of Massachusetts Department of Industrial Accidents office 811firestifffilipffs. 600 Washington Street Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit name: location city /�/�!'�Gy� � /�C dvy �� phone 7 V6 I am a homeowner performing all work myself. Tam a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job r pgz - 3 r r x COtltPariY name - r IN ka MV address 'F r r max; s 5- WO �s a EatY � "��� ahorie# Elm j 151 nisurance I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices C0lI1PariYnalile p /gg a fir/ W � � v � � , ,.r' e'' 3 k 3rvzaa�s _ '," � "` Y .ate SA • wry 3` yFd�-/ �,' 4G�� F� e ,� ��4h�Yi�. �E � ��' P ,���'�"��' �"?'�, 3, � o: i ;city ���� � ��✓� �Rom:� ��.���` „ �' . �__ ... .. _.' .ph�o�le,#n,.A.� ....... " .��.,,, _ �.4�, rips MM- 51 insliraric"exeo Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ce nder Ippains and penalties of perjury that the information provided above is true and correct. � � ^�d - 3 Signature Date 3 ,� Print name J �— ( � L � r G� Phone#� 91 official use only do not write in this area to be completed by city or town official city or town: permit/license# F-lBuilding Department []Licensing Board . check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; FlOther (revised 9/95 P]A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The�Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 . fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 oF��E tom, Town of Barnstable P y °^ Regulatory Services &UMSTABLE,g Thomas F.Geiler,Director MASS E16 9. .�6. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type.of Work:kq � Estimated Cost Address of Work� � / e Owner's Name: 13 P_V q_ '1 C Date of Application: ` 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 ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. (3xRd �tTTS 0 PERJURY I hereby apply for a permi the UJJG/��c--�--- Date Contractor ame Registration No. OR Date Owner's Name 730 CRtR Appaldh 1 Table.1S 2.1b(continued)tl pmeriptive packages for One and Two.-Fsraily Restdeatlal BaUdtaga Hated with Fossil Fuels MAXfMUM MINIMUM slab 'Heating/Cooling Glazing Glazing Ceiling Wall Floor Swmentta Equipment F.Slicieacyj Area'(Y.) U-value R-value' R-value' R-valuer Wall Perim e R-value' R-valuer Package 5101 to 6500 Heating Degree Days° 6 Normal Q 12% 0.40. 38 13 19 10 6 Normal R 12% 0.52 30 I4 14 1Q 6 .85 AFUE S 12% 0.50 38 13 19 10 N/A Normal T iSY. 036 38 13 25 N/A Normal 19 19 IQ 6 U 15'/a 0.46 38 NIA 85 AFUE y 15% 0.44 38 13 25 N/A 6 85 AFUE W 15% 0.52 30 19 19 10 N/A Normal x 12% 032 38 13 25 N/A N/A Normal y 19% 0.42 38 19 25 N/A 90 AFUE Z 19% 0.42 38 13 19 10 6 AA 18% 0.50 30 19 19 10 6 90 AFUE ADDRESS OF PROPERTY: D 1. ADD 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: r 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): tap_ Pe5c�g, AlF NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-foras-580303a 780 CMR Appendix J Footno tes to Table J9.2.Ib: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 f of decorative glass may be excluded from a building design with 300 ft of glazing area. z After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 11.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation•thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. •Wall R values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry, log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaees,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement di::scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. ''For Heating Degree Day requirements of the closest city or town set,Table J5.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table 11.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). �oFt�Ela,, Town of Barnstable Regulatory Services anxxszABLE, y MASS, �, Thomas F.Geiler,Director $A f63q. �0 IEDr�+a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L , as Owner of the subject property _ P P riY hereby authorize Ca �� g c ` 6(to act on my behalf, in all matters relative to work authorized by this Buildmig permit application for(address of job) Signature of Owner Da e Print Name Q:FORMS:O WNERPERMISS ION 1 Board of Building Regulations and.Standards M1 HOME IMf!�GVEMENT CONTRACTOR I Regtrat►ara 0053 3 ` fxptratioli �I/2004 ei widual t Rim"- R` �I VICTOR J.WIINIKuAIVEk Victor Wiinikainen\� �1 58 CAPE COD LN I BARNSTABLE,MA,02630 Administrator- r BOARD•OF BUi6LDI�FG REGIiLATIONS l} License -C�NSTRUCTION'SUPERVISOR } j y. 000998 Num er.'lis' r:I h'a f _ J�r9'l,'*,, "fir no 30�� •� M1 '. ReQkW0e-G;'P - I VICTOR J WIlW11U,INE1 PO BOX 69 ' I j W°BARNSTABLE, MA 02668' Adrninistraior TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �'' to Parcel Permit# �f Health Division Date Issued Conservation Division Fee Tax Collector Treasurer Planning D pt. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village 'A! 2 jo- 0 l Owner EU �/{lGl� t Address �� ^�R Telephone Permit Request %A ''X 002 0 rJ= VIA LUK_ o. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new OP I Estimated Project Cost Q' Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. ! Dwelling Type: Single Family !�Two Family U Multi-Family(#units) Age of Existing Structure Al Historic House: ❑Yes 61"o On Old King's Highway: ❑Yes Basement Type: 6<II ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) C eA- Number of Baths: Full: existing l new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: &6'as ❑Oil ❑Electric ❑Other ' Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes A-N'6 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use - Proposed Use BUILDER INFORMATION _ Name / rI, tl�/� �/Y'��/ Telephone Number 4 4;�'2 �l G Address S rx License# d 9 g` Home Improvement Contractor# d 6' Worker's Compensation# ALL CON TRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - DATE :�S `�� 0 GN r FOR OFFICIAL USE ONLY PE6IT.NO. -' DATEISSUED MAP/PARCEL NO. ADDRESS . VILLAGE_ OWNER- _ �^ - h p ! �' '` `' ' �, :/,•f� �, t DATE OF INSPECTI i •FOUNDATION r 'y' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL.=. 3 yr' •.: GAS: ROUGH FINAL`- t� FINAL BUILDING. DATE CLOSED OUT ASSOCIATION PLAN NO. Y�. a .Z- Department of industrial Accidents Off ev ofIDY8502110,9s 600 Washington Street Boston,Mass 02111 Workers' Cora ensation Insurance Affidavit r„ Xxxx nameV1 /cIS/' l location city /� �� �j A hone# O —2> ❑ I am a homeowner.performMg all w6rk myself. -am a sole etor and have no one worlds in any c;�acity m lover rovi ' workers' compensation for my employees•worlang on this job.:: ::: ::: ::;;:: ; I am an a P .........:::. ❑ P. ....::::::::::::.:.:........:::::.:::.:::,::::..:::::,...............:... ...::..........:.:::::::.... .::. comaanv name: . ad aye s ..:........ . ............. c�tv . ... one, . .... . insuranc e co. oiicv ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the-contractors listed below who have winworkers' co eizsation olices: .......................:.... ..::::.:...:..:....:,>,•:....,.:,.::,.::.,: ;::;.>.::.::::,:.:.:: ::.;:;.;;:.:<?.::.::,.:?.}::::.::::;:::?<::->:;.;>::::.::;:;.:.... e following mP . ::.:::.:: .:.: ::::::::: :.:.::...:::.::::::.::.:.:,.:.: :..:::............:.......::..::::.:,::::::,.,..,:::...... ::.. .......::... :. ......::.:::::::::..................,.,................... ....::::.::::.:.......:.::.....:.::::........:.:::.:. .. are 'k::;:::;:���::i::%::'`::_;::::;�:.'•isi;:ir`:':�:::'ti':�:'�}:ai5:�??ir�fi:;::�:is?•ii::i: �M1riiir>:2�>:��>i>:_ `I ::{^i:•:?:i:C:::{iiri:-'+,iiv�ii:}::?{:};:}:;:<••:v:;i}i:;ii:tiiLi:(:iiiiiiii�>�i::��i?:y{!: ::+�i:?.`:ii:+�:i'r:}!i�iiiiiiiiiii i:'Yi i ::J::�:. .....:::::::::.....::::::::.v::v.v::.v::i:::L::ni}iii}:?i�:•i:•iiii?:t�i lull:•iii'ritii?'`:::.-.•:.}.:p:v:•::•.. .... ..w:n:::::::v::w::.v.v::::.:::r:•::w::::;::::.:::::::::::.... ..... ..... .... ........................................v:n:•r:::x}:.....n..rv.;?.}•:......::::::::::.:;;•• }}::?::.v::...::•+::?:'•.v:::v.v:::::::;.} ::v::.v.:w.v:::::.�:...... .............. .......... ............ ............:........:.............:-.v:n..r......w .Y...........:.....:............;•;.}:J:JY n-.v.vx:ti•::v.}'v:•i-::..- ............................................................................:Js..............,......... r.. .... ..... x:::... ....... ........ ....... ............. .............. ........rr ................ ..rx.�.;�•.......M'iC::.v:::.v:::.}?:???•}:•i:M'r.,;:::.v::••:........::::....• -- ....................... .a.................. r ...... #• .c,. ,.., .............. insurance- .::..::<::.::..:.:....>'.:.:?.:?......}}:.....::.:::::.:..:::.. ,:.::::,,...,.:.:...... .. pog 0/0000/0 :�:: :� ;;:x;; �::nip:�<i�3:�: :;t::::: ;;:�:;i:;:�:�::;;:::;:;:::::;;::c;:;;S:::?::;x::;:::::;r`s::�t:::::�:?;�:;::;;•}.}:?;::??•:?•}:�:<•}>:::::•::::•�:::.:.:....... address: _ . ... ene .....,.:.::,,,:..... FaibuY to secure coverage as required under Section 25A of MQ.152 can Ind to the impn of criminal penalties of a fine up to s1,5o0.00 aadtor one yeah'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a due of$100.00 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 veriltcatioa I do hereby cerii a pairs penalties of pa7ury the the urjomta ion.provided above is tnu and correct .2' 0� Signature Date � ® , Print name D `AIJ ( � Phone# ? ® rG Ccontact use only do not write in this area to be completed by city or town o®dal own• permit/License# ❑Building Department CLieensing Board k if immediate response is required. ❑Selectmen's OMee ❑Health Departrment person• phone#, �other- (gmw 9195 PIA) Tr ml w�. 4b 4 tFIK N �,�ADAAIMI _ e- Aw� BOARD OPau Roc N DONS Op09g8 es 0 00 66 i vpo BO NS(Pg�R' t °F1HE A °� The Town of Barnstable 1ARNSTABLE. • MASM& �0� Department of Health Safety and Environmental.Services ''rfn 59. a 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'9 7 PWV eg%ry&540 ��� Estimated Cost Address of Work: � Owner's Name: Date of Application: 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 ❑Owner pulling own permit Notice is hereby given that: - OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the a �ntof the owner: Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �1 Parcel ©� 19, Permit# r� Health Division ^' yp/ ' L9� Date Issued Conservation Division Fee - c7` Tax Collector Treasurer �,` SEPTIC SYSTEM N.UST E "'STALLED IN E Planning Dept. C®I�PLIANCE WITH TITLES Date Definitive Plan Approved by Planning Board. ENVIRONE NTA`°C®DE.AW 6��f REGU ATIONS Historic-OKH Preservation/Hyannis �✓ �� ®��"Project Street Address ' Village f ors © /"sle Owner E �- �7� - . Add ess/��� Telephone 22 5 Permit Request 7e,c�L Square feet: 1 st floor:existing ® G proposed 2nd floor:existing proposed Total new c k- Estimated Project Cost J-!!� . Zoning District Flood Plain Groundwater Overlay Construction Type &-k9 co Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes &18 On Old King's Highway: ❑Yes XNo Basement Type: mull ❑Cr`awl ' ❑Walkout ❑Other Basement Finished Area(sq.ft:) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new . Half:existing Q new 'Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: &Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes Ckflo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ,, V0 Detached garage:❑.existing ❑new ,size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# . Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name r1`l�cfC�/�Y'5'/'yTelephoneNumber �n� "�iG "��/0'0 ' Address �/� License# �G9 O Home Improvement Contractor# /,:::DQ Worker's Compensation# /4-4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE �` _ �/r ' FOR OFFICIAL USE ONLY di ~ l r ! PERMITMNO. DATE'ISSUED' J { }"•< f , , _ MAP/PARCEL NO. f'M' - jk. '. c :� �`4••�, �i./rf e� � el � • • 'J .;Y�, � ++! � - #a ," � �� 1 i.", 1� ��. I ` '`, , ADDRESS VILLAGE OWNER - { r '�, ;.' tz DATE OF INSPECTION ' FOUNDATION - . , ,•- .,'• a, T� tom. � - .. '> � �� FRAME INSULATION ..ts• = _ . _ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH, ' s FINAL FINAL BUILDING l!/;� ! i -DATE CLOSED OUT ASSOCIATION PLAN NO. ✓ - ^, f i''r' - . .. , ♦ 4 ! ,yam • 4c34 t �. 1� J' .21 �ez, 1 � �o-p- I � 0cr, ®® Advantare MortFmPe Corp. TITLE INSURERS. ) MORTGAGE INSPECTION PLAN THAT THE BUILDINGS SHOW DO ( ) GpWFORM TO SETBACK REQUIREMENTS LAT0 IN JT, SIDE. k REAR SETBACK ONLY) OF Sd1111!! `� �vl) iNSTRUOTED, OR ARE EXEMPT FROM MLATION ENFORCEMENT ACTION UNDER MASS. C.L CHAPTER 40A. SECTION 7. UNLESS OTHERWISE NOTED. IMAASSACHUSETTS CERTIFY THAT THIS PROPERTY IS Not LOCAT® IN THE ESTABLISHED FLOOD COMMUNITY PANEL NO.: 250001 0008C DATE: 8®19-85 DEED ANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT TO THE RECORDED BOOK � THE LATEST DEED OF RECORD. PAGE BUILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE.PROPEeTY.LINE IT IS ADVISED ORE PRECISE SURVEY BE MADE TO VERIFY THESE MEASLMEWFNTS. CERT. NO. r1�FICAT1oN IS BASED ON THE LOCATION OF SURVEY MARKERS o6'b I�1EliS<,' 14R1 V S NOT PLAN BK. PAGE 57 T A PROPERTY SURVEY. VERIFlCATIOtd OF SURVEY MARKOtS:.UM%.AND: ` SHOW. CCOMPLISHED ONLY BY AN ACCURATE, INSTRUMENT SURVEY.`.DRIVEWAYS AR PICTED PLAN � DATED LAN. TO BE USED FOR MORTGAGE,PUFtPO ES4 OFFSETS AS SHOWN ARE NOT TO SE USED FOR THE ESTABLISHMENT OF PROPERTY E'�NE54: ' SCALE: I-- Q RADFORD -�" ENGINEERING COO •�.., �L x ® �- P.O. BOX 1244 JAMES W. BOUGIOUKAS R.L.S. #9529 HAVERHILI. MA. oI839 TEL (IM) 373-2396 \ ff 7 2 ;�. X (� y . A C I w , G - Peck l� s:eoP c:E r w w . ,. S ��+xi`1,r f", jt n 1 1 / _ r. 2•Y ,y! T'�A� k F�7 K• P .., b - - 4 a r �t M , • t T�' s2 ` .FX(frt(/�' , DF Gt.)LL�qs X T a 1 , s y, - ttc� Y. \Joy HIS 1 € 40 , Pi Xv, , e t i .— , �y 04 R / � • r ' 1 , , A) ` The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 ` Workers' Compensation Insurance Affidavit name: / location: 7~� CW�o rb P city A�/gi /`1 ��� '� � . C� ohone# ❑ I am a homeowner performing all work myself. I am a sole rietor and have no one workin in aav ca acity /�% � �///J%%D%%%//////�//,�//��G,��G�''//////.�i^ ,��/�////%//,0�/,////IG�Y�///�i,�y�i/O��r' ❑ I am an employer providing workers' compensation for my employees working oa this job. wmoanv name• • ;. ..,.. :...,:...:. .;:.: ;..;,<;..::::::;:..::. som address- .:.....:..:..:::..::..::.:.::....... city, phone.#. ,..... insurance co. olicv# / /// // // ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: : • company-name: _ ::; ;.:::: : ;::at.;:<:.::::: _. address• .;::, :.:. ................ city ._ .»z<;e::; ...;;. .. .. ................. fiisarance eci. •::.::,;;;:.,:,..::::::»:>;::.:..:. .... ....... . .. ..,... ,.;,,:::,,.,.:: oirev#.. ....:.;,,<,:<:<:>«�:�>: :;::•;:;.::: I. ,p,/ ///// / ,O////////O. vname ;>;•:::...::....:::.. _. .. .:.. . ..::,:::...........::•::.;;:.:::.;:;:....;.:::.:>;: .:.;::;:;.,....;;,;;:;,,,.,.::::.:.•::..:<t:;<•;::.:::;:<: :> address: dtv none#• :::.. .:.:::.... insurance co:. Failure to secur a coverage as required under Section 25A of MGL 152 can lead to the imposition of crbnbw penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I undersmnd that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification 1 do hereby c the paucs d peenaa ties/of pe{ju that the information provided above is true and correct Signature z� r`�✓ Date ` � `F2 Print name C ® b J�z�C �t� Phone# ,4qg � r�40 official use only do not write in this area to be completed by city or town official city or town• perndtflicense# ❑Building Department (]Licensing Board ❑checkif immediate response is required ❑SelectmeWs Office ❑Health Departmtsrt contact person: phone#; (]Other. ({evned 9/95 P1N oFTME . . °: The Town of Barnstable • snxxsrML& • � Department of Health Safety and Environmental Services Anro nee+" 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:*&d.0y40 C .4'/7-1r Cost ��J Address of Work:5S//w£ we. a Owner's Name:_ Date of Application: 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 ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALPilo I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav 5/1 .p' YY* Vx. F DEPA IMEN? ' r PU tC SAFETY • r CONSTRUCT!ON'SLP�='dIS R LICENSE 4S z 0 8���: il9i.� ?Q94 09" I .4e Ristr lcto 'd=.: 30 ;.` 1VICTOR ',NfKAINEN PO BOX 69 N SARIISTAB!E, NA, '02668„ R _ ?a'y. qt.sue an :✓AB•tOCi ./� HOME IMPROVEMENT CONTRACTOR J -RegistrationI0003Y4 }, > t t ype . INDIVIDUAL f Ezpuation_ OblOB/00 VICTO NIINIKAINEN " k rr t58 CAPE COD LN `o �s9ARNSTABLE MA 02630 ADMINISTRATOR ft / 9 .s 147 00, r - ` p�AMir, , 22 r r a t� .ii a r -e. t ; 5tjEx I .:. 7"n ea A .. •�a-s- w��c.i.�r_c s � s!4!o`,'. _D—L_.— �—s r,. k, x U, 77 , t , y, .. lF\ .. - ., r fly. 4. =�,. M It . CAc ti, �g _ o ss 'ry y r �r '6r r i NON k? 10 y` y" „ 4.t 4�eqYa in- L� �c � / a��C° O; L 4. y i Teri � �, - / � _, .. � / A ✓ � 1 ly � _}�' .. T' 7. r n t Town ®f Barnstable *Permit# & Expires 6 months from issue date Regulatory Services Fee Thomas F.Geiler,Director 318b1SN�lbB�p NMO��uilding Division 90010 Tom Perry,CBO, Building Commissioner 8dV 200 Main Street,Hyan#s,MA 02601 � www.town.barnstabl'e.ma.us 0 iice:.508-862-403 d X Fax: 508=790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 7 Property Address �5.� lS 2, [residential Value of Worker Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Con tr cfor's Name . C,;�A tq3t ��;;Telephone Number©?S 31C�12 Home Improvement Contractor License#(if applicable). Xc> a Construction Supervisor's License#(if applicable) or>C--� ❑Workman's Compensation Insurance Check one: ' a sole proprietor ✓f P y~ ✓�aaoaczuaeLld ❑ I am the Homeowner ;. _ Board of Building Regulations and Standards ❑ I have Worker's Compensation Insurance j HOME IMPROVEMENT CONTRACTOR us Insurance Company Name Registration_ ^100053 .Expiration,,,6%8/2006 Workman's Comp.Policy# r Type FndiWual Copy of Insurance Compliance Certificate must be on file. VICTOR J.WIINfi<AtMENr Ti Permit Request(check box) Victor Wiinikaine a `58 CAPE COD �—�, BARNSTABLE,MA 02630, Administrator ❑ Re-roof(stripping old shingles) All construction debris will b4 ❑Re-roof(not stripping, Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner-Letter of Permission. Home provement Contractors License is required. C ft _ SIGNATURE: � -- Q:Forms:expmtrg Revise071405 pF'THE r, Town of Barnstable Regulatory Services MASS.IE$ Thomas F.Geller,Director 0 9. ♦0 '°TForu►+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 der Must .Complete and Sign This Section If Using A Builder I, tJAAJ'0I1-;-w,,, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for ss of Job) / O Signature of Owner Da e e2 Print Name 4 • Q:FORMS:OWNERPERMISSION .sue Rip.. 40C &- cm,—RA—s A r 6 WC s -APACRIZ II 1 ��4CS r f � f k i k' 9' b ............ Y , STD y S14®S IT - /e. tliF� aoo _ T i i t f - f �M.; R \� �Xr� et i/ T— £ I Ab _ � 91, : R U E t\ ° y o „ r �• 'r qN' � r /1 Gt . .S SAGA £ �4- l A-96,A1 Z/s p,