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HomeMy WebLinkAbout0043 SHOREY ROAD l T Town of Barnstable 4 _ ter: . Po`'st This Card So That itis Visible from=the Street A roved',Plan's°Must be'Retained on ob and hi " pP s Ce'rd Must be Kept ranee Posi ing ted n "I Fi - .. I ,g.6 ®. 10 U„tl na ,nspectign Has Been Made. �, „ �„ a Where a:Certifica't f 0ccu" anc >'is°R u�red sueh Bual i f = .`," M:''' " , d rig shallNot be Occupied until ahFinallnspectionfias been made ., ,; p Yq. . ._. _4 rerm it Permit NO. 6-17-4276 Applicant Name: VICTOR J. WIINIKAINEN Approvals Datelssued: 12/21/2017 _. Current User Structure Permit Type: Building= 'Foundation- Residential INTERIOR Work Only- 'Expiration.Date: 06/21/2018 - Residential Map/Lot 267-170 Zoning District: `RB - Sheathing;- Location: 43 SHOREY ROAD;HYANNIS � t Contractor Name: VICTOR J. WIINIKALNEN Framing. 'Owner on Record: GILBERT HENRY A& DIANNE CTRS ' Contractor License 100053 . 2 Address: 4 DICK DR Est Pr ject Cost: $4,800.00- WORCESTER, MA 01609 � `, Chimney: Permit Fee. $85.00 . Description: Build nine foot long by 2ft/4inches wide closet,5 ft Igng bey 16inch t.ee Paid $85.00 Insulation deep cabinet. 7 and 1/2 ifoot long wall behind cabinet andend of closet.Work to be done inutility room in the basement Date 12/21/201°7 Final: 2,? � ; Project:Review`Req: Plumbing/Gas R ° '•. °� Building Official Rough Plumbi ng: r Final Plumbing: -This permit shall be deemed abandoned and-invalid:unless the work authorized by#his permit is commenced within six months after issuance. Rough Gas:. All work authorized by this permit shall conform to the approved applicaii and the approved construction documents•:for which this permit has been granted. All construction,alterations and changes-of use of any building and structures shall be in compl ance`withthe local zori rig by laws and codes. Final Gas. This.permit'shall be displayed in a location clearly visible from access Axe, t or rdad and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. v Electrical The Certificate of Occupancy will not be issued until all applicable si natures b the�8�uildin and"Fire Officials are rovide on the"s ermi : `Service:_ Pp g y g P d g., P t 'Minimum of Five Call Inspections Required for All Construction Work . x. 1.Foundation or Footing Rough: �. x... ' 2.'Sheathing Inspection 3.All-Fireplaces must be inspected at the throat level before firest fluelining'is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage ROUgh: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final 7.Final Inspection before Occupancy „ Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. ` Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT . 80ILDING DEFT �ZEIE DEC 112017 ........Application 13umber. ....�. .� -...... . ........................... A. TCl/VN of E3AR AS" Pra Fee.......................................Of=Fee........................ TotalFee Paid..................................................................... TOWN OF BARNSTABLE Pc=itApproval by.... .........................on... BUILDING PERMIT ..........a..�. ...............Pa� .. ••-•- N Section 1 —Owners Information and Project Location M Project Address 3.� ,B�c�,Y �®/4,� Ylllagel �,ioR-7 Owners Name Q i A/V/,/Z G%1—, �F R7— Owners Legal Address ` I OZ? T State //V = Zip o fo Owners Cell# GCS 8?S 7?1 g E-m6i Section 2—Structural Use (Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3—Type of Permit i ' ❑ New Construction ❑ . Move/Relocate ❑ Accessory Stricture ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify Section 4—Detail Cost of Proposed Construction ��© Square Footage of Project t, C4 0sz 7 4;Aej,4C4i- Age of Structure Dig Safe Number #Of Bedrooms Existing A3 Total#Of Bedrooms (proposed) 1 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Last updated:-111712017 Section 5 -Work Description 12 Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage . ❑ Smoke Detectors ❑ Plumbing ❑ Oas ❑ Fire Suppression ❑-Heating System ❑ Masonry Chimney ❑Add/relocate bedroom -.---_---Water Supply Public- - --0_Private Sewage Disposal ❑ Municipal LJ On Site Historic District ❑ Hyannis Historic District ❑ Old Rings Highway Debris Disposal Facility:A g J`IeAieff P i �_z 11"4 I an using a crane C Yes [![`Rro Section 7—Flood Zone Flood Zone Designation J Within or adjacent to a wetland,coastal bank? Yes ❑ No a' Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes No Last updated 11/72017 0'a- lY /• �cra� c� /7r�9�.�e� . d o CfOf L°I nyerl¢ ,J 6 � P ' r _ Ear `' f DES 1 l 201 fs To 7. WN oFaA�'�'SB ;.r The Commonwealth of Massachusetts , -IDepartment of Industrial Accidents ,- - Office of Investigations 600 Washington Street _ Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plnmbers Applicant Information `�' Please Print Legibly Name(Business/Organization/Individual): C � -J Y Y/L/�/ GR !'�, ` Address: City/State/Zip Phone#: 2,9 21 Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employ er with 4. ❑I am a general contractor and I p Y 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner listed on the attached sheet. 7._.❑Remodeling These sub-contractors have • ' ship and have no employees 8. ❑Demolition workingfor me in an capacity. employees and have workers' 9. ❑Building addition. k Y aP tY [No workers'comp.insurance comp.insurance.$ required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions; 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑.Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152;§1(4),and we have no "t employees. [No workers' 13.�Other1a.Y� ��r'. comp:insurance required *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is'th'e pollcy.and job site information. , Insurance Company Name: - Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip-_ F Attach a copy of the workers'compensation policy declaration'page(showing the policy number and Wiration date). Failure to secure coverage as required under Section 25A of MGL c. 152'can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of. Investigations of the DIA for insurance coverage verification. I do hereby certify under the ins an enalties of perjury that the information provided above 1i true and correct i ature: ?� L s Date: Phone# �d b U Official use only. Do not write in this area,to be completed by city or town official Y City or Town: Permit/License'# Issuing Authority`(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector_ 6.Other Contact Person: Phone#: Information and Instructions � Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,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, §25C(6)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,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to 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. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your 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 D-,partment of Industrial.A dents office of Investigations 600 Wasbington Street Dostm,MA 02111 TeL#617-7274900 ext 406 or 1-977-MMSAM Fax#617-727-7749 Revised 4-24-07 tw.3niass.gav/dia • y I a Office of C`onsnmer Affairs 6c:Bnainess ltegulatisin : HOME IMPROY MENT CONTRACTOR �r; Registration1fl0053 Type s, - 6/8�Zfl98 Individual • Expiration �. x3 VICTOR J.WUNIKAINEI+t� v Ft Victor' Wiinikainen s i _ n , .. 58 CAPE CODsLN _.. } BARNSTABLE,MA 02630 Undersecretary Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Go nstrtri�tit?ristt !visor a CS-000998 Ejx Tres 09/29/201 u a u ; ` , VICTOR J WHNIKAtMEN*r gyr PO BOX88 WEST BARNSTABLE MAC 02668' A Commissioner V`�' Section 9—Construction Supervisor Name C-leA aJ, c E AA?4 z Telephone Number 6 2- 7 87 c� Address c'.gAc�s,p City t5rg�E jF4*State Zip > z h License Number Cs-ooa 5?1? License Typeu a wrg- Expuaticn Date 0 9'4-2 ?— �201 9 Contractors Emafl V'�-L^ 1f eV gAr Cell# I understand my responmWities under the rates and regulations for Licensed Constraclion Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I tmderstand the constraction inspection procedures,specific inspections and documentation by 780 and a Tqwn of Barnstable.Attach a copy of your license. c Signature ---� Date /�2 -O 7 ®f Section 10—Home Improvement Contractor Name Yip�t� .tri�vi�t ��i�' Telephone Number O'g _:3-4 2 Yl Address.3_a TAPE c+p.y 4-Aiyg- City state 22 Zip crz - Registration N er/r�t5 I d my responsibMes under tale rules and regulations for Home Improvement Colractors in accordance with 780 CUR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation by 780 Town of Barnstable.Attach a copy of your ELLC... Signat�e �-\ Date 7- Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Camstructim Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and doctunentatian regaired by 780 CMR and the Town of Barnstable. Side Date APPLICANT SIGNATURE Signature Date / :57�-�®j C� aPrint NameVl�t/o 1�`.-</VV� I1A/Tel ePhone Number � E-mail permit to: Last updated:I Inrzo 17 Section 12—Department Sign-Offs Health Department ER'Zonmg Board(if required) EI Historic District , _❑. Site Plan Review(if required) ❑ . Fire Department ❑ - Conservation - ❑ J For commercial world please take your plans duecdy to the fire*deparbneat for approval Section 13— Owner's Authorization �•� � as Owner of the subject property hereby authorize Vie' ,012 . to_act on my behalf; in all matters relative to work authorized by this building permit application for: y3 Sfiol),vy 12ooDigi°� �� - (Address of job) = Signature of Owner date ,,, Print Name Last updated:1 /7/2017 Town of Barnstable Building Post';T *� hismCard SoThatit s Uisib?IedFrom,the Street Approved Plans Must be Retamedon Job and=this Card Must be Kept - * M MRASL Permit.B, =^:: �R e ra h rs 7 ' •3= k'°' ",'u Y '� z e t. f"3 -v "� 3PostedSUntil�Final�lnspection�Has Whe163 re a Cert�ficate:of Occupancy is Required,such Bwldmg shall Not be OccupeduntilFnallnspect�onhas been made Permit NO. B-17-3924 Applicant Name: VICTOR J.WIINIKAINEN Approvals Date Issued: 12/21/2017 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 06/21/2018 Foundation: Residential Map/Lot: 267-170 Zoning District: RB Sheathing: Location: 43 SHOREY ROAD, HYANNIS Contractor Name VICTOR J WIINIKAINEN Framing: 1 z Owner on Record: GILBERT, HENRY A&DIANNE C TRS Contractor.License; QS-000998 2 Address: 4 DICK DR m Est Project Cost: $1,433.00 Chimney: WORCESTER, MA 01609 Permit Fee: $85.00 Description: INSTALL SHEETROCK TO FINISH LAUNDRY ROOM PLUS 10'OF TRIM ' Insulation: Fee Paid, $85.00 BOARD INSTALL SIX SHEETS OF 4'X8'X1 2"SHEETROCK IN LAUNDRY , / � Final: ROOM. PAINT SHEETROCK TO FINSISH ROOM PLUS 10'OF TRIM Date 12/21/2017 �r ,s BOARD . r ; ¢ Plumbing/Gas Project Review Req: 0 Rough Plumbing: ri E Building Official Final Plumbing: y, •; : This permit shall.be deemed abandoned and invalid unless the work authorized by' his permit is commenced within six months after,issuance. Rough.Gas: All work authorized by this permit shall conform to the approved application and the approved construction docurneritsfdr-WhicIfihis permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoni`!by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public mspec'ion for the entire duration of the work until the completion of the same. Electrical P� '; 3 f � 1 .The Certificate of Occupancy will not be issued until all applicable signatures by the Bu�ldmg phd'Fire Officials are provided°on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work :,. x 1.Foundation or Footing Rough: `_ �.T. ._ •.z 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the.property of the APPLICANT-ISSUED RECIPIENT ,2 u THE t � Application Numb er� . ..�. ............................................ * BARNSTABLE, + Permit Fee.......................................Other Fee........................ MAM ALETotal Fee Paid.............Q. ................................. ...... TOWN OF BT I STgAB�LE l � 1 Permit Approval by..... .... ................On.............?�..J..�. .. BUILDING PERMIT rr�� l APPLICATION Map.......clk.l................Parcel..........l. ........................... Section 1 — Owners Information and Project Location Project Address 6'3 Q6,c Y R OA P Village Owners Name JY<ENR Y a 4ei;4A2V G�4 96,R7- Owners Legal Address `?3 X4 o/2 0Y RoH 0 City 4/ State //Y,# Zip a 2 6 92 Owners Cell# E-mail Q; Q�•�Z'_d p:;i o�h. ! .r+ Section 2—Structural Use Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify l/V S7'�4. .3'G /� ! a 1 ����l �• Section 4—Detail I Cost of Proposed Constructio Square Footage of Project 1� Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design i Last updated: 11/7/2017 i 4 Section 5 - Work Description i� 12 l /0 i Section 6—Project Specifics i ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom 1 Water Supply Public ❑ Private Sewage Disposal ❑ Municipal L�/On Site� P P Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility- f, ' I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ 1 Section 8—Zoning Information i Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/7/2017 ,a The Commonwealth of Massachusetts. _ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / J t Please Print Legibly Name(Business/Organization/Individual): YL Jt>fR /�t Z� ,4/ Address: ., ^9 C% P-z cen z) MA—Pz City/State/Zip:,QM K>T�i►)£ �� 02 b 3 £? Phone #: �6 Z f1 O Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.41 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance. $ 9. ❑Building addition . required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs,or additions 3.❑ I am a homeowner doing all work officers have exercised their . 11.❑Plumbing repairs or additions myself. [No workers' comp. right,of exemption per MGL 12.❑ Roof repairs insurance required.]t. c. 152, §1(4),and we have no, _ employees. [No workers' 13.ErOtherlly S71441, �lff 3,6�stilr� comp, insurance required.] cl-R C� *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. . - I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: - Job Site Address: F City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ppins and penalties of perjury thai the information provided above is true and correct � I Si afore ► -ram Date: Phone#: 5�Og Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department artment 3. City/Town,Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 4 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,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, §25C(6)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,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your 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 0211.1 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 w .mass.gov/dia �a �f r , a i t Aft �y f 4 rl" H ' S Office irs&Business Reg ulation of Consumer Affa tF. HOME IMPROVEMENT CONTRACTOR , t Registration 100053 6: Individual 7 ExPiration 6 " VICTOR J.WIINIKAINEN ti Victor Wiinikainen 58 CAPE COD LN i BARNSTABLE,MA 02630 _" Undersecretary Commonwealth of Massachusetts k Yt 1�t. Division of PRegulationessional s and Standards 91 Board of Buildings Con S6pervisor1 . 0912912019 pir CS-000998 VICTOR J WIINIKAINEtNe PO BOX 69 i 0266W3 g WEST BARNSTABLE MA z5 e Commissioner �r5 Section 9—Construction Supervisor Name 'L�,& ��nr;k o,l lY Telephone Number 6619 3 L z Address 5 S <A FF_ e o p JAIV�_: City&RV S'PA1?k.5_ State Zip 0 2. urJA Vr£a License NumberC5-®ao p5' License Type Expiration Date 0,9 w-,2 9 ,9 0 !c? Contractors Email yr c r*A VVI avu RA 1 N jr4 * eoA 4,10 Cell# I understand m responsibilities under the rules and Y P regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation�quhired by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature �-1 Date. O -g4717 Section 10—Home Improvement Contractor { A I Name�r s�� ��I/N 1 t C�j 1 � Telephone Number J o$ .34 7 7710 Address.57 44PZ COP �,q N z City&K&KS7�4 e6 1, C, State Zip ® 2.., b o °- k ' Registration Number / 6 O D�� Expiration Date i O/ I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation re wired by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date t Section 11 -Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature e_,e�A . Date ///d G` Print Name Y e 7-o R T. V'/ fq l I A(C/V Telephone Number b E-mail permit to: YJ CT0 k kA/1 A r 1.4�EIV a) cc/` l C h.,,;Z`® AST Last updated: 11/7/2017 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board (if required) El Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval± Section 13 —Owner's Authorization as Owner of the subject property Yhereb Y authorize V. �`o .30 1�1/�ii` i'���f to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) /�l�� i us;-c,��� �LILY -1✓Kf�-�- .f-�o-,� Signature of Owner date C. 611 00,E r Print Name �a Last updated: 11/7/2017 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION/ Map .2(0, Parcel 110 ��;� Permit# Health Division 31116 Date Issued Conservation Division ( ®'� C._ Application Fee Tax Collector Permit Fee* ?S •� Treasurer SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. VM TITLE g Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS 1 Historic-OKH Preservation/Hyannis 3&ck;/,s Vell, , 90000 '1 Project S� Street Address 7�L3` ����� �/' l� 2 Village �y !7 y�� ,� ,/ rOwne Address 8 3Xi-fly Ms.t �v��f✓'� Telephone 5'0 C8 ?-�� -2, 13 Permit Request F// 1 J H Z1V7 R X G £PT Afi �'p a 5!Pa.. P f Z� , qz_ I Irk Square feet: 1 st floor: existing Ig/� 7 proposed 2nd floor: existing proposed Total new92,6 Zoning District Flood Plain Groundwater Overlay Si , Project Valuation Construction Type /CR,1r41 i_ Lot Size Grandfathered: ❑Yes • to If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure �a Fri Historic House: 0 Yes A<o On Old King's Highway: ❑Yes &0 Basement Type: ull 0 Crawl O Walkout Cl Other , Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) /0 3 �-- Number of Baths: Full: existing new / Half:existing 0 new O Number of Bedrooms: existing 3 new 0 Total Room Count(not including baths): existing new First Floor Room Count • Heat Type and Fuel eGas 0 Oil ❑Electric ❑Other oe Central Air: ❑Yes No Fireplaces: Existing / New ® Existing wood/coal stove: ❑Yes �No Detached garage:0 existing ❑new size Pool:q existing ❑new size Barn: O existing 0 new, size- Attached garage: existing ❑new size- Shed:❑existing 0 new size Other: Zoning Board of Appeals AuthorizationO -Appeal# Recorded❑ Commercial O Yes *1 o If yes,site plan review# i Current Use 15 T- G /�/ ICJ P proposed Use S /T7 F 4 BUILDER INFORMATION Name !,C(®R �� lC. `��1fF Telephone Number ,?®'R 3 7910 Address C/9��, �a JP License#—0®0 S Af 57;48 A , 61- a ,2 irm 3® Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4e>/� SIGNATURE : �c DATE FOR OFFICIAL USE ONLY' PERMIT NO. 4 ' DATE ISSUED - c MAP i PARCEL NO. ADDRESS VILLAGE - { f OWNER 1 1 t l DATE OF INSPECTION: FOUNDATION FRAME 7/ 900, r INSULATION ill S C� � `? FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROU FINAL GAS: ROU% V FINAL i ' FINAL BUILDING to t m r m0 _ DATE CLOSED OUT m S `,N - ASSOCIATION PLAN NO.Mr } RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 s o Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE x.0031= square feet x$96/sq.foot= � plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.003I= plus from below(if applicable) ACCE SSORY STRUCTURE>120 sq. , >120 sf-500 sf $35.00 ` ' >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: x.0031= square feet x$96/sq.foot= J STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney. —x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 - (plus above if applicable) Permit Fee projcost f ` ' The Commonwealth of Massachusetts Department of Industria[Accidents` _ Aho If/fill1~00 66a Washington Street _ J Boston,Mass. 02111 Workers'..Coin ensati!on.Insurance Affidavit-General Businesses WIN Nampo CIA 7 address. n state: °` zi :C'�r�► hone#' a% �! work si a locatioag full address : am. sole�roprietorand have no one Bpsiness Type: Retail❑Restaurant/Bai•/EatingEstablishment yrorl a le any capacity. []Offici Q Safes ('including Real Estate,Autos etc.)• ❑I am an em to er with sin 1 ees full& art time: [ jam% ///%/% /�/%%//O//i1711��/% fo/i% %m loyees working on this job.;.,. ., I am an;e _pl Dyer providln_g vLorkers compensation Y . . • ; • • " %1. • :.L.tl i.l: ,•':; .. F•. P •It:;r:'.t. •:1•�.'.�". .i• i'•%:''•'.(i�i:',.:J' '.'�•l.. let• `f,•. •'!'. tg:,.. 1 li•:tl.�+�¢ '•�' ... , ,. COIII'eII hems=- •t.: �. ';...h:' pi'. r�' 1�..: :Sti':.:(''�i:c:; fii.i :",t:i ' :,. : '.' '• t't '!;" ..r,• ;•�. .a.• ,xs....'.:t..r :1•".'. �..:�,�: inti.. .a 1'"ix•'.:t•'•: $t1�pBSS ..,• {.a.: :S•� :} ;� t.i ';, 9 ' :}a::•:`rCi; '.L•:' ii'•:';1(: :r +:`• ... ih t• .•t,di •�.` i•i i.t�l •' •: i:, ' ":i.i C O11 • .#:' •''• t 'd t 11 ` ,N';. !.• r. .i•..l:e •'rl:h u.' •:, ,an:4': .,1•1_ia..k:'... '.•::•' • s l.. •.u:•i.:'e•• .:•r.•.,:: .>•.,.n.4 ' am a sole proprietor and"have hired the independent contractors listed below who have the following workers' compensation polices: ' ,;��, t; (.'y, :.1h•^i' .•tip •,t�i: at ta'era4• F,�,;.,, ,. •e• '., ..,.eII �name. .t. �. .•,,.. 1 °'• i a 1 ,"�4.•r°,.�Fi..,.:i•.'Yi.,.;' •c.t•��: •• ' :fin?`: ri`1';•�� '�:nii i�i' ':ii. '••-.V,..j.J •.{'y , i '1' 't .i'r'. i!. .+i'v�..ti�'':y�%•• _ t. '.Ir:• , 'iE:.. '.'::.�. .is 77, .`:rN:•.'li. •*. ••,:1, ,piri ,4.::•&b:w.. , . • /J xL'• ,•� '�:i •'` saaxess• 5.' 4 :,.V , • '.t.` tit. • 1: :.r.. _,'r Y�J. ., :i •.,- 9 •�.�. ^b.q:'t''.. ��;f: r•. :':'•L .r1 '7":i"•tides'#:. Ct! .A � '� :i' .:r.d, nja.;(t 1.:.. '•w:';L•.;ia'k.' ••n{` :S••t J'[M1:;.t •'1�. �;,^ ;it •r"w'r'.: •::°'!•.ii':mf.t. :i''}�i;l.>1`�'�;.,�'�''yy�'•'` •'t ::1"'y�: ,;4,.5;• •.1::�•, •'E•'•, ,•: 1. i; " �:�.:� , •�/'''' ` kr !e,'' ` ,r '•y.,,• '.r:.'�•`U'l1C #t: r.}t•I.i•••r,l yttt, .iisfranc '41 'a,', '•f"1..,, -- 11111111171111, •.r t•., •rq% ;i{.tit• ..{?• tt a: , :�t •,,n,'t +�_} :5•�i r :Sf.J(tt,E :'ti5' 77777 : {a'i••�'• • r,-:.,;, .[•kt z:T,i ')'�• is°'',.• •.t•t,,::. s9:',• •;3qr ..a..ti.._ ':/:. .C• com t '' lOIIE } 'r'_. :i.r .:ra•".;,.t't: •.�. i.St.. t'`� •v. �:yi:`'' 'i . ••.7.1•i-n '•14.' ':•�'a: ••''.�'!.♦ '�• ,L• ..1 p _ ,y1';•S..t ,•( ,l"1�,?l.tt.!'" ••,t7• t.,•, .r 'f.o;7•• .�t.::i. ••3•.�. .� :, I• ~`;;• !;� y:':ti.'.�.�'. 'OZ1C�:ft'i: a'` •j;°. ,..,. is 'k�'' •' .{.': .�•?"'r;• :is ':9:.. .�•'x,. „ ,. .��:,.t w,:1.^ a •.v.:':: insu'range b' Failure to secure coverage as required ender sectionthe form of a STOP WORK ORDER and a fine of$$1100 DO dray againsint up to$1 500'00 and/or t me. I understand that KL one years'imprisonment as well as cfvilpenaltiesin copy of this statement maybe for-war to the Office of Investigations of the DIA for coverage verification. I do hereby ee er t a' pen t' q erjury that the information provided above is true and carte� Date o 3 ,. signature . • � , • �. L •2 64 PhOna#,� official use only do not write in this area to be completed by city or flown official permit/license# []Building Department city ortowa: ❑Licensing Board ❑Selectmen's Office ❑•check if immediate response is required (]Health Department , ` phone#; ❑Other contact person: (revised Sept 20�) Information and Instructions Massachusetts Gefleral Liws`chapter i52 section 25 re wires all to ers to rovide`?workers' c qn .#idn for'their. p q Y p, o?np :, employees; As quoted from the"`law", an employee is.defined as every person m the service of another under any contract of hire;.express or ung�lied; oral or written. artners , association, corporation or other legal entity, or any two or mare of An employer is defnied as an individual,p hip the foregoing engaged in a'joint enterprise,and including the legal'representatives of a deceased,employer, or the-receiver or trustee of an individual,parinership,,association or other legal entity, employing employees. 'Howevei.the owner of a dwelling house having.not'inore than three apartments,and-who resides therein,or the.occupant bf the,dwelling house of another who emploj�s.persbris to do.maiut;enapce, construction or repair work on such dwellmg house'ur on the grounds or . . building appurtenant thereto shall not because of such e#loyment.be deemed to be;an employer. ; IYIGL chapter 152 section 25 also'states fhatevery state-or local licensing-agency shall withhold the issuance dr renewal of a license or perat to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable'evidenee'of••compliance with the insurance coverage required.' Additionally;neither'the' ' commonwealth nor.any of its political subdivisions shall enter into any contract far theperformance of public work until' acceptable evidence of compli.arice with t�a insurance requirements of this chapter have been presented to the contracting . authority: Applicants Please fM iII the workers' eonpensafm affidavit cmmpletely,by checking the box that applies to your situation.. Please phone numbers along with a certificate of insurance as all affidavits maybe submitted supply company name address and-of industrial Accidents-for confirmation of insurance coverage. Also be sure to sign and date the to the Departrnerit affidavit. The affidavit should be returned to the city or town that the application for the pemoit or license is being requested, not the j)epaitment of°Industrial Accidents. Should you have any questions regardni the"law"or if you are required to obtain a:workers.'compensation policy,please call the 17epartnnmt at the number listed below. . City or Towns . Please be sure that the affidavit is complete andprinted legibly. The Department has provided a space at the bottom of the out in the event the Office of Investigations has to contact you regardi�ag the applicant Please affidavit for you to fill be sure to fillip the permit/license number which will be used as a reference number. The.affidavits.maybe' returned to the Department by.mail or PAX•uuless othei'ariangements 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 emce of WesliBatlmns 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 .u. r4l•n ►717-A onn aaf• do 9 gtacMr.A Txhtc.YS.2.Ih(ccntWue�ij gam trt�gQsxfl F`uei; txy,e pxe}cxgct Ar dae sadT''a-F=jtr RrsideatIA gAildins, gr`aerlp ' -mum Hcating/Cocting }y�1tXfM>m vial Floor � ?� Vic. Fr4pm=n% Flftcia�cy� ' �;etling Azca,!('/,} 11,Ysiucs R.Yaluc p�sgc +S70i to 8500 xgtiag Dim t)x 6 Nanmsi 19 t0 Narm�1 0.40 31 SZ 30 13 19 °0.32 19 3 E 13 t0 Narm�t A R tt/ 0.50 " 13 ZS ?�l!' • Nanssal 036 33 19 t0 f3 AFiTE ISrh 0.44 NIA 6A fS AFL1E Y IS'fi 0.4# 30 Is 19 10 KIA No t I5'/. O.SZ 3a 13 NIA NIA rtatsnxI td'/. n3Z N/A go AFLM 1g1/. 0.42 3f 19 19 to d 90•AFLM z0.42 30 i9 19 10 1. AnDRE55 OF PR �1eLv �J� ARE FOOTAGE OF ALL EXTERIOR WALLS: V 3. DARE FOOTAGE OP ALI,GLAZING. �?J �i4. a LAZ]N6 AREA(4 3 I)NIDED CT PA B�.'# ): X cxAaE(Q ..AA see chart above).. SgLE - - a`- ci Ebm?GY ,R rxs METHODS OF DETERM O'TE: YED OVER MORE UVO S RTHIS Lt FORMATYOl�t� ARE AVAILABLE, A 'APPROVA.L; x �w hDIi�tG�NSpgCTOR z � B F YES, Po r a . +Er Town. of Barnstable ]regulatory Services x SONSas LE, Thomas F.Geller,Director 9g 1639. Building Division Tom Perry,Building Commissioner 200 Maur Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 permit no- Date • AFFIDAVIT HOME JMPRO'VFMMNT CONTRACTOR LAW SUppLEMENT TO PERIM APPLICATION MGL c.142A requires that the`oec o onstructioa of add lion tocany p e�existing modernization, c pi d conversion, -improvement,removal,demolition, budding containing at least one but not more than four dwelling units or to structures along are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements.. S �T Estimated Cos 7 <, Type of Work: / 1 - Address of Work 3 S Owner's Name• - lication• o �d T Date of APP I hereby certify that: gegistration is not required for the following reason(s): DWork excluded by law ❑lob Under$1,000 owner-occu ied ' .. ❑Bwldong not P f []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN�E�ME ni UROVEM 'NT WOR DEALING WITEI ORY UNREGISTERED NOT HAVE CONTRACTORS FOR APPLICABLE H ON PROGRAM OR GUARANTY FUND UNDER MGL c.142A. ACCESS TO THE ARBITRATI 'SIGNED UNDE,PENALTIES OF PERJURY Thereby aPPlyfor apermit"sale agel�t o r: ` R Contractor Name egistraticnNo. Date y OR Date - Owner's Name �t�►�, Town of UarnStable A / fRLS\8� \ • tlB��-+. �a�®®_ra•■Aa-� �/ ®'!en^84vT�Ye'O1L�lR . i riCguldl,vl. cce'L ViVVa L&,)J, Thomas F.Geiier,Director ��Eo ►.�°��� Building Division f�i VtitY i @ir"y, U...11ar'ax"a� 200 Main Street, Hyannis,MA 02601 j " I Office: 508-862-4038 Fax: 508-790-6230 I Propertu ()V3er Mast Complete and Sign This Section If Using A Builder s " S4 7 as Owner of the subject proper ty �/ '^� � , /A A ` C ` ' hereby authorize y"/ g 1/Yd dJY< / , to act on my behalf, in all matters relative to work authorized by this building permit application for: f (Address of job) / � ` c:,_.,ature of Owner Date Print Name y ndards,,+ Board of Buiidang Regulations and Sta wEM v OENT CONTRACTOR H me IM�?Ra,, r Re ' aolt # 01I0!53 s E7Er31T Cr 51'004 d dua J NI 5 J.VICTOR WII y r Victor Wiinikainen ;•. G � 58 CAPE COD LN BARN STABLE MA 02630 Administrator. a I -ellrrr�diaG BOA , . Qq ,.re � ;. License BOARD OF BUILDING R€GU W ., : ' '0NS7RUCTI I''4TIONS m, - a: _ R ON supER�ISO r Number. CS 000,998 I Bi th'"d- p9y, 9/1494Pvw '0 i r / esti��c�e�' i70 �I � r .Tr,In T o: 2412 �/C OR J l/I/IINIKA,)#j, Po'sox,69/, UI%BAN RNS7/ABLE - -�. r � Atlrriirnstrator° - "� - a �r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp Parcel: . Application 46 Z~ J Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Aoyl Village Owner,�glSd&I,1,�!` ry e �� fT Address iN.�d�,f� €is/ 4, ct2.� Telephone �®4" Permit Request ClXa�� /q CeN�A 64Ari�/ 1� .�� �z g1Liu 3 mg Square feet: 1st floor: existing/,U-2proposed _2nd floor: existing 0 proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation `� �J ��Construction Type �� Lot Size Grandfathered: ❑Yes ®'No If yes,'aftach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure® . Historic House: ❑Yes *lo On Old King's Highway: ❑Yes 6'I�o Basement Type: [Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 77/j'0A Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 3 new 0 Half: existing 4 new Number of Bedrooms: 3 existing® new Total Room Count (not including baths): existing 7 new ® First Floor-Room Count 4 Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes A Fireplaces: Existing New 0 Existing wood/coal stove: Odes kvo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: Oexisting,❑ noW size_ cal Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 00 Mom' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Wil o If yes, site plan review# Current Use S,&6 , dam/ �L. Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - - Name t-C l o Telephone Numbers Address)-8 Cj4A Cop Zx License# Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �'� e � dSf s, < FZ1 SIGNATURE af t DATE J �."� �� i 16 FOR�OFFICIAL USE ONLY APPLICATION# DATE ISSUED e MAP_/:PARCEL NO. ADDRESS _ VILLAGE OWNER DATE OF INSPECTION: '" _ FO UNDATION4i t FRAME r INSULATION "f FIREPLACE ELECTRICAL: ROUGH _ FINAL ' t PLUMBING: ROUGH FINAL > - GAS: ROUGH FINAL C; FINAL BUILDI.NG _ �� •,( k .' DATE CLOSED OUT ASSOCIATION PLAN NO. 1 — r :3 The Commonwealth of Massachusetts' c 1 Department of Industrial Accidents ^a Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Or ganization/Individual): Y i C.e®A V '4&1j�, 5AIa Address: 4!17 '�g � 3 City/State/Zip 8A {Bq G/ F,04 L1&Ll 16 Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer With 4. El am a general contractor and I * have hired the sub-contractors 6. ❑ New construction et ployees(full and/or part-time). 2. am a sole proprietor or partner- listed on the attached sheet. # ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers,have exercised their 10- Electrical repairs or additions required.] - 3.❑ I am a homeowner doing all work .right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.) employees. [N o workers' 13. OtherC comp.insurance required.] —f — � *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing.workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#:. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Se6tion-25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine; of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby c irpund the ains and penalties,of perjury that the information provided above is true and correct. Si nature: Date: Phone#: e Official use only. Do not write in'this area,to be completed by city or town official City or Town: Permit/License# Issuing Atiihority(circle one): 1. Board of Health'2.-Building Department_3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, 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, §25C(6)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, MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone.number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance.7 If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and.printed legibly. The Department has provided a space at the bottom of the affidavit for you to 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your 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 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-OS Fax# 617-727-7749 www.mass.gov/dia ti IKE BARNSPABLE, • - - 9� 16 Ass. Town of Bariistable Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO , Building Commissioner 200 Main Street, Hyannis, 1v1A 02,601, � •' www.town.biirnstable.ma.us ' Office:.508-862-4038 50879U Fax: - -6230 Property Owner Must Complete at'd'Sign This Section If Using A Builder • caner of the subiect property hereby authorize 7/.�T 2.�,�►✓�'r�►r to act on my 1?ehalf in all matters relative.to work authorized by this.biuldingpermit application for: e f 3 X on �90 (Address of Job) Signature of Owner Date ; Print Name Tf Property Owner-is applying for.permit, please complete the Homeowners License Exemption-Forrn on'the reverse side. r x Q:\�VPFILESTORMSIbuildingpermitformslEXPRESS.doc Revi,eeri n721 10 — j Pot► ro,�y Town of Barnstable Regulatory Services y M " B.AI$STABLE, Thomas F. Geiler, Director y$ lass. ,619. Building Division Tom Perry, Building Commissioner 200 Main Street,_Hyannis, MA 02601 www,town,ba rnsta bie.ma,us Office: 518-862-4038 Fax: 508-790-6230 r HOMEOWNER LICENSE EXEMPTION Please Print DATE: d 10B LOCATION: number street village "HOMEOWNER" name home phone N 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 OFHOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-yearperiod 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 The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section.127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the:provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)For hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack o£awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannotproceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that(lie 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:IWPFILESIFORMSIbuilding permit formslEXPRESS.doc Revised 072110 S ftis.9 Cpseade Double 1-3/4" x 7-1/4" VERSA-LAM®2.0 3100 SP Floor Beam\F1301 BC CALL®3.0 Design Report-US 1 span No cantilevers 1 0/12 slope Thursday,December 09,2010 Build 440 ,s File Name: V Wiinikainen 120910 Job Name: Description: FB01 Address: - 43 Shorey Road Specifier: Joe Madera City, State,Zip: Hyannis, MA Designer: Customer: Victor Wiinikainen Company: Shepley Wood Products Code reports: ESR-1040 _ Misc: ' 1 i ON c 3; En a E •a.- SY .�uz �' e, Lp .3.., >;.� '� `fir., ,.�4F n ' BO,3-1/2" LL 1,040 lbs LL 1,040 lbs DL 549 lbs DL 549 lbs Total Horizontal Product Length=08-00-00 Live Dead Snow Wind Roof Live Trib.(in.) Load Summary Tag..Description Load Type Ref. Start End 100% 90% 115% 133/° 125/o 1 Standard Load Unf.Area(psf) L 00-00-00 08-00-00 20 10 13-00-00 Controls Summary: Value %Allowable Duration Case span Disclosure Pos. Moment 2,824 ft-lbs 33.7% 100% 1 1 -Internal Completeness and accuracy of input must End Shear 1,233 lbs 25.6% 100% 1. 1 -Left be verified by anyone who would rely on Total Load Defl. U696(0.13") 34.5% 1 1 output as evidence of suitability for, 'Live Load Defl. U1,063(0.085") 33.9% 1 1 particular application.Output here based Max Defl. 0:13" 13.0% 1 1 on building code-accepted design. Span[Depth. 12.5: properties and analysis methods: n/a; . . 4 Installation of.BOISE engineered wood. products must be in accOrdance.witti %Allow %Allow current Installation Guide and applicable Bearing Supports . Dim..(L it Vl) . Value . , Support Member ;Material building codes.To obtain Installation Guide B0 Post 3=1/2"x 3-1/2 1,589 lbs n/a 17.3% Unspecified or ask questions,please call B1 _ Post 3-1/2"x 3-1/2" 1,589 lbs n/a 17.3% Unspecified (800)232-0788 before installation. BC CALC®,BC FRAMER®,AJS-- Notes ALLJOIST®,BC RIM BOARD- BCI®, BOISE GLULAM- SIMPLE FRAMING Design meets Code minimum(U240)Total load deflection criteria. SYSTEM®,VERSA-LAM®,VERSA-RIM Design meets Code minimum(U360)Live load deflection criteria. PLUS®,VERSA-RIM®,. Design meets arbitrary(1")Maximum load deflection criteria. VERSA-STRAND@,VERSA-STUD@are trademarks of Boise Cascade,L.L.C. Connection Diagram. L'b d a : c a minimum.=2" c=9-1/4" b minimum. 3 d=12" - Member has no side loads. Connectors.are: 16d Sinker Nails .Page.1 of 1 _;.._.« nI.UNN CLIJU.II'llJ- vcll-lu'uul'nr UI rUUlll' Jart[N' . ��� � � ! Board of Building Regulations and Standards Office o onsumerAtirs smess e u a on ¢ ` Construction Supervisor License HOME IMPROVEMENT CONTRACTOR License: CS . 998. Registration:,�1,00053 Type: x Restricted to: 00 . Expiration 8 Individuaj V R J.WIINIKAINEN VICTOR J WIINIKAINEN , PO BOX 69 W BARNSTABLE, MA 02668 Victor Wiinikainen ` r 58 CAPE COD LN BARNSTABLE,MA 02630 Undersecretary �', _jam• Expiration: 9/29/20.11 ('onunissioner 'Tr#: 2294 - I , i 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 fr v 4, a - N lid without signature „ ,. ss 4 a , • g- a: oFTHE r Town of Barnstable *Permit# Ver on�jrom issue dateRegulatory Services F 9snxrrsT PERMIT Thomas F.Geiler,Director ass Building Division Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 20o Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number-�o l� Not Valid without Red X-Press Imprint Property Address /' ` Residential Value of Workt4 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address C Contractor's Name 16 B C/a,Q , IGd/',�C��� ` �g Telephone Number/'�rJ Home Improvement Contractor License#(if applicable) /®cs d � ❑Workman's Compensation Insurance Check one: Zi'?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) Re-roof(stripping old shingles) All construction debris will be taken to � � 1 ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: ' 714 Q:Forms:build ingpermits/express Revisel 12807 I . ward of B ildiu / HOIjM ►ry1P .; g,Regulat�gns uds M` , `_. a" RO a s N Registratto n. O1TR�j '. e Ex ' 100053 g ? P�ratto�-6/,8/2008 VICTOR J• ,,TYPe: :lndwidual I':. Victor WiiN alnel KAINEN t 58.CAPE COD LN BARNSTABL E MA 02630 �'PutY Adrninistr ator t 1 License or registration valid for individul use only i before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 001 i Boston,Ma.02108 a -without signature F The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affida-vit: Builders/Contractors/Electricians/Plumbers Applicant Information ease Pl Print Le dblY Name(Business/organization/Individual): 1►' E L�e� z �k `� ty Address: City/State/Zip:-�14�� L G c/ Phone.#: J� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-tune). . 2 am a'sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling These sub-contractors hav • ship and have no employees e 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• t 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a.homeowner doing all work officers have exercised their 11.[1 Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12.❑Roof repairs n insurance required.]t c. 152, §1(4),and we have no 13. ���d� employees. [No workers' user comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#:. Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under the ins-and penalties of perjury that the information provided above is true and correct �� --- Si afore: c Date: Phone#: — " 3 b;Z"' b Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statute,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 en a ed in a joint enterprise, and including the legal representative's of a deceased employer, or the of the fore oin g g P g g. g g J rP 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, §25C(6)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,MGL chapter 152, §25C(7)states`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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (Le. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your 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 C6mmonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO. #617-727-490.0 ext 406 or 1-877-MASSAFE Fax# 617-727-774 9 Revised 11-22-06 www.mass..gov/dia �I oF��i�ti Town of Barnstable • anaxsTnatF, • Regulatory Services ArEo►��s Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038' Fax: 508-790-6230 •--- Property Owner Must ` Complete and Sign This Section g If Using A Builder I , as Owner of the subject property hereby authorize �csgg •", �iii�//�Z/� to act on my behalf, in all matters relative to work authorized by this building permit application for: . n� � (Address of Job) Signature of Owner ate not Name QAWPHLESTORMS\building permit forr is\EXPRESS.doc Revise020108 ` �t Town of Barnstable Regulatory Services EAMST"M Thomas F.Geiler,Director ' � MASS, .�� Building Division ptFD MAC A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use'and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the,Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with`said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION ' The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&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\homeexempt.DOC TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,l Map Parcel Permit# �� Health Division 0P,� (A ! D �' Date Issued /d z e—F Conservation Division �( � 10� ,✓"1 ►`--- - _ Application Fee Tax Collector Permit Fee S.b Treasurer U. " ?Trv: SYSTErA VUST BE Planning Dept. LED IN COPAPLIANCE Date Definitive Plan Approved by Planning Board VATH TITLE 5 ^,DENTAL CODE ANE Historic-OKH Preservation/Hyannis 4 REGULATIONS . Project Street Address Village sh�lZ Ems- � Owne� C- 9 N �/C � Addressrlo -,4tAygf ,fie 06- Telephone-FO -� 7�7,2, Permit Request e EALAC9 e IS d ZIY6 ..Z' r�-L /vs /�C',6g4k yXP Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0® Construction Type CCIVC 66 4-5 Z'e Lot Size Grandfathered: ❑Yes 413 If yes, attach supporting documentation. Dwelling Type: Single Family A1101, Two Family ❑ . Multi-Family(#units) Age of Existing Structure House: ❑Yes g g Oo On Old King Highway:s Hi hwa : ❑Yes Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) /V 43,6Cl Basement Unfinished Area(sq.ft), 4 4Cr Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count_ Heat Type and Fuel: �s ❑Oil ' ❑Electric ❑Other Central Air: ❑Yes A o Fireplaces: Existing New Existing wood/coal stove: ❑Yes Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:Cl existing ❑new size Attached garage:,olexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ --Commercial ❑Yes. A<O ._- If yes,site plan�review# Current Use 511Y6419 A4ft2 f. Proposed Use Ar - _ — -- - BUILDER INFORMATION Name 1 l l®g J 6 W //y l /�/,�/ " �!� Telephone Number Address ���� ®� ��-. License# � M _ 4 2 ® 4 3 0 Home Improvement Contractor# , 00 Cy , Worker's Compensation# � �L11 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO1�� 0,VI—Irl SIGNATURE DATE 16 C & FOR OFFICIAL USE ONLY w PERMIT NO. DATE ISSUED MAP/PARCEL NO. ` ADDRESS 'VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL r - PLUMBING: ROUGH —FINAL,,- GAS: ROUGH FINAL `: FINAL BUILDING 66,/�/"• .! 3 C' 3 G/c J.;1i w ,DATE CLOSED OUT 'ASSOCIATION PLAN NO. j • r r c °FINE r, Town of Barnstable Regulatory Services ` saxxszesi Thomas F.Geiler,Director - -- Fi639. 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 as Owner of the subject property hereby authorize C e® J 9 ` Y/F�"l/7G � to act on my behalf, V. j r in all rriatters relative to work authorized by this building permit application for: 3 R �' (Address of Job) ��/1112. � SigAature of Owner Date �}�fctlAy / . Print Name 11.C/1D�dC•!1\111.TODD�DaATCCT/ll.T The Commonwealth of Massachusetts Department of Industrial Accidents ONCe of/oeestigatioos 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name• 1//G G' o 4P, -T �—' L' `_ l k,,O�/V 91 T � �' location: �9 C®P �`oe� city � �Zj -.5 C VfjZ ❑ I am a homeowner performing all work myself. �am a sole etor and have no one workiil in ca achy - ❑ I am an employer providing workers...compensation for my employees•worlang•on•this job..:::::.::.::::.::..:::::::::::.:::::.:::..::::.:?.:??.}::::.::?.:::::::::: `roma v — ::.: }.::. aEl ;cites............... .. .. �9risu�••en VNEENNEWMENWON ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have ohces; workers' co a nsa ti on ..................................... .. - .. ..... ..... the following sip P ::..:. coupanv ::::.... X..: . ..::::.........:.:r::.::. .... } ..........:... ............................................................... �j rwt•.v i:��/' :'r::.":�'T` i:}i`;:'rrisi�:';:?;:}:::: ;:ii:'T:;"{ i.t?:'�ji:;:}�.��i}vvYi'}::>�:::i': :.::::•::::::..........................................:::.::::.::::.::.::....::::::.::..:...::.:::::::..::.::::::::.}:.:;;..:..:... "tine. ;:;:;:;�{;:;y�j�:?;`:;is :�';';:;?>�:�: ':'::`:::c�t:i::l::'i::j$:{:;.`{;:;:�:;:�i:is :..tti ..::::y.v:._:::::::•:::•::..:::.:.:v:v,{v: .:v.v:::•.v:.v.:v::::.v:::::.v.v::::::::v.v.::...................t.w:::?x:::::... ............................................................... v.:::v::::.:-::::.�:.}:^}. :::::•:::.....v...:...r...............4...v.....::•::•••w.:::.... :::.::::....::::..........r........ ................ :adilr ii ............ tih on n�nraa Faitm a to seem a coverage as required mider 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 s copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is trw.and correct. Sio,ture Date /�-� Print name V/G �'I� J ��< f��f���� � Phone#�� g official use only do not write in this area to be completed by city or town official city or town: permit/license# []Building Department ' ❑Licensing Board r Office check if immediate response is required ❑ S elect,rr en a ❑ Po q ❑Health Department contact person: phone it; ❑Other (devised 9195 P1/V t Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their f another under an contract is defined as eve y employees. As quoted from the"law", an employee rY Person in the service o 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 dwelling house having not more than three apartments and who resides therein, or the occupant of the llmg 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 iss uance 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 supplyingp company names, address and phone numbers along with a certificate of insurance as all affidavits may be ^t 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 io 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 Deparfzneat's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investlgadons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 F HE Town of Barnstable i P O Regulatory Services BAMSTABM Thomas F.Geiler,Director ,059. 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 EAPROVEMENT 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. ` PLA*--E 04®.Z ff/5 e 7- o . Type of Work:'84/4 kA71zAP 1-57'/ /A L%>I Estimated Cost Address of Work:q9 AOwlq 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 E]Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply'for a permit as the agent of the owner:: - V C -17 Date Contractor Name Registration No. OR - Date Owner's Name Q:forms:homeaffidav RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= :2 plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS - Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150,00 (p lus lus above if applicable) Permit Fee 3 projcost 7ta CMF.Appc*dix 1 'table.Id-1ilb(eontlnucd) Bated trig FosrO Fue1t prescriptive Paeksgd for 0ae and Two-F saiily Aesldentisl HcildlagY S Hesting/Cooling Glazing Glaring Cefltng Wall Q° 1 �wau p �eiet EquipmentF.MCiMC? Areas('/.) I1-valus� R-vblue� R-value R-vsl R.valual R y4uOT PaB� 'S101 to 6500 Hemting Degree Dsyr� Norma] 6 o.40 38 19 19 l� 6 Nanzssl ' R 12% 0.52 30 13 19 10 6 i5 AFUE 0.50 3a NIA Normal g 12/. 13 25 1[/A T 15'/. 0.36 3E t0 6 Nance! 3 a 19 19 15 AFUE .A V . 0.46 13 � NIA WA V 15'/9 0.44 38 6 i5 AM is'/. O 3Z' 30 19 14 10 N/A NDnTw W 13 25 NIA X 18% 0.32 33 • NIA Nom1a1 19% 0.42 3a 19 25 NIA 6 90 AFUE Y 9o.AFUE 3a 13 14 l0 Z 19% 0.4Z 19 IO 6 AA 18'/. 0 30 10 19 1. ADDRESS OF PROPERTY: - SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4, e/Q GLAZING AREA(93 DIVIDED BY#2): 5 AA see chart above): g, SELECT PACKAGE�(Q-- G ENERGY.REQUIREMENTS 0 ; OTHER MORE INVOL�METHODS OF DETERMINIH ARE AVAILABLE, ASK US FOR THIS INFORMATIOI�t, UIDING.INSPECTOR APPROVAL: !YES'. q•forms- � _ 780 CMR Appendix 1 Footnotes to Table J�.Z.Ib: li s, and doors Glazing area is the ratio of the area of the glazing assemblies ('including sliding-gl to ass doors, s the g is wall basement windows if located in walls that enclose conditioned space,but excluding opaque ) gt area, expressed as a percentage. U�5 to °be excluded from a building design with 300 ft o glazing area,requirement. For example=3 fl of decorative g y 1 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the Natioual Fenestration Rating Council (NFRC) test procedure, or taken from Table 11.5.3 a. U-values are for whole units: center-of-glass U-values cannot be used. 3 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 R�9P�ulation. -30 insulation may be Ceiling R values represent scum of cavity insulation and R-38 insulation may be substitu 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. d Do not include R s wall -values represent the sum.of the wall cavity in plus insulating sheathing(if used) exterior siding structural sheathing,andinteriora a111usoIA 6 insPulating sheathing.ement could be met Wall requirements apply to by R-19 cavity insulation OR R-13 cavityinsulationP woad-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction, s ne floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces, basements, or-garageS).Floors over outside air must meet the ceiling requirements. t e entire opaque portion of any individual basement wall with an average depth less than 50%below grade must s doors of conditioned mczr the same Re included withent as the other glazing. doorsssmust m meet head or U-value requirement basements must be mcl described in Note b. 'The R-value requirements are for unheated slabs• use omAdd an dlanceaapproach 3e 4e orl5bslf you plan to install more if the building utilizes eledtric resistance heating p or word than one piece of cooling equipment, the equipment with the lowest than one piece of heating equipment eat or exceed the efficiency required by the selected package, efficiency must m see-Table 15.2.Ia ' For Heating Degree Day requirements of the closest city or town 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 doo r 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- r doors is less than or equal to the U-value requirement(0.35 for doors), value of all windows o I ;: ti • #' ���✓fie✓Gsm�r�a�uae���..� i Board'of Building Regulations and Standards NOM'E IMQ�VEMENT CONTRACTOR Retra�or� 0053 h 6i8k004 d idual L l VICTOR l WIINI 1 Y�. 'Victor•Wiinikainen 58 CAPE COD LN BARNSTABLE,MA 02630 AAministrator MA BOARD OF BUILDING REGULATIONS� . IONS License: CONSTRUCTION SUPERVISOR Numbe&6S,, 000998 f Bir�fjdate T061-Mf940 Expires 0�9/•2-�J•/2Q05 Tr.no: 2412 Rests eEi9 VICTOR J MINIKA�INEN PO B'OX 6,9 ' W BARNSTABLE, MA U2668 A`` G� Admihistrator Town of Barnstable *Permit# 3 2 '(q � �{•� Expires ti months from issue date • �; Fee � �U �,�,E . Regulatory Services �' Thomas F.Geiler,Director QED a Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w Office: 508-862-4038 MqY 0 Fax: 508-790-6230 Tw�ll of 9 Z��I EXPRE SSdPE/RMwutRed X-P IT PLessI pn TION e�&,V,3 Notnt Map/parcel Number 70 � , (,/ Property Address 7'5 S40 7- • esidential OR ❑Commercial Value of Work �Z Owner's Name&Address / `� ��'"� �• Contractor's Name /�71ilg U 4 � /��`�������� Telephone Number S6,w Home Improvement Contractor License#(if applicable) lC d C' Construction Supervisor's License#(if applicable) �' c ❑Workman's Compensation Insurance gecko : am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) Zr-Other(specify) % -:54�CC `S *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. / /Ai Signature expmtrg ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 7d SEPTIC ma°fS`y1Lm r ;`a' Permit# ;4,30 Health Division INSTALLED IN COMIPLIArN — WITH TITLE 5 e Issued Conservation Division Z lqr7 2g5=== ENVIRONMENTAL CODE AIRS la 2z"i 3Qe GY TOWN REGULATI r,1.,'° Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address f Village W1�5( rS B Owner p—t lA N 4,% �/� Q Address S 40* S Q s Telephone Permit Request Square feet: 1st floor:existing ro osed 2nd floor: existing proposed Total new Estimated Project Cos Zoning District Flood Plain Groundwater Overlay Construction Type CJ CS 0 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 &<o On Old King's Highway: ❑Yes d o Basement Type: Z F ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 12 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: EM"as ,❑Oil ❑Electric ❑Other Central Air: ❑Yes E o Fireplaces: Existing _Z New Existing wood/coal stove: ❑Yes Zwo "j Detached garage:U 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 f�Y`�lllri��Sly Telephone Number Address>:20) C� D �/y License# Q(9C ` g� Home Improvement Contractor# Worker's Compensations# /yam n ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4elrzrv�T v DATE SIGNATURE -- -- _� � `� E _ FOR OFFICIAL USE ONLY r PEA MIT NO. DATE ISSUED MAP/PARCEL NO. ; ADDRESS ' ' " VILLAGE L. ' OWNER , 'a s DATE OF INSPECTION: FOUNDATION.,-'- FRAME INSULATION= ,I FIREPLACE ` ELECTRICAL": r ' ROUGH FINAL PLUMBING: ROUGH FINAL ' F' ; GAS: ROUGH .+FINAL _ FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - f' A The Commonwealth of Massachusetts IRV Department of Industrial Accidents Office OUNCS908 885 r 600 Washington Street ` -= Boston,Mass. 02111 Workers' Compensation Insurance Affidavit •� r nazne: i c �i`/ location: /� t" O IAI city C 0 �O hone#.Sd ❑ I am a homeowner performing all work myself. �I am a sole etor and have no one worlds in anv capacity %/D%%%/%/%/%/%//////////%%�/,//%%//O�/////4%/------ I am an employer providing workers' compensation for my.emp loyees working on this job.:. ::: :: :::?::::::::: :::::::::::::::: ::: :: 11 aura s s. ....:::.;:.:.. :....................... city :::::.::.:::::::::.:::.::.. .::;:;:::::;.:; ... . : phone#. :.;.; olicv insurnnce'c0. ❑ 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: :.: :.. .: : . ;.::::::.. wmanv name: :..:.:.:.. .......... :::.:.::::: ::::.:....::.:...:. ..:.::... ......_..... _..: . _.... ........:... .. :.::.>:��:�. : ::>::»>: ;:::>::<;<»::> address:. . . ..:.. ....:.:...................:.:::......................:::::::::....................................................... ��one; ..::.:....::.:.........::::::..:.......... .:........ .. �'ho ....:.:...::.. ''1) Ci »: "» '>`» address: ::...:::.:::..:.:.:::::.:::::::::.:::::.::. ho ......... ... ;:..;;;::.::.::.::.:::::.:.:::.:.:::::.:::::..::::.:,::::....................:::::..............................:..............................................:::::..:.. ........:.:...........:..............:.......:,.........:.......... ...........................................................::::::w:::..v:::•.�:•.�::.�::::9:•:?v:iiiii:..:... :..::::•:.:.:::•::•:^i}i::4:?•+•:'i.•:q:??•i;.}:??i:ti;i:;j?;::;ii;i::,..: ...........:..... ..:..::.i:?•i:+.•:•i:?4ii:?•i::::.�:::n:�::::::r.i:.iii:XG ?i •i::�::•:::?i•:ii:vi:?•:.�:•:::.:'i:•i:ii:ii••::iiiii::ii:.::':::.i:.i':: ���.....:.::...::.:....::...::.:.:::••::::::::•:.:.::..............::...:::::.::•:.::v:::.:::::...... Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine ail to 51,500.00 andJor 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 ma I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veAncation. I do hereby certi the paims and penalties of pedury that the information provided about is trw•and correct Signature Print name C O ! ` `'0000/1 � 4 Phone# official use only do not write in this area to be completed by city or town official city or town: permitlncense# riBuilding Department ❑Licensing Board use i' Hired ❑Selectmen's Office ❑check if immediate response required ent _ ❑Health Depardn phone#� ❑Other'—._.— ho contac t person: P P ocvum 9195 PJA) • 9 $ Department of Health.Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Cressen Fax: 508-790-6230 BuiIding'Commissione. 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 conaactors,with certain exceptions,along with other . requirements. a _ CNIO Type of Work: I)`� � Estimated Cost Address of Work: S � O L Owner's Name: g,,bP, C 3L 8,ylP,q Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law C]Job Under S1,000 Building not owner-occupied DOwner 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. SIGNER UNDER PENALTIES OF PERJURY I hereby apply for a permit as the a gent of the owner. /� oQ _ Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav UILDING REGU BOARD OF: SUPERVISORS 4 Licern;e: CONSTRUCTION Number.'CS 000998 Birttidate 09129/4940 Tr.no. 4330 EicPires 69129/2001 4 Reykricted To: 00 ` VICTOR J "INIKAINEN PO BOX 69 02668 Administrator i W BARNSTABLE, MA I{p��F NT.CONTRACTOR�x� g tl atia0�00as 31 LAM Ytlt .G �Y ..fr i IINIKAINEN)A -I q ALE t4 Mull 5 02630 4 ApMUg[gATpR xaa a -r ig,, y�,,,.g�{�.Yx 1 .+ � , � �\ fib . � � �� `� ( f /Gj �``a �I d { f �' . ' �,',t _ _ - ,.: ti � � E s .. _: �° ��ly� .L _ -� f`' y f `' _ �-- -' �: ,,,.9_ '. - _ _ _ _ �'=� ' i r` . . y ., �.. . :. :. -�- .... ` . .. ,. _ T� .. e .. r r _. _.. .. � ... .. ,: �. � :r .... - �.y_, ... ., �. .. x� r ►/3 s c,4L _ WA"ea a? 3 $ i 4 { e' i f i ` r1 e_------ __.-.-- -- —_ I ---- r - -- _ G 14 VIE Jf .�� e e P !r iz AJo -JOY ,0007 = ----- "O"Oooe 1 00 60-4 17o IL 5.T Ll y III 3� 40 CIO r:a•r+r.•--'^T','"c "y�+iy"�" ,... t,...^,'.+e!.e'r�.-..ns'✓s.-.csr�"'r '"�` 1 S CA4 e - 4f G � _ AS /Aog 4x4 N_ .t. y N LOT 4 LOT 5 s t I 93.11 LOT 3 N F CD LN O 20 - RES. ZONE: RB FLOOD ZONE: C'. SHOREY ROAD ' . THIS MOF2TGAGE INSPECTION PLAN IS FOR BANK 'USE ON Y TOWN:. BARNSTABLE REGISTRY OWNER:_ HENRY 8 DIANE GI PERT DEED REF: 4099/346 BUYER: GATE:- 5/7/86 PLAN REF: 257/100 SCALE: 1 "= 30 ere y Bert y that the, ui ing OF 'shown ,on' this plan is located on ����ZH YANKEE SURVEY the,ground as shown. and it o a CONSULTANTS position does conform to the g PAUL A.MERMiEw 70 RASPBERRY.LANE zoning law setback requirement of ti MARSTONS MILLS , BARNSTABLE NO. �� MASS 02648 and -does not' lie within the special �o-SS�o� -.flo0d hazard area as. shown on lgNp SURVf V th uLd. 'floo4 pap .dated 4354 This plan not made from an instrument Pau1,A. Merithew, RPLS . survey, not to be' used for fences etc . b�Qy�FTHE T n TOWN OF BARNSTABLE BABH$TABLE, i O�Ya`e�, BUILDING INSPECTOR F r. . . n APPLICATION FOR PERMIT TO .........1'�.4.474k.... .....pucrv.g�....T.e.46r.................................. TYPE OF CONSTRUCTION .......... 1.J*J-Twv...................................................................................... ..........TQ Ne".....J........19.7,�- TO THE INSPECTOR OF BUILDINGS: The un rsigned hereby applie/s for a permit aacc/ording to the following information:7JP -•� Locate n � .. ,.S n.�R..4�. .........w(�. ............ :......... .FAN..+VI.S......I..i?: .:1.................................... ProposedUse ........C�!erV...........11 1.L .t.n.•+C•���. .............................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. d 1 �� Name of Owner ....196ma e....lC....PR-i a� � Address 1 SS 0 e4+rS�........... ..................f. ................ ............ Name of Builder .0964pa'..w.... .....PQQ4r1.A.4..r^.C..Address .....�.�.....,�1�.� ........ ............. Name of Architect ch.14A��.....��... 0�?. .!�.L ..Address es` Number of Rooms .................4..iX.......................................Foundation C O/v.../2_ ...7..4r 4 Exterior ......... .,...�y!!�f./................................................Roofing ..........ASP.A.o9.j-f..... .. Floors ..........P r� . .tib.a d/.................................................Interior .......... Heating .......FqtAd.......lia.......a-tc).......................Plumbing ' ... :4 ..................... ....................................... Fireplace ..................Slzi&m.................................................Approximate Cost ......1..Q}..................................................... Definitive Plan Approved by Planning Board ---------197Z, Diagram of Lot and Building with Dimensions (j�, ®Q SUBJECT TO APPROVAL OF BOARD OF HEALTH — E too, O W U4 L)- (j) CQ U 0 < -r 11 ! r r 0 Q O N Z JQ U, 4 r r �er�chrvy I oW L11 _ SC�iI� X � O m N U- ca � � �� OC: >- m O _l © 0- S i — -- -------_ 0 LLaonj ry Q ¢ 7 � IW. W (n N O < ¢ zz 0 >- '� LLI Az XQ � � zQ wl-- ��� w ~ = zQ � co ct �y I hereby agree to conform to all the Rules and Regulations of the Town of Bprnstabl d above construction. . - Name ... .... ............................. ........ ....... r ..Aborn & Proctor, Inc. 15117 one story No ................. Permit for .................................... single family dwelling ............................................................................... Location Shorey Road ................................................. I West Hyannisport. ......................................................... ..................... Owner Abo.rn.. ...& Proctor. . . , ,....Inc............ .... .... .. . ........ . ... ...... Type of Construction ..................frame........................ Plot ......................... .. Lot ................................ a June 8 72 Permit Granted ....19 ' ............... ...... a. ?L- Date of Inspection ..... .. ....... ........19 T� .00 a-/7a.OA Date Completed ........1 PERMIT REFUSED ................................................................ 19 .......... ................................................................ ................................................................................ ............................................................................... Approved ................................................ 19 ............................................................................... 2-q le or 17 � r r � 5 9� i E / 8,A l p; 0 t , 1 14e- st-A,4 �y, - - - - _------ ---- - - _ - Ckl I - 9 Y/ 2� ;AAf D d'& 5'�a r AlArek ® l .17 4 M l t a� .r OP !+ Alt AAA 1 E� it i s e rq .5 � ► tifit':5 /C_ /ni .F, �i//r♦f ff T � d � % /J'!k'C% �� ��^^+ "' � _ ��C"..1 � � ����e' tp CC -- -------------------- op, 3� I 13' 3. i HALL \AWY' PAYFR: a.Fi 0 DP IL 30 zy qi _ T '.�/ c-I s-% y t , i 1 / ----------I �I � 3 9• - 4 , q3 { .....__.___._----------.._..__ ..... ...._....__.._.__- Xt,97- oq 57 t� t /Nsut�Tr" �nss rv�r Fit �co,uc R EP E K164e s cap It. %.t SrN g£►l��c et _ S o f �. W mr. P- so C, r7- R0c. _.y Lu C .� �wccs •�. er P ---- ---------- - ---- - W% Wit' -SOL Yl E i l l i I 1 zXG'sey�t�s--- Iff r 04 Jf • _ I► / { . f ,` C��sS S r G�''�a•.r , i -- t Iv 7`�a I I• � ►� tD I I' 11 I -- ----— -- Ir y ' '�xl�`' <3t.�cN =o�►M�rAt�d�►�c �--�_ 3cc-cd Qt1 h I �� ,�-. . . �.� .ems— -----���?�`_v�►—P e.131 � 1 �. 2xl2:` s7-A was PAF- '49 a � rl� -f � S � - I—