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0023 SIMMONS POND CIRCLE
(� / �� �. i �� ,� �++k ', �� �``�� ly� �I �rl I�j 80 / 38, Si 20 4I 36, ------------ h " •sZ , N sp 5S L v z: LOT ' M } L0T G j U �. _ CERTIFIED PLOT PLAN OF AfAs�,, ` LdT Z/ SiMr�un�s PvM�� G�r�. `j��rv�,o. ScTB1Et4�S cad ROBERT ��' /V YA ELDF{E N: IN A it h Ito"r A L ZIP A su �� SCALE, �. -0-'0' DATE ' ,DREDGE ENGINEERINQ 99. /✓Lcic. L,as I, CERTIFY THAT THE f uw��-rl vn/ � Q15TERED� rRE019TERED CLIENT,;., ,� ' 3HOWN ON THIS PLAN IS LOCATED ( LA d0� M0."`«�.,,..,, ON THE GROUND AS INUICAI'cQ ri.69U CIVIL LAND �gv,�3 E:NdIIL ' LSt�RVEYORgr,. �BY� ' '. CONFORMS TO THE ZONING LAW9 ..._. OF BARNSTABLE: , MA14S ' CK sy 712 MAIN STREET Ai 11 N q L AF111 FSIINr VEYOR Assessor's ma and lot number �y f g "..c .f�.o. & ppia SYSTEM T M d ALLE IN COM Sewage Permit number .............................................. ......... WTITLE . . � a t ; Z BA"STABLE, i House number ...;. � .`...... ......... ,�� ° i � +I o. g �rA�ggL CO p��� yLAI id TOWN ' F : BARNSTABLE � f BUILDaIHG IHSPECTO APPLICATION FOR PERMIT TO ? t.. r... ���yj�f......... TYPE OF CONSTRUCTION ......................................:::......::................................................................................:... } . ...............� ............ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following informati T r Ms V Location .............. ..... .......�................. f....... .... ........:...........:... . ProposedUse .......:......... .......:. -.7...............................................................................!............ Zoning District ....:. ........... .....................Fire District .... . / .. ............................................ .// .:.....�.:1 :...�1. Name of Owner Address .............. -;, .. S Nameof Builder ............................................:.........:...........:.Address ........................................`..........:................................. . M Name of Architect Address ..:`......... ............... } CS Number of Rooms ................. ..... ..............................:......Foundation .. ..... ......�. ... ....... � ` fit✓ Exterior , g �/.. ................................... Floors .................4: ................... `................::. Interior ....'......... �jY'�-f ................. Heating ....................�...... ... ...........................................Plumbing ........ 1.... ...�� .f.......................... Fireplace ....................................................Approximate. Cost ............;'.. ....1! f�..�l..�,.............. ..:... /. . Definitive Plan Approved by Planning Board __________________________ ----19 ------. Area. Diagram of Lot and Building with -Dimensions Fee �✓ . ........... .... ...! .. ..............T..... SU ECT TO 'APPROVAL OF BOAS a = 13, C OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS , I hereby agree to conform to all the Rules and Regulations of the Town of Barn ble regarding,the above construction. Name .. .. .. Construction Supervisor's License �1:��.. .. ........ NICKULAS, LARRY A=288-210 N6 '26]64 Permit for .......... ..5.1.00X•• S ... ........ _ Locatior .... Simmons Pondj'C i rc l e ........................ . ...................HY.an.n!. p4C1:..................................... Owner La.MY...N.i cku 1 as................................. s Type Construction Frame a. 4 .................... ................ . .......................................................... ........... Plot ............................ Lot ................................ ' Permit Granted J"h...31 .... .....19 84 h Date of Inspection ......... 19 Date CompI 'ted 19 / .��' � �'` •� -. �. .�' �'� rf� ' ♦w of _r; l> Town.of Barnstable Regulatory Services s"R'',�T"Bj'E Thomas F.Geiler,Director prED►,,�:► Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fes: 508-790-6230 -PLAN REVIEW Owner: C Map/Parcel: Project Address 5(0-e t ads nuilder:_ �y N 14 f L The following items were noted on reviewing: Y a-} Reviewed by: Date:.. 7-—3- —D Q:Forms:Plnrvw 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 Please Print Lee% Name(Business/Organization/Individual): �'�7�I,CJ 0A)WI'LL ' Address: /40 yP 414 . 6C0c4e, City/State/Zip: life dAe2W_� Rk �-4V4 Phone-#: 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 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors 2. I am a'sole proprietor or partner- listed on the-attached sheet. 7. Remodeling ship and have no employees These sub-contractors have . g, Demolition working for me m an capacity. employees and have workers' Y P ty $• 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.❑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.❑ Other comp.insurance required.] . 'Any applicant that checks box#1 must also fin 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 worker;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.M 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains-and pen lties of perjury that the information provided above ' true and correct • � • Date: � I� Sienature: p� Phone#• Yy ro 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#: r r 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 bean 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-contiactor(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. 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 Sile 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 fo 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 Massaohusctt Department of Industrial Aocidmts Qffiee of InvestigafiGns 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.rnass.gov/dia i E'O�ti Town-of Barnstable yP °� Regulatory Services * !grAB Thomas F.Geiler,Director asnss. 9� 0:* ``� Buildincr Division b Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 r Fax; 508-790-6230 Permit no. Date . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied . building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ri 't 1 Estimated Cost 30 OO'D ,Address of Work: AP 5'l/7,(1V0A!5 P01JL1� 40V; Owner's Name: � -��✓ �:C Date of Application: /0-7 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner.pulling ownpermit Notice is hereby given that: OWNERS FULLING 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 Ihereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Q:fM=h=ezffldav a� n eonthsn Z•a41 TT 7 ( t� p'seserlgtivo Aacksgd!ar sre wael T'w ajr=ij,Radcow Dallainge Seated �'pels ' HYA7Lfhi'Q14'I , 113TIw11A3tIri1 Cilaustg Gfaang Gelling Wail Flo" $ascssirat Slab 'Henting/CooCung yy �I('fa) Ug4uO R-value' ' &•vslud R-y4ue� Wall ,Fairad� Fgv:pmeat EfHdeae Pale R-731=1 �yalue 5701 to 8300 Hestiag Jjb5 r Days' 1 1Z°/, . 0.40 38 13 19 10 N°� 12% 0.52 30 19 '• 19 10. $ -AM TL '•S9711VE • 12y vo 38 13 I9 10 I3 . 03b 38 13 25 .1dlA RIA. 8iorasal T e IdasmaI lJ WHO 0.44 32 19 19 10 S 15% '0,44 38 13 25 NIAAFUE � � 13% am 30 19 19 10 83 omml NMMI 18%, 032 38 •13 23 NIA NIA Y 11 . IL42 31 19 23 VA NIA Normal 2 13% 6,41 31. 13 19 10 � @0 AFVE ]oya $Sp 30 19 19 10 90AFUE ADDRE55 OF PROPERTY: �` ��� SQ[TARE FOOTAGE OF ALL EXTERIOR WALLS: �(�'06 3, SQLZAR£FOOTAGE OF ALL GLAZINCT: 4, s/e GLAMN4 AREA03 DIVIDED BY•14:2); 70 3. SELECT PACKAGE(Q..AA see ahmt above); , G v g eTT�R MORE Itv'VQLV£I]NMTHOI35 eF r)BIMUZaiI 1G ENERGY REQUME"Y S ARE AVAILABLE. ASK US FOR TiM MO MIATION E ,D NGTNEFECTORAMOVAL: • 1TES;• �0: ' 4�zu�-fd'a4303a tioF ' ti Town of Barnstable: °« Regulatory Services ' AB Thomas F.Geiler,Director Building Division TomFerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign.This Section If Using A Builder as Owner of the subject property hereby authorize i frgjai)`qJ)A) 1U- to act on my behalf, in all matters relative to work authorized bythis Molding permit application for . (Address of Job) Signature of Owner Date Print Name QF0RM1S:0 Vn,TFRPE -MI55ION i jlf LVL HEADER OVER DELETED WALL TJ-BeanO6.25SerialNutuber: 0 627 3 PCs of 1 3/4" x 18" 1.9E Microllam@ LVL Page Enlgine Version:6.25.71 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED JI a b 16'4!■ Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width:7' Primary Load Group-Residential-Living Areas(psf):40.0 Live at 100%duration, 12.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Snow(1.15) 665.0 380.0 0 To 16'4" Adds To TOTAL ROOF LOAD 35/20 Uniform(plf) Floor(1.00) 0.0 80.0 0 To 16'4" Adds To WALL LOAD SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 5.55" 7718/4656/0/12373 All:Blocking 1 Ply 1 1/4"x 18"1.3E TimberStrand@ LSL 2 Stud wall 3.50" 5.55" 7718/4656/0/12373 Al:Blocking 1 Ply 1 1/4"x 18"1.3E TimberStrand@ LSL -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s):Al:Blocking -Bearing length requirement exceeds input at support(s) 1,2.Supplemental hardware is required to satisfy bearing requirements. DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 12121 -9659 20648 Passed(47%) Rt.end Span 1 under Snow loading Moment(Ft-Lbs) 48483 48483 66849 Passed(73%) MID Span 1 under Snow loading Live Load Defl(in) 0.326 0.400 Passed(U589) MID Span 1 under Snow loading Total Load Defl(in) 0.523 0.800 Passed(U367) MID Span 1 under Snow.loading -Deflection Criteria:STAN DARD(LL:U480,TL:L/240). -Bracing(Lu):All compression edges(top and bottom).must be braced at 7'4"o/c unless detailed otherwise. Proper attachment and positioning.of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application,input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code IBC analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S/BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: OPERATOR INFORMATION: R&R IMPROVEMENTS Matthew Gustin DUNHILL JOB Mid-Cape Home Centers YARMOUTH,MA PO BOX 1418 465 ROUTE 134 SOUTH DENNIS,MA 02660 Phone:5083986071 X4987 Fax :5083984559 mgustin@midcape.net Copyright ® 2006 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist. C:\Program Files\Trus Joist\TJ-Beam\Job Files\22.sms LVL HEADER OVER DELETED WALL TJ-Beam®6.25SerialNu :762 3 Pcs of 1 3/4" x 18" 1.9E Microllam@ LVL Paget EngneVersion:26.5.1 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Operator Notes: CALCULATED AS A FLUSH BEAM. PROJECT INFORMATION: OPERATOR INFORMATION: R&R IMPROVEMENTS Matthew Gustin DUNHILL JOB Mid-Cape Home Centers YARMOUTH,MA PO BOX 1418 465 ROUTE 134 SOUTH DENNIS,MA 02660 Phone:5083986071 X4987 Fax :5083984559 mgustin@midcape.net Copyright C 2006 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist. _ C:\Program Files\Trus Joist\TJ-Beam\Job Files\22.sms ®�} "j ,VIALVL HEADER OVER DELETED WALL TJ-BeamU 6.25 Serial Number:7004103627 3 Pcs of 1 3/4" x 18" 1.9E Microllam@ LVL User:, Engine Vers07 ion: THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Page 3 Engine Version:6.25.71 CONTROLS FOR THE APPLICATION AND LOADS LISTED Load Group: Primary Load Group 16' 0.001, ^ Max. Vertical Reaction Total (lbs) 12373 12373 Max. Vertical Reaction Live (lbs) 7718 7718 Required Bearing Length in 5.55(W)„ 5.55(W) Max. Unbraced Length (in) 88 Loading on all spans, LDF = 0.90 , 1.0 Dead Shear at Support (lbs) 3634 -3634 Max Shear at Support (lbs) 4561 -4561 Member Reaction (lbs) 4561 4561 Support Reaction (lbs) 4656 4656 Moment (Ft-Lbs) 18243 Loading on all spans, LDF = 1.00 1.0 Dead + 1.0 Floor Shear at Support (lbs) 5419 -5419 Max Shear at Support (lbs) 6801 -6801 Member Reaction (lbs) 6801 6801 Support Reaction (lbs) 6942 6942 Moment (Ft-Lbs) 27203 Live Deflection (in) 0.097 Total Deflection (in) 0.293 Loading on all spans, LDF = 1.15 1.0 Dead + 1.0 Floor + 1.0 Snow Shear at Support (lbs) 9659 -9659 Max Shear at Support (lbs) 12121 -12121 Member Reaction (lbs) 12121 12121 Support Reaction (lbs) 12373 12373 Moment (Ft-Lbs) 48483 Live Deflection (in) 0.326' Total Deflection (in) 0.523 PROJECT INFORMATION: OPERATOR INFORMATION: R&R IMPROVEMENTS Matthew Gustin DUNHILL JOB Mid-Cape Home Centers YARMOUTH,MA PO BOX 1418 465 ROUTE 134 SOUTH DENNIS,MA 02660 Phone:5083986071 X4987 Fax :5083984559 mgustin@midcape.net Copyright C 2006 by Trus Joist, a Weyerhaeuser Business - Microllam® is a registered trademark of Trus Joist. - C:\Program Files\Trus Joist\TJ-Beam\Job Files\22.sms - S s. 3 E ..+ bo o S o : 3.4 64to SS /.6 M :GRflAGE 1 L %9S r N I•' t t6:7 "J O " s' , .I • I -OJT k.�1 ! 40 Z T p �L J.- °.per CERTIFIED F'LOfi FLAN LbTtlz/ Sw►Mur�s PVNv" Grr Rr_i8�r2T• /7 YA v. ELDRESCALEtit `N Y hp Sl1'R'j :. Y^ --iDffDGE ENGINEERING'.-ca N .. /c1� `.•�s t.CERTIFY THAT THE , o rJ�✓�.tZ/ON CL.IEMT.;,,,,_,.,,,,,,,_, SHOWN O N : THIS` PLAN 13 LOCATE:n 4E019TEREq rRl"OISTIRED ( 8gvz3 I CIVIL. I:AND �4 MO. �.�,;,.,...... , ON THE GROUND A9 INDICATED o.Wl) ILENnINEER 8URVEYOR pR,sYt , '' CONFORMS TO THE ZONING LAW�1 - OF ':9A►iNSTAHI_E MA'ZiS 712 MAIN STREET ►IYANRl a MASSkA.. E Pf (�. I AFItI . gtINVEY�7R: 074 V ✓�1�LlIGLL6 � Board of Building Regulations and Standards HOME IMP,,ROVEMENT CONTRACTOR i - Registration 1259$2 Ex iration 010$ ype Individual 1 �7 MATTHE,W`M DUNHILLy 9` MATTHEW DUNHILL r MASHPEE MA 02649 ` A'tlmmIstr$tor 1 w A! f [17.1", 1 lnl��.*�,,: —11 •s� �tLs ?-r �t xa r .q �.�t 1-» if44i - � x BOARD OF BUILDING REGULATIONS '� �� License ONSTRUCTION SUPERVISOR ` 'q f '� Number CS0,064982 � Birtda07/03 1969, #r xr` �Expir s `0 03 2008' Tr no 27784,' x . } ,MATTH M DUNH x MASHPEE MA A2649Z Commissioner DID, 79 1 IeZ�� To f t�� 05/04/2005 08: 19 FAX 781 994 2353 NEW CENTURY MORTGAGE 10001/004 ;• RICHARD COSTA PHONE:781-838-1566 To: David Mattos , Date: 5/4/2005 Re: 23 Simmons Pond Circle Fax: 508-790-6230 Pages:4 (W/COVER) U nt O For Review. O Please Comment O Please Reply 0 Please Recycle " se advise. Here are the docs in question. If you have any questions, xt" callI"n�c THANK YOU,. " RICHARD ( J f E 1{ i � L W k QS ' C G - e _cc Lu �, 'xn u 13 SCALA O 4? O O s. CJ ' c ' ir, 05/04/2005 08:20 -AX 781 394 2353 NE'R. CENTURY MORTGAGE (6002/004 IUILDING P,E Mi'I :�$') .1.75 CYE;+'BAs,E. IA :?2ri:J,y 1-�ESS 23 F371MMONS POND C'i.TRCLF PHOSE ' HYANNIS UP 1,.1`i 4I BLOCK LOT -SIZE DMIELOPMENT' 1)1S?'RICT HY �'�RKIT '74810 DESCRIPTION SHED 12 X 18 POST & BEAM r`BRMIT TYPE I3ADDS TITLE BUILDING PERMIT ADD SHED ' i;OtJTKACTORO: PINE HARBOR BLDG.C). [N(j., Department of ARCHITECTS: Regulatory Services 'I;()TA-T FEES: $35.00 . BOND $-00 13ONSTRUCTION COSTS $4,300.00 28 OTHER NONRESIDENTIAL• HLDC 1 PRIVATE 0 • MAW _ .. BL'ILI?IN D ISION BY . I / y l� , L'!ATF', rtisUED 02, 18/2004 EkPTRATIO?� .DA • r 1 ` f 0.5/04/2005 09:20 FAX 781 994 2.353 NEW CENTURY MORTGAGE �Q0%13/004 L'uwN OF BAR.NS`i'APJ.,,K �. lUi:LDING PERMIT i ARti:.:EL ID 2139 .175 (�EOBA ,P, ,ZL� :.32�');{q tit:+irtF!';::; 2.3 SI:MMON8 POND r fRef.,E PH .Nr�' + ' 21 . f3LOC'faLOT IS U!SF. DEVRLOPMENT ' U.ESTRICT HX ._..Y... ..... 1PF.A;i91'1' 74:810 DESCRIPTION SHED • 12 X 16 POST & BEAM NIHRMIT `i'YPE, 13ADDS TITLE BUILDING PERMIT, ADD SHED CONTRt TORS: N I NP, 14ARBOR BLTDG,(''0. INC. Department 0� ARCHITECTS: Regulatory Services :"'OTAL F ERS- '35.UOµ I,140618 RUCTION COSTS 328 OT14ER NONRESIDENT_ IAI,:',BLDG 1 PRIVATE +► MAM fi BUILD DRIISION BY DATE [SS[ ED 02/,18/2'U04 .4,XPIRATION_ DA'TL THIS PERIA7T CCNVEYS•NO RIGHT TO OCCUPY ANY STREET, ALLEY OR sior!WALK OR ANY PART THEREOF,EITmrzA T6MPORARILY OR PERMANENTLY.EN• CROACHMENT$ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY 6E OBTAINED FROM THE DEPARTMENT OP PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SU6DIVI$ION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST 6E RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATION$OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE,WHERE A CERTIFICATE OF OCCU• PERMITS A PLUMBING AND MFOR (READY TO LATH). PANCY iS REQUIRED,SUCH BUILDING SHALL NOT®E ANICAL ELECTRICAL, INSTALLATIONS. ECH- 3.INSULATION. OCCUPIED UN71L F1Ngs INSPECTION MAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY . q1u IL0'NG INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 HEATING INSPEC-1'ION APPROVALS ENGINEERING.DEPARTMENT 2 BOARD OF.HEALTH OTHER: SITE PLAN REVIEW APPROVAL• WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN 51X CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC• MONTHS OF DATE THE PERMIT 15 ISSUED AS I TELEPHONE OR WRITTEN NOTIFICA- TION, NOTED ABOVE, TION. eJ TI) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION O Map - 289 Parcel /975 Permit# -7 7 ,�_A� i Health-Division C a) it -4 Date issued r Conservation Division Z Iy 0 S- G Application Fee "' Tax Collector ':�ah-,������ Per Fee 4 35 ,00" Treasurer rr ' SEPTIC SYSTEM Planning Dept. INSTALLED t1�; �AUST BF Date Definitive Plan Approved by Planning Board ENVIRONMENTq ('_("OE ANL Historic-OKH Preservation/Hyannis TOWN REGULA i IONS Project Street Address 2-3 51o2npn 5 And (_i lr''le Village 0_nn%s ( ' Owner Co r I05 S.r 05.�0 Address 291 G►oVefOOCS Ale, MPA:fi)(_ Telephone (181) 3M - 4181 Permit Requestl t ,l y 3) _ 2Z6+ Y1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existingnew Half:existing new g Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas 0 Oil ❑ Electric O Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ® No Detached garage:❑existing ❑new. size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed: ❑existing dnew size l2.i( Ila Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes CNo If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name-TAMP 5 �o Mc.Gro:{6 Telephone Number 508—q30 2800 Address 259I Queen AmP_ RA, License# C S 0739to,5 1- OX Lilc)h , M {l ®2loy Home Improvement Contractor# 13293 Worker's Compensation# WC 78 2 713 a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _ _ b 7 FOR OFFICIAL USE ONLY ' PERMIT NO. f v.•, DATE ISSUED r _ { MAP/PARCEL NO. ADDRESS r VILLAGE OWNER i j DATE OF INSPECTION: ` FOUNDATION FRAME s: - INSULATION s FIREPLACE ELECTRICAL: ROUGH FINAL A.; PLUMBING: ROUGH FINAL . — ' GAS: ROUGt%c FINAL .� FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. �; a ' i i I NHH I u oil 1 I IN V*Am t�J ZAM Ljs lac 13 °Ate- . � cic�lg'T'S 46uac. Lo A-FI o N o , AjEfs nngv---w o--r B E ACCU Rdk-rE STANDARD LEGEND NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY MAP28 EDGE OF DECIDUOUS TREES EDGE OF BRUSH ' ORCHARD OR NURSERY '•I T' V EDGE OF CONIFEROUS TREES MARSH AREA EDGE OF WATER DIRT ROAD DRIVEWAY .. E—PARKING LOT PAVED ROAD V -- DRAINAGE DITCH ----- PATH/TRAIL MAP 289 MAP 289 PARCEL LINE** rAP3z- �--MAP# 175 177 021 —PARCEL NUMBER #367 - HOUSE NUMBER 23 2 FOOT CONTOUR LINE —!0 10 FOOT CONTOUR LINE Elevation based on NGVD29 4.9 SPOT ELEVATION STONEWALL -X--X- FENCE RETAINING WALL - +-+-+- RAIL ROAD TRACK r. -= STONE JETTY MAP- 8o SWIMMING POOL PORCH/DECK C� 0 BUILDING/STRUCTURE 5 =!Y DOCK/PIER r - HYDRANT e VALVE OO MANHOLE o POST 0'P FLAG POLE T O W N O F B A R N S T A B L E G E O G R A P H 1- C I N F O -R M A T 1 O N S Y S T E M S U N 1 T .o SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James TOWER 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD ¢ LIGHT POLE O Ell CfRIC BOX v' e 0 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards s 1 INCH=40 FEET* enlarged scale. on the map. at a scale of 1"-100'. Parcel lines were digitized from FY2004 Town of Barnstable Assessor's tax ma I _ The Commonwealth of Massachusetts Department of Industrial Accidents exce Onflyesmadoffs 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name CarlQS` S _ Pond ' location. 23 S��,�,ons ci AM ano,ts hone# 395-4 81 ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one workii in ca achy I am an em I raviding workers' compensation for my empl es working on`this job.......±:?<a::K::a: .:. •:.}:+i}:•:?.:}:.?Yti??•:;.,}..:i•:i?.vh{{ :.::• ....:....:,,..:::.:...r\v:::•:;a:n•. ::Y::.v?}• :::a::;.,v::::. ......... ...:. .:...::::::n•:::::..,..:r•:::::•:. •:n•.•:�.K•:a}:.}..... ........... ...............n......r... ....::...:..... .r !..:.... ?i ic$:;K!a; ..;... . .:....ran..: .:.,......... .:] ....r...w..................r..........r, ...r.....:.......... ....,...:..... .:...,.. .........;.........:n..2•.v;}.,.n;,•.}}•{:.±••r �$:i`.2::;+•.}>#: is±.2r':.r. ..... n .. .i........... .::4..:r.: r:± .x........:.. n.n.n.r....... :.v...........v....... ......:. .v .. ..... +•i•:?fix::?•;••..;:;:.?±:vi v:}i:r}v]:w:.{:•: v.L.v:$ '":{$:i.x+v i:C�$X'.;+$$i' .:}... ..r$y::•r::::•.:•?.wh .:.2:x +.h:......r};.-vA•v:r'�::$:$•:.;.. .:tinv: �?4 n.TL.l•.. +!.:••.:,•}::? nt.:• l.. } : •.•h•:Y!;;::2a;::ti?S:••;;:.,;:{.}:},,+.,...,x v.+,.:?}:•::?:a• ..4:r;.tt.},pf.,u.;2'G':':;:h•.: t;> { 2�. ..r...:.......n..:. ..;, ..nivr.•:•4n^::. 4:. }:inT}:n•:.vt:{:v.] ...:.h..,.....r n.ti•.. :.Q••..r. v:., :............n.....xr}n........: ...... .n., ....,$C.rwn:v....r..xv....r. ..:. ....).?.-...{.:. ..{n,:•4... t...rr:{•,v.:.n...:..:?J.:iv!hv:TT.}}i}•.+•:?ti^:.r:nif:•:::!t::i::i••':4.:?4:•}:�?h`R}i. ),«\••::.:}�;.?•;.}v::;. ..!.v. ,..{.v$:;.....$:v••�•+>.,: n4.,...,T,.,fv},;•.•:::.•::.... •:r\8 A•:•n•.v.+.'6.....;r;ray..;,.;..;. a};.:: ......:,,: .:. , a..t,....•:r...,... ..{..}..2.. +•:x:•.:$:.};?.^,r.{{a::•w.v:hv:±::.v •v::::-.r•::.. «:Y...... 4.:{. .....:vv.+....r.h.,: r ....a 4. aA::?•}rv.2...:..... ...K v.v.r..r..:•w::}±:n•:.,:n4n.,.:.�C:>.!•,v-•. 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L:vi :r..•ee�� ?}`ar.•.,•f..u...,:.... :Sfi{.:t•:;.:{.{:{.;;ft;}.?a::••.,•.,.,•......... fi•:L:w:ck':w..,.'.,;. ,.:a.n...:•Y:. r.•::•r:..::•hC•:.,•:>;,5.:•n4-.::.a;f;,x..:..n.... ,L}:i:,+{...Yh}7..,•:. ;v..•.a:nv.:•:;::.:W.v.!A,vL•:!?•Y\{anL«:.,w:r???•T:{:.a k•:�•{.•.•n.. O�� FaffrQe to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crtnlinat penalties of a Sae up to SI,500.00 and/or one years'imprisonment as weR as civfi penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me: I understand fhat a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage veriitcatlon. I do hereby certify the pains and penalties of perjury that the information provided above is trap and eor/reat Si tune - .Pimt name official use only do not write in this area to be completed by city or town oMcial city or town: perndt/llcense# ❑Building Department ❑Licensing Board ❑checkif immedlate response is required ❑Selectmen's Office ❑Health Department contact person: Phone#; - ❑Other,_,_ Oniud 9195 P]ql Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as as individual,pp,artnershi association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or, building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall.withhold the issuance or renewal se o r permit too operate a business or to construct buildings in the commonwealth for any applicant who has of a license P P . with the insurance coverage required. Additionally,neither the aced acceptable evidence of compliance not prod p 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. v Applicants .4 please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,'address and phone numbers along with a certificate 'of insurance as all affidavits maybe . . Accidents for confirmation of insurance coverage. Also be sure to sign and submitted to the Department of Industrial ��. 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 numibei r. The affidavits may be returned o the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us'a. call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 . •tHe Town of Barnstable �oF r�ti Regulatory Services • snxxsTABM Thomas F.Geiler,Director Building Division lED MPS Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME MROVEMENT 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. J Type of Work ��Y �L,U Estimated Cost l t ) Address of Work: 3 �9 m rn�n5 �rantA 01 rc-`P Owner's Name: (�f71('`OS 7 yflisN 06- Date of Application: OILL I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000 - []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A• SIGNED R PENALTIES OF PERJURY I hereby apply for a permit as the agent of owner: f Date1 Contractor Name Registration No. OR Date Owner's Name °FTH�T , Town of Barnstable Regulatory Services saxxszaHi.E, Mass. $ Thomas F.Geller,Director Ac61 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 I• La'-X05 S, LSt 0, as.Owner of the subject property hereby authorize �o�me3 R , MC.r� d'0. to act on my behalf,. in all matters relative to work authorized by this building permit application for: . Z- S trilMntLS r0i5 / relLo_ (Address of Job) Signature of Owner ;Date, Car /CSS � . Cost"0. Print Name Q:F0RMS:0WNEUERM0SI0N ' tJ fGP. ��f2���iGIIE�G�I'GfIG e./��(,U/JG��I�G(.3�G1,G3�GLlk Board of Buildin Re ulations One Ashburton Pace, Km 1301 rz=�� Boston, Ma 02108-1618 Ucense= CONSTRUCTION SUPERVISOR UCENSE ointidat. 03114/1970 Number. CS 073865 Expires:0311412004 Restricted To: 1G JAMES R MCGRATH 204 CRANVIEW RD BREWSTER. MA 02631 Tr.no: 18918 Keep top for mcetpt and dtange of address notification. 92w eOMMV6�w a r` III Board of Building,Regulations and Standards _ One Ashburton Place - Room 1301 11..11 Boston. Massachusetts 02108 Home Improvement Contractor Rcgist�ration i Reoistration: 132935 Type: Private Corporation Expiration: 10/31/2004 McGRATH POST & BEAM CO. JAMES WGRATH 259 QUEEN ANNE RD. HARWICH. MA 02645 - Update Address and return card.Mark reason for change. Addraw Renewal t?mphrvment host Card _ �� ;%/,g tia9r�nrkaiarsy.+ll�(i of:.•�la�ucie7 ttoard at&utding Regulations mod Standards License or registration valid for individul use only HOME pAPROVICUENT CONTRACTOR Aefore the expiration date, If found return to:, i Board of Building Itegulations and Standards ' Roostrstion: 132M One Asbbartno Plate Rut 1301 Expiration: low/2004 Boston,Ma.02108 Typo: Private CorporatlOs► MCCRATH POST&BEAM CO. JAMES McGRATH -4�tiZ����9/ 259 QUEEN ANNE RD. • y.... z HARWICH.MA 02645 4�im;n:atr�,ar - Not valid withwrt sit! attire _ { 05/23/03 12:13pm P. 00Z The Commonwealth of Massachusetts Department of Indus&ial Accidents :_ - Otllcsolli�dyis 600 Washington Street Boston,Mass 02111 Workers' Cotapcnsation Insurance Affidavit nne d _�� 1 am a homeowner performing ail work myself. I am a sole proprietor end Ime no one-orkine in any capacih iJ'�am an employer pro,iding workers' compcnsatioo for my employees working on this jab. f rv� •tom.��a�.. cgpranl n�tnt.__� n - nzlti SSs 0 \ _ATV l inxu ice-t or homeowner(circle one/and ha�•e hired the contractors listed below'%%ho ha%e 0 I am.a sole proprietor. general contractor. the following %vorkcri• compensation polices: address: • DhQ a• insur,nct to. an n • a.ttuioaNal ptseale[a ots Ase aP to S1�-�and/or failure to setart cavtrage as Minced nodes Section 2SA of MCL 132 cat Ind to rie impeaid Itat sae: I asdeabsd Idat a FAt one Years,imprisonment as wen as civil penalties in the to o[a STOP N►O>2IC ORDER tad averiG��+�s�' copy of this statement may be farw girded to the Olfirce of Invest"aloof of the DtiA for eovtrnpe I do hereby certij) under the pain an p n /t'es ry that the Mfa-iasdon provided*bow is dot and cams signature Phone q _�•:.1_V Print name .r `'� a - "•' - official use on]. de not write in this area to he completed by tltp OF town oflttltl ' r,a_ �_, permit/lirease a n8aitdia�Department City or town:__ - b(,ietaslit Board • - Qgetecttaea's office Q theeh if immediate response is required OWN"Departmeat phone tt•_ � .� contact person: r BUILDING DEPARTMENT CONSTRUCTION SUPERVISOR FORM PLEASE PRINT. job Location:_ Number Street Village Owner of Property: �— - - jC ('o nstruction Su ervisor: ` _ --b "� phone No. ' P Name Liccnsc No. Address, 1,icensed Designee: License No. (If other than Supervisor) Name 2.15 Responsibility of each license holder: 2,15.1 The license holder shalt he fully and completely responsible for all work for which he is supervising. He shall be responsible for seeing that all work is d om,pursuant to the state building code and the drawings as approved by the building olfiicial. 2.15.2 The license holder shall be responsible to supervise the construction, reconstruction, alteration, repair,removal or demolition involving the structural elements of building and structures only pursuant to the state building code and all other applicable laws of the commonwealth, even tbougb he, the license <r subcontractor or contractor to the permit holder. holder.is not the permit hold<;r but only' 2.15.3 The license holder shall immediately notify the building otficial in writing of the d►scovely of any violations which art;covered by the iWilding pernut. on e these 2.1ra.4 Any licenseewho shall willfully violate subsections 2.15.1,2.15.2 or 2.1 ect tor or an others c ion suspension of rules and regulations and any procedures, as amended, shall be subs license by the board. 2.16 All building permit applications shall cotttair1 the name, signature and license number of the construction supervisor who is to supervise those persons engaged in coosrntctioa, reconstruction, alteration,repair,removal of demolition as regulated by section 109.1.1 of the code and these rules and regulations. In the event that such licensee is no longer supervising said persons,the e d r a shall immediately cease ut. ntil a successor license holder is substituted on the t ecords of the building p 2.17 The license holder shall be responsible for r'egtlesting ail required inspections. Failure to do so may be deemed a violation of the permit conditions. 1 have read and understand my responsibilities of the buildin regulations Iounderstand4the construction supervisors in accordance with section )tly.l.l of the s ,�, inspection procedures and the specific inspection as called For by the building official. FI SURANCE COVERAGE: ave a current liability insurance policy or its substanMI equivalent which meets the requirements of MGl Ch.152 Yes No ❑ if LA. ou have checked y%%please indicate the type coverage by checking the appropriate box. ty insurance policy Other type of indemnity ❑ Bond ❑ t CE WAIVER: tam aware chat the licensee ddo �snot have the insurance coverage required by ne Laws.and that my signature on this permit application waivesmis requin?ment. Check one: ownerAg¢Mry Aden — Building Official Approval: Signature: I HOMEnW1YF,RLlCENSE EXF.MFTZON PLEASE PEUNT: DATE: JOB LOCATION: -- -� NAME STREET ADDRESS SECTION OF TOWN NAME HONE PHONE WORK PHONE PRESENT MAILING ADDRESS _ CITY OR TOWN STATE ZIP CODE The cumnt exemption far`Homeowner' was extended to include owner—occupied dweilinsts of one or that such units and to allow such homeowners to engage an individual for hire who does not possess a license,pro Ldedhomeowner shall act as su r. (State Buildiing Code Section 108.3.S.1) De ici�ti A of Homeowner: t resi on which there is ac is intended h he/she resrde.4 or intends , Person(s)who owns a parcel of land on wkuc a de to be,a one or two Tandy attached or detached stricture assessory to such use and/or farm structures. A person who constmucts mere than one home in a two-year pad shall not be considered a homeowner;such"homeowner" shall submit to the building officia►1,on a form acceptable to the building official,that he/she shall be re m for all such work perform under the buildine permit.(Section 109.3.5.l) ' The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicablecodes,by-laws,rules and regulations. The undersigned `horoeowoet' certifies that he / she understands the Town of Yamioutb Building �paztin�nt minimum inspection procedures and requirements and that he she will comply with said pmceduxes and requirements. HOMEOWNERS SIGNATURE APPROVAL OF BUILDING OFMCIAL INSURANCE COVERAGE- s of MGI,Ch.14Z. I have a current lability insurance poficy or its substantial equivalent,which meets the�quament Yes❑ No 0 the appropriate box_ If you have cl=kcd M,please indicate the type coverage by checking ee policy Ll Other type of indemnity 0 Bond ❑ A liability pu Y OWNER'S INSURANCE'WAIVER l am aware that the licensee does trot have the insurance coverage `s Mass.General Laws and that m y signature on by Chapter 142 of the this permit appltcatron waives tbas ceq Check one: Owner ❑ Agent ❑ Si�paature of Owner or Owner's Agent h:homouwttttia�;rnp ; I For office use only Permit No. Date AFFIDAVff Dome Xmprovement Contractor Law Supplement to Permit Application MGL c. 142A requires that the 'reconstruction, alteration, renovation,rupair modernization, mvetsion, , improvement, removal, dctnolitioa or construction of an addition to any pre-existing awnet-occupi©d building containing at least one but not more than four dwelling units or structure which am adjacenther t to such residence or building' be done by registxred contractors. with certain exceptions, alongvn requirements. Type of Work: . Est.Cost V/Add Tess of Word - -- " Owner Name: Date of Permit Application: I hereby certify that-- Registration is not required for the following rcason(s): Work excluded by law Job under$1,000 Building not owner occupied Owner pull"uag own permit Other(specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH BLE HOME UNREGISTERED CONTRACTORS FOR APPLICAITRATION - ❑V�ROVEMENT WORK DO J4NTp�R MG c.ACCESS i4 2THEA PROGRAM OR GUARANT Signed wader pettalties of per1urY I reby apply for a permit as the agent of the owner: bbor ,_3 35 Date Cootractor Name Registration No. oft; notice, I Y apP y p as the owner of the above Notwithstanding the above hereby 1 for a proprty= TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION- Ma Parcel r =A l p ppication Health Division Date Issued-. , r Conservation Division '� Application F61� �77/ Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address -2-✓a -511V - Village _ G/A'IJI 15 Owner NkC,S Address / ¢ S f3td H82)Fh'S> NA- Telephone C-751) -31S- 4-79 f F H r Permit Request Square feet: 1st floor:existing /?. proposed )60 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiaj[ �Q Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family _ Two Family ❑ Multi-Family(#units) Age of Existing Structure-21M 114 Historic House: ❑Yes ;d No On Old King's Highway: ❑Yes 'f No Basement Type: 4 Full ❑Crawl ❑Walkout ❑Other � I Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new` j Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Roomv,Count CV' Heat Type and Fuel: TA Gas ❑Oil ❑Electric ❑Other Central Air: XYes ]No Fireplaces: Existing ' New Existing wood/cal stover)(Yesj ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:0 existing ❑new size �0 �f 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 I t'f'� �- ��/N li/-��. Telephone Number_ 5-01ir ✓`� ��I� Address 5/(VAIA) 6142 p. License# c--s ®� 41 Home Improvement Contractor# l �r Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO d' T SIGNATURE DATE } 1y FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED P/PARCEL NO. ADDRESS VILLAGE OWNER ff - 7 -a`7 y . DATE OF INSPECTION: `r G-- FOUNDATION t:-'o t r - r S -7 ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING. ROUGH FINAL f 1 GAS: ROUGH � 4 — FINAL .p ' FINAL BUILDING 0 DATE CLOSED OUT r ASSOCIATION PLAN NO. rf t� j� r. June 29, 2009 Town of Barnstable Regulatory Services 1 Tom Perry,Building Comm. �C� Building Division 200 Main Street Hyannis,Ma. 02601 `"'� — !Lf 61 14 Dear sir: I respectfully request your assistance in the matter of my complaint against my neighbor, Carlos S. Costa of 23 Simmonds Pond Circle,Hyannis,02601. Mr. Costa has attached a lean to on an existing shed. This lean to extends to my property line with no set back as required by ordnance. (a copy of my complaint of 5/7/09 is attached) According to Building Inspector Mr. Paul Roma,he has inspected the structure and has told me that the structure is non-conforming and that he has verbally(on 5/29/09) informed Mr. Costa that the structure must be removed. I followed up with Mr. Roma on 6/16/09 when no perceived action-had been taken by Mr. Costa and learned from Mr. Roma that he would revisit the site and that if no action had been initiated,that he would send a written order to Mr. Costa. I asked Mr. Roma if he would copy me with the written order and was told that he would. It is now 6/29/09 and there is still no evidence that Mr. Costa intends to remove the offending structure. I have not received a copy of a written order that Mr. Roma promised me and I am concerned that this matter is not being taken seriously by Mr. Costa. I request therefore that your office become involved in this matter and assist in bringing this situation to an acceptable resolution by the removal of this offending structure., Your intervention in this matter is earnestly requested. Sincerely, Hachig Aj rw ; 5 Pitchers y Hyannis,Ma. 02601 (508) 790-0288 Town of Barnstable Regulatory Services � \ 0 Thomas F.Geiler,Director \ U anRxsrnate, a Building Division se34. �tEo MP'�a Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINOUIRY REPORT Rec'd b Date. t� 6 � y; . Complaint Name: C �`-off 5F,+ Map/Parcel Location � f , Address: Originator Name: Street: Village: '40 62MIS Stater l Zip: 02 L ) Telephone: J, - Complaint Description: _ zo FOR OFFICI USE ONLY Inspector's Action/Comments Date: Inspector: 7'' k Additional Info.Attached °F1HE Tp�, Town of Barnstable Regulatory Services w BARN rnsLe, MASS. Thomas F. Geiler, Director i639• ♦0 '°rEn,rpsA 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 July 14, 2009 Mr. Hachig Aghjayan 5 Pitchers Way Hyannis, MA 02601 Re: 23 Simmons Pond Dear Mr. Aghjayan, Yesterday I received your letter which served as a reminder to send you a copy of the letter. sent to Mr. Costa regarding the above referenced property. Please find enclosed a copy of that letter. If you have any questions, please contact this office. Sincerely, Paul Roma Local Inspector /Yl�s Pat.,L e is McC hia-I L ajJ ae�� FS D . o k G 9 6 Mess 02 (y -7 qq q S , . r .. Town of Barnstable OF THE Tp� ., ti Regulatory Services � � ifV Thomas F.Geiler,Director6 $" MASS.`�' Building Division 1639. �AtFp Mpt s Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 COMPLAINVINQUIRY REPORT Dater Q Rec'd by: Complaint Name: Cif `oS z� 5F4- Map/Parcel Location , Address: �3 �r�`i/Ji S G� &VAur Originator Name: �� 4, , Street: ,� �J i�. Village: juq A",`; State: _Zip: Telephone: �6 9- 79b Complaint Description:- FOR OFFIC USE ONLY Inspector's Action/Comments Date: Inspector: _ yY Additional Info.Attached J �9 /��w��c �1 Q:foinns:complaint i� , oF1HE r Town of Barnstable Regulatory Services 4 4 • BAMSTABLE. « MASS. Thomas F. Geiler,Director- . �'ArF1639. Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us s Office: 508-862-4038 Fax: 508-790-6230 July 1, 2009 Mr. Carlos Costa P.O. Box 696 Hyannisport, MA 02647-9998 Re: 23 Simmons Pond Dear Mr. Costa, This letter will confirm our several conversations about the above referenced address. At some time after the permit was issued for your shed, a roof structure was added to the rear section. This roof appears to be encroaching into the required 10' setback.We discussed the need of removing the roof by the first of July to conform to setbacks or of having a survey to show that it is not encroaching. If the survey has been done,please notify this office of the results. Otherwise,the roof must come off. If you have any questions please contact this office and thank you for your cooperation. Sincerely, P Paul Roma Local.Inspector x r Town of Barnstable *Permit# ?66-164 7�(p Expires 6.f onths from issue date Regulatory Services Fee �p 41 D . S. PERMIT Thomas F.Geiler,Director AR 3 2007 Building Division M 1 Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Jof Valid without Red X-Press Imprint Map/parcel Number Property Address d -3 St wt m 0911 f t o n j C t rdt [residential Value of Work o2 (700, Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address CQ r /o s Co 5fi k -7 3 Jr r rn rn o rL r Po aj Cyr c /P ,yrG�✓�t s 1� !�' � ��e l Contractor's Name h t jheht I/e p fj� k6LAI e Telephone Number Home Improvement Contractor License#(if applicable) r 3 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner E�'I have Worker's Compensation Insurance Insurance Company Named Y&04 02s �,r Cud 5, �6 P 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 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side 2 O-Replacement Windows/doors/sliders. U-Value_r (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. / f SIGNATURE: / it Q:Forms:expmtrg Revise061306 HONIE IMPROVEWNTCONTRA . Sold,Furnished and InAalled by: Branch Name: Date: �� THD At-Hume Services,Inc. d/b/a The Home Depot At-Humc SeMccs +� 345A(irecriwood Street,Wurcester,MA 01607 Branch Number: "7 —Job R c ta6� Toll Free(800)657-5 182; Pax:508-756-2859 Federal IV#75-2698460 ME Lac#C 02439 t;t Cont.U0 1 G427 t� C'T•L,il;#565522; MA Humo immprovement eontmetur Rc𞾫 installation Address: S 1 ri►m on S! 4 i I r 1—�el �d City I State Zip purcha9 ' : Last d DI to of Drlver'll Lie.#&Ex Mutyr: Work Phone, }louse rhone . (7st)T3b'- 1315 Rome Address: g�t�— Zip (if diffencnt from installation Address) City E-mail Address(to receive updates and promotions from The Home Depot):- - --� Proicet lnfo�rmation: YWc/1'uu ("PuM1125el'").the owners of'the property located at the above installation address, offer to coast wit,► ,fume Depot U.S.A., Inc. (`114 w Depot")to furnish, deliver and arrange for the installation of all materials as described on the attached Spec SheetL5 a ,incorporated herein by refezc- f. nec and made a part hereo f2centract if, upon re-inspection of the job,Home Depot determines.that It Home Depot reservex the right to cancel th cannot pcilorm its obligations due to a structural problem with the home, pricing errors or because work required to complete the job was not included in the Slice Sheet or Contract. DEPOSIT PAYMENT OPTIONS (subject w rat a vairrcation and/or crmlil approval.) OCR 1. Chcck,rashias Cheek or US Postal Service Moncy Order P FCONTRACT AMOUN r �„ � (Mtwc pa ble to mo Hotno Mpot). 1 2. credit Card* ndtor other payment options-Clrele One Belm *LESS D»raslT s visa MasterCard Discover American caress BALANCE DU E The t•lumo Depot Horne improvement Loan o dome Depot Credit Card ON COMPLETION $. L]Now Account n tx1ssting Account (NIL&HDCC ONLY) *Minimum 25%of Contract Amount due upon Available Credit:S y�0 (HIL&HDCC ONLY) execution of this coatract, XP.Ditto: Natne a$it appear%oti card: • �r-i-0 5 S — Indicate Payment Method For *By my/nur signature bcluw,UWe agree to allow Home Depot to BALANCE DUE ON COMPLETION**: charge the shove r nc �redifcdard for the deposit indicated. � l4CldaSignature At ro-45 t-. " o �a 0 HIL or HDCC AuthoriMiun.Codes ** ay be Subjcc to Credit Approval,Fund osit Final Payment Verification and/or Credit Card Authorization # # Purchaser agrees that,immediately upon completion of.the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire� Aa;cement: This agreement and its attacbments> including any financing agreement, cant lin the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement Signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project tx complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior. to the actual completion of the work,to be performed under the contract. You may cancel tbix transaction any time prior to midnight of the third business day after the date of'othis contract. Sec Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10/.+ of the contract amount if job Is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will be a service charge equal to 259/9 of the contract amount if job Is cancelled by Purchaser AFTER materials are ordered. _ .,., .,.,,,•: •rr,nnec nt~ TUTC t't1NTRACT. I/WLl -n1a11 AOarPs ttu rG1.G1rw ukP.u.....»---------- ------ roicr't Information: i/Wc/You ("purchaser").the owners of the property located at the above installation address,offer w with llomc Depot U.S.A.,lt+c. ('il.ome Depot")to furnish,dcliver and arrange far the installation of all materals as ►ntruut :scribed on the attached Spec Sheet Al r3 V ,incorporated herein by refezt-net:and nutde a part hereof, ame Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that t � lnnot petform its obligations due to a structural problem with the home, pricing errors or because work required t4 rmplete the job was not Included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS (Subject w fund verification arwor credit approval.) & I. Check.Cashiers Chock or US Postal•Service MMY Ordor CONTRACT AMOUNT $ A\QA (Made pa bk to The Hotne ftot). rt C, p0 2. cftdit Card* d/or oWer Paynw"t options-Code One Se" 'LESS DEPOSIT $ o'� Visa MasterCard Discover Amcricao livress BALANCE DIJ lE 9 7 $ The dtumc Depot Horde lmpivvemcat Loam timme Dgvt Credit Card ON COMPLETION t LJ New Account n Existing Account (1II1,&wl)CC ONLY) *Minimum 25%of Contract Amount due upon Available Credit:S�Dom_ (HIL&1.11)CC ONLY) execution of thib contract. Acetq•� _ /'' ,fit = r Fiume as it t►ppcars cm card: 4 r_i5 — Indicate Payment Method For *By my/nur signature bcluw,We agree to allow Nome Depot to BALANCE DUE ON COMPLETION"' charge the ahnve n ' card titer the deposit indicated. 1� .3 /6 , — r1 {` idcr x Signature t** Vy'be - D h1�ri n o t re+9 Drj f HIL or HDCC Authorization Codes su j/eet to Credit Approval,Fund D osit Final Payment Verification and/or Credit Card Authorization # - # Purchaser agecs that,immediately upon completion of the work,Purchaset will execute a Completion Cortifrcatc and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire A=crnent: This agreement and it attachments, including any financing agreornent, conhtin the Complete agreement between the parties and caa not be amended or modified unless in writing in a scpatitc agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled4n copy of the contract at ifie time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits bume repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract, You may cancel this transaction any time prior to midnight of the third business day after the date of ibis contract•. Sec Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10% of the contract .amount if job Is cancelled by Purchaser AFTER the third business day,but BEFORE materials sre ordered.There will be a service charge equal to 25%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELA CO�PYW OF THIS TRACT AND TWO COMPL TERMS OF 0prES OF HE NOTICE ACKNOWLEDGE RECEIPT OF OF CANCELLATION. BY MY/OUR SfGNNrURE BELOW, i/WE UNDERSTANll THAT OT O VERIFY A iS REVIEW cT TO R R CREDIT I My/OUR CREDIT HISTORY AND 1IWE AUTBORIZE HOME D1~t'OT TO Vlr LE AND REVIEW MY/OUR CREDIT RECORD WnB AN INDEPENDENT CREDIT REPORTING AGENCY AND R.Ei,EASF,THEM FROM ALL L1A131LTIX INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. f Dom; /© O�_ SUBMITTED BY: t.b Ctrs Uot Date: f b� ACCEPTED BY: Horntlowncr Date. Homeowner NOTICE.ADDITIONAL TERMS AjiD CONDFI'IONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 1 p.24.o6 CSC White—Srenc h File Yellow—Customer Fink—Sales Consultant .�• ra roroocraraor•n i :I,JnN 4 4TC::)R )PRP-T T-NHW 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 Please Print Lel?ibly Name (Business/Organization/Individual): De,,00 Address: q City/State/Zip:R" Phone #: 9�'P Are you an employer? Check the appropriate box: Type of protect(required): 1.04 I am a employer with 10 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have.hired the sub-contractors 2.❑.I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an ea aci workers' comp. insurance. Y P h'• 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10:❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions myself. [No workers' comp. -c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers'. comp. insurance required.] 13.0 Other *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: (�1'rJ s 1�'� XN S - C 0 - Policy#or Self-ins.Lia#: '(� -�. Expiration Date: `> © ® Job Site Address: 02 .3 5r ei,?ra ors 44 Ci /State/Zi 60/ 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 pains and penalties ofperjury that the information provided above is true and correct. Signature: / 1�.�r� �n� p�� , Date: Phone#: J ki 9�'2L 4 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 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 bean 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. 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' "`""""`-co npensation policy;please..call the Department-at-the number listedbelow.-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 Fax# 617-727-7749 Revised 5-26-OS www.mass.gov/dia x1d1H: CERTIFICATE OF INSURANCE CERTIFICATE NUMBER " _ ATL=001234410-01.' PRODUCER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS - MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE homedepot.certrequest@marsh.com POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE FAX(212)948-0902 AFFORDED BY THE POLICIES DESCRIBED HEREIN. . 3475 PIEDMONT ROAD,SUITE 1200 COMPANIES AFFORDING COVERAGE ATLANTA,GA 30305 r COMPANY . 00492-THD-IPUSA-07-08 IPUSA A STEADFAST INSURANCE COMPANY INSURED COMPANY ' - - , HOME DEPOT USA,INC. i B ZURICH AMERICAN INSURANCE COMPANY 2455 PACES FERRY ROAD NW BUILDING C-8 r COMPANY " ATLANTA,GA 30339 C AMERICAN HOME ASSURANCE COMPANY COMPANY D NEW HAMPSHIRE INS COMPANY COVERAGES - Thie cert sate supersedes:and replaces:any_previously issued certificate for the policy_period noted,below. 2- THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAYBE ISSUED OR MAY I PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE I LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MM/DDIYY) DATE(MM/DD/YY) A GENERAL LIABILITY IPR 3757 608-02 03/01/07 03/01/08 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000 _ CLAIMS MADE OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000,000 OW NEWS&CONTRACTOR'S PROT EACH.OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one file) $ 1,000,000 MED EXP(Any one person $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-04 03/01/07 03/01/08 COMBINED SINGLE LIMIT $ 1,000,000 I X ANY AUTO ' ALL OW NED AUTOS BODILY INJURY - $ I' SCHEDULED AUTOS (Per person) C HIRED AUTOS BODILY INJURY $ (Per accident) c NON-OWNED AUTOS ' X SELF-INSURED AUTO PROPERTY DAMAGE $ HYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN AUTO ONLY: EACH ACCIDENT $ I AGGREGATE $ A EXCESS LIABILITY IPR 3757 608-02 03/01/07 03/01/08 EACH OCCURRENCE $ 5,000,000 NUMBRELLA FORM AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM $ C WORKERS COMPENSATION AND 2921209(CA) 03/01/07 03/01/08 X TORY a rt- ER EMPLOYERS'LIABILITY E 2921210(FL) 03/01/07 03/01/08 EL EACH ACCIDENT $ 1,000,000 F THE PROPRIETOR/ X INCL 2921211 (AZ,ID,MD,VA) 03/01/07 03/01/08 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTNE 2921208 AOS D OFFICERS ARE: EXCL (ADS) 03/01/07 03/01/08 EL DISEASE-EACH EMPLOYEE $ 1,000,000 C OTHER 2921213(QSI) 03/01/07 03/01/08 E WORKERS'COMPENSATION 2921212(KY,MO,NY,WI) 03/01/07 03/01/08 G TEXAS EMPLOYERS TNS-C44642086(TX) 03/01/07 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY SIR 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS CERTIFICATE.HOLD,ER g;;.. CANCELLATION.." > + SHOULD ANY OF THE POLICES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL_tea DAYS WRITTEN NOTICE TO THE FOR EVIDENCE ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR r LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. , BY: Mary Radaszewski VALID AS OF: 02/28/07 s ' DATE(MM/Dpin) ADDITIONAL INFORMATION ATL-001234410-01 02'%28%0 PRODUCER COMPANIES AFFORDING COVERAGE # MARSH USA,INC. COMPANY 1 homedepot.certrequest@,marsh.com FAX(212)948-0902 E ILLINOIS NATIONAL INSURANCE COMPANY 3475 PIEDMONT ROAD,SUITE 1200 ATLANTA,GA 30305 COMPANY F NATIONAL UNION FIRE INS CO 100492-THD-IPUSA-07-08 IPUSA INSURED COMPANY HOME DEPOT USA,INC. G ILLINOIS UNION INSURANCE CO 2455 PACES FERRY ROAD NW BUILDING C-8 ATLANTA,GA 30339 COMPANY H TEXT d _ I d I I - P i k t I I I CERTIFICATE HOLDER - FOR EVIDENCE ONLY I d MARSH USA INC.BY Mary Radaszewski Pao i S i 9-N0_FR-%C_ The Home Depot ka 6500-Series Double Hung Vinyl Window j Architectural-grade, Soft Coat Low E and National Fenestration Rating Council® Argon Gas-filled Insulating Glass Unit a � i ENERGY PERFORMANCE RATINGS U-Factor(U.SJI-P) Solar Heat Gain Coefficient Visible Transmittance 0w33 Om29 Om48 • Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental conditions and a specific product size.NFRC does not recommend any product and does not warrant the suitability of any product for any specific use. ENERGY STARO Qualified in all 50 States ® Northern South/Central Mostly Heating Heating&Cooling North/Central ❑ Southern Heating&Cooling Mostly CoolingNITIMS ME �. •�D I DP-25 Test Size:48 x 80 Test Number:05-30307.01 I i ✓fte TDO nYIF tomAaefL a�✓(�GCL062c�uc6Pl� f Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrai Board of Building Regulations and Standards 126893 ! ion Expiration ;g/312008 One Ashburton Place Rm 1301 Boston Ma.02108 Type Supplement Card ' t r t , .y THE Home Depot.At Home Sery c M N I E L PEL0QUIN , 3200 COBB GALLERIA{NY'#20 c;� ` Atlantic,GA 30339 Administrator Not valid without signature f 4 0 'r' " 4d91?" 33r"� "\�. e. :.7. `.;i,;.. .'i', Assessor's„office (1st floor): Ass ,- { ,/tii,, OF THETD essor's map arid lot number ..........J..�...,;/............. ............„ Board of Health (3rd, floor): Sewage Permit number ........................................................ L BABa9TAXE, i Engineering Department (3rd floor): �o rasa House number ............ ° i639 Definitive Plan Approved by Planning Board _______""__________________"_"__19_""_____ . N' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR-__ ..-_,, APPLICATIONFOR PERMIT TO .............................. ........ .... ...................................^...................................... TYPE OF CONSTRUCTION W 0 0 r � .. �W .. .................................................. ................ �.v,UTz..b.... 19 -- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby o plies for a permit according to the following information: 4 ..Location ..........C. . �.//��}/Y/.4!.N., ...Q�/ �.. . ......................................... ProposedUse 17�Gk .......................................................................................... Zoning District ......,`.�V........................................................Fire District ......�� ...... ........................................................ 1c1f/�A� �f'(��YNL��r� Z3 SrMvttaus /tin �( acLK Nameof Owner ................................................................. ..Address ........................................ ........................................ Nameof Builder ....................................................................Address ..................:................................................................. Nameof Architect ..................................................................Address ..................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exlerior ..... ......:.................................................................Roofing .................. .............................................................. Floors .......VQ0 .............................................................Interior ................................. -Heating ..................................................................................Plumbing Fireplace ........................... ..............Approximate Cost ............ .�!.v. .... n.......... Area ..... 40... /'.... .......... - Oc7 Diagram of Lot and" Building with Dimensions FeeO-"'— ............................................. 5 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .1/ ..........r ............ Construction„ Supervisor's License HENDEE, RICHARD COPLEY A=289-175 110 r ou I- /7 No' .32,950.,., Permit for ...Bui1d...Deck...... ..,..,Single,.Family,,.Dwel,lin Location ... 2.3....S .mon,',S,,,Pond... ircle, ....................Hy,anni S.P.4rt.............................. Owner ....Richard Copley Hendee Type of Construction ....Frame ............................ ............................................................................... Plot ............................ Lot ................................ Permit Gran'ed .......Jq. n.Q...6..................19 89 Date of Inspection ....................................19 Date Completed ......................................19 Assessor's office (1st floor): Ass-es-sor's map and lot number .... �Q, "..1.. ,� ,,,, �QOFTHE,To�o Board,of Health (3rd' floor):' ` Sewage Permit .number ..........:............................................... 2 339Ba9TGDLE, J Engineering Department (3rd-floor): mber p 039• House nu �0 y........ :.................. ........ D Mix{►• Definitive Plan' Approved by Planning Board ____ __________e______-.._____-- -------- . APPLICATIONS"PROCESSED; 8:30--9:30 A.M. and••1:00-2:00 P.M. only. - TOWN. OF BA�RNSTABLE BUILDING INSPECTOR /Ld �. APPLICATION :FOR PERMIT'TO ................ ..... ...... ..................................:..:......... ......... .... TYPE OF CONSTRUCTION W o 0 0 � �, 5 d £_LLI/V .. t.. ; .. ...... r�......... . ........... . ..............:....�`.....!`...b 19gcl.._ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit ccording to the following. information: location .........C .. `M ..:. :. � L. �. .... .Proposed Use .............................K ...... ...................................... ............................ ............ .... .............. Zoning 'District ......... ...................... 1�.�U........:............... ::.....:...............Fire Distract Y/�N is d 0 238 . f}AW 4S Name of. Owner Address z s1 M att aUS un �( etc LW, ` Name of, Builder ..............Address Name of Architect .........r. .. Address ...............:.................................................................... Number of Rooms ................................... ...Foundation ......................................................... Exlerior ........ ..Roofing ................................................................... Floors :Q ...........................................:..................Interior 7_ Y Heating ..........,.Plumbing _ • Fireplace .......................... ._................: .. ....... ..•........:........Approximate Cost ....... : �/ ....�...... .... ... ....... ....,..... Area yl b.Q '. Oct Diagram of Lot and Building with Dimensions Fee Q } r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform_ to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's .License !!... ,,,,,,,,,,,,,, L 4' HENDEE, RICHARD COPLEY No j,..3�.9.50.. Permit for .....Bu•i1d...DECK... '3r S ngJ.e E.amily...IIwelrl.i ng. ........ y Y 23 Si nmon" s Pond Circl Location .. .... .. ........ .......... .. 4 _ r. s f.. .... '=.Hvdnnis.port....... Richard Co le Hendee ' ` ...........Owner ......._.... .. �_ .. .. ... .. .. Type of Construction .'..Frame • ••• „•.••• .... ................. ..' 2t'. :..... . ........ C".�. . ... . as - �,,.� � � �'1, +�� _ • Plot ............................ Lot t ................. "June- '6" 89 v , Permit Gran,ed ........... .........!...... :19 Date of Inspection ..`...........................:......19 " Date Completed ......... ................. 19 r —•�i Ott � • ' . . { .. . , .. ` f - .. � — t. try ,f. a-.t f � • i"' 44 Q, i �b • � - rzLPG _ i � I ? cp I' IL I' t z I I --- I -------- ...- -------\ r \I I I 1 y TOWN, OF BARNSTABLE #, permit No 26754 ' Building Inspector 11AU2TAU Cash ov OCCUPANCY PERMIT f- : Issued to, j,aSCYy N1,Cki114S Address LL „. !A)t 21, 23 SiRmns Pond Circle, Hvavni.sport Wiring Inspector - Inspection date �� Plumbing Inspect r f Tnspection date a' v vyli •er .._ I 'YGas Inspector 1 t p r Ins ection.date / �t p �n -� 1 ro.�e_ i ( v i�Yflsis�cat t p r- C� U A T iEngineeringg Department �'�. Inspection /�� 7 'Fa, Ins ection date Board of'Health , '!-.�j L/ THIS PERMIT.WILL:NOTSIBE VALID, AND THE BUILDING.SHALL .NOT. BE OCCUPIED UNTIL SIGNED BY THE BUILDING'INSPECTOR UPON,,SATISFACTORY COMPLIANCE WITH •TOWN REQUIREMENTS AND IN ACCORDANCE -WITH SECTION 119:0:OF THE-MASSACHUSETTS STATE BUILDING CODE. �y y . -Building Inspector J - FROM }_ TOWN OF BARNSTABLE BUILDING DEPARTMENT W. Francis Lahteine & < K, *.,a 37 MAIN STREET HYANNIS, MA 021�1# Town Clerk Phone. 775-1120 SUBJECT: FOLD MERE , DATE - ... August 27, 1984 Av MESSAGE ti Work has-been: carp leted =Ier Permi.t• #26764 (Tarr Ni.cJct I s) . Please release-Bcnd e-.-- - - SIGNED ' �. / 1a DATE - - - REPLY. , �% �lAsses ap arid I�otAyumbc}er/<� . .".. .�. ...... osTHETo v Sewa4ge 'Permit number ....................... BABHST a LE. i House number ........ ..... ............: � ............................ MAB 9 1639- f 'k TOWN OF BARNSTABLE UILD'IHG„ INSPECTOR- B ,--- APPLICATION FOR PERMIT TO ................. ,........ .......... .t.. r.. ......../.,....f.., ! -�.......... �,. TYPE,OF CONSTRUCTION ................................................:.................................................................................... .................7 k............... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..............���...................................... .�...® ....... 7....................................... `r... .................................... ProposedUse ................................ .. ................... ,..........T t d Zoning District ......... ......... %` ...................................Fire District ......... ......................................... Name of Owner .............................. .f"!.-..�'Address .....f . �.. .. �..4. ?... ,�. Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ................. Foundation ............ ...... Exterior .................... ✓ `- ..................................Roofing ............ t''., ........... /,f'.... ...................................................... // �•1 c Floors .................................. ...�...,�,........................................Interior ............:.....................................`...... Heating ..................// 1.. ...........................................Plumbing ............. ....!... .................f......................... ° f Fireplace ..............`_ � .....................................................Approximate Cost ............... .. ,`/.......................... J Definitive Plan Approved by Planning Board --------------------------------19--------. Area ..........'r....... ... Diagram of Lot and Building with Dimensions ��� �1 !...7� Fee ..........`........ SUBJECT TO APPROVAL OF BOARD OF HEALTH � ��/� 1 7G C/ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barns able regarding the above construction. _ Name .... ..... ....�... . . . � ..�.�. .. .. � Construction Supervisor's License f�. �... ....(. ........ NICKULAS, LARRY A= fiO No 26.1`?4...... Permit for ......1.a...SXS?.ry...... ....... ........U.ng.le...Fami.l.y...DwzJ..l.in.g.... ...... ......... „ Location Lot 21, 2 $,jmmQn.S...Pon. Ird.e N Hyannis ........ ................................................................ Owner ..Lar..r. N.i cku.la.s............... Type of Construction Frame Plot ....................... Lot :...........:................... Permit Granted ...4A.Y...3.1............. :.........19 84 Date of Inspection . Date Completed .....19 t � . • .,_ w EK I. T• i I-- ff fff GA d;?.A 615 — 7j -FT r LTI -r 63 J t GS4 G4YLEL DELI f 1 — Lr- M A 7-7- D V iN H l L-L- D 73 . w'B- • SCAEF:/ �p`/•-O„- APPROVED BY: DRAWN., yf_a 9-D 7 YEVISED ' SkARun1 MALo.UjE- �-��c and '773I-lo(o>y • r DRAWING NUMBER �aFa ' ssl MULLION LJI.vVouo OU /Z �a0 a2 Jy�//G n't9�cy -cx IST. !U£R•I Py Un1 ,SITS 1 I 3 DELETE W/+-LL5. d L°VL tfEATE2 outR CSEE 5P�G5� I ► �J T Accr=fy r ^� y op7. Gu 02 o r- . 4X$ .po,5- -rmRxx EXIST7N6 T-UL-L- r-OuAil), ' j 3 = a I N GOUT. 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