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0040 SIMMONS POND CIRCLE
� �� ��s t ,� i� I 40 s4 PO"d(NX qiycuri Amr, X4 02647 August 14, 2014 Town of Barnstable 200 Main Street Hyannis,MA 02601 RE: 40 Simmons Pond Circle To Whom It May Concern: The changes of the cabinet layout in the entertaining space at the above referenced property were due to the addition of my aquarium.The aquarium is the focal point of the room. The cabinetry surrounding the aquarium is needed to neatly store all of the equipment required to maintain the aquarium. The addition of the bar and its placement is also due to the aquariums location so myself and my guests while entertaining can view it. Sincerely, R. Brian Ladner .: 4 i i t 41 Dear Sir, August 14, 2014 4 I'm writing this letter to hopefully answer any lingering questions about the Ladner's recreation space design. My directions from Brian were that he wanted a five ft. fish tank near the bar and cabinets to house the electronics. The bar should allow guests to view both the fish tank and the TV from the bar itself The shape of the bar evolved to accommodate these parameters. No range, dishwasher or refrigerator, other than a beverage cooler and an ice maker were required. He made it clear to me that this was a wet bar and media space only, not a kitchen. When I suggested that a dishwasher would still be helpful, even for a wet bar, he rejected the idea as being unnecessary. This is an entertainment space entirely and was never meant to be a kitchen. It does not meet the basic requirements of any kitchen I design. A microwave and a beverage cooler certainly don't add up to a working kitchen. We do numerous living space designs; media centers, walk-in closets, libraries, master suites, etc. Some can be quite extensive in their cabinet design. This project was by no means the most extensive we have done. I have been in homes in the Town of Barnstable with even more extensive wet bars and media rooms. Apparently these were approved without issue. We generally consider the architect's cabinet layout to be just a suggestion of space utilization. We invariably modify those plans to suit the specific needs of the client and how they will use the space. I've never been asked to submit cabinet plans for further approval. Further, I've never had a design fail inspection in any town on the Cape, or anywhere I've worked. The changes in cabinet layout were a result of the addition of the fish tank. The cabinetry surrounding the tank are needed to house the mechanical systems required to maintain the"tank. The addition of the bar and its placement are also due to the fish tanks location. s I hope this answers any questions sufficiently. _ Sincerely, 651 -AAFN SrxE6 Chas Hinckley V . 1 ROUTE 28 EF Winslow Design Studio WVESz YARMOUTH,AAA 651 Main St, West Yarmouth, MA 02673 A a �73 a' 508-771-5630 i = TE 771 63o' FAX: s=77i-5652 www.dWinslowxom " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 2 Map Parcel Application g�/3 00 Health`Division Date Issued l0 ,�/3;,. Conservation Division `� 3 Su�� ��Z h 13 ::'Application F e too- Planning Dept, Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation/ Hyannis Project Street Address f l?11 l ��.� ®' J K.LI c , Village Owner(Xro L Et L DA ER e_T"OT Address o 6 zw&uk ele hone_ `� 8 3 � 2-�. egftiYAS CAL f-, U-) fi9rvl f r-i 01,(1 Ck-d� In C z o Square feet: 1 st floor: existing proposed 2nd floor: existing A9 posed/1,0Total new Zoning District Flood Plain Groundwater Overlay Project Val ua ion 000Construction Type l� 1 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family l" Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes IlNo On Old King's Highway: ❑Yes M"No Basement Type: ❑ Full ❑ Crawl ❑Walkout W/Other r2A CA(,-76- Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existinglew Total Room Count (not including baths): existing new First Floor Room Coun �. Heat Type andFuel: 6/Gas ' ❑ Oil ❑ Electric ❑Other Central Air: MYes/ ❑ No Fireplaces: Existing lef New Existing wood/coal stove: ❑Yes A No Detached garage: ❑existing ®'new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes W to If yes, site plan review# Current Use NO A/i5� Proposed Use a-9 k �45 APPLICANT INFORMATION -A (BUILDER OR HOMEOWNER) Name 00 L� CO )elephone Number � Address co �U wQ!�:06 U.5 15 lid , License #d5 7� U 2- 5 Home.Improvement Contractor Worker's Compensation #6L!P Z2j /2,atl— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOO� lt>� SIGNATURE DATE 2 2' `� L r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED I MAP/PARCEL NO. . . .- ADDRESS VILLAGE ,.- OWNER s DATE OF INSPECTION: ` FOUNDATION- , .._._ ..._ FRAME E a r INSULATION- FIREPLACE f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL •GAS:- ROUGH t'" E" FINAL fYEINAL BUILDING - ,s.D.- — f i DATE CLOSED OUT �` ASSOCIATION PLAN NO. -- t The Commonwealth of Massachusetts Department of Industriril Accidents Office of Investigations 600 Washington Street Boston, MA 02111 l s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibly � J / Name (Business/Organizatio Individual). Address: City/State/Zip: Phone #: L?17(� d� Are you an employer? Check the appropriate box: Type of project(required): 1.4gi I am a employer with 4. ❑ I am,a general contractor and I 6.tew construction - employees(full and/or part-time).* have hired the sub-contractors2.-❑ I am a sole proprietor or partneg-. listed on the attached sheet:+ - - 2• modeling 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 required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MG'L 11;❑ 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' li,❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. I 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 their workers'comp.policy information. I ani an employer that is providing►porkers'compensation insurance for my employees. Below is the policy and job site information. ]]� - Insurance Company Name: RTIM _roolo o Policy#or Self-ins. Lie.#: ItiDC- SZ O Expiration Date: Job Site Address: v 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 i¢nprisonment, 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 verificat' I do her certify under the iry that the information provided above its true and correct. Si na Date: C / f� Phone#: Official use only. Do not write in this area,to be completed by city.or town official. City or Town: Permit/License# Issuing Authority(circle one): n 1'. Board of Health, 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Phone#:- - l TE(MMIDDIYYYY) ACC>oR ® CERTIFICATE OF LIABILITY INSURANCE DA08/2612013 ��. 08l2s/Z013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01361-001 NNAANIE CT - Morrill Insurance Agency Inc aco.Ifo. : (781)762-7300 a/c.No.: 17 Central St EMAIL Norwood,MA 02062 ADDRESS: SURER(S) F O NG COVERAGE NAI INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: Collins C O'Connor Jr INSURERC, 60 Waterhouse Road INSURER D: Bourne,MA 02632 INSURERS: . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE 1 y POLICY NUMBER MUplpp CY F AAM� IYYYY LIMITS - GENERAL LIABILITY - EACH OCCURRENCE $` COMMERCIAL GENERAL LIABILITY DAMAGE TO REMED $ PREMISES Ea occunertce CLAIMS-MADE OCCUR MED EXP(Any one person) $ - PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMPIOPAGG $ OLICY SCOT OC A - COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS - Per accident $ Y $ UMBRELLA UAS OCCUR - EACH OCCURRENCE $ EXCESS LUIB CLAIMS MADE AGGREGATE $ yypRDERDg Cpty�pERETENTION$ - yy� TH $ AND PAPLOYERS'LIABIA YIN X TORY LIMITS IOU ffiP UTIVE E.L.EACH ACCIDENT $ 100,000.00 A (Mandatory Itl�'I 0 NIA vwcsoos521o1zo1z snsnol2 snsnols �(ffMandatory in NH) E.L DISEASE•EA EMPLOYEE $ 100,000.00 D RIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000.00 - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) i The workers compensation policy does not provide coverage for Collins C OConnor Jr CERTIFICATE HOLDER CANCELLATION Town Of Barnstable MA 200 MAin Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hyannis,MA 02601 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD REScheck Software Version 4.4.2 Compliance Certificate Project Title: Denny O'Connor Energy Code: 2009 IECC Location: Hyannis,Massachusetts z Construction Type: Single Family a, Building Orientation: Bldg.faces 90 deg.from North Conditioned Floor Area: 2080 ft2 Glazing Area Percentage: 12% Heating Degree Days: 6137 ` Climate Zone: 5 r. Construction Site: Owner/Agent: Designer/Contractor: Ladner Residence Denny O'Connoor Colony Insulation,Inc 40 Simmons Pond Road 50 Waterhouse Road- 28 Jonathan Bourne Drive Hyannis,MA Bourne,MA 02532 Pocasset,MA 02559' e a c a o Compliance:0.7%Better Than Code Ceiling 1:Flat Ceiling or Scissor Truss 840 38.0 0.0 25 Ceiling 2:Cathedral Ceiling 480, 30.0 0.0 16 Wall 1:Wood Frame;16"o.c. 152 21.0 0.0 6 Orientation:Front Window 1:Wood Frame:Double Pane with Low-E 27,, ' F 0.290 8 SHGC:0.50 Orientation:Front Door 1:Solid t. 20 0.290 6 ~ Orientation:Front Wall 2:Wood Frame,16"o.c, 320 21.0 0.0 14 Orientation:Back Window 2:Wood Frame:Double Pane with Low-E 19 s .0.290 6 SHGC:0.50 Orientation:Back Door 2:Glass 48 .: 0.290 14 SHGC:0.50. Orientation:Back Wall 3:Wood Frame, 16"o.c. 248 21.0 0.0 14 Orientation:Left Side Window 3:Wood Frame:Double Pane with Low-E 9 0.290• 3 SHGC:0.50 Orientation:Left Side Wall 4:Wood Frame,16"o.c. 248 21.0 0.0 14 Orientation:Right Side Window 4:Wood Frame:Double Pane with Low-E 9 0.290 3 SHGC:0.50 Orientation:Right Side Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 1240 30.0 0.0 41 Boiler 1:Other(Except Gas-Fired Steam)85 AFUE r Compliance Statement: The proposed building design described here with the building plans,specifications,and other calculations submitted with the permit application.The proposed buil ing has been designed to meet the 2009 IECC requirements in REScheck Version 4.4.2 and to comply with the mandatory:requi n Wlisted in the RESc .c9 nlnspection Ch list. XX • l� Project Title: Denny O'Connor Report date: 01/16/13 Data filename:C:\Users\june.000\Documents\REScheck\O'Conner-1-16-13.40Sim ondPDRd-Hyannis.rck Page 1 of 5 Name-Title Signature Date r r ... ,. _ � �. .a•''�' dry r � '�}-, r� . a -- - ' i a 41 _c ' Y Project,Title: Denny O'Connor A'' +. ",'` r Report date: 01/16/13 Data filename:C:\Users\june.000\Documents\REScheck\O'Co6ner-1-16,13-40SimmondPDRd-Hyannis.r6k. ,. Page 2 of 5 REScheck Software Version 4.4.2 Inspection Checklist Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation Comments: ❑ Ceiling 2:Cathedral Ceiling,R-30.0 cavity.insulation . Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R 21.0 cavity insulation Comments: ❑ Wall 2:Wood Frame,16"o.c.,R-21.0 cavity insulation Comments: Cl Wall 3:Wood Frame,16"o.c.,R-21.0 cavity insulation Comments: ❑Wall 4:Wood Frame,16"o.c.,R-21.0 cavity insulation " Comments: Windows: ❑ Window 1:Wood Frame:Double Pane with Low-E,:U-factor:0.290 - For windows without labeled U-factors,describe features: #Panes Frame Type Thermal.Break? Yes No Comments: ❑ Window 2:Wood Frame:Double Pane with Low-E,U-factor:0.290 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: ❑ Window 3:Wood Frame:Double Pane with Low-E,U-factor:0.290 For windows without labeled U-factors,describe features: " #Panes Frame Type Thermal Break? Yes,-- - No Comments: ❑ Window 4:'Wood Frame:Double Pane with Low-E,U-factor:0.290 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1:Solid,U-factor:0.290 Comments: ❑ Door 2:.Glass,U-factor:0.290 Comments: Floors: ❑'Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-30.0 cavity insulation , Comments: Floor insulation is installed in permanent contact with the underside of the subfloor decking. Heating and Cooling Equipment: Project Title: Denny O'Connor Report date:01/16/13 Data filename:C:\Users\june.000\Documents\REScheck\O'Conner-1-16-13-40SimmondPDRd-Hyannis.rck Page 3 of 5 Y>e NA ❑ Boiler 1:Other(Except Gas-Fired Steam):85 AFUE or higher. Make and Model Number. Air Leakage: (j Joints(including rim joist junctions),attic access openings,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed with caulk,gasketed,weatherstripped or otherwise sealed with an air barrier material,suitable film or solid material. s ❑ Air barrier and sealing exists on common walls between dwelling units,on exterior walls behind tubs/showers,and in openings between window/doorjambs and framing. ❑ Recessed lights in the building thermal envelope are 1)type IC rated and ASTM E283 labeled and 2)sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. . .:.:,. (j Wood-burning fireplaces have gasketed doors and outdoor combustion air. ❑ Automatic or gravity dampers are installed on all outdoor air intakes and exhausts. Air Sealing and Insulation: ❑ Building envelope air tightness and insulation installation complies by either 1)a post rough-in blower.door test result of less than 7 ACH at 50 pascals OR 2)the following items have been satisfied: (a)Air barriers and thermal barrier:Installed on outside of air-permeable insulation and breaks or joints in the air barrier are filled or repaired. (b)Ceiling/attic:Air barrier in any dropped ceiling/soffit is substantially aligned with insulation and any gaps are sealed. (c)Above-grade walls:Insulation is installed in substantia.h contact and continuous alignment with the building envelope air barrier. (d)Floors:Air barrier is installed at any exposed edge of insulation. ' (e)Plumbing and wiring:Insulation is placed between outside and pipes.Batt insulation is cut to fit around wiring and plumbing,or sprayed/blown insulation extends behind piping and wiring. (f) Comers,headers,narrow framing cavities,and rim joists are insulated: r � (9)Shower/tub on exterior wall:Insulation exists between showers/tubs and exterior wall. Materials Identification and Installation: s ❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions. ❑ Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R-value. ❑ Materials and equipment are identified so that compliance can be determined: ` ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided. ❑ Insulation R-values,glazing U-factors,and heating equipment efficiency are clearly marked on the building plans or specifications. Duct Insulation: ` ❑ All ducts not completely inside the building envelope are insulated to at least R-6. w " Duct Construction and Testing: ❑ Building framing cavities are not used as supply ducts. Lj All joints and seams of air ducts,air handlers,filter boxes,and building cavities used as return ducts are substantially airtight by means of tapes,-mastics,liquid sealants,gasketing,or other approved closure systems.Tapes,mastics,and fasteners Iare rated UL 181A or UL 181 B and are labeled according to the duct construction.Metal duct connections with equipment and/or fittings.are mechanically. fastened.Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with'a minimum of three equally spaced sheet-metal screws. , Exceptions: Joint and seams covered with spray polyurethane foam. Where a partially inaccessible duct connection exists,mechanical fasteners can be equally spaced on'the exposed portion of the joint so as to prevent a hinge effect., Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in w.g.(500 Pa). ❑ All ducts and air handlers are located within conditioned space. Heating and Cooling Equipment Sizing: 3 ❑ Additional requirements for equipment sizing are included by an inspection for compliance with the International.Residential.Code. ❑ For systems serving multiple dwelling units documentation has been submitted demonstrating compliancemith 2009 IECC Commercial Building Mechanical and/or Service Water Heating(Sections 503 and 504). . - Circulating Service Hot Water Systems: 1 ❑ Circulating service hot water pipes are insulated to R-2. " ❑ Circulating service hot water systems include an automatic or accessible manual switch to turn offthe circulating pump when the system is not in use. Project Title: Denny O'Connor - Report date: 01/16/13 Data filename:C:\Users\june.000\Documents\REScheck\O'Conner-1-16-13-40SimmondPDRd-Hyannis.rck Page 4 of 5 I Heating and Cooling Piping Insulation: O HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3. Swimming Pools: Heated swimming pools have an on/off heater switch. Pool heaters operating on natural gas or LPG have an electronicpilot'light. Timer switches on pool heaters and pumps are present. ' Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar-and/or waste-heat-recovery systems. Heated swimming pools have a cover on or at the water surface.For pools heated over 90 degrees F(32 degrees C)the cover has a minimum insulation value of R-12. Exceptions: Covers are not required when 60%of the heating energy is from site-recovered energy or solar energy source. Other Requirements: Fi Snow-and ice-melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting r off the system when a)the pavement temperature is above 50 degrees F,b)no precipitation is falling,and c)the outdoor temperature is above 40 degrees F(a manual shutoff control is also permitted to satisfy.requirement's'). Certificate: • A permanent certificate is provided on or in the electrical,distribution panel listing the predominant,insulation R-values;window U-factors;type and efficiency of space-conditioning and water heating equipment.The certificate does not cover or obstruct the visibility of the circuit directory label,service disconnect label or other required labels., NOTES TO FIELD:(Building De partment artment Use Only) ` Project Title: Denny O'Connor Report date: 01/16/13 Data filename:C:\Users\june.000\Documents\REScheck\O'Conner-1-16-13-40SimmondPDRd-Hyannis.rck Page 5 of 5 I Ceiling I Roof 38.00 Wall 21.00 Floor I Foundation 30.00 Ductwork(unconditioned spaces): Window 0.29 0.50 Door 0.29 0.50 Other Non-Gas-Fired Boiler Water Heater: Name: Date: Comments: Proposal C01011Y MSUIR11011, Mc 28 Jonathan Bourne Drive Pocasset, MA 02559 " Tel. 508-563-6049 Fax: 508-564-6117 Proposal Submitted to: Phone: Date:: Denny O'Connor 508-509-3039 `January 16, 2013 50 Waterhouse Road Bourne, MA 02532 rJob Location: Ladner Residence 40 Simmons Pond Rd f f Hyannis MA We submit specifications and estimates for: Insulation:, Garage w/Room Over Description Type R-Factor Flat Ceiling .12"Kraft Faced Fiberglas w/PVE `R:38 t • Garage Ceiling 9"Kraft Faced Fiberglas Slopes to Plate 8 '/4"Kraft Faced Fiberglas.w/PV R:30 Exterior Wall 5 ''/2"Kraft Faced Fiberglas R:21 f. •- Garage Walls 6" Kraft Faced Fiberglas` R:19 Stairwell& Risers 3 %2' -Kraft Faced Fiberglas d R:15 WE ACCEPT VISA &MASTER CARD . We propose hereby to furnish material and labor,complete in accordance with above'specifications,for the sum:; ' Four Thousand—Five Hundred Dollars($ 4, 500.00) Payment to be made as follows: Terms to be Discussed-Upon Acceptance of this Proposal OPTIONAL &ADDITIONAL.(priced separately) White-Seamless Aluminum Gutters &Downspouts—Installed Add: $ 650.00 Owens Corning Energy Complete ..,.Add: $ 980.00' All material is guaranteed tote asf specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above Geoff Smith , the estimate. All agreements contingent upon strikes,accidents or delays a§ ' beyond our control.Owner to carry fire,tornado and other necessary insur- Note:This proposal may be withdrawn_ by us if not_ ance.Our workers are fully covered by Worker's Compensation Insurance: accepted within' 10 days Acceptance of Proposal-The above prices,specifications and conditions Signature - are satisfactory and are hereby accepted.You are authorized to do the work as specified.Payment will be made as outlined above. Default.If Customer fails to make payment within thirty(30)days from the date of' Signature Invoice,they shall be in default.A customer in default will be responsible for all Legal fees(33%of debt)and costs in the collection of this debt.Interest shall accrue at the rate of 1''/2%per month of the unpaid debt(18%per annum.) r Town of Barnstable Regulatory Services t Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 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 1 j � . (�c tihcs--�� to act on my behalf, in all matters relative to work authorized by this building permit 'T® ��Mr1f1CLn'� �{�O�d L°1r'c�Q (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final, inspections are performed and accepted. S' e of Owner Signature of Applicant Print Name Print Name _ Date Q:FORMS:OWNMPERMNSIONPOOLS 62012 Town of Barnstable Regulatory Services f R�A7.RTtRiR' : Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER7: 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 Ofcial 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 a 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 eannot 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. C:\Users\dec UiINAppData\L.ocal\M=soft\Wmdows\Temporary Internet Ffles\Contnntoutlook\QRE6ZUBN'02RESS.doc Revised 053012 ESTIMATED CONSTRUCTION COSTS LICENSED CONSTRUCTION SUPERVISOR(CSL) ITEMS EST. COST NAME OF CSL-HOLDER BUILDING: ELECTRICAL: ADDRESS PLUMBING GAS MECHANICAL(HVAC) SIGNATURE MECHANICAL(FIRE SUPPRESSION) TELEPHONE: TOTAL PROJECT COST: LICENSE NUMBER: EXPIRATION DATE: REGISTERED HOME IMPROVEMENT CONTRACTOR(HIC) LIST CSL TYPE(SEE BELOW) HIC Company Name of HIC Registrant Name TYPE MERM U Unrestricted(up to 35, 000 Cu. Ft.) Address R Restricted 1 &.2.Fami1y-Dwe1ling____ M Masonry Only Signature Phone RC Residential Roofing Covering Registration Number WS Residential Window and Siding Expiration Date SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. C. 152 § 25C16)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in thin denial of the issuance of the building permit Signed Affidavit Attached? Yes ---- ❑ _____ ❑ OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUMDING PERMIT Iva/7- as Owner of the Subject property hereby authorize to act S ,9 ' on my behalf, in all matters relative to work authorized by this building permit application. (�'-2 z Signature of Owner Date (Signed under the pains and penalties of perjury) Owner Authorized Agent ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. Print Name Own r Date OWiVER RESPONSIBILITY FOR BUILDING PERmrr An Owner who obtains a building permit to do his/her own work,or an owner who hires and unregistered contractor(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL) can be found in 780 CMR Regulations 110.R6 and 110.R5, respectfully. Owner's Signature Date i For Town Use Only TOWN SEWER // BOARD OF HEALTH SEPTIC PERMIT # COMMENTS: CONSERVATION COMMISSION FILE# COMMENTS: TOWN PLANNER ' BUILDINGS 75 YEARS OR OLDER ARE SUBJECT TO SECTION 3-1.4 OF TOWN BYLAWS AND REQUIRE A $50.00 FILING FEE AND SUBJECT TO PLANS UPON REQUEST. COMMENTS: PLANNING BOARD SITE PLAN REVIEW # a' J SPECIAL PERMIT #` -ZONING BOARD-OF APP-EALS.. 1 SPECIAL PERMIT # VARIANCE# INSPECTOR OF BUILDINGS . COMMENTS: APPROVED BY INSPECTOR OF BUILDINGS DATE 9 ':lassaciuseas -Deoartrnert cu �-- Board of Buiid n.g Regulations and Shandar::;s License:CS-093230 COLLINS C OCONNOR JR 50 WATERHOUSE ROAD BOURNE MA 02532 Commissioner 11/07/2013 lc�x07ce of Goun-:r Ai ;^rfsi ess"1ic;u?ata HOME IMPROVEMENT CONTRACTOR . Registration: 149070 Typa: Expiration: :;!-Ilzi:(2013 individual C 'S C O'COtsl�, _. `� COLLINS OCONW Q,t 50 vJATERHOUSE;RI 30URtJE,MA 02532 Undersecretary �:-t L 47 Prepared By'and l eturn To.' - _ Donald J.-O`Neil° O'Neil&-Bloom,LLP ' I 10 Mechanic Street Suite 150 Worcester,MA 01608 ' Property Appraiser's'Parcel LID.,, ' (folio)Number(s) 09-46-05-00000 10FO TRUSTEE'S CERTIFICATE Pursuant to M.G.L. c. 184,§35 I, Carol E. Ladner, as Trustee of the Carol E. Ladner Trust - 2009, a trust created by a Trust Agreement dated June 19, 2009 (the "Trust'), with a mailing address of 40 Simmons Pond Circle, ' Hyannisport, MA 02647, do hereby.certify and attest as follows: 1. On or about June 19, 2009, Carol E. Ladner, as grantor, created the Carol E. Ladner J Trust-2009. The Trust, as of the date hereof is in full force and effect;_- 2. I am the current Trustee of the Trust. B. Brian Ladner, Ronald F. Ladner, and Francis J. Ladner are the successor Trustees of the Trust; 3. The trustees of the Trust have the power to perform discretionary acts as trustees ` without the consent,;concurrence of direction of the beneficiaries; 4. The trustees of the Trust have authority to act with respect to real estate owned by'the Trust,-and have full-and absolute vower�undex the Trust to-conve y any i. nterest in reaV esta#:e ,end improvements,therePn held in the Trust and.no ,purchaser or, third party,,WWI be bouud-to mg ure whether the trustee has said power or is properly exercising said power or to see-to the application of any trust asset paid:to the trustee for a conveyance thereof; 5. There are. no facts which constitute conditions precedent to acts by the trustees or , which are in any other manner germane to affairs of the Trust; and 6. All porties may rely without further inquiry on my acts as trustee. tea,-jv�- .. - ,. y v{c .. .{,,,...,. •`wc _: �:;�E'F�,.`°.i'Fd1z-.. _.«d. _ _ .. _. .:wy:;.aa .yw B�^.,_ ro :.. .. _._....... .,=.....�._,. Jx . - - Signed under.the pains and penalties of perjury this day of April,2012." fl fitness Signature) ` Carol E.Ladner,Trustee STATE OF FLORIDA Lee,ss. April /4�2012 On this _ day of April 2012, before me, the undersigned notary public,tpersonkMy appeared Carol E. Laadner, trustee as> aforesaid, proved'to.,fine through atisfac to sry evidence of identification, whici was photographic identification w><th signature ><ssued,by a;federal or,state governmental agency, "0 oath or a�natton`of�a credible`wrtness, 0.person l knowledge of"the undersigned,to be the person whose name is signed on the preceding or attached;document, and acknowledged to.' that he signed it voluntarily. No blic: x ?+nyq.+., .k •'„ten dr 4 '. y s ° r ryMr •% ��n yktr fie. t �w ,: r-s+ z'. ..� .`"v"nN••6 o 'MATTHEW I PONZIO,IV . gs0 F_ Notary Public-State of Florida My CommiOen Exp(res^Sea 21,20' •�; ���o .w Commisslon#DD 792042 •P„p Bonded TtmeughNdMalNotaryA . 'F Carol K Ladner a of Hyannisport,Barnstable County,Massaehusetts, for consideration paid, and 'in fall consideration of less than One Hundred Dollars ($100.00) grant to Carol E.Ladner,Trustee of the Carol E.Ladner Trust-2009 of 40 Simmons Pond,Circle,Hyannisport,MA 02647 with qurtckbn covenants (Description and encumbrances,if any) A certain parcel of land with all.the buildings thereon situated in Barnstable (Hyannisport), Barnstable County,Massachusetts,.bounded and described as follows: NORTHWESTERLY: By Lot 16,as shown on plan hereinafter referred to,Two Hundred Forty Seven and 76/100.(247.76)feet; EASTERLY: By the line of Simmons Pond Circle,as shown on said plan,Fifty and 09/100(50.09)feet; SOUTHEASTERLY: By Lot 18,as shown on said plan,Three Hundred Thirteen and 96/100(3 and NORTHWESTERLY: By`land now or formerly of Barnstable Water Co., 'as shown on. said plan;Three Hundred Eleven and 70/100(311.70)feet. Said land is shown as LOT 17 and containing 43,565 square feet of land,more or less, on Land Court Plan 36483=D,which said plan is duly filed with the Land Court in Boston. This conveyance is made subject to.certain rights of Larry Nickolas to grant rights of way in said Simmons Pond Circle for all purposes for which public ways are now or may hereafter be used in the Town of Barnstable for the benefit of his remaining land shown on said plan and the right to grant utility easements in strips of land'ten feet (10') in width.adjoining said Simmons Pond Circle,all as set forth in Document No.363,043. The above described;lot rs`conveyed together with a right of way to use said Simmons Pond Circle for all purposes for:which:`public-ways are now or may hereafter be used in the Town of. Barnstable. Subject to and with the benefit of the provisions of a Declaration of Protective`Covenants, Easements and Other Provisions dated July 17, 1984 and registered as Document No. 340,629. - Subject to an easement to Commonwealth Electric Company et al dated July.99, 1984 and registered as Docket No.342,581. FOR TITLE: See:Certificate of Title No. 151148,Document No.'748,385. Witness my hand and seal this tg L ay of March,2012. % 1 VL1 Carol E.Ladner State of Florida Lee, ss.-: March ZZ;2012 On this 2.2 day of March, 2012, before me, the undersigned Notary Public, personally appeared the above-named Carol E. Ladner, proved to me by satisfactory,evidence of identification, being (check whichever applies): 1P or other state or federal' governmental document bearing a photographic image, o oath or affirmation of a credible witness known to'me who knows the above signatory, or o .my-own personal knowledge of the identity of the signatory, to be,the person whose name is signed above, and acknowledged the foregoing to be signed by her voluntarily for its stated purpose. I No ublic: Commis ' n Expires: Sep �2 7,Z o!2 s MATTHEW J.PONZIO,IV Oly Notarg Public-State of Florida 4 n =My Commission Exp res Sep 27,2012 Commission# DD 792942 i ',•°�;;° Bonded Through National Notary Assn. ° r - f Commonwealth"of Massachusetts' ' Sheet�Metal 'ermit F ' ` - - ��Date: 9 ? Permit#0 1 D k, _ APR 18 2014 Estimated Job Cost: $ Permit Fee: $ � . Plans Submitted: YES NOr ® �R �,J�tj�eviewed: YES NO, `M Business License# 3?3 i Applicant License# ' o3' • Business Information: Property Owner/Job Location Informatlon: v . Name: !p �`Zl�k12 � /�v) C�=' Name: 'Ot �� y1` Street:. t" d� E�2 ` 0 S(�w V, K � WIT) IV D Q ��= S Street: oil S G� City/Town. ' r ✓1 1 -1"7- 44- City/Town: m E Telephone: S -1 Telephone: �. � qj by ,. .. Photo I.D. required/Copy of Phoio I.D.attached: YES A(NO Staff Initial -1 /M-1-unrestricted license J-2_ /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family ` �` Multi-family. ,Condo/Townhouses i Other 'i Y Commercial: Office Retail. Industrial " , Educational 47 Institutional Other, Square Footage: under 10,000 sq. ft. over 10,000 sq:ft. f .Number of Stories •' x:* Sheet metal workto.be completed: - New Work: L/ Renovation: -HVAC Metal Watershed,Roofing il- Kitchen Exhaust System Metal Chimney/Vents : Air Balancing Provide detailed description of work to be done: L " r 50-699-0144 04:OS:42 p.m. 02-25-2011 218 INSURANCE COVERAGE; I have a current liability insurance policy or Its equivalent which meets the requirements of M.G.L.Ch.112 Yes E3 No❑ N you have checked Yea.Indicate the a of coverage by checking the appropriate box below: A liability,Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAVER:I am aware that the licensee does not have the insurance coverage required by.Chapter 112,of the. Massachusetts General Laws,and that my signature on this permit application waives this requiremerrt. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By dmidag this bo I hereby wrttty that a9 of the defalls end hrfomadon i have sutonitted(orerdered)regarding this application are true and .aa�rrate to Ore bast of my krwwledge and that all sheet mall wmk aad Ineadledons pert r aad under the permit Rued for this application will be In compliaaae Frith all pwdnmd provision of the 1Nassadnmetts 8uidbrg Code and Chapter 112 of the General laws _ _ _ Duct inspection required prior to insulation installation:YES NO" Progress Inspections Date Comments Final Inspection Date Comments Type of License: By Master We ❑Master-Restricted cityfrown 0joumeypersal Signature of Licensee _ Permu# ❑Joumeyperson-Restrcted ' $ ❑ License Number: Fee Check at www.maso.govldai Inspector Signature of Permit Approval The Commonwealth of Massachusetts_ f p Department'of Industrial Accidents Office of Investigations ' 600 Washington Street r.- ' 'Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: Po 361, (� i(1)'1 Sf- City/ •tate/Zip: `�f l �),�4phone� #' - 07 r AY1en an opr employer?Check the app iate box: Type of project(required): am a employer with�n 4: ❑ I am a general contractor and I employees full and/or ah-time .* 'have hired the sub-contractors 6.,❑ w construction ( P ) . 4 . 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no em to ees These sub{contractors have g• Demolition'. working for me in an capacity. employees and have workers; - g y p ty• 9. D Building addition ' [No workers' comp. insurance comp. msurance.$ requi red.]ui 5. ❑ We are a corporation and its 10:0'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 employees. [No workers' 13.❑ Other -comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. - Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those ' 't se 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 foamy employees. Below is the policy and job site information. Insurance Company Name: �`f()I �' �% V1� ' U l a (b i P Y Policy#or Self-ins.Lic.#: .� 'Expiration Date: SMl' 0 a Job Site Address: /q1 11 �i� F � ��'1C1/.�V��I� .:City/State/Zip:`" Vin/S 0A � - 11 . Attach a copy of the workers'compensation policy declaration page(showing the policy nu ber 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:rnprisonr^enL-as well as civil penalties in the form of: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 ` r Investigations of the DIA for insurance coverage verification. I do hereby ti un th pVnsan' enaIt. of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. Do not write in this area,to'be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): ` r ` 1.Board of Health 2.Building'Department 3.vCity/Town Clerk 4.Electrical Inspector 5.'Plumbing Inspector 6.Other ' Contact Person: . A, �' ' Phone# + I i CERTIFICATE OF LIABILITY INSURANCE DATE(MWDOM'YY) 04/01/20i4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY- THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT .CONSTITUTE. •A CONTRACT BETWEEN THE ISSUING :INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.' IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be "endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require,an endorsement. A statement on this certificate does;not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Sherry or Dick Ostrander Insurance Agency PHONE,r 50f3-966-111fi F 5OB-966-11Q5. ac No,Ext: fAIC,No).. 94 David Road ADDRESS: info@ostranderinsurance.com Bellingham, MA 02019. . - 'INSURERIS)AFFORDING COVERAGE NAM 1' INSURER 4:Norfolk 6 Dedham Mutual insurance Co INSURED INSURERB: Tom Fricker Heating 6 AC Inc. INSURER C: PO BOX 308 T. INSURER D: •. . Franklin, MA 02038 INSURER'S: .INSURER F r. :.. -.. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS, TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE, BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT;: TERM OR 'CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH: RESPECT TO WHICH THIS CERTFICAit MAY-BE"ISSUED`OR MAY- PERTAIN,-;THE -INSURANCE'AFFORDED: BY. THE dPOLICIES <DESCRIBED-HEREIN, IS,SUBJECT-,TO ,ALL THE _TERMS,. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF POLICY EXP - ILTR A TYPE OF:INSURANCE )NSR WVD POLICY NUMBER "(MMIDDIYYYY) (MWDONYYY) - LIMITS GENERAL LIABILITY EACH OCCURRENCE 8 1,000,000.00 . X COMMERCIAL GENERAL LIABILITY R02105.63' 09-28-13 0i3-28-14. PREMISEDAMAGE S(Eaoccurrenca) $' S0,.000.00 CLAIMS-MADE' ❑.00CUR. - MED EXP(Any one person) ..- $, 5.,000.00 r PERSONAL&ADV INJURY $: incl. . GENERAL AGGREGATE $ 2,Q00 j 000.00 GEN'L AGGREGATE LIMIT APPLIES PER:PRO. $ PRODUCTS.COMP/OP AGG. $ .inCl POLICY JECT LOC •- :. AUTOMOBILE LIABILITY - - - (Ee accident) $ ' BODILY INJURY(Per person) .$ ANY AUTO - ALLOWNED 'SCHEDULED- t BODILY INJURY(Per accident) $ AUTOS AUTOS p `} NON-OWNED PROPERTYDA GE' $ HIRED AUTOS AUTOS - - (Per accident) - UMBRELLA LIAR OCCUR , - EACH OCCURRENCE 8. { EXCESS LIAB CLAIMS-MADE"' - - AGGREGATE: $ OED RETENTION $ A WORKERS COMPENSATION WEND4383 " 02-12-14 02-12-15 }( TORY LIMITS'" ER AND EMPLOYERS'LIABILITY Y I N ANY PRO PRIETORIPARTNEREXECUTIVE NIA '. _ EL EACH ACCIDENT `.$ 100,000.00" .' OFFICERIMEMBER EXCLUDED? ❑ (Mandatory inNH) EL.DISEASE-EAEMPLOYEE -$ 100,000.00. If yes,describe.under - s E L.DISEASE POLICY LIMIT $ 500.000.00 00.000.,00 DESCRIPTION OF OPERATIONS balm-. .. _T } I DESCRIPTION OF OPERATIONS I.LOCATIONS/VEHICLES(Attach ACORD 101.Additional Remarks;Schedule,If more apace Is required) Description of operations: Electirical and wiring, -including heating and air, conditioning installation as burner installations, but,not plumbiriga CERTIFICATE HOLDER CANCELLA110N s Town of Barnstable SHOULD ANY OF THE: ABOVE DESCRIBED POLICIES.BE'.CANCELLED BEFORE ' Building Division THE EXPIRATION DATE THEREOF„ NOTICE' WILL BE, 'DELIVERED IN : ACCORDANCE WITH THE POLICY PROVISIONS: .200 Main Street Hyannis, 'MA 02601 y r AUTHORIZED P E�SEN ©1988- 10tACORD CORP O.RATION.:All rights reserved.. ACORD 25(2010106) The ACORD name:and.logo are.registered irnarks of ACORD " { COMMONWEALTH OF MASSACHUSETTS SHEET METAL WORKERS AS A;MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO a TH;OMAS R TRICKER d'r. P::O BOXY 30`8 FRANKLIN MA '02038 ',0308 1 .88'03 12/28/14� 289709 1 a - i y ., 1 !_o f - ... ♦ _ .,,� �'-H' �.r-._. _..._ ,R .•.... � it w .� ..1: - � ETti Town of Barnstable Regulatory Services EARNST"MASS.$' Richard V.Scali,Interim Director Building Division Tom Perry,Building Commissioner 200 Maim Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete.and Sign This Section If Using A Builder I,—-'1�'� r �l`l ri ;as Owner of the subject property hereby authorize / to act on my behalf, in all matters relative to work authorized by this.building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or.utilized before fence is installed and all final inspections are performed and accepted. ignature Abwner ture of Applicant Print Name Print Name Date t - Town of Barnstable Regulatory Services ' oFt Tod Richard V.Scali,Interim Director Building Division =naxsra ILE, Tom Perry,Building Commissioner 163q� M�e� 200 Main Street, Hyannis,MA 02601 f www.tovvn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6210 HOMEOWNER LICENSE EXEMPTION • , - •� i�' -_ Please Print DATE:_ JOB.LOCATION: 1 D S*WN,5 1�nu�Qmbe�rp-y�� n' street village "HOMEOWNER /": ►I f`�11 "C i 'I "! 11 0 name nn �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 Persons)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 re a ents and that he/she will comply with said procedures and requirements. S e of Ho eo er 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.\WPFD FS\FORMS\bm7ding permit formsUMRESS.doc i PROJE . NAME: v+` ADDRESS: ACV 1 vvi li►��'v�S P �� PERMIT# PERMIT DATE: M/P: LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered in MAPS program on: 7 1 BY: . y - q/wpfiles/forms/archive TOWN OF MRNI'�TA s! 2 3 J+TTER OF INTENT R. Brian Ladner �40-Simmons-Pond Circle DIVIS.ir "'� Hyannis Port,KMA 02647 September 17, 2013 Town of Barnstable 200 Main Street Hyannis, MA 026oi R. Brian Ladner offers this Letter of Intent ("the Letter") confirming Cl, and outlining the Intent of Property Use. My intended use of the newly constructed detached garage located at 4o Simmons Pond Circle is o house my collection of automobiles and entertain guests in the above Bar/Game/Media room. Sincerely, R. Brian Ladner COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. Septembers, 2013 On this-IjEday of September 2013, before me, the undersigned notary public, personally appeared R. Brian Ladner, proved to me 1 through satisfactory evidence of identification, which was photographic identificatio with signature issued by a federal or state government agency, ath or affirmation of credible witness, personal knowledge of the undersigned, to be the person whose name is signed on the preceding document, and acknowledged to me that he signed it voluntarily. Notary Public: 1Arvaat �LA�yd-y`.,, My Commission Expires: O'v Z.y Zo/6 FRAPiCi� J. L.ADNER UV AltCOMMONWEALTH OF IA66ACHL.' nS My Commission Expires June 2016 J TOWN'-OF'BARNSTABLE'. permit No S _ �• " • ,. Boil 'Inspector iwn.et •:' 1Ilg. _ Cash ----- ------- p. OCCUPANCY PERMIT Bond' issu6d,to • arry.'I�icku as' :Ada`ress Wiring.Inspector f � � "���. 'Inspection date . r Plumbing Inspector '� Inspection date. " Gas Inspector , p .� Inspection date ., d 7v Ct -r� d7G r a. f.✓ 1 ,9 A P �r X. Engineering De artment q'e 4 / Ins ection date C Board of Health �r 'tir�L� Inspection date THIS PERMIT WILL NOT.BED VALID,'AND THE.-BUILDING, SHALL, NOT BE, OCCUPIED UNTIL SIGNED BY, THE' BUILDING INSPECTOR UPON 'SAITISFACTORY;COMPLIANCE WITH;"TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS.STATE .'.BUILDING-CODE., .......................... ...... .. .. ......,. ..... Building Inspector. fir_ °•, TOWN OF BARNSTABLEC � � BUILDING DEPARTMENT i RUNSTA TOWN OFFICE BUILDING °9 �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: May 21, 1985 An Occupancy Permit has been issued for the.:building authorized by Building Permit #........._....27828 ..2 7.$2 8_.... _ . .. .... _......_................................................................................... ».......»................... .. I. issued to ................._..........._... .Larry ... Nickulas �. ................................................_..�._...._��. Please release the performance bond. Assessor's map and lot `number .n .. ... ... o � � THE ��� g.`� `� BUST SF Q..°` roe♦ Sewage Permit number" ......:. ° t�� S 9. I%v CO%APLIAN s OINSTALLED WI 14 TITLE i BaaBASg LE, House number ............. ... ...'.." .................:. �y wy ,� r F. ` vo 1639- TOWN OF BARNSTABLE 01 BUILDING INSPECTOR cAPPLICATION FOR PERMIT TO :....:........ ... ...............z .........v�..�y................. � ... TYPEOF CONSTRUCTION .................. . ...... ..................................................................................... .............1..7/Gr... 11........19... .J TO THE INSPECTOR OF BUILDINGS: " The undersigned hereby applies for a permit according to the following information: Location ...........L�. ... ........47............ .......... /........ ......................... ProposedUse y � � l�........... . ..... .................................... ................................... ..................................I......................... Zoning District e.IZ ...................Fire District .!�' ti� .............. ..... ............................. ........... ......................... .................................. Name of Owner ..... Address .. 0 ...`�� !.. .. 14 Name of Builder ........�� ...........Address............................. /............ Nameof Architect ..................................................................Address ............................................................................,....... Number of Rooms. .............. ...........................................:..Foundation ' Gf.../............................................. Exterior ............... ......................................................Roofing ......... Floors v�� ..........:....................................Interior ................. ��G ./.. Heating '?�- ..................................:................Plumbing ...................0�... T ...?... ......................... Fireplace ..................... .. .........................................................Approximate. Cost�/�� ..........................G.. ... ........... , Definitive Plan Approved by Planning Board ___ __________19_ __. Area . ............. � /� � i Diagram of Lot and Building with Dimensions Fee /........ : .............. Z_ " SUBJECT TO APPROVAL 'OF BOARD OF HEALTH F &)AJ 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 .. �........ -NICItULAS, LARRY 27828 1112 Story No' ................. Permit for .................................... Single Family Dwelling ............................................................................... Location L.O.t...1.7.......4.0...Simmons. . Pond Circle .. . . . .. .. .. ......... Hyannis . ................................................................................ Owner .....Larry Nickulas ........................................... Type of Construction ..... ........................ ........................................................................ Plot ............................ Lot .............................. May 1, - 85 -Permit Granted ......................:,.............. 19 -Date of Inspection .................................y:1;9 Date Completed — . ............1 ,00r 2 6 3a > N s c p UJAY 75 A \� • 2g 8,. d Pi- o $ �.oT , CERTIFIED PLOT PLAN yet Lo TMMONs ROE€RT " y�}IV/ 5 BRUCE EL.DRED yIN ✓ �'. I'StASL sw^ . , SCALES 4DI DATES /124/8-S (fjPKD-GE ENQI EE• 1NG i CERTIFY THAT THE F00nlf3A T t 0A/ E®ItTERED REGISTERED CL.IEtdT �, f SHOWN ON THIS PLAN IS LOCATED JOLA AiO, -ON THE GROUND A9 INDICATED AMID CIVIL LAND ---- �'ENOINEER 8U ' �• CNF�Rk3 TO THE ZONN ` LAWS , _ Of I3A1$ 4STAOL /, �M-A83 7I2 MAIN STREET CH.8Y _ H YA N r1J / 5, MASS, SHEET_LCF._•_ DA E, : REG. LAND SURVE7. YOR 4, 1 409- Assessor's office(1 st Floor): SEFRC SYSTEMAssessor's map and lot number ply 1-7 P, INSTALLED IN COPOP ,� :Y: TSE Board of Health(3rd floor): Z!Y- ENVIROMP2WALWLE 5Sewage Permit number � 7 i C®� 9TODLL Engineering Department(3rd floor): 1S! TOWNREGD�Tt�D� ° 6S& ®m° House number 4� _ b Planning Board 19 Y0'Y d Definitive Plan Approved Y 9 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION f 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to th following information: Location �& &Sj M G Loo' l7 , Proposed Use SW I m M , Zoning District Fire District P Cl 1 Name of OwnerFhnni Address q o V 1 M cc Name of Builder t i C T I I —�—� Address ���7 ,) T ,� G( Y1.Y1 1 tS m . Name of Architect 0(:)n e- Address Number of Rooms Foundation Exterior- Roofing Floors " Interior Heating 'Plumbing S� Fireplace Approximate Cost ' 1 w oo- �. fF. Area '4k; Diagram of Lot and Building with Dimensions Fe: O, 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 I � Construction Supervisor's License ' S_� in`� LADNER, R. BRIAN i No 32815 Permit For Build Pool Accessory to Dwelling Location 40 Simmons Pond Circle z ` Hyannis Owner R Brian Ladner - Type of Construction Vinyl , Plot---- Lot r - Permit Granted April 21 , 19 89 Date of Inspection 19 1 i t Date Completed 19 ?�C �'CP ,) `C) fi • r r. File No.: 3 5 7 1. 1 i PIoun'tain, Dearborn & Whiting Registration Book: Page: Client: - Timothy J . Fitzgerald.,. Jr : & Lots : 173648.31 1 ' Owner. Joyce A. Fitzgerald Plan_ No:: ( ) R . Brian Ladner & 974.79 Applicant': _ Carol L. Ladner_ Cert. of-Title: 'CensusIractNo;._�one Available Assessor's•Plan:, Lct(s): MORTGAGE I NSPECTJ 0N, P' L .:0T PL. A ':N , ; N B A R N S' T A B LE •'N%F Barnstable , Water Coinpany . I..o t 1 .7 , 43 , 565 S . P_ r 1 Lot `I'B •`9[S`_ � �� .. . .. mac: �J�• L,ot 16 I t3o• 40 �.�,,x 1 . r I S I M M 0 N S P 0 N D C I R C L E Date: /zo/8s Scale: t II=C 0 ' 1 CERTIFY TO MOUNTAIN, DEARBORN, : & WHITING, 'AND ITS TITLE INSURANCE COMPANY, THAT THERE ARE NO VISIBLE EASEMENTS OR ENCROACHMENTS. EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE, SUPERVISION.: THE LOCATION OF THE DWELLING AS SHOWN 'HEREON IS IN COMP<'IANCE WITH THE LOCAL .APPLICABLE ZONING BY-LAWS IN EFFECT WHEN CONSTRUCTED WITH RESPECT TG- HORIZONTAL DIMENSIONAL REQUIREMENTS. THE DWELLING SHOWN HEREON DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD , DES LAURIERS&ASSOC IATES',•INC. ZONE AS SHOWN ON A --MAP OF COMMUNITY . NUMBER 250001C DATED 8/19/85 BY THE P.O. Palk 1.6e30 s�la ., 03 Sturbrkge, MA 028-O (6 559-8028 P.O.Ffox 541.6J0 Main Sr.,+�"3.Srurtxidge.MA OU18.O.`,-11(617)341-2213 F E .M.A. �► °-sss-vsss ` or•����,c rRT TAN 1 31 GENERAL NOTES:(1)The declarations made above are on the basis of my knowledge,Information;and belief.as the result of, a mortgage piot1plan tape survey Inspection made to the normal standard oP care of registered land surveyors.practicing In Massachusetts.(2)Declarations are made to the above named client only as of this date.(3)=This plan was not made for recording purposes,for.use in preparing deed descriptions or for constructions.(4)Vertficdtlons of property line dimensions, , building offsets, fences, or lot configuration may be accomplished only by an accurate instrument survey. 1 LOU"r lun�Ct,P_2o Parcel Detail Pagel of 3 � •aa� A i '`,; 'i� �-d. �.y "f(* `. �C/'i:�C.r/!/. 1✓ � �..,.r....«--:+.. '""- ��'�ti ,. � a# 4 E m%ss, i era, "* } k° .• '" .0 7 y 'p $ ,`. - vx. Logged In As: Parcel Detail Wednesday, January 9 2013 Parcel Lookup o Parcel Info Parcel j289-172 I Developer 1LOT 1r-� ID Lot Location,40 SIMMONS POND CIRCLE Pri I Frontage Sec[- --- -- --- - - _--- --- -) Sec — Road ' Frontage __ ... ....... . Fire I Village IHYANNIS ) IHYANNIS District Town sewer exists at this Road� — address I-N Index 12108 Asbuilt Septic Scan: Interactive .'� � 289172 1 Map v Owner Info _ .- ._.._ Co- -__. OwrierILADNER,CAROL E - %LADNER, CAROL E TR Owner' Streetl ICAROL E LADNER TRUST 2069 — Street2,40 SIMMONS POND CIRCLE T City IHYANNIS PORT I State,MA Zip Io2W47 Country v Land Info Acres i .00 . Use!Single Fam MDL-01 I Zoning iRe�Nghbd olos Topography[Level RoadPaved Utilities (Public Water,Gas,Septic Location Marginal View v Construction Info B uHilli g I ®f I Year11985 _ I Roof Gable/Hip Ext Wood Shingle Built Struct Wall Living r.. Roof ...... .__ --- AC 11428 ( jAsph/F GIs/Cmp I 'None Area Cover Type' �_ ..... .... ..._.. ___..__.. Bed i - Style,Cape Cod I Wall(Drywall I Rooms Bedrooms _. Int ._ _.._:__.. Bath r. Model IResiaential ( FloorlHardwood I Rooms'2 Full Heat Total http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22182 1/9/2013 Parcel Detail Page 2 of 3 Grade[Average Plus ( Type;Mot Water I Rooms6 Rooms- - Heat -- --- Found-- stories i 1 11/2 Stories ( Gas_ I !Poured Conc. Fuel ation' „. a 9�MA& Gross 13760 Area Permit History Issue Permit Insp Date Purpose # Amount Date Comments , 04/01/1989 B32815 $16,000 01/15/1990 HY 00:00:00 SW.POO 05/01/1985 B27828 $701000 HY 1 .5 ST Visit History Date Who Purpose 02/22/2002 00:00:00 Paul Talbot Meas/Listed-Interior Access 07/1.5/1988 00:00:00 ML Meas/Listed-Interior Access- - Sales History Line Sale Owner Book/Page Sale Date Price P 1 12/07/1998 LADNER, CAROL E C151148 $1 LADNER R BRIAN & 2 01/15/1988 CAROL E C113389 $1901000 FITZGERALD,TIMOTHY J 3 05/15/1985 C101597 $140,800 JR ET AL 4 07/15/1984 NICKULAS, LARRY C97479 $1 L5— 08/01/2.012 LADN ER, CAROL E TR C197800 $1 Assessment History Save , Building Land Total Year XF.Value OB Value Parcel # Value Value Value 1 2013 $141 ,100 $407900 $20,8100 $161 ,200 $3641000 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22182 1/9/2013 Parcel Detail Page 3 of 3 2 2012 $144,300 $40,000 $17,300 $155,000 $356,600 3 2011 $1801200 $3,900 $13,200 $155,000 $352,300 4 2010 $1791600 $32900 $187300 $157,500 $3597300 5 2009 $1777100 $21800 $101700 $217,800 $4081400 6 2008 $1901300 .$2,800 $10,700 $238,400' $442,200 8 2007 $2221100 $21800 $10,700 $2381400 $4741000 9 2006 $1941000 $21800 -$11 ,000 $2057700 $413,500 10 2005 $175,800 $2,800 $11.,300 $187,000 $3761 900 11 2004 $1401600 $2,800 $11 ,400 $159,000 $3131800 12 2003 $1241700 $21800 $111600 $657000 $204;100 13 2002 $122,000 $2,700 $10,900 $65,000 $200,600 14 2001 $1221000 $2,900 $10,900 $65,000 $2001800 15 2000 $95,500 $2,800 $31500 $501000 $151,800 16 1999 $951500 $27800 $3,500 $50,000 $151 ,800 17 1998 $957500 $2,800 $31500 $50,000 $151 ,800 18 1997 $96,000 $0 $0 $50,000 $156,500 19 1996 $96,000 $0 $0 $50,000 $1567500 20 1995 $967000 $0 $0 $50,000 $156,500 21 1994 $96,800 $0 $0 $45,000 $1501800 22 1993 $961800 $0 $0 $45,000 $150,800 23 1992 $110,000 $0 $0 $50,000 $1,70,300 24 1991 $1187200 $0 $0 $70,000 $1997600 25 1990 $118,200 $0 $0 $701000 $188,200 26 1989 $1181200 $0 $0 $70,000 . $188,200 27 1988 $94500 - $0 $0 . .$40,000 $134,500 28 1987 $941 500 $0 $0 $40,000 $1347 500 29 1986 $0 $0 $0 $40,000 $40,000 Photos http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=22182 1/9/2013 je-� � aft �V�Mtn ej 1 ram' ! TINc� v '7oz a.ffyout P2uzEuz9 nEsds 508.428.8700•fax 508.428.8524 �www.lujeanprinting.com 4507 Route 28•Cotuit, MA 02635 i t � TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION. Map �0 Parcel `- Application# Health Division Date Issued Conservation Division •Application Fee ' Tax Collector Permit Fee Treasurer V ' Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address fi[o Jam,m marn5 Village gyano►S Owner + IJrtar� �� fly Address frimOflS rc,�a Telephone Permit Request i)e. v_3a tt C-gAcc_+,-_ e)C&5 a ar e_ _,A 4-ran.c-. dzzY' �.r (,-A.43 iCc Je�f Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District __Flood Plain Groundwater Overlay tin Project'4Valuati6 _ �o0 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old 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: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: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: Ij'Yes ?^0 No LI CD 4-17 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size 4 - ,)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 INFORMATIO -930 Name 7�A)sc� c n Telephone Number Soy, ,3 `�I.1 �3 �flL�ns� Address Cke SfeC Imo('t vz License# O+il 'tw nn 15 ('ham Oc�.&(a O Home Improvement Contractor# ( 3 Worker's Compensation# `ZZ`l 00 ALL CONSTRUCTION DEBRIS SULTING FROM THIS PROJECT WILL BE TAKEN TO 1 1 OWAs SIGNATURE DATE c' i FOR OFFICIAL USE ONLY . APPLICATION# i DATE.ISSUED M AP/PARCEL N0. ! ADDRESS VILLAGE OWNER G k DATE OF INSPECTION: FOUNDATION FRAME 0 `0 l0k, ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. ,per The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' wtivw.mass.gov/dia ' Workers-Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers A_lnplicant Information ` .Please Print Legibly Name(Business/Organization/Individual): S n 5 ICSLc� •Address City/State/Zip: (I f cnO� ? MIA- ��n, Phone.#: Are you an employer?Check the appropriate bog: :Type of project(required), i•U I am a employer with 4. ❑ I am a general contractor and I 6 (l New construction . employees(full and/or part time).* have hired the sub contractors listed on the-attached-sheet. 7. ❑Remodeling 2.El I am a'sole proprietor or partner- These sub-contractors have � ship and have no employees 8. ❑Demolition: avorking for me in any capacity: employees and have workers' $, 9, []$wilding addition [No workers' comp,insurance comp,insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing ill-work : officers have exercised their 11.❑Plumbing repairs or additions ' myself.[No workers'comp. right of exemption per MGL 12,❑Roof repairs insurance.re L. ed t c. 152, §1(4), and we have no ] employees. [No workers' 13.❑Other comp;insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors mutt submit anew affidavit indicating such. $Contract=that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. Ian' an employer that is providing workers'compensation insurance for my employees. Below is.the policy,and job site information. _ I Insurance Company Na=eirnt.c� ► Y II_� 'IJ Uri Policy#or Self-ins.Licr# �'Z-1 �X� Expiration Date: Job Site Address: 1 ( �.?1�1tY�CS�d� Of 'r<:�D City/State/Zip: y s r11, d�o( Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date). Failure,to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-yearimprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against thq violator. Be advised that a copy of this statement maybe forwarded to the Office of' Investi ations of the 1) e coverage verification. 'do her under the ins and enald o erjury that the information provided above is true and correct 0 .Si afar ' Date: Phone#: Official use only. Do not write in this area, to be completed by city or town offciat , 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 t 6.Other Phone#: Contact Person: r• f °FTME�os� Town of Barnstable Regulatory Services �BMV'STABM Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ' Gtfi 1(�t-Sdi Type of Work: _ c � Estimated Cos 2-5OZa r 0D -4 a-r i wt Get ett.t���1) AddressofWork: eta' ryf)tS QaQ¢.0 Owner's Name: t.OVE0 ( � (r t�d yl n-e_� Date of Application: I—D 7 I hereby certify that; Registration is not required for the following reason(s): FlWork excluded by law OJob 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 fo s the agent ofltbe owner: ' /7 / 3 3 `7 Da a Contractor Name Registration No. OR Date Owner's Name Q*nnslomeaffidav 'town of Barnstable. . Regulatory Services - asAss Thomas F.GelIer,Director ��TFn µad aim Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 . Fax: 508-790-6230 Property Owner Must Complete and Sign TMs Section If Using A Builder T, a r, cLn L -c:k as Owner of the subject property, herebyauIthorize L n S'L 3 to pact on my behalf, in all matters relative to.work authorized by this building permit application for:Dam 6' n 5 Je (Address of Job) Signature of Owner Date Print Name r QTORM&OWNERPERMISSION 11/09/2007 17:26 1 PAGE 01 rage 1 01,L icate �mlil3 lltlEt Chenoe CertliOl Ada cort Hold+tlr Both of Farm _"tip L— Template Dates: CERTIFICATE OF LIABILITY INSURANCE �r13/zoo7-12/v2oo7 This certificate is issu®d as a metier of information only and confers no rlghls upon the Certificate holder. Producer This certificate does not emend,extend or after the coverage afforded by the policies below. Rogers&Gray Ins.-So.Dennis insurers Affording coverage NAIC A 434 Route 134 - P, 0. Box 1601 COMPANY A Peerless Insurance South Dennis,MA 02660-1601 COMPANY a Arrow Mutual Insured COMPANY C E F Winslow Plumbing 8 Heating, Inc. COMPANY D COMPANY E 8 Reardon Circle South Yarmouth MA 02664 iCoverages l THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY I I REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR O HER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, 1 THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU6JECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Insr Addl Type of Insurance Policy Number Policy Policy Limits Ltr Ins Effective Date Expiration Date A GENERAL LIABILITY CBP9919974 12/1/2006 12/1/2007 Each Occurrence 1.000.000 Com Gen Liab ante a to Rented Premises Ea Occurrence 100 00 Med Ex (any one person) 5,000 Claims Made Personal&Adv Injury 1.000,000 X Occurrence eneral A re ale 2,000,000 Products-Com IQP AA9 nkvw 0 0 . Gen Agn Lmt lies Per. Policy Project Location A AUTOMOBILE LIABILITY BA8218494 12/1/2006 12/1/2007 combined Single Limit 1,000.00 Any Auto 'a accident Bodily Injury U Owned Autos Per ef$On Scheduled Autos 6odlly Injury Per accident Hired Autos Properly Damage Pon-Owned Autos Per accident i GARAGE LIABILITY . KumOnl -Ea Accident Jy Auto er Than Ea Acc Anuto Oni _ A EXCESS LIABILITY CU9918875 12/1/2006 12/1/2007 Each occurrence 5 000,0v0 re ate S,000,UU Claims Made i Occurrence I Deductible X Retention 10.000 B WORKERS COMPENSATION AND 1580A 1/1/2007 1/1/2008 C EMPLOYERS'LIABILITY X ry or Any Proprlenor/Partner Llndts" executive/Officer/Member. E.L Each Accident 500,00 Excluded? E.L:Disease Es Employee 500.00 l M.L.Disease Ea-folic Limit 500.000 j i OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Description of Ops.will be a combination of the following httn.c•%/wwR.i-ccr.net/active/A25-2001.asn7CertKev=O&CertTemplateKey=1648508159&Flags=O&IsWindo:.. 11/9%07 { � I i { Carol& Brian Ladner Carol & Brian Ladner 3 ® 40 Simmons Pond Cir 40 Simmons Pond Cir Hyannis,Ma 02601 Hyannis, MA 02601 Sept. 10,2007 508-778-4910 a Kitchen Proiect : - Carpentry: We will remove and dispose of existing kitchen cabinets and counter tops. Ap e ry } We will remove existing garage door,move and frame new opening for a 3'0" x 6' 0" door. We will supply and install new fire coded door. We will construct a new landing and stairs in garage. x e k Cabinets: NZ ,, We will supply and install Corsi Custom Home beaded inset, Fashion# 15 AV Elite cabinets. Cabinet construction will be furniture grade maple with plywood carcasses and maple-dovetailed drawers. The (3)base corner cabinets will include lazy susans and the (3) B18BRS cabinets will have (2) a rollout trays each. Molding build-up will consist of 5 '/4" Fascia and 3 ''/4" Large Crown to finish to ceiling. Panels for 36"refrigerator and 24" _.' dishwasher doors not priced until specific models are chosen. Hardware and glass are not priced in this contract. Counter Tops: We will supply and install custom granite counter top in St. Cecilia with Ogee p � edge treatment. x . . yy HEAT: jg We will remove existing baseboard in dining room, isolate heat loop with isolating ball valves, replace fast feed valve,backflow preventer and 92) auto vents. f 65t MtN STREET , R Rovrc 2$; We will supply and install approximately 19"of slant fin#15 baseboard WEST YARMQUTH,MA radiation in white. " 02673 We will supply and install (1) small toe kick heater under kitchen cabinet. TES.:508-771-563o We will purge system when complete. , FAX:508-771-5652 www.eWnslowcom f f � h i PLUMBING: We will supply and install Kohler K- 14577-T2 Tidings with Game Birds sink and K-691 BIVVinnata pull-down spray kitchen faucet in Brushed Bronze. We will supply and install a shutoff and water line to refrigerator icemaker. We will install owner supplied 24" dishwasher. We will increase 1gt few feet of gas main from meter into building. . , IRA � We will install gas line to owner supplied gas range. Please note: Model has not been selected yet,venting not included at this � % time. �. Electric: TN I � We will remove existingcounter height receptacle outlets. We will supply and g p Pp Y install plugmold under the upper cabinets for counter receptacles, in both kitchen and dining room,protected by a GFCI breaker. a a 17 We will supply and install Seagull Ambience under-cabinet lighting, in both kitchen and dining room controlled by dimmer switches. We will add one recessed light in kitchen area and replace (5) existing recessed lights trim to match new. f # We will supply and install puck lights in each of the upper cabinets in dining x room, (8)total. We will relocate owner-supplied dining room light to center of table. c X We install a TV outlet and receptacle in dining room TV cabinet. d Y We will supply and install a 240-volt 40-amp 10-circuit sub-panel located to the left of existing house panel. 4hsx We will relocate existing low voltage keypad and motion detector within 651'IVI?TY. N STREET h` RouTr 2s kitchen. WTST.YARMOUTTi MA Tile: 02673 ® ® ® We will supply and install Caribe Desert Cream Imperial 4X4 natural TEL.:508-771-563o Travertine field tile on back splash area in kitchen and dining room . FAX:508-771-5652 www 4winslow.com wSLOW ' We will supply and install (3)the murals: 1) Still life with Lemons in sideboard in dining room. 2) Still life with Fruit Basket in other sideboard. 3) Still life with Fine Meal above range. x i Paint: Kitchen Ceiling: We will supply and install 1 coat of finished color to g� pp Y ( ) = �E ceiling. Kitchen and hall trim: Prep,prime, sand and apply (2) coats of finish. Kitchen walls: Patch sand and apply (2) coats of base finish and(1) coat of faux finish. ` g Floor finishing: 1 f � 5* We will sand and apply (3) coats of Satin Urethane floor finish to kitchen, dining room and hallway wood floors. V 1 .�4 Permits. We will furnish any necessary permits and inspection required by law. 4, Includes: Mass Sales Tax. TOTAL $96,936.00 30% Down Payment 29,081.00 30%Payment upon commencing tear out 29,081.00 30% Payment upon commencing cabinet install 29,081.00 10% Final due upon substantial completion 9,693.00 a �s { txk ,� t Prepared By: Date { g C as nc le 4. Accepted By Date ` a ti Brian dner C MN.F4 G' 'S L 65i MATN STREET } RoUTE,28, WEST YARMOUTH`MA 02673 TEL.:508-771-5630 FAX:508-771-5652 www.efwinslow.com �/xe �o�,ireonuaeea/�i a��/�aaaac�euarl� . Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:, 132379 Board of Building Regulations and Standards -- Expiration: 1/18/2009 One Ashburton Place Rm 1301 Boston,Ma.02108 3 Type: Supplement Card r. E.F.PLUMBING&HEATING CO;�,I UAVID ANDERSON i 8 REARDON CIRCLE;, ry SOUTH YARMOUTH,MR t)2664 Administrator Not valid without signature i`-;Y,- .�".y..- Jr�ti. ^'S�+^�1• e;� .Yh •,_ -_ „�_ �`" '�+ -. .-ter`'+• _ .-'-'•___ - ter'_ — -^ _--- N 1 ' mNm Gl . J�ee �anr•nw�ucaeal� a �-•i� c�uiGel.�a - e BOARD OF BUILDIN REGULATIONS License: CONSTRUCTION SUPERVISOR 14Um6er. CS O49405 Expires: 09/10/2008 Tr. no. 1607.0 Restricted: 00 DAV ID C ANDERSON 34 WINCHESTER DR SQ DENNIS, NIA 02660 Commissioner D m s r if d r j i t• { e *Permit Town of Barnstable Expires$months from issue date ulatOr- Services..... _.. Fee-.. -Geiler,DirectorX-PRSS TE �'0reo " ---• ....-. _._ �. ._._.. Building Division SAY 18 200a. Perry, Building Commissioner '. .200 MainStFeet,• Hyannis,MA 02601=... TOWN OF BAFNSTABLE Office: 508-862-4038 • Fax:'508-790-6230 . .. •. . . :;�•, -- _;:� �;.::: .......::. . ......• . : •... ..,•, _ :- •`• •. , ... .._.: "''EXPS : �R1GYT'Y'-AI�LICA�'TON - RESIDENTIAL ONLY. ,p Not Valid without Red X-Press Imprint Map/parcel Number Property Address esideutial Value of Work ,�L ' Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name_ f" Telephone Number �J��-� Home Improvement Contractor License#(if applicable) 'Z ' e��> Construction Supervisor's License#(if applicable) ❑Worlanan's Compensation Insurance Check one: [] I am a sole proprietor I2111the Homeowner [fI'bave Worker's Compensation Insurance Insurance Company Name � y'ne Workman's Comp.Policy# � �T r, 2 — e Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) e-roof(stripping old shingles) All construction debris will be taken to []Re-roo of stripping. Going over existing layers of roof) e-side Replacement Windows. U=Value (maximum.44) *Where required: Issuance of this perrmt does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner_must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature Q:Forms:expmtr`g Revise063004 f Town of Barnstable . O��E Toys, • . Regulatory Services. Zama 'I' Lomw F.Geilers Director �� se' �,•� Building Division rn Mph TomPerry, Building Commissiouer 200 Main Street, $yannis,MA 02601 www.iown barnstable;mama ti - Fax: 508 790-6230 Office: 508-862-4038 ' . ' Prop �Y.Qwn St . u er M e Complete aild Sign This Section If Using ABuilder as Owner of the subject property 4 �'z to act on my behalf;. hereby authorize, �z in all fitters relative to work authorized byth s bun&g permit application ; for (Address of job} tur of O e wner Sim - Print hTame ` The Commonwealth,of Massachusetts Department of Industrial Accidents Office oflnuesdgat/ons 600 Washington Street, e Floor. -- a Boston,Mass. 02111 Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors ig name address: city state: zip: phone# work site location(full address)' ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction❑Remodel ❑ I am a sole ro rietor and have no one workin m' any capacity. ❑Building Addition an employer providing workers'compensation for my employees working on this fob coin an <ttame �s v at�ill•ess, �'., , �i'fi•F - A ;,414°"' I. 0 F t e ' +,.. iCLLA`va�,Tdj}�''1 4y ty? 4''.f.(� 4�y� i 1 _ _ ._ 41` �. 3 �{ ���^ `Sf` "''A'°'/•'����'`�.� .Yri�iF3;��S,.D't e �'t V�R�;�r•;_ ..�'� `x,+�., , - ausuranee�cb.. n � s �;�����.�.,, '�n tt�ltc , ;. � •. ❑ 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 City phone!/ E � die comaanvua`iite �' F Gty b:. tih one, .:. e 1n'SllranCxE':C f Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the fora[of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the aims/and hies of perjury that the information provided above is true and correct Signature JOl Date • 4 Print name�l `�lc i-r �/ !�1�/ Phone#,.�� ?2f WREM f,. [ftfy, l use only do not write in this area to be completed by city or town official , r town: - permit/license# ❑Building Department"❑Licensing Boardeck if immediate response is required ❑Selectmen's Office❑Health Departmentct person: phone#; ❑Other Sept.2003) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in-the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall.enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the'permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street,71h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 Board of Building Regulations and Standards License or registration valid for individul use only i HOME IM, OVEMENT CONTRACTOR before tiie expiration date. If found return to: Re istratron. 28560 Board if Pailding Regulations and Standards 2007 - One Ashburton Place Rm 1301 F iidual Roston,N'Aa.02108 RICHARD VIyLLAv _ 3 i RICHARD VILLA 109 WAGON LANE HYANNIS MA 02601 Administrator Not valid without signature 263" f�l ---- - ---- - ------------' --- ---------- ----- — --'---- ---- M >Y i GARAGE N ?3 New Door ocation 322 9.. 65 2. 832 41 2• 123" (W7848L W3F>ISB W1848R tV�t43013 W243O8 V1/3O15B 1230 WC243O� ° 'Z+34 BRSIB " __.___ _________ _________ __________ ________ _________ ___ _.__. .___ w M m- O5 ` C7 m Ia Carol Ladner ►- N m w 40 Simmons Pond Cir k F0aT F1(05 m Hyannis, MA 02601 c m di` N o= 508-778-4910 W LL __ _______ _________ n' WETR SU6362DIDW i RS p mw CV) n W1848R W36156 W1848L � .gg 1230R W3O3O6 1230 a N N ?fir.'.:. ..a•r:1 ar �:=�' r ass a�"P,.T�..3 w.,�.: '.: 3.. �;m 3���F...x:� e�'*.?.. ._, t:�5..�'�... ,.�€.. 163" 37 s.. I, 122" 322;" be Designed: 10/31/2007 All dimensions _size designations given are 0 1 This is an original design and must not _ subject to verification on job site and H N o E s released or copied unless applicable fee has Printed: 10/31/2007 adjustment to fit job conditions. been paid or job order placed. All rawing ch ladner kitchen hood _garage D #: .r Double 2 x 8 header matching existing Match existing 2 x 4 framing o 3068 Fire rated door as per code North Bevatoon xv �1 o-400 0 C. t, So ' cd B a 11der ACC ] Svs � p a g 8 � •.'.. �! c,f, •. r �„ r +. i 1 `� `F j 1 �. L ��