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HomeMy WebLinkAbout0064 SOUTH STREET �,v/✓r w7k. 1�� - --- - - I ' �ommonwealth'o'f M ssachusetts }` V Stlb-Metal Pefmit r$`Map 3a1 Parcel'^ Date e� � '��"y SEP 17 2018 Permit# —� , E'stunated Job:Cost $ 1118 r A B L� k 13:�? ernut Fee. �,T. 1l!11r �` I- �N Plans Su Plans Reviewed:YES y NO ie ed: Y . NO t Business Z-icense# I 1111 A 1pp icant License .r, 4 6 rh ... _ s Business Information Property Owner/Job Location Information: f Name `�� ►`t'S 1 Name: M e /�cz�-�e Street'.-, (�`� 53�� S7 . .. City/Town �. `I ►o. , N►,4 Q ycc 3 City/Town: t a b t , p . .r.., .. . . .. .: :. 'Telephone: 50'�-3°�1 - v Photo I D required/'Copy'`of Ph'oto.I:D. attached: YE'S ✓ NO Staff Initial es; de J 2/M=2 restricted to dwellings 3=stories or less and commercial up to 10,000 sq. ft. /2-stories or less Resideiihal'1-2'fair l Multi4,kftil' Condo/Townhouses Oilier i Y y' rCommrcial ' Office :$' : Retail ..-_ Industrial . _ . Educational 1Fre'Dpt Approval Institutional Other Square„Footage under TOOOO.sq ft. -�/_ over 10,000 sq. ft. _ _ Number of Stories: Sheet metal work to be completed: New Work: 1.1� Renovation: HVAC .. Metal Watershed Roofing Kitchen Exhaust System .. ,Ts{ 1Vletal Chirnriey./Vents Air Balancing Provide detailed description of work to be done: Y 5 `Z�w► �uCzL'� I-l�'�i f C oaLk O(e S ;later• 4" r , h Y: IN�URA OV�RAGE 3 _ y S95 �x� t $,fie K`"s�{�t• �i.. 'r r w, :_�` ^r •c (. x I have a current Ilabillty insurance policy or its equrval'ent which meets the requirerd`dk 'd MAL.dh.112. Yes No A / If yoiihave checked ;in,icate the type of coverage'by checking tte appropriate b'oz below: A liability Insurance policy ] Other Type of•indmnity BonaEl a# 1 a L ! 7 `J "1 � y y + z v �, $ OWNER S SIiNSfURANCE WAIVER I am aware that the licensee does not have the insurahce coves a re aired by Chapter 112 of the 'f h� R2 1 J",.47p A. 'ti.Jy..,+: s£ 3 3,i. x 1 (.Y ,y w Massachusetts General Laws,and that my signature on this ode it applieatf'ofi uua vi?s-this`re'qui ement. ' 61ie61k One Only y fi. Ovun,e'Y Agent ❑ ❑ Sgnatur ere'of Owrrer`or Own s Agent. v Y { f Y \y 9....u �.y r d fr f t �.: 6 + - a r h l f F z ails and information I have submitted(or entered)regarding this application are true and 13 checkmthis box I hereb certi that all of the det accurate to the best of my knowledge,arid that all sheet metal work and Installations performed undef the permit issued for this application will be. , s a k w"-�t 3 .,a .,. < w G•...., c. in compliance with all:.pertinent provision o,e Massachusetts Building Code and Chapter 112 of fhe`General Laws. ,a Duct Ins peCtion`required prior to in'sulatidn instaliatron:YES NO P'ro�r,`•es�s Inspections ' Comments Date Comrnnts } 'Y 5 t i a T "e of Lice YP nse: Master ❑IMaster=Rest idt6d ity/Town ; ❑J'ourneyperson i Signa a L` `nse'e ermit# e b , a _ ❑,Joumeyperson-Restricted - . _ Llce ber nse u Check'ai wO.Aaa's.govldgl r ispector Signature of-Pennit'ApprovaC 4 P ' F 7wse commonvveitlt�i may ♦� (��jj�} Li l o S Of m�iysac/i�J GLL'' . t. i � a,mL } F`t .: . 1.' /yam■ �{y�p/� T'j� .�y.� �y/T��/,�.j� p { b} k'?'� y aJ'` A f • Y.��/L//�%G/L�D�Zli�.7LI�.��c4riiiG/L'/.J , - p C1,ffice o,fill, ... ' 00,�ahingfon Street ,, B MA 02111 i w, Jnass gov/din ' 4'orkers' Compensation: raAice Affidavit. �uilderslContractors/EIectnciats/1'luibers f . Ly hgant nfo ration" .se s P'Tir 4 (Busme rgamzataon%Indzvadal) ' °Ad ess /�Y /?Fc C> '/State/Zi I✓1� : ! Are yo' employer? Che the appropriate bdg: z -Ty*of project(regiiirecl):' 1. am a er ployer�vrth 3 3.._ 4. ❑ I am a general contactor and I employees(full and/or part tmiel:*. have hired the sub-contractors 6 ❑New construction . 2 ❑ I'aaa a sole proprietor or partner= listed tfie attaclied shed . 7: ❑Remodeling Izave n4 employees T15 ese sub=contractors have" 8: ❑Derhohtitan s working for me m anyncapaczty employees'and have workers' [No vVorkers' comp msurance comp msuxance.$ 9 ❑ g addrtlQn reguaed j orporation anclit reparts'or additions 3 ❑ T am a homeowner do'mg'a11 work' officers have exercised them 1.1 (]Pluiabmg repairs or additions myself [No workers camp. right of exemption per mc, 12:[]Roof rep §1airs c_ 152, 4, and we have nb O e' ye to "es. o workers' (I`i comp msnce required] *Any applicant that aheoks boX'#1 most also fill out the section below showing then workers'cdnV=itidn policy mfarmatian. t Homeowners who submct this affidavit inch th are do all work and then hire outside cmtra to�•s mustsubmit a new affedavit indicating such. caking eY � - t$Contractors that check tins box must attached an addrtmoat sheet sbowmg the name of thb sub contiactnts and state whether oruot those entities have emliloyees If the sub-conteacinis have rt` to $t *� .. ._ �_.,,�� ,...-„:, .� z-> . �P�� eyaiu"stProndetheu• wvrkcrseC4poticyriumb er. I am an employ"ei that is providing workers',co''rrm ensatzon insurance or in P f y employees. Below is the pOUCY and job site Insurance Company Policy#at Self-ins Lac # �/4 of( q 9, yL� ExpaationDate: o1p/9 Job'Site Address: p. . City/State/Zig: i Attar h a copy of the workers' crimperisation policy ileclarafitia age(showing the policy number and expiration date). Failure to secure coverage as required raider S"ection 25A of MGI c. 152 can lead to the i iosition of criminal penalties of a foe'up 500.00 and/or one year imprisonment, as well as'civil penalties in the form of a STOP WORK ORDER and a flue of tip to$250 00 a'day against the vaolato=; Be dbised that a copy of this statement may be for*&—de'd to the OfFce of w Tuvestttions ofthe DIA for msrance cooeiaue yerlficatton I do her ce `: under thhe arts and F`en "'s o perjury that the in ormation prm�ided above is true and correcc P P fp'� ry f S e: Date:' 9-to Phone# %5 bf. 77r 13 6 ......:.:.. O ficuseonly. Donot wrke rrt ffiis area, tb b or.townty' Town• erruitLicensesuzng AIIthor'ty(circle one)c 1'Board of Health 2 9 du g Department 3.City/Town Clerk 4.Electrical Inspector 5.pTumliing Inspector ff ' M Oer ,n C IttB h 3�b } OCt t }a t P erson �. a • Phone# 6 , r Town of Brnsable s tt Thotmas F Ge�ler Director. . Ulld"" r. # 1 �•� it Tam Periy,Building Commissioner , 200 Mairi�Street,.Hyahn s l,02601. www townbarnstable.niaus �1 Office: 508462 4038 , Fax: 569490-6236 �. a Pro perry,Owner 1Vhtst z Complete and'Sign t is Section ,:If UsLfi_g A Builder as Okvnet of the"subject property hereby`autho=e to b • rt. cto .0 n lilyelia f -4 .�1 a in all ' s rnattets relative to work.authottzeci b "t y this building pei-aatt 50sn� (Address of Job') - v Pool fences and alarms"are the responsibility of the a IYcarit. Pools b:erfilled before fence is irstalle P:P a aiid p .;.. .. ... .. ools e µ, are not to f Fi utihz d t>l allJfinal i Vs ec Ons ate p otmecl and .: erf ;accepted. , Signature of Owner S e o _. lot ignatur f Applicant k ldrN 4 Print.Nanae � — . Print Muh6 1 r..�'y 4 L L L, f. Date QORMS.OWNEI2PELMISSIONPOOLS" 2 � 1 ^'< :a r' •. Vic, 7hlI�.L. ' .._ ! ..� .d\ .,�:._.:>� ._t d.,1. ... . .... .i �• .. .. _. � . . .. � - � e - ,. o. . r TOWN OF BARNSTABLE YF r J (SSLES;TE Fb1 Ld5i4� L3E { s z t - 9/17/2018 Mass.Corporations,external master page William Francis Galvin i S j Secretary ofthe CommonwealthofMassachusetts Corporations Division Business Entity Summary ID Number: 001321605 Request certificate New search Summary for: THREE GULLS LLC The exact name of the Domestic Limited Liability Company (LLC): THREE GULLS LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001321605 Date of Organization in Massachusetts: 04-06-2018 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: 10 SOUTH BARN ROAD City or town, State, Zip code, HOPKINTON, MA 01748 USA Country: The name and address of the Resident Agent: Name: PETER F. MCAREE Address: P.O. BOX 1189 20 HEIRS LANDING City or town, State, Zip code, SOUTH DENNIS, MA 02660 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER LESLIE ANN MCAREE 10 SOUTH BARN ROAD HOPKINTON, MA 01748 USA MANAGER PETER FRANCIS MCAREE 10 SOUTH BARN ROAD HOPKINTON, MA 01748 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address i The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address http:Ucorp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001321605&SEARCH_TYPE=1 1/2 9/17/2018 Mass.Corporations,external master page REAL PROPERTY I PETER FRANCIS MCAREE 110 SOUTH BARN ROAD HOPKINTON, MA 01748 USA CJ U Confidential J Merger 0 Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report 0 Annual Report - Professional Articles of Entity Conversion Certificate of Amendment View filings Comments or notes associated with this business entity: New search http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001321605&SEARCH_TYPE=1 2/2 11 LAWRENCE READY MIXED CONCRETE CO. 888-8002 TOLL FREE 1-800-633-8889 �� f , VI alrk �:7 t _ 4 p _ f f { � }per'"'--.�.._ .?_...._._..y -.._-Y_._-•- �. _j.. ...,....._....! -:-F---,#--....�...._...._.}r...... i-'-^- .__ 3 , � ..._,�.._. ' -Q_ [5�-✓�`L.�/' SG 'c J S"t� f g t t , 4 } i - - , i RVING CAPE COD d rt S to • '^ ,' rw .� ,+'p ti T -.. `t. t a • r 'down of Barnstable Building 8AFL SrA8M ,Post This Card So That it is Visible From the Street' Approved Plans M_ust be Retained on Job and this Card Must be Kept +r IM � Posted Until Final Inspection Has Been Made. v '. �er it Ro mac" Where a Certificate_&Occupancy is Required;such Building shall Not be Occupied until a Final.lnspection has been made Permit No. B-19-4111 Applicant Name: PETER APPLETON Approvals Date Issued: 12/19/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 06/19/2020 Foundation: Residential Map/Lot 327-250 Zoning District: HD Sheathing: Location: 64 SOUTH.STREET, HYANNIS Contractor Name:_ PETER APPLETON Framing: 1 Owner on Record: THREE GULLS LLC Contractor License: 103218 2 Address: 418 S JESSUP STREET Est. Project Cost: $40,000:00 Chimney: PHILIDELPHIA, PA 19147 Permit Fee: $ 254.00 Description: FINISH BASEMENT W/PLAYROOM AND ADD ABTHROOM REMOVE Insulation: Fee Paid: $254.00 10'WALL UPSTAIRS 1ST FLOOR TO CREATE OPEN SPACE 4 17 Final: + Date: -f 12/19/2019 Project Review Req: R-19 insulation required in basement walls. w . i wt Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and thesapproved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road.and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. �_— Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: j Service: 1.Foundation or Footing Air 2.Sheathing Inspection � M _ Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Pe sons con ing with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). 14!� .- Building plans are to be available on site fire Department fir All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 'DEC 0 9 209 Application Number.. _ �....1. ........�f..�JI. ................. 00 MAS& Permit Fee.......................................Other Fee:....................... 163 TotalFee Paid............................................................... ...... TOWN OF BARNSTABLE . Permit Approval by.................................On........................... BUILDING PERMIT Map... ... ................Pardel....... ............. APPLICATION Section I — Ownir's Information and Project Location , (0 Village _^4 Project Address V PL/ 7 Owners Name. e- Owners Legal Address City 214•L 6o et, State -zip Owners Cell# 15 —L-2q 2-229 02 E-mail AMILA i­' 41,,-14e & Section 2 -Use .of Structure Use Group— ❑ Commercial Structure over 35,000 cubic feet Co❑ erclal Structure under 35,000 cubic feet Singl Two Family. Dwelling Section 3 — Type of Permit U'Rew Construction Move/Relocate 1:1 Accessory Structure El Change of use El Demo/(entire structure) U;-rinish Basement El Family/Amnesty ❑ Fire Alarm Rebuild, ❑ Deck Apartment El Sprinkler System ❑ Addition E] Retaining wall F1 . Solar glRenovation El Pool "ulation Other—Specify, Section 4 - Work Description (0,i,5 0 AJ /?U U� &,40 /i V 0 f l OtQ U 94 41v ts'e & Last updated: 11/15/2018 Application Number...........................................:........ Section 5—Detail Cost of Proposed Construction Z/o,Uw,L" Square Footage of Project' �pw Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics E'Viring ❑ Oil Tank Storage ES'moke Detectors 2'flumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: . s� .PIle 4AO 19i I am using a crane ❑ Yes [B�No Section 7—Flood Zone i Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 Application Number............................................. Section 9-Construction Supervisor Name Telephone Number Address 3`7 P`J ICU city. vc�L� C'S ���' State >�(+�- Zip License Number L90 S4"Y License Type U' Expiration Date Contractors Emai �le 7Z (s'•�''^ � l G6✓k Cell # �`c�jo`�` ° I understand my responsibilities under the rules'and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation req ' y 80 CMR the Town of Barnstable.Attach a copy of your license. Signature � Date Section 10—Home Improvement Contractor Name Telephone Number �`� Address 37 6)�-(rj> City 0-eA State VU44- Zip jo-49� Registration Number 2O-3 1F Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation require 780 CMR a Town of Barnstable.Attach a copy of your H.I.C... Signature t.1— Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number. Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780,CMR and the Town of Barnstable. Signature Date,,4 . PPLICANT SIGNATURE Signature Date Print Name -Telephone Number 6 y 06 E-mail permit to: - 42,g& ��-� �, (�wv�r1 f C6 Last updated: 11/152018 Q Section 12—Department Sign-Offs Health Department, ❑ Zoning Board (if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ 4' For commercial work,please take your plans directly to the fire department for approval Section 13 — Owner's Authorization i as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name , Last updated: 11/15/2018 N�Lx), `} Q , S t J- v-A U� I has p a ��{Lill Vf n 1(pu oC. ' C)N ✓1 t2 w✓J�IIS 0 C R ►3 .�-►Ls��,9 f o cs� F g r O Cp )1-6t Oj4-s t4 6 Vi r n, r i J � s rfri•l�F. Ilk CAP f {Po p 56 ji-ti4 S EO C0 1'- ti9 pl a a4— P �A-u a I qA OP , s� [ � I SC oANEO 7 2018 i Q Y 9 ` r� z ' - 4� n 5� o fle � co 19 jtj ce- am �Co v� N� o . uommonweann or massacnuserrs ®� Division of Professional Licensure Board of Building Regulltions and Standards Cons4`iClit1iSrvisor J , CS-005414 �ires 06/08/2020 PETER J APFkkETON: 37 BAIRD WA'ij CENTERVILLE h1ifA 02 :�, . ��'Q/fiS T IL��S ��• Commissioner �ie e0aynmeo�iaul�o�G�ae�ii�aeG`Ca . . _ j it Office of Consumer Affairs,&Business regulation HOME IMPROVEMENT CONTRACTOR Registration valid for,individual use only TYPE:Indmdiial - before the expiration date. If found return to: P—eaistratioh expiration Office of Consumer Affairs and Business Regulation 103218 07/05/2020 1000 Washington Street-Suite 716 PETER APPLETO Boston,MA 02118 l PETER) APPLE CCQ'e --l 37(LAIRD WAYi —1 z j 2. 1 Ot Val l h ature GEN' ERVILLE,MA 02532 Undersecretary GU s' n a Dear Mr. Appleton, i hope this note finds you well and congratulations on your new granddaughter Payton!. I am writing at Pete Jr.'s request to provide authorization for you and Pete to move forward with the work I discussed with Pete at my home located at 64 South Street, Hyannis, MA. The work involves among- otherthings, finishing the baseme-nt and building an island in the kitchen. Please let me know if you need any additional information for the permits or to move forward. Thank you in advance for your help. I look forward to hopefully meeting you soon. Best, Michele Martin NOTICE 4 A NOTICE TO63 4 W TO 4 d i a EMPLOYEES EMPLOYEES o�v 6V0.. The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22, &30, this will give you notice that I(we)have provided payment to our injured employees under the above mentioned chapter by insuring with: , Associated Employers Insurance Company NAME OF INSURANCE COMPANY P.O. Box 4070 Burlington, MA 01803-0970, ADDRESS OF INSURANCE COMPANY WCC-500-5013114-2019A 03/24/2019-03/24/2020 POLICY NUMBER EFFECTIVE DATES 411 Route 28 Chagnon Insurance Agency Inc West Yarmouth, MA 02673 NAME OF INSURANCE AGENT ADDRESS PHONE Appleton Construction 37 Baird Way Centerville, MA 02632 EMPLOYER ADDRESS 02/22/2019 DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the proviisions of the Workers Compensation Act. A copy of the First Report of Injury mast be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mrrssgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. Address: 77 &•' r2 0 11-(,fY City/State/Zip: (4x�)l��' . l� 0As 4hone#: Are yo a ployer?Check the appropriate box: Type of project(required): L lam a employer with � 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no-employees These sub-contractors have g• emolition workingfor me in an aci employees and have workers' Y capacity. t 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. We are a corporation and its 10. lectrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11. umbing repairs or additions mysel£[No workers'comp. right of exemption per MGL 12.[1 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 entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. v I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �G�t � t✓'�� Policy#or Self-ins.Lic.#: 4, IrIb i 11 • c�O ��A Expiration Date: 3 cS d Job Site Address: tOq Sop} S City/State/Zip:.4, Ldse S. Attach a copy of the workers'compensation policy declaration page(showing the policy numb 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, er a pains d penalties o perjury that the information provided above is true and correct / � Si mature: �/°-" Date: Phone#. Ojftial 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#: 1 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 �y in the service of another under 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 inchrding the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addres (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 perniWlicense 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 fume 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 bike 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 Aeddents . Office oflnvestiptions 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 www:maw.gov/dia .wwise cascade Triple 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP PASSED FB02 (Floor Beam) BC CALC®Member Report Dry 1 span I No cant. December 9,2019 07:33.54 Build 7295 Job name: I File name: Address: South Street Description: OPTION 2 City, State,Zip: Hyannis, MA Specifier: Builder: Peter Appleton Designer: Joe Madera Code reports: ESR-1040 Company: Shepley Wood Products 0 1 a-00-00 B1 132 Total Horizontal Product Length=10-00-00 Reaction Summary (Down / Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live B 1, 3-1/2" 1800/0 655/0 B2, 3-1/2" 1800/0 655/0 Load Summary Live Dead Snow Wind Roof Tributary Live Tag Description Load Type Ref. Start End Loc. 100% 90% 115% 160% 125% 0 Self-Weight Unf. Lin. (lb/ft) L 00-00-00 10-00-00 Top 11 00-00-00 1 Standard Load Unf.Area(lb/ft2) L 00-00-00 10-00-00 Top 30 10 12-00-00 Controls Summary . Value %Allowable Duration Case Location Pos. Moment 5588 ft-Ibs 44.5% 100% 1 05-00-00 End Shear 2015 Ibs 27.9% 100% 1 00-10-12 Total Load Deflection L/417(0.275") 57.6% n\a 1 05-00-00 Live Load Deflection L/569 (0.201") 63.3% n\a 2 05-00-00 Max Defl. 0.275" 27.5% n\a 1 05-00-00 Span/Depth 15.8 %Allow %Allow Bearing Supports Dim.(LxW) Value Support Member Material B1 Wall/Plate 3-1/2"x 5-1/4" 2455 Ibs n\a 17.8% Unspecified B2 Wall/Plate 3-1/2"x 5-1/4" 2455 Ibs n\a 17.8% Unspecified Notes Design meets Code minimum (L/240)Total load deflection criteria. Design meets Code minimum (L/360) Live load deflection criteria. Design meets arbitrary(1")Maximum Total load deflection criteria. Calculations assume member is fully braced. BC CALC®analysis is based on IBC 2015. Design based on Dry Service Condition. Connection Diagram: Full Length of Member �{ b d a c e Page 1 of 2 3hwoiseCascade Triple 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SP PASSEQ FB02 (Floor Beam) BC CALL®Member Report Dry 11 span I No cant. December 9, 2019 07:3354 Build 7295 Job name: File name: Address: 30 South Street Description: OPTION 2 City, State,Zip: Hyannis, MA Specifier: Builder: Peter Appleton Designer: Joe Madera Code reports: ESR-1040 Company: Shepley Wood Products Connection Diagram: Full Length of Member a minimum=2" c=3-1/4" b minimum=4" d =24 e minimum= 1" All FastenMaster screws may be installed from one side of multiply Versa-Lam beams. Connectors are: FMFL005 Disclosure Use of the Boise Cascade Software is subject to the terms of the End User License Agreement(EULA). Completeness and accuracy of input must be reviewed and verified by a qualified engineer or other appropriate expert to assure its adequacy,prior to anyone relying on such output as evidence of suitability for a particular application.The output here is based on building code-accepted design properties and analysis methods. Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions, please call(800)232-0788 before installation. BC CALC®,BC FRAMER®,AJSTM, ALLJOIST®,BC RIM BOARDTM'BCI®, BOISE GLULAMTM,BC FloorValue®, VERSA-LAW,VERSA-RIM PLUS®, Page 2 of 2 1 0 -t:�Lj 1. {,e 40,e 4L ss�w'Af P�IoQ jf �l�t ' w✓tar �� r S i roperty Location: 64 SOU'1'N S'1' MAP ID: 327/ 250/// Other ID: Bldg#: 1 Card 1 of 1 Print Date:12/23/1998 . TR Element Gd. Uh. Description Commercial Data Elements �tyle ype onven Iona Element Ud. Description ode] 1 Residential Heat rade C C Frame Type 22 Baths/Plumbing BAS tones 1.5 1 1/2 Stories UBM ccupancy 0Ceiling/Wall ooms/Prtns xterior Wall 1 14 ood Shingle /o Common Wall 2226 2 Wall Height oof Structure 03 able/Hip oof Cover 03 sph/F Gls/Cmp nterior Wall I 8 Typical � men z 2 ement Code ' 'escrrptron Factor nterior Floor 1 20 Typical 2omplex 2 loor Adj nit Location eating Fuel 1 None 24 BAS 4 eating Type 1 None Number of Units UBM C Type 1 None Number of Levels %Ownership edrooms 4 Bedrooms FHS athrooms 1 1 Bathrooms �� ' .y ' 0 Full �, n_ � otal Rooms Rooms ]on j.Base e Adj.Factor .14427 e(Q)Index .90 ath Type Base Rate 9.43 BA itchen Style .Value New 8,955 Built 920 Year Built 975 1 Physcl Dep 2 nl Obslnc Obslncl.Cond.Code o e escn tron m e ercenta a l Cond% %verall Cond. 8 ON Singleam eprec.Bldg Value 53,800 s< a � •• Code Description' nus Unit Frice Yr. 23p,.t %Cnd Apr. a ue - ��'� _ =:ate. �., �. .max s•�:i. ,¢, �,. ;...�. .Ss< 41- 'Wo e escrrptron Living Area rose rea Area nu Cost n eprec. a uer FirstFloor , FHS Half Story,Finished 431 624 437 34.62 21,60 UBM Basement,Unfinished 0 771 156 9.91 7,71 U. ross LIVILease Area g a: 68,95 Town of Barnstable Building Car-' drS,o Thatit isU�s�bleFrom the Street'-ApprouedPlans"MustbeRetamedon Job3and this Card Must be;Kept 6AR�23RA-8IE. Fs gh ,:"aiY'z, `�- x," ..., 3• n r._. „'e a.-�`,; "x T -,i""-..>+" - ¥ M' Posted Untll''Final Inspection Has Been3 Made ` 4 Where a Certificateof Occupancy isRequ�red;such Building s(�all Not be Occupieduntil a FEmallnspection has been made ,46 Permit _ Permit No. B-18-1762 Applicant Name: Peter McAree Approvals Date Issued: 06/27/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 12/27/2018 Foundation: Location: 64 SOUTH STREET, HYANNIS Map/Lot 327-250 Zoning District: HD Sheathing: Owner on Record: Peter McAree(d/b/a Three Gulls LLC) ? 'ontractor, ame:; Framing: 1� Address: 10 South Barn Roads CoritractorLicense 29r�a�/,8 Hopkinton, MA 01748 Y Este Protect Cost: $50,000.00 Chimney: �, Description: Addition of second floor shed dormer and 2nc1 floor full bath. First Permit Fee: $305.00 i Insulation: floor kitchen and bath alterations. External repai pp,,siding and Fee Paid s $305.00 i trim where necessary. Demolition of rear handicap ramp(in poor ` Final: c� i Date 6/27/2018 zz /9 Rll�� condition);regrade and replace with a rear step 41 Project Review Req: NEW DORMER FOR EXISTING FINISHED SPACE`- Plumbing/Gas Rough Plumbing: T ,. � ,Building Official f Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzed byihs permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved appl catio�n"an 1th6''approved construction documeri6466which-this permit has been granted. 771— All construction,alterations and changes of use of any building and structures shalllpe in compliance with the local zornng by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street orJ'road and shall be maintained open for pubhccinspect on for the entire duration of the work until the completion of the same. ,�,, IT �� � , Electrical The Certificate of Occupancy will not be issued until all applicable sign aturesb,fkthe'Buildmgand Fire Officials are rovided on,this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: , ` 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �hi.L SF�T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3c�,) Parcels Permit# �� Health Division ;, Date Issued Conservation Division Fee tQ . Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis �'� 0(J Project Street Address Village ly'y1�q!V N/:S YYI✓� Owner at%L\l d CK -GA feu1 rtiS e/Z Address Telephone n Permit Request eQ S CX_0 0 6e 11OV4 S n 6�0 6kL- w� Oon�, i 6ivyi ik j9 (:5��-P C' o-r . �S�. �,uy C'l7AIc.K-1 el's� ,2 ��vvrh�� cG Square feet: 1st floor: exis ing proposed 2nd floor: existing -,proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay 1 �� 9 Y Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 13 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: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name �P f'g P11) Telephone Number Address �1 I l 19 C=1cJ)01_) 0 License# CmtG t Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1216QA) SIGNATURE . DATE �Gbv FOR OFFICIAL USE ONLY s` PERMIT NO., DATE ISSUED g MAP/PARCEL NO. t _ i f ADDRESS '"' VILLAGE , OWNER s DATE OF INSPECTION: ' FOUNDATION. ' FRAME .� INSULATION - ~ FIREPLACE ' ELECTRICAL: ROUGH FINAL ` 'PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL ; FINAL BUILDING ' DATE CLOSED OUT ' ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name U9•�J A S,</) location: I TIC}fZ t G GY\ C I i2 city Vi vhone# ❑ I am a homeowner performing all work myself. ❑ I am a sole plouletor and have no one worldng in any capacity I am an em Toyer providing workers' compensation for 1ny employees worlang on this job. ' P ..:.:..:.:.: ...:.:::::.::::..:. Com A ad dress— cites.... 4 ... . .. ........ . shone#... . insurance co. t- Lei.: 1 ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' co ensation polices: KX wm anv name. address. ::. »: .. ..........:....................:: : :: :::::.::..,. ohone:: . ; : . : : :: ; :d W. :??L::4:FT::Yi:v?4::??•:�iiii:{h:?^:?}i:•?:??v:•i??•i'iiiiiiii:i::•�}^l`,:^C: .t.... . ......... ........ ................... .....::::.....:....t....:..n.............. ....................�•:v :: :::'t.•ii::?4:•iii}:??{i•?:•:::v:.�Y•(vlr.::�:�:.:�::::.�:::::::: COME ..:. address: :::.:.:.:.: ne :.;;:.;::.:?.>;;;:.;:.;;;:::;.:;.:;;.:<:;;.;>:<::;;:>:<:;:;.:;.;:.;:.:.;;;;:.;:.;;:;.>::;.::....:::.:, ::::.:::..............::::::........ ......................... .................................................. ......... ......................... ::::.............::::.............::::::.. :.:..................... .:?:::.......:::..:::..... .... insurance co:::.>;:,:.:.,;.;;:,;:.:;;>::,>:;;,;<.:<.:,;,;,,...:.:,.,.:..:,:::,..:.,.:.:::. :::,.,.....,.,,:.,..,............ .... .. oliR �. Failure to secmrs coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a rile up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification I do hereby certify p f perjury that the information provided above is ow.and coned Signature Date Print name Phone ted by city or town oincial City or town: permit/ticense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Onnce Cont. _ OHealth Department ctac person: phone#; ❑ u�� (�evued 9/95 P1A) oFTMe�o . f. : The Town of Barnstable • a�uver�sre • �m� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 5087790-6230 Building Commissioner Permit no.— Date— AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost J Address of Work: d� �� S✓ Owner's Name: Date of Applicatioj� -o I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED. CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav 1 1 1 : . r hiOME Y . R � EHE ]T CONTRACTORS REGISTRATION � and of RU A;d ng Regulations and Standa ` One Ashburton Place - Room 1301 Boston, Massachusetts o2108 HOME IMPROVEMENT CONTRACTOR Registration 112536 , Expiratio-n O4/06/O1 TYPe - DBA RWE IMVO% FIT COWRACToR FRASER CONSTRUCTION co J Registration 112536 _ DEAN C. FRASER �' Type - ODA 1 TARRAGON CIR -- -- -- ------ - EIPITWOR 04/06/01 COTUIT MA 02635 i ERASER CONSTRUCTION co OEAN C. ERASER Goo ' RitR&ffR CIR 4 TUIT NA o2635 Property Location: 64 SOUTH ST MAP ID: 327/ 250/l l Other ID: Bldg#: 1 Card 1 of 1 Print Date:12/23/1998 Description code Appraised Value Assessed Value 83 SCHOOL ST RESIDNTL 1010 53,80C 53,80C 801 HYANNIS,MA 02601 BARNSTABLE,MA d .� max,.:. s . . :.. ,�., ccoun an Ret. Tax Dist. 400 Land Ct# Per-Prop. #SR VISION Life Estate DL 1 Notes: DL2 Iota! , X .:. �.. 9... . .,.. �.; -s ...z_ e...,.�n.:<a ,«..-�.... _. --.so-: c_.. r. Gode Assessed Value Yr. Code Assessed Value Yr. Gode Assessed value of ota. ota. 67,6UC Ints signature acknowledges a visit by a Data Collector or Assessor Year I)vpelDescription Amount .Code Description Number �Amount Comm.Int. �4�T A Appraised Bldg.Value(Card) 53,800 Appraised XF(B)Value(Bldg) 0 Appraised OB(L)Value(Bldg) 0 Total. I c Appraiseda 1 .,,. ...w�.. -T rZ�a: ,_ .,,$- , a,�•..:a �, ,'$:. �;4 h„, :µ,3. ..�,'.3. . .$,t .�"4 Scial Land Valuelu g) 1 e 4,000 0 USE............. Total Appraised Card Value Total Appraised Parcel Value 67,800 Valuation Method: Cost(Market Valuation Net'lotal AppraisedParcel Value -_�"., ...'°,�.^ ,.-�..�,. ._ ... V- -.ak Permit ID Issue Date ), e Description Amount Insp.Date o C Comp. Date Gomp. CommFnts Date ID Gd. x urpos esu t zed „,v ��'� ?�• � �,�' x �v,3,; �i:. r F �;..;. �. Bg C., x,w ".,.. .Ns,,_�.,.�.0 6r .,.. ,. .. ,.� .::; ,cu,'q ...�. .v, :: a i...... ....... "... �, s 9 .7y,'� ,fr c.,,.v.,. •^,z:'.f h � � i �,':Use Code Description _ one D Prontage Depth units Unit Price L Paclor actor Nbhd. A dj. Notes-Ad/lapeCial Fricing Adj. unit Price Lana value Single Yam i , Total an nit UNI I ALJ 6tal LanTyu--� ,