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0118 SOUTHGATE DRIVE
Fjk/ i Building Town of Barnstable 1 g - u ng r rnrnns� Post This Card So°That`it is Visible From the Streets-Approved Plan's Must be Retained on Job and this Card Must be Kept Posted Until Final;Inspection Has,Been Made < �ey.m�* Wher"e a Certitrtcate of occupancy is Required;such Building shall Not be Occupied until,a Final Inspection has been made• 1 111 1 Permit No. B-19-4090 Applicant Name: W. Ray Colwell Approvals Date Issued: 12/09/2019 Current Use: Structure Permit Type: Building-Insulation- Residential Expiration Date: 06/09/2020 Foundation: Location: 118 SOUTHGATE DRIVE, HYANNIS Map/Lot 306-279 Zoning District: RB Sheathing: Name: °�,SC.EnergY Framing:Owner on Record: BROUGHTON,CHESTER E JR&LINDA A TRS Contractor .. g: 1 Address: 118 SOUTHGATE DRIVE Contractor License: 19490 2 HYANNIS, MA 02601 .� Est. Pcoje_ct Cost: $3,376.00 Chimney: Description: Insulation;See Contract ..Permit-Fee: $85.00 Insulation: Project'Review Req: Fee Paid; $85.00 1 Date = ,'' Final: 12/9/2019 � Plumbing/Gas Rough Plumbing: A-- 4 Building Official - Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorzed by this permit is commenced within six months after"issuance. All work authorized by this permit shall conform to the approved application=and-the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structuresshall,be in compliance with the local zoning by-laws and codes. I a Final Gas: 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 work until the completion of the same. _ a� Electrical The Certificate of Occupancy will not be issued until all applicable signatures-by the Bu<ilding and Fire Officials are provided on-this,l5ermit. Minimum of Five Call Inspections Required for All Construction Work: Service: 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" M(as set forth in GL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 13__ IV S � t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V� Parcel Application Health Division Date Issued -�� Conservation Division Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address SOCAA G-4.V2 . V Village �\Itcvvn,z, Owner Address Telephone ��J E3q� 52 Z/ Permit Request 00 Vey f,to" t' �- 5 stew �® 4 5-0 w4 K2Zo -_a x Square feet: 1 st floor: existing proposed 2nd floor: existing proposed-_-__7 _Total'new, --' Zoning District Flood Plain Groundwater Overlay '_{ ` PRoject Valuation,. , -,� 600 Construction Type .a t Lot Size Grandfathered: ❑Yes ❑ No If yes, attach Jupportinidocementation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) f C41 € Age of Existing Structure Historic House: ❑Yes ?�No On Old King's Highway: 'Yes aMo 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 g-w APPLICANT INFORMATION AAVI o"A:F (BUILDER OR HOMEOWNER) I I Name �h �k� Telephone Number Address License # 014g76 0 266 Home Improvement Contractor# 1 b Email a t�l uvi , Y v Worker's Compensation # 5u 4714CA-V 4zull P ALL CONSTRUCTION DE IS S ING FRO THIS PROJECT WILL BE TAKEN TO :2 .e_,w&4e,C C 01 SIGNATURE DATE 2 L�,�� 111� Iz�. FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED F MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. CONTRACT My Generation Energy, Inc. .; A HIC# 163006 FID# 26-4343622 MyGeneralionEnergy 3 Diamonds Path Unit 2 South Dennis, MA 02660 508-237-8228 CONTRACTOR: My Generation Energy, Inc. ` OWNER: LINDA&CHESTER BROUGHTON LEGAL ADDRESS: PROJECT ADDRESS: 118 Southgate Dr,Hyannis,MA 02601 , DATE: JA PROJECT: Design,provision, and installation of a renewable energy system. The system is a roof- mounted, grid-interconnected electrical solar photovoltaic array with 5.000 kW(DC STC)rated capacity. The system will comply with all Commonwealth Solar 11 requirements as stated in Program Manual Solicitation 2014-CSII-Version 20a. Major equipment and components will include; Modules: Hyundai—HiS-S250 MG(20 each) Inverters: Enphase Energy—M215-60-2LL Monitoring Hardware—Enphase Energy Envoy(w/lifetime subscription) Mounting Hardware: SnapNrac SCOPE OF WORK: My Generation Energy proposes to furnish a turnkey system including design services,project management,recommendations, installation,labor and materials in accordance with the plans, specifications and requirements as approved by the owner. This service includes responsibility for: obtaining necessary building permits; application for electrical service interconnection; scheduling and participating in inspections. Owner is responsible for providing information as necessary and in a timely fashion to support the following: Submittal of Commonwealth Solar Rebate applications and supporting materials,NSTAR interconnection applications,permit applications, and allow.access as necessary for the installation at agreed scheduled times. r TIME SCHEDULE: Order to commence on March 15,2015. Installation to commence on Aril 10, 2015 or to be determined by April 7,.2015 (subject to weather,permitting, delivery and availability of components). Project completion is estimated to be April 30, 2015 (subject to inspection,utility, and forms processing schedules).No work shall begin;prior to the signing of this contract and transmittal to the owner of a copy of this signed contract. I PRICE AND PAYMENT SCHEDULE: " The total system price is$18,600.00. Payment will be made in three installments; deposit, order,and completion: Deposit allowance is $2000.00 due at signing of this contract. Initial payment shall be one half of total system amount, $9,300.00, due at the time of order. Final payment shall be the remainder of the total system amount, 7 300.00, due at time of completion (passed relevant inspections, submitted utility interconnection completion form,and project completion form). CONDITIONS: It is understood and agreed that My Generation Energy shall not be held liable for any loss,damage or delays occasioned by fire,lockouts, acts of God or the public enemy, accidents, boycotts,material shortages,disturbed labor conditions,delayed delivery of sellers suppliers,force majeure,inclement weather,floods, freight embargoes, causes beyond his control. Prices quoted in - this contract and subsequent submissions are based upon current prices and upon the condition that the proposal and/or submissions will be accepted within thirty(30)days. PERMIT NOTICE: For any and all necessary construction-related permits,it shall be the obligation of the contractor to obtain such permits as the owner's agent. If the owner(s)secure their own construction-related permits or deal with unregistered contractors,they shall be excluded from access to the Guarantee Fund. ` INSTALLER WARRANTY: My Generation Energy warrants the system installation for a period of five(5)years on defective workmanship,PV project or component breakdown(except for the lesser intervals noted in Manufacturers' Warranty Summary), or degradation in electrical output of more than fifteen percent(15%)from their originally rated electrical output. This warranty covers materials and associated labor.Parts may be repaired or replaced at the discretion of My Generation Energy. In 4 addition, all manufacturer warranties apply.Renewable energy systems are,by nature, load driven and dependent. Owner assumes responsibility for proper maintenance and use of the system. MANUFACTURERS' WARRANTY SUMMARY: (See manufacturers'literature for details)Hyundai PV Modules: Ten(10)year,limited on materials and workmanship,twenty five(25)year limited on power output.Enphase Micro-Inverters: Twenty five(25)year limited on materials and workmanship. ' SnapNrac Components: Ten(10)year limited on materials and workmanship,five(5).year limited on anodized finish. TERMS: The entire outstanding amount of the contract to be paid upon completion. A 1.5%service charge per month will be made on all past due accounts. . OTHER CONSIDERATIONS: All home improvement contractors and subcontractors shall be registered.Any inquiries about a contractor or subcontractor relating to a registration should be directed to: Registration Division,Program Coordinator One Ashburton Place Room 1301 Boston,Ma 02108 Tel: (617) 727-3200 ext.25239 2 You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof,provided you notify the seller in writing at his main office or branch by ordinary mail,posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. Attachment A. THIS PROPOSAL IS SUBMITTED IN DUPLICATE. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. SUBMITTED: My Gener ' n E r ,Inc. ACCEPTED: Owner(s) . SIGNED: NAME: &i±DP4.u3 ul P 1a a 112— zv 1-0 DATE: i 2- / I/ of Ll y M A Mass. Corporations, external master page Page 1 of 2 Corporations Division Business Entity Summary ID Number: 264343622 Request certificate New search J Summary for: MY GENERATION ENERGY, INC. The exact name of the Domestic Profit Corporation: MY GENERATION ENERGY, INC. Entity type: Domestic Profit Corporation Identification Number: 264343622 Date of Organization in Massachusetts: 02-27-2009 Last date certain: Current Fiscal Month/Day: 01/31 Previous Fiscal Month/Day: 01/31 The location of the Principal Office: Address: 3 DIAMONDS PATH, UNIT 2 City or town, State, Zip code, SOUTH DENNIS, MA 02660 USA Country: The name and address of the Registered Agent: Name: LUKE HINKLE Address: 326 YANKEE DRIVE City or town, State, Zip code, BREWSTER, MA 02631 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT ANDREW WADE 579 MAIN STREET, UNIT B CHATHAM, MA 02633 USA TREASURER ANDREW WADE 579 MAIN STREET, UNIT B CHATHAM, MA 02633 USA' SECRETARY ANDREW WADE 579 MAIN STREET, UNIT B CHATHAM, MA 02633 USA ASSISTANT LUKE HINKLE 326 YANKEE DRIVE BREWSTER, MA 02631 SECRETARY USA DIRECTOR ANDREW WADE 579 MAIN STREET, UNIT B CHATHAM, MA 02633 USA Business entity stock is publicly traded: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.a... 4/2/2015 Mass. Corporations, external master page Page 2 of 2 The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and Class of Stock Par value per share outstanding No. of shares Total par No. of shares value CNP $ 0.00 250,000 $ 0.00 0 05 r Confidential Merger F Consent Data Allowed Manufacturing View filings for this business entity: :,ALL FILINGS 1Z Administrative Dissolution i Annual Report Application For Revival Articles of Amendment _1 _L I.L_.1_._ I"•... ._J_._ " View filings Comments or notes associated with this business entity: New search http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.a... 4/2/2015 Mass. Corporations, external master page Page 1 of 2 Corporations Division Business Entity Summary ID Number: 264366796 Flkequest certificate New search Summary for: BALTIC COMPANY, INC. The exact name of the Domestic Profit Corporation: BALTIC COMPANY, INC. Entity type: Domestic Profit Corporation Identification Number: 264366796 Date of Organization in Massachusetts: 03-03-2009 Last date certain: Current Fiscal Month/Day: 12/31 The location of the Principal Office: Address: 447 WINSLOW GRAY RD City or town, State, Zip code, S. YARMOUTH, MA 02664 USA Country: The name and address of the Registered Agent: Name: LINAS REVINSKAS Address: 447 WINSLOW GRAY RD City or town, State, Zip code, S. YARMOUTH, MA 02664 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT LINAS REVINSKAS 447 WINSLOW GRAY RD S. YARMOUTH, MA 02664 USA TREASURER LINAS REVINSKAS 447 WINSLOW GRAY RD S. YARMOUTH, MA 02664 USA SECRETARY LINAS REVINSKAS 447 WINSLOW GRAY RD S. YARMOUTH, MA 02664 USA DIRECTOR LINAS REVINSKAS 447 WINSLOW GRAY RD S. YARMOUTH, MA 02664 USA Business entity stock is publicly traded:- http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.a... 4/2/2015 Mass. Corporations, external master page Page 2 of 2 The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and Class of Stock Par value per share outstanding No.of shares Total par_ No.of shares value CNP $ 0.00 100,000 $ 0.00 100,000 r 0 Confidential r Merger . r Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Administrative Dissolution Annual Report Application For Revival Articles of Amendment View filings Comments or notes associated with this business entity: L New search l http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.a... 4/2/2015 RECEIVED 01/01/2004 04:0BPM /24/2015 9:13:06 A14 PST (GMT-8) FP,OM: 100005-TO: 150874468,11 Paue: 3 of 3 AC � CERTIFICATE OF LIABILITY INSURANCE DA'E(MMIDDIYYYY) 3/24/2015 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 1NSURER(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 WANED,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 endorsements). PRODUCER BRYDEN&-SULLNAN OF DENNIS INC NAME CT PO BOX 1497 PHONE FAX SOUTH DENNIS, MA 02660 x Arc No: EJbAIL ADDRESS: .INSURERS AFFORDING COVERAGE NAIC 11 INSUREDINSURERA: LM Insurance Corporation 33600 BALTIC COMPANY INC INSURER 0: 87 CAMP OPECHEE ROAD INSURERC: CENTERVILLE MA 02632 INSURERD: tNSURERE: INSURER f COVERAGES CERTIFICATE NUMBER: 23920429 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. ADDL SUBR POLICYEFF POLICY EXP ILI'RR TYPE OF INSURANCEINSD POLICY NUMBER MMNDlYYI'Y MMIDDIYYYY1 LIMITS t COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCURRT — MED EXP(Any one poison) $ PERSONAL-S ADV INJURY $ ' GEN'L AGGREGATE LIMIT APPLIES PER; GENERALAGGREGATE $ POLICY PRO- F ❑ JECT LOC PRODUCTS-COMPfOP AGG S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - Me accident ANY AUTO BODILY INJURY(Per person) $- ALL OWNED SCHEDULED AUTOS AUTOS... ' BODILY INJURY(Per.acddent) $ HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE AUTOS Paraccident - $ $ UMBRELLA LIAR OCGUR EACH OCCURRENCE $ EXCESS LIAB CLAIM§-MADE AGGREGATE $ DED RETENTION .$ A WORKERS COMPENSATION WC5=31S-384924-025 3/25/2015 3125/2016 PER OTH- AND EMPLOYERS'LIABILITY YIN, ✓ STATUTE ERANY _ OFFICF11ME BOREXCLUDED ECUTNE -NIA Ek.EACH:ACCIDENT $ 500000 ory (flies,d w'be and El,DISEASE-EA EMPLOYE S 500060 If yes,doscrbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if name space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and-supersedes all previously issued Certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION MY GENERATION ENERGY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE�CANCELLED:BEFORE 3 DIAMONDS PATH UNIT#2 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SOUTH DENNIS MA 02660 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORtZED.REPRESENTATNE Ud LM Insurance Corporation ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 25{2014/t)1) The ACORD name and logo are registered marks of ACORD CERT NO.: 23920429 CLIENT cont: 1595',69. Anne Chandler 3124/2045 12::11:44 PM (EDT) Page t of 1 i ' orkeff C tea n Sub- e s is _..n `3 r= f •,-�d ¢!-w spas .fld�i'j�+Y€a$t3fT>E�1�F.r9,_��tt GZYC3�r"'��a`s'33'(Ir.1;t�rF��ES'i�'9=•�'��i` �2vIC��i�c''�eFE(itilg. .. cPYi'�iitfi3iC1 ? `71e eSCElVPu tb l�rC)I �C5' LsrFC{��'t35e3`ttIfs 3&': l$rifTit T}tii�1;� rS fi2StlFt CG TbUfiij?cC1t #5 w gmGt 9Cy � xwt '� e If t have.iigp ea� m as I aan..a sole-bro 16rmr�w s rL`y $a IPand.�f�Va.P+��i�;I3���#w' wrong ftaYs"S4?;esrii`y ,s!'� .. s i:'o b C 'f tT SiL{t`a' ' 'i wa:its idX `�u ic3 signauvm � e`pnrax cue Please Odntsnairr of z�1 I v o rovEr3 c krr� ns a tsort i ¢s req e-ma above i s m sole pro b#etgr or haven* in al�r"s��t3s?; dtl:'f1 i r)5,i CeCta 7lf d-e7 itebafrisAm - 1j� `�Yt'G�2t;t8[t/: �3ca'tht,hib r 606m beci tided I Itoa and er3il "iie?FYg.t't'�`�.? 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Phone (�:4 —l�. ` Are You as employerCheck the.appropriate box: -Type of project(requ'ireil l..E 1 am a employer with �: I ath a getteral contractor and 1 ( Nevrconstrzciion_ employees(felt and/or p4rt.tirre)_ hake hired the sub=contractors .❑I artx a sole proprietor arpartner- listed on the attached sheet 7 Retriodeltitg_ These sub=contractors have ship and have no a;n1ployees 8. Demolition working forme in any capaci employees and'tiaue workers' 44 ctatrt insu>ance.t 9 Q I3ttaldingadiitton i [No-workers cotrip.:nsurance -p IO[ Electrical re aias or additions } r,ctuired.] `.E Nve are a corporation and its 1 officers lZare exerctsed.tlterr �.i. Plumhin re airs or.addzrtons I❑ l am a borneow-ner doing U Fvork � g p. myself. [No work-ers'comp. ri�itofex�mptiora.per(vICL Iz;�Roufrepairs: insurance required.]x c.,t$2b§1('4),and we haveno I3, enplayees;.(No work otllet ers.' , S comp.tnsiizancerequireti:j °'.Ary applicant chat chec'e s box: also Ell out the s,;iiFxon below sh,0-Wing their workers'coxitpensation?pr'hcy.i�ift�m pair: 1#onu aicnexs v ho submit t3iis aFfdavit in3icating they are doing all work and:theq hire outside conlxactUrs mustsut ixut a.ne�v a claeit indiqungsuc, tCmitactc rs that chick,this bti�i must attached wi additianal sheet sl vMn0he-name of ornoifliose:entities have employees. If-thesoli-con!s Ctorshave-empioyees'tlxeyroustprori.6their*Ote !et2mlr gol,cynuxnl�er. ff.rtln an enapt�}$erlhut;rsp1avalipt w©xk�rs'.rorripensQtirltp irtsuraltce Porn:}=ernpia ees< Bi low is#h poiidy.ttlid b,cite . Ett f f}1'11tYttiokl;. ,tmuran e Company hlatne Potz y or Se-1 f ins f.ic #: ._ . .. _ .Exp ratio late: Job Site Address:. _ CztviSfatelZip= rR�S d z—� r ': r `fi a e showin the: Dire l`Haiti er. and ez iratitrn date Attacl�t a cgpr of.the workers c _petasattott:poltcy declra a ott p , ( _ g p. ). . _ . l),i _ ) Failure-to secitze aaveraae as.requrred finder Section 25A of IvfGl c I5 can lead to:tlie ixtipostfian.of criminal penalises of a .Pine up to S t,500.00 andror one::<year Jr,pasori rent,as;c�+ell as>civil pe altles ri the form of a STUD WORK QRDER,and a fine of up ea.$,256:0 a day.agalnst-the violator. Be advised ibat a copy of ftus statemont ri ay b0 fozwarded to the Dfiacc of lltvestiatiotts of the DIA for iiisur coverage verification: . 7 do ItoWcertifl$ ly' at 61.6tiforniopded-11 t'Poitr wr ni��as:rue altd crlrrcct Yanaturo Date>. FFC,Issm, nly. nn riht writs i1t d is area,to becotnptefed by olly.or towns or Town: Permit/License# ing Authority(circle one): 1..Board of Health 2.Building Department 3.City/Tfwrz Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person. _ Pbone##: Construction uwvir =- m Job I,.( - Liceilse At'dtes d cif 353 Es t "� inSG' Tie ghee( appticai ). esporiMbIl'€ f€ur' ek.. P . r 1 5A The: cense:hbjd r:Shad be fUlb-I and C0M.Pte a4 r SP0mI for all work— oe wh h.hetshe is.superAsIn s Heishe.shall be r n,s bl for seeing:ffm_ri ali o !s t'0ile.pursa antto,7.8 C%, r �in s s p r;ved i t ra: Bus#d%ng medial, s cif sa ii :€ pa ie W rk: R5.2.15.2 Tie.lice s i old r shall be responsible to supet%4se they conslruefion, ramnstrud5on,anion,V�Pslr,rat.weal or don,61�ur3 invol qnq uA vat ' and all oter a plf=bla_iawt el fism-CmmonweaRk ever, ou e license holder is not the pe;mit holdes,bift; parmi i�:cidfsr: N.0-iffication cif, iolations- O.ZM5.3 The license.holder ll rnmed ely ff#y thm b ll i g s� of h of a l violations wMk�h a>a covered by the-buiUdirg rn'ti_ g7 ,y ,{ p _G..8 s.1: - tY. ij.c'.1�iJ �?li;�c`�."Ett,ta'�.. ii 3R' � X aiUG�.. �i �v.v ��. iM1. '.aT: ravo fton or suspension of license dy the.Board of Build€g Re-guiatibm an Standards P4;m =• ppil of ons :2_16 All..uuild ng pe if appiiceticns shall.-contain thea na e.,-tignalure and t3+er.,se..rsum;berof thi coon uction su evisor Nvho is to suparw*i�e t rose-er1ga regulated� �y 7 0 C R 1: 8_ .5 any in e etient'that stxc :iicens i$;-no}orl on Wpervisin said.pemns,to work-shaFj irr,meditf ly else-un l p new lmcense fed on the:t acords 6f the building.depaftrmentx.R I'hsve sea an d � d spon r l l es r e �Lutes and =--gul i ns fo r licensing mnstr ct n:superviso.,s in accordarfm wiff,he State ttc;:ng Ca-L.- .l understand the construction inspection fnspection pmmd rev and i'ha spec ie ingpactioris ar,batted for he by building offficM. h •F.b1s/NHYAl-.4'W�N�^' .v-H"!r � .. - .. for individul uso, only Office offConsumermflars Bus!'/ License or registration valid i ' before the expiration date. If found.retur � to, £_ � � t t Type. Office o Consumer A>�fa rs and us ness a utla-don 03 erad� 11 Private ° . ' Suitt 4, Boston,MA O11 MY GENER-A- TION ENEROY, INC 26 Y EE I EIT fader ecre.ta o si ... . . _... ildi R u i Standards _ License: CS-09"76 Ma- CENTE RVILLEMA ;4 ' � i Linda and Chester Broughton Site Photos 118 South Gate Drive, Hyannis Location of the 20 panels. proposed s :r . t t.. k South Gate Drive Location of the 20 proposed panels. UAT 1.3 5e U[2) 32 .. 4 Sect[ TQS BMT 2 t[2) 5 32 My Generation Energy Andrew Wade — 'Linda and Chester Broughton i South �'. �,���r ��� _ '�fi 't.?4� ^.•Y�P}� Smx"�''.. � � .Ps,ayf 'y+, r.1g': } y ei e W n r 1 1 �����C,����lil�i1�l����l�e�il�,�li���li���►ice► ■■�■��®��®�®�■■irww�..�_®ram■:�■�■3 EII®I�I��IIIII _ IIII�111 L I, _ II�II _ I�®l®Ili®I��I®I®II�Il� 11®I®i��I®I�YI®ICI I ,I I®I�11®I�.IIi I�. I®i .11II.®I IIII I ■:��■■�B■■ .�■%.�®aim■err■'�ww�■=�■rt■ice II®I®ill®l1�1®I®II_�I®III■I®II.�I®II f Linda and Chester Broughton Site Photos 118 South Gate Drive, Hyannis Solar panel =44.1 lbs per module 20 Modules=10501bs Inverter =4.4 lbs per module Projected Area of Array =340 sf Associated hardware =4 lbs per module Added dead load=3.08 psf Total = 52.5 lbs per module Ground snow load=30 psf TAB Rb a A a") RAMR VMS F comm- a La1 � f.. .Lb—tm pill &7 Lb k+ =M Elio ga diet Etas! Q�S �.AS�3 Ft#iF ®s5 !i#9B®C!i fI ir�iteda 1dE2199# � 3 6ttZ 9indmin 17tiAF#.e'I 11A 1$s 1 `�' 1 �-].4l 11 S. 1-15 INN 2044 Dow i� 1 � ' I 1-1!l. 1 7 1 1-m 11g� i i I dins ' 2 (1 R J M11 t 1 10.3 1-6 [4 11am:rat , W 134 17AGI 224, MW b 1-7 134 117-1 W 2Q 1klil 14=1• 1742 M11 F1 rt�l e' 02 &-0 1.:1h 7-'i1 1 S 42, ' 21-1 11.4 16--3 1&10 16 SO-! en P1— c ;de] i4=1j 1 94 rb &11 14-4 M-61 me.b . I mo 10. 13 ' mi, ± 1 + - =1�1 1 1 1 SQUTher Vint 1912 8-7 U4 I&I M ¢2 7.10 1 G ?: Isle 17=3 124 14- 1-4 5-;10 5-6 11'0 1 1; i � e•�a ruled ER-2 11011 1 1: lro 1. 1 WG 1; ` ;��� 2 f,1�11; 1�1 � 1�$ �'Im� �=� 1�'�, F SfflN6-tb!zflr c ".2 11-4 F'. R 1;R- $4. 9.1 1&3 Im I Maximum allowable span 18'-5" Actual maximum span - 12' My Generation Energy Andrew Wade — Roof Attachments "AFNMCK E OSITION L FUOT SROA AC► CMIRREL NUT ( X I- S.S. 'BULT AND SMApWArX SPLIT WASHER ST"ARD . RAIL . S.S. FLANGE WT SNACK CO)POSITION ` ROOF FL#SHING S.S. LAG SCREW WITH FLAT WASHER: (SEE ENGINEERM Mi�MENTS FUR ,r DOLT ENAEDNENT -REOUVREMENTS eSj — MIN. EMI IENT IS TYPICAL) SNAP 4 _ o L FOOT 1 SEAL PE"EtRATIIIN AN>t WDER BASE Y)TH APPRu tiArE ROOF SEALANT ROOF DECKING TYP. RAFTER TYP. IN G. ' 'u i• Linda and Chester Broughton Site Photos 118 South Gate Drive, Hyannis Location of the 20 proposed panels. �� , ,y 44 South Gate Drive Location of the 20 proposed panels. z' UAT . .,, 13 GAR 32 RAS . Sect[2] ect[ � TO BMT 2 Sl*t(2) 5 32 . My Generation Energy Andrew Wade — 'Linda and Chester Broughton PhotosSite • South Gate Drive, Hyannis [fie) IN' t • • • • • • r �' •7}° b AARIAW rMk v.'� "• .'�x'_ �.� -�qr '^m 'i gym.- .�waws !p��r �y Kx �i�l�lla�I�11®I®II�I����I®III_�I®I��I®ICI I � S ..�. _ _ �__ Imo'_ � _ . _ • _ . . II® .��■�■..�■��®•sew i.�.■wlwrr.., a='. ■ILII I +II I IL�IIL�I I I. I®I�11®II�� . I Linda and Chester Broughton Site Photos 118 South Gate Drive, Hyannis Solar panel =44.1 lbs per module 20 Modules=10501bs Inverter =4.4 lbs per module Projected Area of Array =340,sf Associated hardware =4 lbs per module Added dead load=3.08 psf Total= 52.5 lbs per module Ground snow load=30 psf TAOW- RUFNIt Ra to WO JAM 2XIO a,wig la'12 Oa* mot E r�i i d 6 i�i dal Wirral 9a&Aldi r7 bm"93 del! iWcio'6 6ro k . bay NN) tBldwi i s Or4wh &91 EZA W 1041 Z240 7'-1 1 145 14-5 114 2 �,Jks fi lth 8-2 11411 i-J 114 214 7.3 104 1 . Is 6 1.44 l :fir 11'2 1 17 [V 22� _ i 'F 134 IN, 1.0 _= 1—fig # + O 11=5 ! MCI 1 8-116 1�3 q�-� +$ft-OKMI Ow Via: 1',1 IAs:li 1" I -.i;1 184 2 Mr,b [7i!0 LAW `! 4 1 19.1' 214 234 118 1 710 1 2 M4 22-10 uik M!fir€m #3 6_7 9-8 12A I+a-7 1 5-1 $4 17.E U-0' 1. Luc Ar SS 8.15 1-3-4 INS 22V1 --7 84 11.9 1 2 1-9 21.10 . ru e.la a 8-2 C1=111 151: 21,3 M-6 16-4 19 2 E1-11; 1$.'I; ! �$ 21-5 2-5 1" 0.6 1&6 lid Maximum allowable span- 18'-5" Actual maximum span — 12' My Generation Energy Andrew Wade — I Roof Attachments SNAPMACK CCtPOSITION L FOOT NRAiCK CHA £L NUT X I' S.S. BOLT AND SNAPNRAt K SPLIT VASHER. STANDARD D RAIL 3, FLAN&E WT SNOPWCK MPOSITION R1313F FLASHING s S,S, LAG SGREV WITH FLAT VASWR' (SEE ENGINEEfIM DOCMENTS FOR OLT E E E T E T - B N. 1�M N MEN S WN. ENIM--EXT IS TYPICAL) Si APNRA K L. FOOT BAW SEAL PENET TION 4*42 V100 BASE VITH A,PPmFRIAFE ROOF SEALANT WOOF UEIiiE7NG TYP. RAFTER TYP. iTZTc A' .� - yr" � .✓ - - My Generation energy,Inc. 3©iBmcxtds Path Un 2 � % tn Phone 508-694-6884 � 2 - %hJVJVJ WvGen�r 4ic�sEr� c a cc�€ri Town of Barnstable Building DlvWion 240 Main Street Hyannis, MA 02601 ATTN: sew La on February 12, 2015 Dear Mr. Lawn: I arty writing to grant permission to Linas ReVinskas to c as cvnstructlori supervisor for projects under My Gen,eration Energyr Inc. Please refer to Construction Supervisor License number CS 94476:06arlthe Massachusetts Department of Public Safety Board ofr Buii ing Regulations and Standards- please you have any quesuians, phase feel free to contact.meat your convenience. Authorized y, Andrew Wade President and CEO My Generation.Energy;Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `(O6 Parcel Application 9 Health Division Date Issued 7/.2 Conservation Division Application Fee Planning Dept. Permit Fee S Date Definitive Plan Approved by Planning Board i Historic - OKH _ Preservation / Hyannis Project Street Address r -AP Village / Owner Address 7' Telephone Permit Request ��- 4P /n s-u a 7L . 5/2 iE Tie 0 .Square feet: 1 st floor: existingproposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation D Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# u its) Age of Existing Structure Historic House: ❑Yes �On Old King's Highway: ❑Yes ®-P�o Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.)TJ Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existin new Total Room Count (not including ,): existing new First Floor Room Count 7 Heat Type and Fuel: �as ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing_/New Existing wood/coal stove: ❑Yes C 44-0- etached garage: ❑ existing ❑ n w size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing new sizeal�hed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# ., Current Use Proposed Use ; > -f': 07 APPLICANT INFORMATION �= (BUILDER OR HOMEOWNER) a •• u.� NO -. Name Telephone Number Address ✓ License# CJ Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE /oft-�j AA k FOR OFFICIAL USE ONLY t APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER . DATE OF INSPECTION: •FOUNDATION. 3 FRAME INSULATION FIREPLACE { ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable y�P Regulatory Services . ASTABLE, t Thomas F.Geiler,Director MASS. 9�A 1639• ��� Building Division tE�►rlA'I A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ,+ Please Print DATE:-' Sp JOB LOCATION: f z / J number/ 4�e�, illage "HOMEOWNER": name - home phone# work phone# CURRENT MAILING ADDRESS: �` � Q[i`/haa,7 e_ T fYJ/RI (f /4u it. " 1 M �l ci /town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwe�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. i ature of Homeowner Approval of Building Official M t 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,.parti cu I arly 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, 1 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:forms:homeexempt oFE r Town of Barnstable Regulatory Services * &42NSMLE. MASS.i639• � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner lSt Complete and Sign T s Section If Using A ' der I, , as Owner of the subject property hereby authoriz to act on my behalf, in all matters relative to rk au orized by this building permit t (Ad dr s Job) Pool fences a d alarms are the re onsibility of the applicant. Pools are not to be d or utilized before fe e is installed and all final inspections ar performed and accepted. k2-/ Signature_ Owner gnature'of Applicant Print Name Print ame N rY Date QTORMS:OWNERPERNIISSIONPOOLS 62012 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly i Name (Business/Organization/Individual): CIO ` Address: ` - /J City/State/Zip: ` Phone#: Are you an employer?Ched the appropriate box: Type of project(required): L❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition ' workingfor me in an capacity. employees and have workers' Y P tY• � 9. ❑.Building addition [No workers' comp.insurance comp.insurance. utred.] I 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.M I am a homeowner doing all work officers,zrqhave exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: 4 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under.Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties ofperjury that the information provided above is true and correct Siarafore 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 4.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 4-24-07 vvww.mass.gov/dia _a FILE COPS W N ' Q W � U O m A= 150.47' T=89.67' OLn N W ^ �` J .00 4: °"i LOT 27 y I 1 574.9 S.F. 7 BUILDING LOCATION PLAN FOR 18 SOUTHGATE DR., HYANNIS, MA PREPARED FOR ti ChE5TER LINDA 13ROUGHTON N DATE: 1 h' SCALE: DRAWN BY: TM YV q No RUM� ' yl. 1 " = 30' OG-03-201.3 JOB NUMBER: PEV15ION: SHEET NUMBER: v SS° o 04- 123 CPP-2 a WELLER A550CIATE5 1645 FALMOUTH RD., SUITE 4C -- P.O. BOX 417 CENTERVILLE, MA 02632 3-�_3 2 WINDY WAY, #232 NANTUCKET. MA 02554 TELEPHONE*- FAX: (508) 775-0735 EMAIL: trl5Weller@comca5t.net REGISTERED LAND 5URVEYOR5 ENVIROMENTAL CONSULTANTS Traverse PC FILE COP 45�.00p 1 Ao 4 vit Richard Desmarais 115 Old -[-oar:n l?.ruse Rd. 1 So. Yarmouth, WIA 02664 �yf r s � r �.3 • •�.�n0 � �r �.`1 +'i✓ Mom' � i' ' .. po ;� . r- •� S�'•��� �' ,ram'.' '�r:•�••+ 16. �� `,s _f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel � 2� Application Health Division "` Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board S—I Historic - OKH _ Preservation/Hyannis Project Street Address Z/A+Z,i� Village Gr Owner Q Address Telephones Permit Request U yAli Square feet: 1 st floor: existing 76 proposed 2nd floor: existing s_�proposed Total new��� Zoning District Flood Plain Groundwater Overlay Project Valuation g P1 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach��u�pportin ocu ntation. Dwelling Type: Single Family &,-- Two Family ❑ Multi-Family (# units), © ,Y.� Age of Existing Structure 3v2 Historic House: ❑Yes 69�Oon Old Kirig! Highw ❑es l9- - Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement-Unfinished Area(sq ft) ° Number of Baths: Full: existing new Half: existing H Number of Bedrooms: yS existingo'new Total Room Count (not inclu/din aths): existing new First Floor Room Count Heat Type and Fuel: Gam" as ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing Z_—New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size— Attached Attached garage: ❑ existing new ize _Shed: ❑ existing ❑ new size _ Other: .. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) A/A6�1- U-<e_ Telephone Number Address License # _ ® � d Home Improvement Contractor# O 03f4 u 9( ,-- Worker's Compensation # ALL CONSTRUCTION DEBRIS RE LILTING FROM HIS PROJECT WILL BE TAKEN TO I SIGNATUR DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. r. ADDRESS VILLAGE OWNER DATE OF INSPECTION: t: -_FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ,t PLUMBING: ROUGH FINAL A GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r 4 PHILBROOK ENGINEERING & CONSTRUCTION 107 Beach Street, Dennis,MA 02638-1826 Phone—508-385-8682 E-mail—Tvarnphil@MSN.com BUILDING ALTERATIONS&ADDMIN Date: 24 April 2013 To: Mr.Thomas Perry Building Commissioner—Town of Barnstable ;, { From: T.Varnum Philbrook, P.E. RE: BROUGHTON Residence, 118 Southgate Drive, Hyannis,MA �. Dear Mr.Perry; a This is the simple Wind Zone design review I performed for the 2 Car Garage and wing addition for Richard Desmarais,LLC. The front(garage)wall must be framed using APA Narrow Wall details which are noted and attached. The remainder is conventional framing and foundation construction consistent with the WFCM 1 &2 Family manual procedures. Based upon this review the construction needs to meet 110 MPH wind requirements for EXP,B. This construction will take advantage of portal framing at the garage door wall and use conventional anchor bolts set at dedicated locations for uplift . and-lateral restraint. For other work: _ Ag a. ,H ader and Jack studs per opening are marked,matched to header spans' �x t b Atthe-2 floor where rafters plate over the box longer Simpson H8 Hurricane strap are needed c. AAnchor bolt spacing is standardized on the foundation plan to 32"o/c ' d Th&garage/house common wall needs interior plywood added to:stiffen the garage and connector This narrative,outlines the key requirements for the job as the Wh ed.of the Residential Building Code is yy, 4 ' applied�kThank you and as always please call me with any questions or'comments. x 3 R se pectfiilly, � � '• T.VARNUM PHILBROOK;P.E. Cell Phone; 508-364-1301 1 encl;Design Submittals OF VA q\ 'f. VA N. `n1 a I'HIL K ., c� itrCvl-f L CIO No. 3CG90 _ rarF9EclS'f ER����'``� tvp , r A WC Guide to Wood Constructidn in High Wind Areas:110 mph,Wind Zone' Massachusetts Checklist fot Compliance(780 C"MR 5301.2.1.1) P13-15; BROUGHTON ADDITION; 118 Southgate Drive, Hyannis, MA Q Check Compliance 1.1 SCOPE WindSpeed(3-sec.gust)............ ...........................:...........................................................................110 mph Wind Exposure Category......................................I.........................• .................................................................. 1.2 APPLICABILITY - Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) 2 stories :5 2 stories Roof Pitch .................................................:.........................(Fig 2) ..........................:.............-12— :5 12:12 11' MeanRoof Height .................................................................(Fig 2)..............................................—24—ft 533 Building Width,W .............................................................. Fig 3)...I �, ......I....I.....� ................ 24 ft :5 80' "1 BuildingLength, L ..............................................................(Fig 3).....;.............................. .........—24—ft <80' Building Aspect Ratio(L/W) ........................ r�........:......(Fig 4)...........also 1.57...............I..........1.0 :5 3:1 r g2 ... Nominal Height of Tallest Openin ..................................(Fig 4).:-.EXCEPT Garage Doors...... —6'8"—:5 6'8" —,1, 1.3 FRAMING CONNECTIONS • General compliance with framing connections....................(Table 2)..................... ................................ Ir 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete................................................................... .......................... .................................... ConcreteMasonry...............I......................... ....................................................................................... n/a 2.2 ANCHORAGE TO FOUNDATION"' 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in�oncrete only Bolt Spacing—general .................................... .........(Table 4)...varies—59"or 72 ............... —32—in. CN#1 Bolt Spacing from endfJoint of plate ......... ............(Fig 5)......................................—8—in.:5 6"—12" —.r— Bolt Embedment—concrete.........................................(Fig 5)...............................................—9—in.z 7" 1— Bolt Embedment—masonry....................*........................(Fig 5)........:................... .............. in.2:15" _n/a— Plate Washer............ .............................................. ..(Fig 5):........ ..for single plates:.......�:3"x 3"x ,3.1 FLOORS Floor framing member spans chicked ..... ............I.............(per AWC Span Calculator)..,.'-:............................... CN#2 Maximum Floor Opening Dimension....................................(Fig 6)................................................ 12 ft:5 12' n/a Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)....Balloon Kitchen/Loft... Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall ..............(Fig-7)....................................................—ft :5d n1a Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall.................(Fig 8)..................................................... ft.:5'd —n/i, Floor Bracing at Endwalls................................. ..................(Fig 9).....Continuous Ceiling Diaphragms............ Floor Sheathing.Type ....................................... ...............(per 780 CMR Chapter 55).................................... — Floor Sheathing Thickness ..................... ............(per 780 CMR Chapter 55)...................... 3/4—in. ** * . 'Floor Sheathing Fastening..................................................(Table 2) 10d Bx nails-at-6—in edge/.-12—infield 4.1 WALLS Wall Height Loadbearing walls........................................... .. .. .....(Fig 10 and Table 5)......... .........._8_A :5 10,. . ... Non-Loadbearing walls.............. ...... I ........E .... .. :........(Fig 10 and Table 5).....:................—11.5—ft :5 20' Wall Stud Spacing .........**"*'****I *I** ****..." :. .. ......... ...---(Fig 10 and Table 5).........:.......—16—in.524"o.c. Wall Story Offsets . .......................... ............ ......(Figs 7&8)...................................... —ft':5 d _n/a- 4.2 EXTERIOR WALLS' Wood Studs Loadbearing walls.....................:'..........:.......:........a......(Table 5)........::....................2x 4" 7 ft 6 in. d_ walls.....,..:...:.:..................................(Table 5)............... ............2x-4"— 11 ft 6 iA. Gable End Wall Bracing Full Height Endwall Studs..................................... 'L.(Fig 10).............. .................................................... WSP Attic Floor Length.............................. ............(Fig 11)................................................ ft aW13 —n/a Gypsum Ceiling Length(if WSP not used)..................(Fig 11).................. .......100%.......—ft 2t 0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. ..(Fig 11).............................. .............. n/a or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays—r— Double Top Plate Splice Length ........................................................(Fig 13 and Table 6).....................................—6—ft Splice Connection(no.of 16d common nails).............(Table 6)..............................................:.........-6_ AWC Guide to Wood Construction in High,Wind Areas: IIO mph Wind Zone,, Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Loadbearing Wall Connections Lateral(no.of 16d common nails) ..............................(Tables 7).......:....... ...................................... 2 - d— Non-Loadbearing Wall Connections ' Lateral(no.of 16d common nails)........:...:...:..............(Table 8)...............:...........:........................ ...._2_ Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)_ Header Spans ..................................:........................(Table 9).........................:..... .._6_ft_6_in.:5 1 ... _d— Sill Plate Spans .........................................................(Table 9)......................:..........._3_ft—in.<- 11' -- Full Height Studs (no.of studs):..................................(Table 9)...................: ....................._3_ d— Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.............................................................(Table 9)........................:.::......._6- ft_0_in.s 12' d Sill Plate Spans...........................................................(Table 9).......... .........._3- ft_in.:512" _11' Full Height Studs(no. of studs).................................,.(Table 9) .... :.... ...._3— d— Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W ' Nominal Height of Tallest Opening2 :.................................................................................6'8"s 6'8" d_ SheathingType...........................:. ..............(note 11).................................................... 7/16" _d_ . . Edge Nail Spacing.................�..w..........:..:....`..(Table 10 or note 11 if less)..........;..........:_6_in. d. Field Nail Spacing p g..:.................:....................(Table 10)................................:.::.............r 12_in. d— Shear Connection(no.of 16d common nails)(Table 10)............... ............... ':...:...... .3/ft_ _ d Percent Full-Height Sheathing. :. R s` CN#3 ..... able 10 ...:1 Fir re .-63/o<avail... 67 /o _ 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)....:.......:........ _n/a_ 'Maximum Building Dimension, L , .. Nominal Height of Tallest Opening z ......... ......... ......... 6'8":5 6'.8" ' d SheathingType.................................::..........(note 11)......................................................._7/16" d Edge Nail Spacing...............:...................: .:(Table 11 or note 11 if less)....................._6_in. d_ Spacing Field Nail S - P 9............. (Table 11)......:.........................................._12_in. d— Shear Connection(no.of 16d common nails)(Table 1.1)................................. _ _ - Percent Full-Height Sheathing.......................(Table 11))....15`Flr req. =63%<avail....._81_% CN#3 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)...........:......... Wall Cladding Ratedfor Wind Speed?....WC Shingles....................................:................................................................... d_ 5.1 ROOFS . _ - Roof framing member spans checked?..,.:.............:....(For Rafters use AWC Span Tool,see BBRS Website) J. Roof Overhang ...........................:.........................(Figure 19 1 ft<-smaller of 2'or L/3 -.I— Truss or Rafter Connections at Loadbearing Walls - Proprietary Connectors Uplift............................:..........:.:........(Table 12)............................ ..............U=_202 plf CN#4 Lateral............:::.:................'...........(Table 12).......... ............:r......................L=_132 Of CN#4 tShear.............:.'..............................(Table 12)...............................................S=-58 plf CN#4 Ridge Strap Connections, if collar ties not used per page 21...(Table 13)...:.:....:....................T_=_194 plf J. Gable Rake Outlooker ........ ..........(Figure 20 1 Yft:5 smaller of 2'or L/2 _d_ Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors "Uplift....:..:.........................:.:..`....:....(Table 14).:.................'...........::...........U= lb. _n/a Lateral no.of 16d.common nails ... ..L= lb. m _n/a_ - ( ) (Table 14).......:..:...........:.............. Roof Sheathing Type...::...............................:.............(per 780 CMR Chapters 58 and 59)............ d— Roof Sheathing Thickness...........................................: ..................................................7/16">-7/16"WSP d. Roof Sheathing Fastening ............ able 2 .................................................8d Bx _d= Notes: 1. • This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of , 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not - required per the WFCM 110 mph Guide:, a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 r^ L c. Uplift Straps per Figure 14 Y d. All Straps per figure.17 e. Corner Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added.to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. 4. Const. Note#1 -maximum 59"o/c for 1-3 stories for all loads(Shear, Lateral&Uplift)-Reset to 32"o/c 5. Const. Note#2-AWC Calculator;#2 KD SPF(s)= 14'6°@ 16"o/c for 40 Ib/LL(some vibrations may be felt) 6. Const. Note#3-Roof, Ceiling&1 Floor. Plywood garage common wall. See APA Notes for Garage Door Wall 7. k Const. Note#4-Provide longer Simpson H8 Hurricane Ties at all rafter tails to 2"d floor box r x AWC Guide to Wood Construction inaHigh'Wind Areas:110 mph'Wind Zone Massachusetts Checklist tot Compliance j780 CMR 5301.2.1.0' t z ZmN 1 1 1 / f 1., I, 1 1_ ,. -• � al .. .� ill II Ij �. Z • , 1, d da 1 1� a � it (i. . � • { 1 FRAMING MEMM9%S i 1 EDGE SmY + 1 s I w w MIN. 1 e . STMa'C,iERED NAIL PATTERN PANEL 4 ' _ PAW EDGE DousLF NAIL EDGE SPACPIG omL s Detai 'Vertical and Horizontal Nailing for Panel Attachment AWC Guide to Wood Construction in High.Wind Areas:`110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMi 5301.2.1.1)1 8. = a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: L Panels shall be installed with strength axis parallel to studs. - ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction, panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel.Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. - v. Horizontal nail spacing at double top plates, band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment WHIEN THIS EDGE Flews ON FWMINGUSESdNAILS - ATB"or- _ Y 1-I ' 1 11 11 1 - S • Itl - f 1i J o 1'I I r 1 aQ n Il • - 1 13 fl 11 1 1 1.1 ^ 1 W • C 11 it 1 Rn p II 11 F , Hri 1 II tl 11 Ill It . VME 90M NA}R-SPAdNG p i See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment OPH NORROW [ROMIN6 ALL METHOD 4 The APA Narrow Wall Bracing Method is a simple, site-built solution that allows builders,to construct h. segments as narrow as 16 inches next to window and door openings. Be sure to check for these essential details when constructing the APA Narrow Wall Bracing Method around garage openings. For complete information on the APA Narrow Wall Bracing method and its applications in locations other than' the garage,please see APA publication Narrow Walls That Work,Form D420. ' Wall x sheathing ' must extend up over f -.�. Z header o NO Y} 0.�•�,� '_ O .�Ox } K. , x 4 � P�TOR Nail schedule t a[ Y Pam. V 8d common F=— = i EXTERIOR at 3"O.C. VIEW OF t GARAGE ... xK i I OPENING 1 ` ' Wall x sheathing. ? must extend €Y up over header oo �nioo q o f �tl� o 0 t Sheathing Rib s� rT joint at o o;'o r s1 approx. k ' Nail schedule o'o `" r , mid height o 0 3 8d common ft o o' o .oy`6 c at 3"o.c. .SO Lt q y�� i o APA THE ENGINEERED WOOD ASSOCIATION ,.i ..,.. :...:...m,..,,. ..vti,�.a.w.,..-x.z•_ra�:. ,..:.....:a._..�.va�._:rar.h+.+.x.�..bxa,.4.w..y. ..6 Extend header to kin stud y 5u" Nail top plate• g o gIg � to header V F � '4` with two rowsvi of•16d nails ] r f t t. 2 O Ml.�r§`i�� x a ma `s INTERIOR .� g yt�: t �f•� i `VIEW OF t 'ar GARAGE. OPENING t• .,. r oInstall ea 'M c F o 1000-lb strop ,n Yw.ea,r».w.a.nw•..w a... - - v..+ f �I),....rv,tA .t. .,,rr x��t. a .m.tii-waa+s -s'.�i:.-+..w. e.,'f Ae r _.c.W<-+i- 5` d 2 anchor bolts with . . ��.....•..>,..,,,,_.-.......a,�.- ..�....-.. .�..�.. .�,,.� a ry .mina 3"x 'x3f1-6° 114 plate wasFiers r ' o f Nail corner studs together O o s 2 rows of 16d at 24"o.c I ` r ' Stud optional to �\r o ` support interior finish Gypsum f r � "'� yp I* optional I g 8d at 'f ifs 1 a 8d at 3"o.c. x (PLAN VIEW OF CORNER DETAIL) y - We have field representatives in many major U.S.cities and in Canada who DISCLAIMER ` Z can help answer questions involving APA trademarked products.For additional O The information contained herein is based on APA-The Engineered Wood ' assistance in specifying engineered wood products,contact us: Association's continuing programs of laboratory testing,product research,oniJ o s comprehensive field experience. Neither APA, nor its members make any war APA-THE ENGINEERED WOOD ASSOCIATION runty,expressed or implied,or assume any legal liability or responsibility for the HEADQUARTERS use,application of,and/or reference to opinions, findings,conclusions,or rec- 0 7011 So.19th St.•Tacoma,Washington 98466' ommendotions included in,this publication. Consult your local jurisdiction or p (253)565-6600•Fax:(253)565-7265 design professional to assure compliance with code,construction, and perfor- 3 monce requirements. Because APA has no control over quality of workmanship or the conditions under which engineered wood products are used, it cannot w accept responsibility for product performance or designs as actually constructed. z z W PRODUCT SUPPORT HELP DESK 25( 3)620-7400•E-mail Address:helP @apowood.org p@apawood.org APA Form No.F435 THE ENGINEERED o Issued January 2006/0010 WOOD ASSOCIATION N f Maximum Span Calculator for Joists & Rafters Page 1 of 2 Atoval A"'E'OD... Maximum Span Calculator V4P'O"" for Wood Joists & Rafters www.awc.or SpeC1e5 Spruce-Pine-Fir(South)-` Size 2xlo + Grade o. 2 + Member Type Floor Joists + Deflection Limit L/350 Spacing (in) 16 Wet service conditions? No Exterior Exposure Incised lumber? No Live Load (psf) ao - .l Dead Load (psf) Io Cal culateMaximum.Horizontal Span' Go to Span Options-Calculator for Wood Joists&Rafters LIMITS of USE HELP RESTART Span Calculator for • �• # Wood Joists and Rafters e _ �!�A!__� available for the Whone. Span Calculator for Wood Joists and Rafters QW also available for the- sPAro ; Android OS. The Maximum Horizontal Span-is: 14 ft. 6 in, with a minimum bearing length of 0.96 in. re uired at each end of the member. Property lValue Species Spruce=Pine-Fir (South) Grade 1INo. 2 f Size 2x10 Iodulus of Elasticity (E) 1100000 psi ' Bending Strength (Fb) 980.38 psi Bearing Strength (FCp) 335 psi Shear Strength (FV) 135 psi While every effort has been made to insure the accuracy of the information presented, and special. Comments? info@awc.org. effort has been made to assure that the information reflects the state-of-the-art, neither http://www.awc.org/calculators/span/calc/timbercalcstyle.asp?species=Spruce-Pine-Fir+%28 South%... 4/24/2013 r N lu N Q W IV w ��4� (1) (L O O 0.00, R= 110.00, 2 +++N A= 1 50.47' cn i p T=69,.G7' 0 �� + 1 � N In � + ® q D roS�D, ® ® °"�/ LOT 27 ® y 1 1574.5 5.f. & , to E31JILDING LOCATION PLAN FOR w 1 18 50UTHGATE DR., t1YANN15, MA 1 PREPARED FOR CHE5TER * LINDA 13ROUGHTON p 2�� 5CAL E. 11 — 1 DATE: DRAWN BY: TM W s W. 04-20-201 2 ® RUMBA �- NA I791 % JOB NUMBER: 04- 1 23 P,EV151ON: 5HEE7 NUMBER: sS� p� a WELLER * A550CIATE5 I G45 FALMOUTH RD., SUITE 4C — P.O. BOX 4 1 7 CENTERVILLE. MA 02G32 '\ 2 WINDY WAY, #232 NANTUCKET, MA 02554 l TELEPHONE $ FAX: (505) 775-0735 EMAIL: trisweller@COMCast.net REGISTERED LAND 5URVEYORS.4 ENVIROMENTAL CONSULTANTS Traverse PC The Commonwealth of Massachusetts Department of IndustrialAccidents - - Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please(Print Legibly Name (Business/Organization/Individual): (AafqJz lw, of a e Address: // City/State/Zip:: Utl G Phone#: V `1 A=am plover Check the appropriate box: Type of project(required): 1. ployer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-'contractors 6. ❑New construction 2.El I am a sole proprietor or partner listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Demoli employees and have workers' working for me in any capacity. $ . 9.. wilding addition [No workers'comp. insurance comp. msur^sice. , required.] 5. We are a corporation and its 10..❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no h employees. [No workers' 13.❑ Other . or 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. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information 1 A^ I Insurance Company Name: ;P ( ,f- =-/ � .Policy#or Self-ins.Lic.#: S Expiration Date: Job Site Address: City/State/Zip: > .Attach a copy of the workers' pensation policy declaration page(showing the policy nu er 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$1,50.0.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day-against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby,certify under the pains d penalties ofperjury 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: w Phone#: Information and .Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. . Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more ..' of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee.of an individual,partnership, association or other legal entity,employing employees. However the' owner of a dwelling house having not more than three apartment's 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 Iicensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if. necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no-employees other than the' members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial , Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town.that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please.call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly."The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current. policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city.or ' town)."A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to the- applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must:be filled out eac1 year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to.burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions; please do not hesitate to give us a call. The Department's address,telephone and fax number:The Commonvealth of Massachusetts ` Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel, #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 4-24-07 www.mass.gov/dia i ACORD. CERTIFICATE OF LIABILITY INSURANCE F DATE(MM1DDNYYY) 04/15/2013 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 CONTACT NAME: Joanne Bretton Southeastern Insurance Agency, Inc. A"IN �: 508.997.6061 AlcNo:508.990.2731 439 State Rd. E-MAIL ADDRESS: P.O. BOX 79398 PRODUCER CUSTOMER ID#: North Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Merchants Mutual Insurance Com 23329 RICHARD DESMARAIS BUILDER LLC -INSURER B: Merchants Insurance Group 115 OLD TOWN HOUSE RD INSURER C: SOUTH YARMOUTH, MA 02664-1679 -INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 2013 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. INSR LTR TYPE OF INSURANCE NSR SWVD POLICY NUMBER UBR POLICY EFF POLICY EXP LIMITS MM/DD MMIDD GENERAL LIABILITY BOP909450 05101/2012 05/01/2013 EACH OCCURRENCE $ 1,000,00( COMMERCIAL GENERAL LIABILITY DAMAGE (RENTED PREMISESSEa occurrence $ 500,00( CLAIMS-MADE i I OCCUR MED EXP(Any one person) $ 15,00( A X PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIREDAUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION - WCA9096577 05/01/2012 05/01/2013 1 ORY LIMITS OT AND EMPLOYERS'LIABILITY Y/NER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,00( B OFFICER/MEMBEREXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00( If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Mr. & Mrs. Chester Broughton AUTHORIZED REPRESENTATIVE 118 Southgate Hy nnis, MA 02601 Joanne Bretton ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ... ac�izr3cCh . r. _ ,�;llcrss on eczlC�z,o`SSReguiatt dI ec�rL'{fairs&P'°sxII Consumer ENS CO�T�ctpFt Zype � pifice of o�EM Indivtduai • ME 1MpR ,�p7239 P� 9istrat�on �130i2p�4 won i� , p ira EX R1C�R� pesmatats SE RD Underse�retarY - -- Rt�hacd WN HCU 02664 115 0SN�PRMC0�N' S� License or registration valid for individul use only If found return to before the expiration date. to* er Affairs and Business Reg Office of Consume ]park parkplaza- uite 5170 Boston,MA 02116 .1 of valid without signature oub4ic Safet`I ac s Depar+nent o+ Standards class husott �;vns and. .3 T'.i si�GCiu1 un,tructittn Supct'N.!,or ;a -049883 _;sense:CS R15 OLD TO�IIUII66 S YARMOU' '` .:Or 0313 �i s =xpira /�� 112014 ��mtr;issiorer 1' . 1 5 °FAT Town of Barnstable Regulatory Services MAE& Thomas F.Geiler,Director i639• ��� - '°�,, Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, � - , as Owner of the subject property hereby authorize j t!I 4/3 to act on my behalf, in all matters relative to work authorized by this buRding permit JJ G`7//� (Addy 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. Signature of Owner Sign tote of Applicant Print Name Print Name Date QTORNMOWNERPERMISSIONPOOLS 6/2012 TOWN OF BARNSTABLE BUILDING PI5][tMIT A�A�N�� Map t306 :: Parcel^ Application #rQ61J11J047S,S Health'Division Date Issued (,el ��• (0 Conservation Division Application Fee d L577 Planning Dept. Permit Fee Z` Date Definitive Plan Approved by Planning Board . Historic ` OKH Preservation / Hyannis Project Street Address �50 Village 9" /P Owner Address Pa. a�a. (, G�Oa� Telephone Permit Request r— -_ " �- -- — ti I) (LA a na e /ry �!UQ r- �re /o ZD) Square feet: 1 st floor: existing 16,Eproposed '-- 2nd floor: existinawproposed — Total new Zoning District Flood Plain Groundwater Overlay Project Valuation / Construction Type Z� Lot Size . �'07 ,fro S 1 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. i Dwelling Type: Single Family : LO/ Two Family ❑ Multi-Family (# units) hv�tits� �y�a Age of Existing Structure Historic House: ❑Yes &r/No On Old King's Highway: ❑Yes eNo Basement Type: 2/Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) — Basement Unfinished Area (sq.ft) oZ 4-1 X 7 Number of Baths: Full: existing_ new — Half: existing new Number of Bedrooms: 3 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 2'�o 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 U/No If yes, site plan review# Current Use c roposed Use i 17 r-- _ m haime APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name AJ Telephone Number -`/A — IVS, "a/�7� I Address - �� License # 1_--6 Ed ?�!M 6/ Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �P_ 16tuAZ act n a/ SIGNATURE DATE 6 /U • ti FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 4 , INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. *� The Comrnonwealtla.of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street_ c Boston,'MA 02II1 y� ww*mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _pplicant Information Please Print Le�i� Name (Business/Organization/Individual): AdLdress � City/State/Zip: 64Phone #: _ — Are you an employer? Check the appropriate box:.,. Type of project(required): 1.❑ I am a employer with . 4 [] I am a general contractor and I .6. Q New construction * have hired the sub-contractors : " ". _ _._"_ employees (full and/or"part-time). 7, Remodelin 2.[� I am a sole proprictor'.or partner-_ listed on.the attached sheet. ❑ g These sub-contractors have g, Demolition ship and have no employees ers' working for me employees and have work ID any capacity. 9. 0 Building addition [No workers' co comp. rnsurance.I mp_:insurance 10.� Electrical repairs or addition quired.] 5• � We are a'corporation and°its 3. . I am a homeowner doing all work officers have exercised their. I I.❑ Plumbing repairs or additioi myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,'§1(4),,and we have no employees. [No workers'- 13.0 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.s-b"mit this affidavit indicating they are doing all work and then hire outs ide.conEractors must submit new affidavit indicating.such. ' _.. . tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those-entities have, employees. If the sub-contractors have employees,they.must provide their workers'comp,policy number.. I am an emp toy erthat is providing workers'compensation insurance for my, employees. Below is the policy and job site information Insurance'Company Name:, Policy#or Self_'ins.Lic. #: Expiration Dater Job Site Address: City/State/Zip: Attach a copy of the'workers' compensation policy declaration page.(showing the policynumb.er 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; ER and a f. fine up to$1,500.00 and/or one-yeai imprisonment,as well as civil penalties`in the form of a STOP'WORK ORD 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. ` do hereby certify icnderlhe pains andpenalties of erjttry that the informationprou ded above is true and correct. Si ature: :Date: � Phone# '�i�� "'I� g rOfficialonly. Do''of write in this area, to_be completed by city or town officialPermit/License# n:Issuing Auhority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Tnspecto'r. 6. Other Phone#: Contact Person: ti • r M . Information and fustructi®Ps Massachusetts General Laws chapter 152 requires all employers to prthe'serviocekof anotherennderoany contrac of hn for their yees. Pursuant to this statute, an ernplUee is defined as "...every peoy rson'm express or implied, oral or written." J An errrptoyer is defined as "an individual,partnership, association,corporation or other legal entity, oranytwooreMore of the foregoing engaged in ajointentcrprise, and including the legal.representatives of a deceased emp to er, o receiver or trustee of an in 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 empl6y4'persons`to,do maintenance, cons tn�ction or repair work on such dwelling ho ise j or.on the grounds or building appurtenant'thereto shall'no`t because ofs chi employment be deemed to be an employ MGL chapter 152, §25C(6)also slates 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 Y�ho has not produced acceptable evidence of compliance with the insurance coverage required. •Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s) of insurance, Limited Liability Companies (LLC)or Limited,Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,e policy is required. Be advised that this affidavit may be submitted lo.the Department of Industrial Accidents forconfirmafion of insurance coverage.IAlso 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 beingxequested,vot the Department of Industrial Accidents: Should you have any questions regarding the law or.if you are required to obtain a workers' comensation policy,pl ease call the Department at the number listed below:`Self-insured companies should enter their p 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 tbe.Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permiUlicense number which will be used as a.reference number:.In addition, an,applicant that muss submit multiple permiUlieense applications in any given year, need only submit one affidavit indicating cu(ciY Dr policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in 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 than a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or perrmit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's addiess, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4400 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 PPNlicP.ri 4-24-0? r occ n vv/rjia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant ame: Site Address: Name: ` L print Town: a 1� Applicant Phone: Applicant Signature: Date of Application: _A NEW CONSTRUC ON: choose ONE of the f lowin P, two o tzons 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Slab Ceiling or Basement Q Option 1: Fenestration y e'xposed Wall Floor Wall Perimeter Fenestration HSPF SEER U-factor floors R-Value -R-Value R-Value R-Value F R-Value and Depth National Appliance Energy R-10, Conservation Act(NAECA)of .35 R-38 R-19 R-19 R-10 4`ft IM as amended,minimums or greater as applicable Note: This forrri is not required if you choose either of the two versions of REScheck as listed below. Option 2: REScheek Version 4.1.2 or later variant software analysis must be completed . r (780 CMR 6107.3.2) REScheck-Web-which can be accessed at http•//www energycodes. oy/resGheck/ ADDITIONS OR ALTERATIONS,TO EXISTING BUfLDINGS,:OVER.5 YEARS OLD . *Buildings under 5 years old must use option 91 or 42 in New Construction ection above. Complete the following formula to determine the-% of glazing: (a) Gross Wall & Ceiling Area equ4is Formula- (100 x b,= a) SF 1 _ _ - 1k00 x % of.glazing b a . (b) Glazing area equals S.F. If glazing is.< 40% use the charf-below If-glazing is > 40.% roceed to "SUNROOIvI" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS70 EXISTING ('LOW=RISE RESIDENTIAL BUILDINGS`), MAXIMUM MINIMUM f . Ceiling grid � Slab Perimeter �. Fenestration V all Floor Basement Wall R-Value Exposed:floors , R-Value `'R-value R-Value U-factor R-Value and Depth �391 f 'R-37 a R-13 i R-191 ( R-107 10,,4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the fu11.R-value over the entire ceiling area(i.e. not com ressed over exterior walls, and including any access openings). - SUNROOM—An addition or alteration to.an existing building/dwelling unit where.the total glazing.area of said addition.exceeds 40% of the combined gross wall and ceiling aea of the. addition: Note: Owner to fill out Consumer Inforrngtzon'Form (found inAppendix 120.P) Town of Barnstable o Regulatory Services Thomas F. Geiler,Director saxxsrABLF- . ���� wilding Division l�dMat Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 wwwv.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: /7 6 JOB LOCATION: number street1 village "HOMEOWNER'S I 0MY—.2Ao -e sy �. name home phone#hone# CURRENT MAILING ADDRESS: D city/town T 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 in 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-lac ceptable 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. (Sifnature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic`feet or larger will be required.to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Anyhomeowner 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 persons)for hire to do such work,that such Homeowner shall act as supervisor." n are that they are assuming the responsibilities of a,supervisor(see Appendix Q, Many homeowners who use this exemption are unaw 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,fonn/certification for.use in your community.. Q;\WPFILES\FORMS\homeexempt.DOC ' OpTFiE Tp� Town of Barnstable Regulatory Services vnsnes iE$` 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 Property Owner Must Complete and Sign This Section If Using A Builder Ir , as Owner of the subject property hereby authorize to act on my behalf, m all matters relative to work authori7,ed'by this building permit application for: (Address of Job) Signature of Ovmer Date Print Name If Property Owner is applying for permit please complete the Homeowners ]License Exemption Form on the reverse side. Q:FOWS:DWNERPER JSSION J i o C9 Y- ' f �5a kf V Roo 5t,at ad o o F(A .Y --e, rooms -f roo 5q m for Y r—C40-7— 1 1S-�, ILA- �.1 � -5 6Tfa���r. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 Parcel: 1 '.Application # Health Division t V 1 Date Issued L U Conservation Division Application Fe Planning Dept. Permit Feeo�� Date Definitive Plan Approved by Planning Board Historic ' OKH - Preservation /Hyannis Project Street Address Village Ll w� Owner 7-2-t- A 0 K Address __`/ � So Telephone T2 2-- . 1 5r' Permit Request e-en c S4 ate+-e,-7 DL-te -rD u-, A'T e« 1D ,qm 4. e Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2 Construction Type ' x Lot Size Grandfathered: ❑Yes ❑ No If yes, attac{=supporting oc entation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) o Age of Existing Structure Historic House: ❑Yes ❑ No On Old King sF�Highway Ll 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name O L77 S7741-e Telephone Number S-0-k Y 7 7- 3-3- 3 3' Address (09 lY 1 C.6 L PEA ,S W, `1 License# C" _S .5(7 9�f Le e OzL V9 Home Improvement Contractor# f 6 Z Worker's Compensation # 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ga A) S i_ A y�i 'D Lt m k s-7-e-Z (ar&) S z re SIGNATURE DATE ? 11410 . Y, FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ', ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents. ' Office of Investigations 600 Washington Street c ` ; Boston,MA 02111 . www..mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LelZibly Name (Business/Organization/Individual): rI i.t l.fl ti Address: City/State/Zip: IAAJh Ptc /4-4 Phone#: 5ay V-7 r 3 3 r Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with _ 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-tirne).* have hired the sub-contractors _.._ listed on the attached sheet. 7. El Remodeling 2:❑ I am a sole proprietor.or partner- ship and have no employees These sub-contractors have g, ❑Demolition employees and have workers' working for me in any capacity. 9 ' ❑ Building addition No workers'.comp. insurance comp. insurance.: 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information Insurance Company Name: Policy#or Self-ins. Lic.~#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'.compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do I;ereby certify under t ains,and penalties ofperjury 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): 1.Board of Health 1.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: MULTISTATE RESTORATION INC. Fire o Flood o Wind P.O. Box 2210 • Mashpee, MA 02649 • Tel: (508) 477-3333 • Toll Free: (866) 921-9111 • Fax: (401) 723-8294 CAPE COD DIVISION • roy@multi-staterestoration.com 03/11/10 To Whom It May Concern: Richard Lauria is employed by Multi-State Restoration. Mr. Lauria is in charge of my construction division. Any questions please feel free to call me at 508-922-8965. Thank.y Roy M Ricci (Owner) �Y r T•awn of BarnstabJe o , Regulatory Services M ` y q` Thomas F Geiler, Director �o Building Division Torsi Perry, Building Commissioner 200 Main Strcet, Hyannis,MA 02601 rvwrv.town.barnstable.ma.us , Office: 508-862-4038 Fax: 508--" Prop erty Owrie r mus t Com fete and Sign This Section P If� .A.Buzldcr T, Cue S 7'ek— 60 49 c�PJ , as Owner of the subject.property hereby authorize T `�-�c� S�'+�e to act on illy behalf, m all autters relative to work-authorized by this building permit application for (Address of Job) Signature of Owner Date cl�(Zf 57 eA— 2.Z Lt C 7-0� Print Name If Property Owner is-applying for permit please complete the Homeowners Lic.ense'Exemptzon Form on the re�vefse s1dC. Town of Barnstable N�pp Tim rp�y� Regulatory Se> vices Thomas F. Geiler, Director 'Mtvrsr,is[�, ' $uldirlg Z?iviSion a6yq .a PrED �h Tom Perry,Building Commissioner: 200 Maid-Sir cet1.Hyannis,KA. 02601 ptr�v.tovsn.barnsfable.ma.us r Fax: 509-790-623 0 Office: 509-962-4038 HOT`ZED.WNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number strcct HOM> OWNER home phone# workpbone# name CURRHNI"MAILING ADDRESS: ci ty/town stag np code The current exemption for"homeowners" was extended to include owner-occupied dwellings of six units or less and to allow ho mcowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFll,,T1-T0M OF HO112E0'S'WEk2 Persons) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures, A person who constructs more than one home in a two-year period shall not be considered a homeo,Amcr, Such "hameowner"shall submit to the$tending Official on a form acceptable to the Building Official that he/she shall be responsible for all such work performcd trader the building permit. (Section 109.1.1) T c undersigned"homeowner"assumes responsibility for compliance with the State Building Codc and other applicable codes, bylaws,rules and regulations, The undersigned"homeowner" certifies that_hc/sbc understands the Town of Barnstable Building DcpaxtrRcnt mini,-r,um inspection procedures and requirements and that be/she will comply with said procedures and Signature of Hamcowncr Approval of Building Official Notc: Thrce-family dwcllings containing 35,000 cubic feet or larger will be rcquircd to comply with the Stbto Building Code Section 127.0 Construction Control. .HOh DWNER'S EXEMPTION The Code stairs that: "Any homeowner performing work for which a building perrrdt is required shai)be cxempl from the provisions of this scetion.(Sec6cn I D9.1.1 -Licensing of construction Supervisors);provided that if[he hOrrcO ' rngages a persons)for hirz to do such work that such Homeowncx sha])act as supervisor•" • Many homeowners who use this czerrrpdon arc unaware that they arc assuming the responnbilitics of a supervisor(sec Appendix Q, Rules&Rzguladons for Licensing Construction Supayisors,SccEon 2.15) This lack of awareness bftcn results in serious problems,particularly in this case,our Board cannot proceed against the unlicensed person as it would with a licensed when the homcowna hires unlicrnscd persons. Supervisor. The homeovmcr acting is Supervisor is ultimatr)y responsble. To ensure that the homeowner is fu1ly aware of hisAq responnbili4cs,many communities require, i part of them cur application, that the hOmcDwner ccrtifY that he/she understands the responsibilities of a Superosor. On the last page o[this issue is a•form cumcnlly used by several towns. 'You may cart I amend and adopt such a forrsleervfieation for use in your community. --------------- F _ a fL, FLC/l. _ y . Ps s� e � i . . � � , .. S - - ��� _. wmu.war�mvovw�rg F -- g } - — _ G .. _ - �. tff _ '. f � - � � - .. � i r _ iF. y � .� -�: �. . . . � � _ f � � � �:. . ; �M ,�: f..�- . ,;�''��' tJv, i 1 ,. _ } � ro '. i stir- � _ n + ., F _ ' � .N i �- � � r` -� _ i � + j -_ _ .. a �. � i � � ,� '',�Y,�*, 1 �. .. .. ,� � ". .. 7 -. F '.. ` _ � `.� {ri � _c+w:��..mw'ar�swva-�u-�r.e(v•e.w� _ __ _ .__ _ �1i From: 03/08/2010 13:05 #571 P.001/004 Client#:34309 MULTISTA:. ACORDTM CERTfFICq,TE OF LiAB1LITY'INSURANGE` 3,"8;zo°"""' PRooucER THIS CERTIFICATE IS ISSUED AS AMATTER:OF INFORMATION Starkweather 8 Shepley ONLY AND CONFERS NO RIGHTS UPON TIiE:CERTIFICATE: PO BoX 549 HOLDER.THIS CERTIFICATE DOES NOTAMEND:EXTEND:.OR. ALTER THE COVERAGEAF.FORDED:BY THEPOLIGIES'BELOW: Providence;RF:11290141549 401 435-3600r INSURERS AFFORDING COVERAGE :NAIL4 INSURED IN URERA :Employers Mutual lns MuItlState Restoration,Inc iNsuRERe;13eaconMutual Ins Co YI35 ChaNeS`Street ialsuRERc';HaltTord lns_Group North Providence,RI ;02904:: INSURER D 42 INSURERE::.; COVERAGES THE POLICIES OF'INSU"CF LISTED'BELOW HAVE BEEN ISSUED TO THE INSURED NAMEf}gBpVE FOR:THEPOLIdY PERIOD:(NOICATEM NOTWITHSTANDING ANY"L2EOUIREMEN7 7ERI);OR CONDITION OF ANY.CONTRACT OR OTHER DOCUMENT WITH:RESPECT TO WHICH His CERTIFICATE MAY.A ISSUED 0.R MAY:PERTAIN THE INSURANCE AFFORDED BY TH:E POLICIE$DES¢RIBED HEREINIS SUBJEGT:TO ALL THE TERMS;EXCLUSIONS AND:CANDRIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN;MAY HAVE BEEN REDUCED BY PAID CLAIMS: LTR NSR :TYRE OF INSURANCE ;.POIICY NUMBER ' POLICY EFFECTIVE POLICYEXPIRATIO MIDD DATE MMJDDJYY UrypTg :.. A GENERAL"IJABILRY< ... 3D66311 .01101110 01101/11:, EACHoccURRENCE. 51''000000. X COMMERCIN-GENERALIJABILI'fY DAMAGE"TORENTED' :$300000" CLNMS MADE;�X OCCUR P¢D EXP(Arryane Deleon) S5'000' . PERsDNnaAliy;Ituuev 51 000 000' . - GENERAL AGGREGATE $2 606660 . . GEN'LAGOJiEGATELIMf.TAPPLIE9-PER PRODUCTS COMP/OPAGG -$2 000 OOO - Ili POLICY..: IECT X LOC A AUTOMOBILEL.IABILITY:, 3E66311/RI 01.1111J10 OV01111 COMBINED SINGLE LIMIT A.' " X ANYAUTD 3Z663111MA 0.1./01M0 0.1101141. (tea Ienl} $.OMODO _X. ALL OWNID scHEDULFOAtITos " BO�ILYINJUftY $ (P peisci) X HIRED AUTOS BODILY INJURY .. 'X NON-OWNEDAUT0.4 :',, .. ...., j; (Per flgxdenl) -. I—Drive OtherCac. '. ` ... PROPERTY.DAMAGE $. " {Per-aeUde"rd) GARAGE LIABILITY . O.ONLY.:EA ACCIDENT: 'ANY'AUTO < OTHERTNAN 'IAACC.:$.. : AGO EXCESSIUMBRELLAf1ABILlIY EACH OCCURRENCE;r S - - OCCUR CLAIMS MADE :'4AGGREGATE- .DEl EDUCTIBLE. .S . . RETENTION ,.8.,. '.B WORKERSCOMPENaAYlGN�AND . 50645/R! '�::. '. 4210'1109. EMPLOYERS'LNBSJTY - :3 WC STATU- OTH $. C ANY PROPRiEfoRJPARTNERJExECUTNE. ' 02WEGTIC23601MA .� 07M6/09 07/16/;10 E.LEACH.ACCIDENT 4500 000 . .OFFICERIMEMBER EXCLUDED?. ... - If yes`desclbe:Utldv - _ E.L DISEASE-EA EMPLOYEE i500 OOO SPECIAL PROVISIONS bel :: ,. 'OTHER. . '.. ....-. ' :. ._. .. .. .:.: POLICY LIMR. �SSOO.000. : EL DISEASE: .. "DESCRIPTION OFOPEBATIONSJLOCATIONSJVEHICL.ESl EXCLUSIONS ADDED BY ENOORSEIRFMI ggECWL PROVISIONB RE: 118 Southgate Or,HyanHls MA CERTIFICATE HOLDER CANCELLATION 10 Da s for Non P ment _ SHOULD ANY OP THE AW_ DESCRIBED POLICIES BE CANCfD D BEFORE THE EXPIRATION TOWn'OTBarrlStdl)Ie DATE.THEREOF;THEiSSUINGINSURERYALCL7IDEAVOR TOMAIL 3D DAYS WRITTEN 2OO Main,Street NOTICE TO THE'CERTIFICATE HOLDER NAMED TO'THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA.02601 (MPOSENQOBGGATIONARLIABIUTY.OFANY.KIND UPON THE INSURER,"ITS AGENTS OR . REPRESENTATNES, . ... AUTHORIZE&A PRESENTAT_IVE <�ii/!/- a0dg7:�'/!�'a=�h� W1��. 4 ; ®cth�r►�waJp�. ACORD 25(200tl00 `oft #82557951M245579 MBB ®ACORD CORPORATION 19e' ro Z33 r �l assuchusetts- Department of Puhli� Safet> Board of Build_ Regulations and Standards Construction.Supervisor License License: CS 51784 Restricted to: 1 G RICHARD D LAURIA 1 LEAH DR . . r ROCKLAND, MA 02370;, Expiration: 4/1/2011 .. Tr#: 14552 ell. (umniissiuner. R ,a is .. , • - 91te e -aa W Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Home Improvement`C-*ctor Registration Registration: 140427 -- Type: Corporation Expiration: 10/15/2011 Tr# 290319 MULTI-STATE RESTORATION, III , ' ROY RICCI P. O. Box 2210 µ~ y MASPHEE, MA 02649 Update Address and return card.Mark reason for change. ❑ Address ❑ Renewal Employment Lost Card DPS-CA1 0 50M-04/04-G101216 - ✓die Lr anv�rcoouoeal� a�./�aaaar,�ivael�6 License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR p Office of Consumer Affairs and Business Regulation •. u,pRegistratioO_o;,)4,0427 10 Park Plaza-Suite 5170 ExpiratjoojY OF /2011 Tr# 290319 - Boston,MA 02116 Type i =Corpox�tlon MULTI-STATE RESTORATION INC.CAPE COD ROY RICCI 21 PEQUOT RD MASPHEE,MA 02649 Undersecretary vali without signature Town of Barnstable *Permit# 8 60_1 ®P f � S P E �T Expires 6 months from issue date �C Regulatory Services Fee �� 61--D SEp g - ZOOS Thomas F.Geiler,Director Building Division TOWN OF BARNSTABYom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint lap/parcel N.umbef&_(,_42!2 roperty Address ,fir q G Res dential Value of Work�oC 000 o p Minimum fee of$25.00 for work under$6000.00 wner's Name&Address egwL;4� VA ontractor's Name Telephone Number ome Improvement Contractor License#(if applicable) onstruction Supervisor's License#(if applicable) ]Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation-Insurance surance Company Name orkman's Comp.Policy# )py of Insurance Compliance Certificate must be on file. rmit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to L�F T ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. �ome Improvement Contractors License is required. JNATURE: orms:expmtrg ise071405 The Commonwealth of Massachusetts Department of Industrial Accidents Office.of Investigations f 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Name (Business/orpnizationadividual): �, - 1"t. Address:_ A, A o kc) City/State/Zip: ,C� MA Q/Oof Phone#: 1-�/,3 ���—A1,5_6 Are you an employer? Check the"appropriate bog:. Type of proJect(required):• i.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g, ❑ Building addition [No workers' comp.insurance 5. [1 We are a corporation and its officers have exercised their 10.0 Electrical repairs or.additions required:] . . 3. I am a Homeowner doing all work right of exemption per MGL 1"1.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no. 12.❑ Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp:policy information. I am an employer that is providing workers compensation insurance for my employees.'Below is the policy and job site. information. - Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration.Date:_ Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500,.00 and/or one-year imprisonment, as well as.civil penalties in the form of a STOP-WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to,the Office of . Investigations of the DIA for insurance coverage verification. I do hereby certi 'der the pains and penalties of perjury that the i ormation provided above is true and correct t Si nature: = c--Date: Pho a#: Official use only. Do not write in this area,to be completed by city or town official: City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Assessor's map and lot number.�A. / ..... ®. z / 4. G %TH E Sewage Permit number 1y Z BAHBSTAIILE, i House number '.._//.( '.'........................................................., y NAG& �p 1639. \e0� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........... .f.t . '' ���� C� ////,: �� ....�..............�........:....................j,, ............ TYPE OF CONSTRUCTION ...................._.,..r.�: } (^J, J ..... .�e...�.�G� ..��` j. -................................... I ✓ i ...........il� L'.:..Vzzl �f 19...r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...........:............... ..... ............. ................ ' ..d .!. ...!... ;"�;,/,--C......f,( . .....: ..! !�� .. ...... Proposed Use ........................................ ......... � q%� !.! 1�......... .. ' x!r�!�/. !g''........................................ Zoning District ..................... .,3.,.j.......................................Fire District / � ..� �............ r................................... Name of Owner �.1 .�!' �.. � �/C, Address ..........1 ..D X / U C� �i�t-.2<'cjr ........ ............. Nameof Builder ..................-fi'f`?. ' �...............................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ��'.......................................Foundation ......... . .. � �> � C / ! y i „- r Exterior ........... .. /(........?::.. ✓ - ..............Roofing ...............a........:�.*��/-1..�:...f ................. ...... Jam... . Floors ................ ......e........7........4.t:...; /....... ................Interior .....................�... T .. ./�..l�.F.. ` .................., c Heating g -..... �.. = Fireplace .7 .` ............................Approximate Cost '�%. �:.. ..�� �J � r Definitive Plan Approved by Planning Board ________7_ �' ________19------ )� Area ... f r". ...�.................... Diagram of Lot and Building with Dimensions , �G,Gj,� j �✓ Fee ........:...,.. .. .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........e .//. '`,t 4:.r........t.�. ... ��i ......... GREENBRIER CORPORATION 23617 One Story No ................. Permit for ........................r':........... Single Family Dwell "ng .............................................V8 . ..................... Location „Lot #2 7 1uthgate Drive Hyannis Owner „Greenbrier Corp. Type of Construction ,Frame ................................................................................ Plot ............................ Lot ................................ Permit Granted ...November 5, 19 81 .................................... Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED 19 ............................ ................................................... .......... ........ ............ ......................................... Approved ................................................ 19 ...........:................................................................... ............................................................................... Yl A ssessor's map and lot numberTHE .. ... a ? .. � Sewage Permit number S r�y '�� X / s p Z BAHB�STABLE, i t House number ..-......l. ..................................................... � �'', �f�� { r,,�163 m� WO �yy�.�,g g�COMP�l����� G� pYAYa�O TOWN OF 'BARIfi TALE � � BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......... . .�. ./..1.�.!�{ .0 .J.. )..,.�..,/ /��6� l< v TYPE OF CONSTRUCTION ..........:............. . 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: /� Location .........................../.:..Q...l..... ...�:7................,��..�.t� �.r .....t'cZ.t... . y�l��..�....... Proposed Use ............................... .1.`w�./ .........F !e ...........�`'t/ ll f /y�/.............. .......................... ZoningDistrict ...................../Z o.......................................Fire District .......... .....................1 ................................... Name of Owner ...........................................................� 9 7 Address ........../ p.�C... ........................................--v.'�r��-•� Name of Builder .................................Address Nameof Architect ..................................................................Address� .................................................................................... Number of Rooms ....................&.......................................Foundation ......... Exterior ...........C AfA....... - . /' ..............Roofing ............. :J�. ..� ...� ....�'..... ..... Floors ........ ... ..I....1...... ............Interior ..................../F. . .. °-z.. . �.!?.C.. ................... Heating ............... �....x..6 .-S............Plumbing ...................it ....... �....�..C... Fireplace ........................ .. ..............................................Approximate Cost .............. ..0.i2........................ Definitive Plan Approved by Planning Board ______� �_______19__. p j Area �!�../ .................... Diagram of Lot and Building with Dimensions Flod FeeSUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the cilpove construction. f<- I Name ........G�G;G' /•`...... P .g GREENBRIVCO.RRATION f E 23617One 1 2 Story ~Wo.. ................ P .............�`:.......`.....Y Single F ' 11 ' ........................... ..............5................ Location ...I'ot. 8 Soutizgate„Dr. = Hyannis .................. ... ................ s �- , Greenbrier Cor .� � Owner ......................................... ......................... A Type of Construction .....Frame - .................................................. .......... Plot ............................. Lot ........................... November 5, 81 Permit Granted ........................................19 Date of�lnspection ....................................19 t ,' Date Completed ................. ...1974 4. PERMIT REFUSED ......................................................... .. 19 ` .......................... ............................................... ......................................................... ....................., i ................................................................ ... ........ Approved ................................................ 19 �* i ............ .......................................... .................. , f ........................ I TOWN W BARNSTABLE• permit No ; 1 ' `a Building'.Inspector ` • roa.a ' J Cash -- AU rr o0 639. � �arar'� ff OCCUPANCY PERMIT Bond ' l L No building�'nor structure shall be erected; and°.no land, building or strue't" all used for a,new, different;: changed,,or enlarged use without',a ;Building Permit therefor " first'having been obtained from.the rBuilding-Inspector:"No-building shai be occupied:.until a r certificate of occupancy has.been'issued:by the Building. Inspector " Issued to G L r1�IC].er::Corp. :•� :4ddress�;, r Lot "118 Shut CL �i II Tarsni.E, Wiring Inspector 6 l..✓,'i /� <.� Easpection:date Plumbing Irispeotor'dy A ~i-oY" s.. Inspection date k �. Gas Inspector LL if -CMl�at'�. ' /;. Inspection date. ; :a �;v: , 9 Engmeering Department` � f� , Inspection date A�y A 5c,.d • THIS'PERMIT WYLL NOT BE'VALID, ANDrTHE BUILDING SHALL NOT BE, OCCUPIED :UNTIL a SIGNED`-BY THE BUILDING.4INSPECTOR,:UPON>SATISFACTORY COMPLIANCE WrTH ''TOWN REQUIREMENTS Er> t Building/Inspector �. z 77 3 7. �4 91 FRc .I s- +, rLc, - L I CERTIFIED PLOT PLAN RQBER. NEW CONSTRUCTION ONLY = aRuc;E. 2.�. ELDf2C� !^ IN . -TOP .OF .FOUNDATION ISM FEE d ABOVE LOW POINT OF ADJACENT '/" ► 1 + :�, . ROAD• ° ko s _^ . :: SCALE, 50' DATE, l©/22/1R f WOM LD EDGE E G GL NG l I CERTIFY THAT THE �sD,�,T"''�'IENT . SHOWN 4N THIS PLAN IS LOCATED EOISTERED RE8ISTEREQ JOR ,4 ON THE GROUND AS. INDICATED AND' CIVIL LAND .. CONFORMS TO THE ZONING LAWS , ENGINEER SURVEYOR €� '� ,... WFHSTABLE, MAS3� 712 MAtN ST CH'NYC ,*HYANNIS, MASS. SH99 .,' ..�., : RED. LAND SURVEYOR_= ' 77 '- w .. .. --- _ . . .- . ....I.. . .. . .. 1 .. .. . . r, - . . r1: ..., - -. .. '. .. ., . , .. .. .. .'. ... . . 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