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0033 THIRD AVENUE (HYANNIS)
i � _ _ _ e laad �a FtMEr Town of Barnstable *Permit# �O� Expires 6 months from issue date Regulatory Services FeeHASS 4cb 1 CL Thomas F.Geiler,Director XmPRESS PERMIT Building Division Tom Perry, CBO, Building Commissioner FEB O 2 2012 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-4038 TOWN OF BARAf3LV-6230 ' EXPRESS PERMIT APPLICATION 7 RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address c.5 ///Y/ 1941'=-, /�' esidential Value of Work -.I aa-) A inimum'fee of$35.00 for work an $6000.00 Owner's Name&Address.,-_ //V(/ -�d� off' GG.�'l/�/�"iI!� �iQ✓' � SlDG'�j;�G/` ���C� Contractor's Nam Telephone Number SVJP� �otQ -41S-74F Home Improvement Contractor License#(if applicable) //// �1 Construction Supervisor's License#(if applicable)F � � • P'Vorlanan's Compensation Insurance . Check one: (oI am.a sole proprietor ss r ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance.CompanyN, ame t Workman's Comp. Policy# �� � j �"" Q � ✓/ Copy of Insurance Compliance Certificate must accompany each permit - Permit Request(check box) //��� / ❑ Re-roof(stripping old shingles) All'construction debris will be taken to Re-roof(not stripping. Going-over existing layers of roof) Ve-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc. ***Note: Property Owner must sign Property Owner Letter of Permission: A copy of,the Home Improvement Contractors License& Construction Supervisors-License is required: - IGNATURE: I PFILESIFORMS1buf7ding permit f raslEXPRESS.doc , _;4 n-7n i i n The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street .` Boston,MA 02111 w •�•� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip:/,/ i_* AA_Y_&4hone.#: �y Are you an employer? Check the appropriate box: Type of project(required):. 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. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition workingfor me in an capacity. employees and have workers' Y P ts'• $. 9. ❑Building addition [No workers'comp.insurance comp,insurance. required.] 5. 0`We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 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:z/�� ' ,Policy#or Self-ins.tic.#: f4/ GyZ.6"' � �� �,o�-�®f1�C�®`'A/l Expiration Date: Job Site.Address: Sg City/State/Zip: Attach a copy of the workers' compensation policy declaration page"(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains-and Penalties of perjury that the information provided above is true and correct. Signature Date: Phone# Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall I enter into any contract fm the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial 'Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant, Please be sure to fill in the permittlicense 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 I city or town)."A copy of the.affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Comnouwc*th ofMassaehuwtts - Department of 1ndustfial A.ccicleuts Qftice of Inv.estigations 600 Washington Street Boston,MA 02..111 Tel.##6.17-727-4900 ext.406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov#dia �tHE Town of Barnstable Regulatory'Services aAaxsTnBM MAM Thomas F.Geiler,Director 619 ram+ 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 N Property Owner,Must , Complete and Sign This Section If Using A Builder L �lr�➢ Api-i� ► �' � ��2c�L—Y ,as Owner of the subject property hereby authorize `?-L>gV vzT �.�_ to act on my behalf, . in all matters relative to work authorized by this building pertnit " (Address of Job) **Pool fences and alarms are the responsibility of the applicant: Pools are not to,be,filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted Sig �6ure of Owner Signature of Applicant Print Name Print Name /Date Q:FORMS:OWNERPERMISSIONPOOLS THE Town of Barnstable , � -- '�'+.ry,�„ Regulatory Services BARNST"LE, Thomas F.Geiler,Director 1 .•� Building Division rED MA'I A ,Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS:. city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six.units or less and to allow homeowners to,engage an individual for hire who does not possess a'license,provided that the owner acts as supervisor. { DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and- requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In.this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many.communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt �►� �® 1211212011 CERTIFICATE OF LIABILITY_INSURANCE °ATE`` "°0f'""Y' 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 DOWLING&O'NEIL INSURANCE AGENCY I CONTACT 973 IYANNOUGH RD PHONE 508 77 6 Arc No 508 7 8-1 1 HYANNIS, MA 02601 E-NWL ADDRESS: INSURERS AFFORDING COVERAGE NAIC 11 INSURER A: LIBERTY MUTUAL GROUP INSURED INSURER B: ROBERT GLOVER DBA ROBERT GLOVER BUILDING INsuRERc: PO BOX 703 INSURER D: MARSTON MILLS MA 02648 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 11840251 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 TYPE OF INSURANCE POLICY NUMBER POLICY YY ICY EXP LTR LIMITS GENERAL LIABILJTY EACH OCCURRENCE $ DAMACOMMERCIAL GENERAL LIABILITY PRtJVII ESCE, occurrence $ CLAIMS44ADE DOCCUR MED EXP Any one erson $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY Fl PRO LOC $ AUTOMOBILE LIABILITY s end IRMITL M $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accidenl) $ AUTOS AUTOS NON-OWNED P OPa� �AAAAGE $ HIRED AUTOS AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ $ A wORKERs COMPENSATION WC2-31 S-320856-011 4/19/2011 4/19/2012 wC l 1 1 s ATU ok AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 ❑N OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR ROBERT GLOVER Workers Compensation Insurance:Part One of the policy applies only to the Workers Compensation Law of the State of MA. CERTIFICATE HOLDER CANCELLAT10N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 200 MAIN STRET HYANNIS MA 02601 AUTHONiMDREPRESENTATIVE Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CERT t�.i 11a90251 CLIENT CODE: 1364178 Anne Chandler 12/12/2011 8,12,44 AM Page 1 of 1 _ fLicense or registrationevalid for indmoul-use only_- -before the..expiration date. If found return to: , Office of Consumer Affairs and Business Regulation 1 10 Park Plaza-Suite 5170 L.,... .-.Boston,.MA.02.116---.... without s_gnatfire._,' _. IL On guess roamer airs NTF-610 s Z Type: �n__ O{C►ce°i Ov 1pEN HOME,MPon I11112 pgP tra 1�� 0 ExP� tio j �r f R vE� = �✓R[ji �ec�cetax'1 GLO T me j , vpaers. ROB�R 7p3113 p0 g0X NS \BLS M�a, ; �artme�'ot Puhlcc Satet� 1�a�sachusetts 'b�l «ulatorrS and St�indrds BoarcT-ot Bu►ldrn Re erv,isor Lpceise t si, Construction ShP CS 3 .T t ' Ucense.. 9868 , f Restricted to;, t —. ROBERT j GLOVER PO BOX 703 MARSTON.,MILLS;;,MA 02648 E xpiration: 5/2gJ2012 Tr# 23910' z Comm�sg�one.r.. f ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION / A lication # ';10 Map Parcel ( pp Health-Division Date Issued t . Conservation Division ' ,Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board VF— Historic - OKH Preservation/ Hyannis Project Street Address Villaget °��yte/��i Owner AI ��' � Address 1#k V Telephone Permit Request ti Square feet: 1.st floor: existing—proposed2nd floor: existing _proposed 0 Total new Zoning District Flood Plain Groundwater Overlay Project Valuation r Construction Type Lot Size o X7 AGA�w Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure WAW Historic House: ❑Yes 4I No On Old King's Highway: ❑Yes No Basement Type: ?&Full 44 Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new 0 — Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing 16— new 40 First Floor Room Count Heat Type and Fuel: ZGas ❑Oil ❑ Electric ❑ Other Central Air: 6Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes J No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:44 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes A No If yes, site plan review# Current Use cS'�/fi�/,� �� �� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �d� C r���� � Telephone Number cF c Address ,7e License # ~6 Home Improvement Contractor#1 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I F ' i „ tr f FOR OFFICIAL USE ONLY r APPLICATION# r DATE ISSUED :5: - P!iTii ' }a> z .MAP/PARCEL NO;.zA. .t_ ADDRESS.. VILLAGE OWNER DATE OF INSPECTION: IF ^ FRAME FIREPLACE ELECTRICAL: ROUGH FINAL i; PLUMBING: ROUGH FINAL y: GAS _ ROUGH FINAL t t _,_:.F�INALBUILDING � ;ti' , ti t -.DATE CLOSED OIhT.!Fw 0 6_.. _ r ASSOCIATION PLAN NO. The Commonwealth of Massachusetts i 1 Department of Industrial Accidents Office of Investigations ; f ;dills / 600 Washington Street. Boston, MA 02111 cV1. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): e v lwf e Address: ay City/State/Zip:/����) ►' AWL-6 Nw Phone Y:zo Are you an employer?Check the appropriate box: Type of project(required): 1.RrI am a employer with t� 4. ❑ I am a general contractor and I 6. New constructi❑ on. employees(full and/or part-time).* have.hired the sub-contractors 7. Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # ❑ g ship and have no employees These sub-contractors have 8. ❑ Demolition . working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp, insurance 5. ❑ We are a corporation and its officers have exercised their ]0.❑ Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box 4 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #:614�o3ls` 0�� Expiration Date: Job Site Address: City/State/Zip: 4/ff--�J Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th and ti f per,.r that the information provided above is true and correct. Si nature: Date: Phone#: ®� —' 7 ��r 7a 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 S. Plumbing Inspector 6.Other' Contact Person: Phone#: Information and Instructions Massachusetts.General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not-more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely;by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not.required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that.the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of.Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple,permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary.) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 5-26-05 www.mass..gov/dia 4/12/2010 7:07:19 AM PST (GMT-8) FROM: insurancevisions.com—TO: 15087781218 Page: 3 of 3 :f DAIS(I/IWb/►YYY) A CERTIFICATE OF LIABILITY INSURANCE 411212010 PRODUCER DOWLING&O'NEIL INS AGENCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 973 tYANNOUGH RD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HYANNIS,MA 02601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 508 775-1620 508 7784218 INSURERS AFFORDING COVERAGE NAIC# INSURED ROBERT GLOVER INBURERA DBA ROBERT GLOVER BUILDING INSURERB: PO BOX 703 INSURER C: MARSTON MILLS MA 02648 INSURER I} INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEiDTOTHE INSURES?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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. am POLCY NUMBER POLICY EFFECTIVE POLICY ELATION GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES e one a $ CLANS MADE M OCCUR LED ESP(Anyone ram1 PERSONAL$ADV INJURY $ GENERALAGGREGATE $ i GENL AGGREGATE LIMITAPPLIES PER: PRODUCTS.COMP/OP AGG $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HRED AUTOS BODILY INJURY $ NOWOWNED AUTOS PROPERTY DAMAGE $ - (Per accident) GARAGE UABILIIY AUTO ONLY-EAACCIDENT $ ANYAUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ E=SS/UA(WELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS cLENBATNON WC2-315 320956-010 4H 91�110 4/19/2011 / STATu o - AND EMPLOYERS•LIABILITY ANY PROPRIETORPARTNERIEXECIITNE YIN E.L.EACH ACCIDENT $ 100000 OFFICERIMEMBERFXCLl1DED7 a (Mandatory In NH) E.L.DISEASE.EA EMPLOYE $ 100000 If dabeder SP eaPRO unSIONSDebw EL DISEASE-POLtCYUMR 500000 OTHER DESCRIPTION OF OPIStAT1ON$I LOCATCUS I VENICLEB/EKOLUW Ag ADM Br 93WORSEMEMT/SPECIAL PROVISIONS ROBERT GLOVER IS INCLUDED BY THE WORKERS COMPENSATION POLICY Workers Compensation Insurance:Pert One of the policy applies only to the Workers Compensation Lew of the State of MA. CERTIFICATE HOLDER CANCELLA ION SHOULD ANYOFTHE ABOVE DESCRIBED POUGES BE CANCELLED eEFgORETHE EXPIRATION n TOWN OF BARNSTABLE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAY$WRITTEN. 230 SOUTH STREET NOTICE TO THE CERTIRCATE HOLDER NAIIEDTOTHELEFT,BUTFAIUIRET00030SHALL HYANN IS MA 02601 IMPOSE NO OBLIGATION OR LNIBS3TY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ` AUMORIZED REPRESENTATIVE ✓�. - Jeff Eldridge ACORD 25(2009101) 01988-2009 ACORD CORPORATION. All tights reserved. Cgar NO.: 7L97013 CLIENT COOK: 1364118 Deb 0eroche mt 4/12/20LO 7:05:10 AN Page L of 1 f ' 1HE Town of Barnstable ` Regulatory Services aAMsresc.E. Muss. g Thomas F. Geiler,Director 163¢ �m 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 ABuilder as Owner of the subject property hereby authorize �'Q��, ���'� � to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) g4M SigLkue of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION I' Town of Barnstable �oF YKE rDky yw� o Regulatory Services STAB Thomas F.Geiler,Director � i63D b Building Division PrFD AM't A Tom Perry,Building Commissioner 200 Main-Stree Hyannis MA..02601. s www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER,.: name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER . Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building pcmvt is rcquirzd shall be exempt from the provisions of this section.(Section 1D9.1.1 -Licensing of construction Supervisors);provided that if the hom ereown engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responnbilitics,many communities require,as part of the permit application., that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the Iasi page of this issue is S.form currently used by several towns. You may care t amend and adopt such a fom/certiftcation for use in your community. Q:for rrts:homeexempt �Q oorvrr ec� '..__.. . �. Office o onsumer ai rs mess c u a ion HOME IMPROVEMENT CONTRACTOR Registration: ;-111157 Type: _` Expiration 12/9/2012 DBA R VER BUILDING CO ROBERT GLOVER t PO BOX 703/13 CLIO,, BOG RD`V MARSTONS MILLS, MA 02648 Undersecretary } License or registration-valid for individul use only before the expiration date.,If found return tw Office of-Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 of valid without s gnature y I 0 Massachusetts- Depatrtment of Public Safety Board of Building Regulations and Stanl&trds Construction Supervisor License ,License: CS 39868 Restricted-to: 00 - ROBERTJ•GLOVER ' PO BOX 703 MARSTONS MILLS, MA 02648 ' Expiration: 5/24/2012 ('ununisinncr Tr#: 23910 • F � r I. �v w v � r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / Parcel ' Application #o� Health bivision Date Issued Conservation Division Application Fee ,- Planning Dept. Permit Fee �/ o Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village ����/�� �5�✓1dU Owner ��Ni� �- �c��� 1� Address aGC���rl�l�'/�/�/F!/ G�Ql9'� Telephone ®� ✓ �" �7, 2� Permit Request 010FIe/47 �Zj f/` 'S�i' 0� pt✓�. Square feet: 1 st floor: existing— proposed 0 2nd floor: existing proposed 0 Total new t Flood Plain Groundwater Overlay �! Zoning District � y Project Valuation /�®!ad Construction Type c.J D0,0 � ` Lot Size a, a,7 /C Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 9' Two Family ❑ Multi-Family (# units) Age of Existing Structure 4C �, Historic House: ❑Yes ®-No On Old King's Highway: ❑Yes A6lo Basement Type: ❑ Full O'Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) ✓(�� Number of Baths: Full: existing new.O Half: existing d new Number of Bedrooms: existing Onew µ --� Total Room Count (not including baths): existing new First Floor Room Count= !. N Heat Type and Fuel: s-Gas ❑ Oil ❑ Electric ❑ Other — ia w >— Central Air: ❑Yes Gd'6o Fireplaces: Existing ` New 40 Existing wood coal stop: ❑,Yes ® No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑Listing I new size_ Attached garage: [existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: e �, Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ®.No If yes, site plan review# Current Use S/' J`'�U � VN*W pp Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) l Name �� d' � �� Telephone Number L/���� Andress ,6 License # ?8 !4 j��2 �.t,: y Home Improvement Contractor# 11/ 4—7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ����� SIGNATURE DATE t . ;x FOR OFFICIAL USE ONLY s 'APPLICATION# r ; ' DATE ISSUED 4 MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL p " PLUMBING: ROUGH FINAL z GAS: ROUGH 'FINAL' FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. v r} - t , ,i TIke Commonwe�ltrc of Icsssacrir�sez�s ,Department of IrldustrictjAccidents Office of rnvestigations 600 Washington Street .Boston, MA 02111 ,, }i�WW.111 C1S5'.gOV�C�ta Workers' Compensation lagnrance, A-fflda•vit: Builders/Contractors/Electriciatts/Tlumbers A • licaut Zn_formatiob lease Pant Le 'bI . / (JJ Name CBusi.ncss/Organi7ationffndividual): s � , .Address: U d phone City/State/Zip: / Are you an employer? Check the'appropriate box,' Type of project(required): 1.VI am a cmploycr with 4• I am a general contractor and I 6. []Now construction cmployecs (full and)or part time),* have hired tbcsoti-contractors listed on the attached shoot 7, []Remodeling 2.❑ I am a'sole proprietor or partner- These sub-contractors have ship and have no employees S. [] Demolition cmployecs and have workers', addition working for mein any capacity. Buildin 9, 0 g workers' co isisurancc Comp. i:amramc.t ' �o �' We are a corporation and its 10.[] Electrical repairs or additions• required] officers bavc exorcised their 11_❑Plumbing repairs or additions 3,FIT am a bomeowncr doing all work right of exemption per IvIGL myself [No workers comp. - 12.0 Roof repairs insura nce required_] c, ISM,, §1(4), and we have no employees. [No workers' 13.❑ Othex . comp.insurance required:] ' ]Oy dp jjc: nt that chec'kr box#1 mud 21so fill out tho r=tion bclowshovAng thew workcra' compensation policy infomation. t liomtowntrG who submit this affidavit indicating tb&y arc doing all work and then hire outside cant must submit a new afdavitindicating such. tcomtractors that check this box must attached an additional shoot showing the nano of the sub-conhractory and state wbethcr or not those tnbtics have crnployc:cs. If the sub-contractors have cmployecs,they court pravidt their workers'comp.policy number. ran emproyer thrd isprovidingworkers'compensation insurancefor my employees. BeCatV is thepaCicy ar<rljob site m a • information. O /f��vj�� . In uzancc CompanyNamc: �b/� E7cpuationDate: y �l ( — /�. Polio# or Solf--ins, Lic. /f'/ tatc/Zi 6�1 lob Sife Address: TAWNU� City/S p:/ Attach a cope of the workers'compensaf�on policy de0aration pa-8 (sbowing the policy number and expiration date). Failure to secure covcrago as requited undcz Section 25 A of MGL c. 152 can lead to•the imposition of criminal ponalties of a fino tip to 51,500.00 and/or ono-ycar imprisonrnent, as well as civil pcnaldcs in the form of a STOP WORK ORDER and s fine of up to S250,D0 a day against tho violator, Be advised that a copy of this statement may be forwarded to tha Office of Invests ati.00s of the blA for insurance covers c verification. rdo hereby certify under the a' s• ndpe es o perjury that the irrformation providdeed/above•is true andcor7ect,; Si ahrre: Date; ! `�•/� Phone # � / 70 Offccial use only, Do no!write in this area,fo be completed by city or town officiaC City or Town: PernXl icense# l_ssui-og kutbority (circle one); , I Board of Health 2, Building Department 3, City/Tow-a Clerk 4. Electrical Inspector 5, Plumbing Inspec{or. 6, 0 th e r .. rue Oils Information and M assachusetts Gcneral Laws chapter 152 requires all employers to provide workers' cod P ndb0any contract�oflhirces; Pursuant to this statute, an empfoyee is defined as "•..eYery person in the service f express or implied, oral or written_" hi association, corporation or otbcr legal entity, or any two or more An employer is defined as "an individual,partncrs p, of the foregoing engaged in a joint enterprise, amd including the legal representatives of a deeeasio ecs lHowevcr, tho receiver or trustee of an individual, paxtnership, association or other legal entity, employing mp y e oc��upant of the owner of a dWelling housb baying not rare than throe apartments and wbo-ur resides cpa�wo k on such dwelling house dwelling house of another who employs persons to do znam uilding appurtenant thereto shall not because of such employrncut be deemed or on the grounds or b to be an employer." MCL cbaptcr 152, §25C(6) also states that"eYery state or local licensing agency shall t'rithhold the issuance or rene�a.l of a Incense or permit to opera•te a business or to construct bu�dlthes�nsvrzn canna e���r��uiz•edY applicant.who has notproduced•accept-a evidence of e commnce wt Additionally,MGL ohaptcr 152, §25C(7) states 'Neither the OA blctcvide norncc of conzplian c a2ty Ofits political h the iBLuranco cntcr•into any contract for,rho performanco of public work untilp requirements of this chapter have berm presented to the contracting authority. Applicants- the fill out-the workers' compensation affidavit completely,by chcc)dng the boxes that apply to your situation and, if ]access supply sub-contractors) na.mc(s),address(cs) and phone numbcr(s) along wi h Ace�Soyc S other than the. insurance. Limited Liability Companics'(LLC) or Limited Liability Partnerships(LIP membars or partners,arc notxcquixcd to carry workers' compcnsation insurance. If an LLC or LLP does have employees, apolictm y is required Pe advised that this affidavit may be submit date theed to the pffida t.ntLlae affidavit of lshould Accidents for confumatiou of�urancc coverage. Also be sure to stgn an bo zctuincd to the city or town that the*application forthe permit of license is bring any zq uired to obtain a workers' of Industrial Accidents. Should you have any questions regarding the law or if y corrzpcnsation policy,please call the 1)cpartmcat at the nufnbcr listed below. Self-insured companies should cntcr their Self-insuranGo license number on the appropriato line. City or ToWP QftiG1A15 irbOttDM Pleasc be susc that the affidavit is complete and printed legibly. The Department has pro o die ltcaatt ' of tho affidavit for you to fill out in the event the Offeo of lnvcstigations has to contact y gaiding the Pp • Plcaso bo sure to fill in the permiVhccnsc uumbcx which giy ll be cd n cdeonly submit roncc-aumbcr. In ad dari that must submit multiply permi4rcnsc app t indicating current hcaisons ur y policy information(i.f Accessary) and under"lob Site Address" o°m pk d bt stbhoe�write tovm ley b pry ided to the oz tDWn)."A ebpy of the affidavit that has been officially stampedY applicant as proof tbat a valid affidavit is on file foi'futLu c o�ts t n t related o any business occnses. A-now affidavit r cobzamfcrcial°vcntuxe year.Whero a home owner or citizen is obtaining a hccns p. (i e. a dog license ox•permit to burn leaves etc.) said person is NOT required to complete this affidavit l'he Office of Investiga-dons would hke to thank you in advance for your cooperation and should you beyc any questions,. please do not besitatc to give us a call. T1ic Dcpastment's address, tciephoac•and fax number: 'Dirt Commonwealth of 4aswhus�tts Dep4z-tnac�-nt of kdustcial A ccid�nts Offxce Of Iayestigati.ons 600 Washington Street $Aston, MA 02111 Tel # 617-727-4WO cxt 406 pr 1-$77-MASSAFE Fax# 617-7.27-7749 Rcviscd 11-22-06 www.rna.�.s.go-v/dia 3 , �0p1H6ro Town of Barnstable ce s � z tr ez- . Regula o � x{rcxsra'SLZ, Thomas F. Geil'er, Director qp �61� Building Division rya naa.�a g ' Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 w�vw.town.barnsta ble.ma.us Office; 508=862=4038— — - Fax_ 508-790-6230 Property Owner must Complete anal Sign. This 5ectiota ' If Using A }guilder, X, Ja Leftmost is Owner of the subjectpxopCrV heteb authorize �o� to act on'my behalf, in all matters relative to work authotized by this building permit5application.for: (Address of Job) j 9 10 igtnature of Owner Date -J O. Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. I . r L' r Town of Barnstable °f YNE r�y� 12egulatoxY Services Thomas F. Geiler, Director MA55. -s<� ,a7P• ��� Buildiag Division PrEay� Tom Perry,Building Commissioner 200 Main Street, Hyannis., MA.02601 -AIyly.to,,i,n.barustable.ma.us Fax: 508-790-6230 Office: 508-862-4038 ---------_-- ____=_—________--_— HmabWNE R LICENSE EXEMPTION Please Print DATE: JOH*LOCATION: street village number "HOMEOWNCR": home phone,# work phone# name CURRENT MAILING ADDRESS: slate zip code city/town Ilings of ts or less The current exemption for"homcdwn s"was extended to does not possessca liae d d,vrovided that the owner actsna to allow homeowners to engage an indry idual for hire supervisor. bEMITIDN.OF HOMEOWNER to de, oil which there is, or is intended l of land on he/shed ssirridictures aor intends cc d$cry torsuch use and/or farm structures' to Pcrson(s) who owns a parce be, a one.or two-fanuly dwelling, attached or detacbe person who constructs more than one home ffcial on.aaforznlacd shall not be ceptable to the Building Of6 al,ered a homeowner, at he/she shall be "homeowner".shall submit-to the Building med under the building Per.nA (Section 109.L 1) res onsible for all such work ezfor The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules.and regulations. Th'e undersigned "homeowner"certifies that ments and that he/she understands the Town opt Barnstable,thsaid procedugesD and �ent minimum inspection procedures and require e will comply requirements, Signature of HOmeOwner Approval of Building Official . Note; Three-family dwellings containing 35,000 cubic feet or larger will be required.to c omply with the State Building Code Section 127.0 Construction Control. FIOMEOWNER'S ExE,KPTION The Code,s Late$that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109,1,1 Licensing of construction Superrisors);provided chat if the homeowner engages a person($)Cor hire to do such work, that such HDme0lYner shall act as supervisor," the }Many homeowners who us,this cX Supervis u Section nzwArc at 1they are lack of away ncesooften)retsults ins rioussproblemsppartor(sr i ul�arly Rules &•Regulations for Licensing se, our Board cannot proceed against the unlicensed person as it would Huth a licensed when the homeowner hires unliccnscd persons. In this ea , Supervisor. The homeowner acting as Supervisor is ultimately responsib)c. To ensure,that the homeown r is fully awaTr the rcospons'cr ticresponsibilities of i Suities'sor,y co th last,page oft[his&issue is atform currc tly'used by Pc that the homeowner ccrtifythat hc/sh . .___. + i artnnl such a fon rtification for use to your community. ASSES.S'ORS MAP 24£' 107 kl,AP 246-110 LOT 192 LOT 219 x, 100' yl� f E 44:0 LO.T 221 o GARAGE' LOT 190 -� - 30 NEB i' ri mew �t �►TE4� ASS�'S`SOR�,r , „✓ N MAP 248-Y0 ASSESSORS LOT 1.88 0 LOT 223 53. 0 PROPOSED I: ✓/II/i/✓ o - - 20' SE'f BA ', LOT 225 :; i v sr #V� LOT 186 \ `° t L 23 CD R 14. 97 100 d MAWE STREET GRAPHIC SCALE ! an 0 10 20 6.10 AM PST (GMT-8) FROM: insurancevisions.com-TO: 15087791218 Page: 2 of 2 a CERTIFICATE OF LIABILITY INSURANCE P"0D°c"t DOWLING&O'NEIL INS AGENCY ING THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 973 IYANNOUGH RD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HYANNIS,MA 02601 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)775-1620 INSURERS AFFORDING COVERAGE NAIC 9 ROBERT GLOVER WSURER A.- DBA ROBERT GLOVER BUILDING wSURERB.- PO BOX 703 MARSTON MILLS MA 02648 INSURERc INSURER D. WSURM E: COVERAGES THE P01.JCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POUCY 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 I3YTHE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MRTYPE OF Otant"ICE AWL P03JCY NLXNBBR POL CTN PO E LICT aM A710N LADTS GENERAL WISI11TY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIEWO 13ES EB elite $ CLAIMS MADE [D OCCUR _ MEo EXP a� $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCT$-COIMPIOPAGG $ POLICY PRn- LOD AUTOMOBILE LIABILITY - ANY AUTO ssoorklent)INED LELIM(C $ ALL OWNED AUTOS SGIEDULIMAUTOS Merp au INJURY $ HIRED AUTOS BODILY INJURY $ NON-OWNED,AUTOS (Pararddenly PROPERTY DAMAGE f (Paraccidsm) GARAGE LIABLnY AUTO ONLY-EA ACCIDENT f ANY AUTO OTHER THAN FA ACC s AUTO ONLY: AGG $ EXCESS I tIMBRELlik LIABILITY EACH OCCURRENCC $ OCCUR CLAIMS MADE AGGREGATE S f D�UCTIBLE f RETENTION $ $ A YroNLERS COMPENSATION WC231 S-a2085"19 411 WZ09 4/19/2010 w0 srATu OTH- ANDEMPLOYFRIII-LIABI[IMT YIN ANY PRDPRIETOWARRJEMMCUrTVE - E.L.EACH ACCIDENT( Q OFFICERIMEMBEREXCLUUED7 �Y . yes�A�in NNI E.L DISEASE.EA If s EMPLOY $ QO 0 dPReVOde bebw E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIFTI011 OF OPERATIONS I LOCATIONS 1 VEILICLPS f EXOLDSIDNS ADDED BY ENDORSEMR I SPECIAL PROVISIONS THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR ROBERT GLOVER Wailers Compensation Insurance:Part One of the policy applies only to the Workers Compensation Law of the State of MA. CTIFICATg HWER CANQELIATION SHOULD ANYOFTNE ABOVE DESCRIBED POLICIES 13ECMCELLM BFFORETHEEXPIRATION TOWN OF BARNSTABLE DATE 70EREOF,THE ISSUING ROAM WILL ENDEAVOR TO MAIL 10 DAYS WRTTTEN 23.O SOUTH STREET NOTICE TO TUG CERTIFICATE HOLDER NAMEOTo THE-LEFT,BUT FAILURE To00goSMALL HYANNIS MA 02601 IMPOSE NO OBLIGATION OR LIABLITY OF ANY KIND UPON THE INSURER,ITS AoeNrd OR REPRESENTATIVES. AVn10RWW REPRESENTATIVE Jeff ElTiridge J �•���L�� ACORD 25(2009101) 01988-2009 ACORD CORPORATION. All rfghts reserved. CxRT NO., 6190711 CLITINT C096, 136/08 heb herochemont 11/4/2009 LL:13:30 AM Page 1 of 1 �. �.� �p9Z0�II�SIIIW SNO1S2ib6"J � _ 08 Od JNlall(18 2J3nOlJI i�a X3 e 2tO1�d211NUP 1N3W3A�'�dW1 3WOH spaepue;S pie s" Ue n;�a �u��f�a o Leo Board'of Bwiding Regulations arid-Standards Consfruction`Supervisc� License x License hCS39868 r t • i ra irati n { �4 Tr# 24099 ROBq, T,J .GLOU £ rf PO BOX 703 MARSTONS MILM:MA 02648._ Commisswner `Y __ _ License or registrad6Yalid for indrvidul:use only .} before the expiration ate. ►.:`found return fo Board.of Building Reglations and Standards One Ashburton.Place I^,m 1301, Boston Nia:02]08 `I Not volid w ittluut signntw e /r• f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t Map 4/(© ®/0 Parcel / Application# Health Division Conservation Division qh yk Af, Permit# Tax Collector Date Issued //mill ,3 O Treasurer Application Fe V 0 Planning Dept. Permit Fee —a-0 , 8 Date Definitive Plan Approved by Planning Board ® S Historic-OKH Preservation/Hyannis Project Street Address _531 �1rc. AMC Village W e.S i J:HAnJN;S PnAX Owner L ► )b5io,-L Address SAMr Telephone CO3.yg.T Vhic1taLrL, SMrz k Permit Request E'�'�RP1[( 2� ADOi TiW-J Square feet: 1 st floor:existing&,f proposed 557 2nd floor:existing proposed Total new 5-5 Zoning District Flood Plain Groundwater Overlay Project Valuation S,(0 Construction Type Al Lot Size J,�W Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ;:L Dwelling Type: Single Family &r' Two Family ❑ Multi-Family(#unfits)) Age of Existing Structure Historic House: ❑Yes (2 o On Old King's Highway: ❑,Yes = ❑No Basement Type: Q Full ,rawl ❑Walkout ❑Other ! r� j o Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _36 Number of Baths: Full:existing / new / Half:existing new Number of Bedrooms: existing 3 new Z Total Room Count(not including baths):existing :5� new / First Floor Room Count 5-& ;✓� /6� e✓ Heat Type and Fuel: 'Gas ❑Oil ❑Electric ❑Other Central Air: Y<s ❑No Fireplaces: Existing _� New ® Existing wood/coal stove: ❑Yes Cilo Detached garage:Misting ❑new size YYO 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# - C t Use Proposed Use UILDER INFORMATION Name i tom-- Telephone Number -�'203 3 ZJ- Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO?W6%&Q cA,&. 4 SIGNATURE DATE $,;Qb FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. I I t ` ADDRESS VILLAGE OWNER r t c . DATE OF INSPECTION: FOUNDATION FRAME ' -7 z I i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �lC- `0`7 DATE CLOSED OUT ASSOCIATION PLAN NO. 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 Name (Business/Organization/lndividual): Address: _S7 i WA_L�t City/State/Zip: Phone#&aY,X k5&7jA -'13I Are you an employer? Check the-appropriate box: 'Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New constriction employees(full and/or part-time).* have hired the sub-cofactors 2.❑ I am a sole proprietor or pamer- listed on the attached sheet:`t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for ine in any capacity. workers' comp. insurance. 9. ❑ Building addition Wamu orkers' comp. insurance 5. El We are a corporation and its ] officers have exercised their 10.❑ Electrical repairs or additions 3. I a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t 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 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.Lie. #: 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si ature: X_,,JjADate: — Phone#:Lmr� Ak� 6tS--n(.-In L 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 Devartment 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 3. 6. Other ,I Contact person: Phone#: Town of Barnstable A � Regulatory Services B STABIX ' Thomas F.Geiler,Director y nsnss. g. 16g9• p,• Building Division �fD MA'1 Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit no. ` Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: —Estimated Cost 1.5 j&) Address of Work: Owner's Name: �311 1 �` Date of Application:4���& I hereby certify that: Registration is not required for the,following reason(s): , ❑Work excluded by law ❑Job Under$1,000 OBu g not owner-occupied caner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Signature Registration No. 0 ate Owner's Signature Q:wpfiles.forms:homeaff day Rev: 060606 r • RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 � . Alterations/Renovations $ 50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE lstm square feet x$96/sq.foot= x.0041= 221,.n-2— plus om below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1'000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 Table J=b(eoottaae4 Prescriptive Packages for due and Two-Family Residential Baildlaga Heated with-POW l Fuels MAXfMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab Heating/Cooling Ate' U-value, R-value' R-value' R-value° Wall Pecimexa Equipment Efficient}' package R-value° R-value' 5701 to 6500 Heating Degree Days' ` 12% 0.40 38 13 1 19 10 6 Normal R 12% 0.52 30 19 l9 10 6 Normal S 12% 0.50 38 13 19 10 6 85-MJE T 15% 036 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 1 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 83 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 032 38 13 25 NIA N/A Normal Y I S% 0.42 38 19 25 N/A N/A Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 19% 1 0.50 30 1 19 19 10 6 90 AM 4 1. ADDRESS OF PROPERTY: IV,, 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: -1 U 3. SQUARE FOOTAGE OF ALL GLAZING: l�6 4. %GLAZING AREA(#3 DIVIDED BY#2): �ly 5. SELECT PACKAGE(Q—AA-see chart above): C NG /S� NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-®80303 a F> Town of Barnstable OF THE rpm Regulatory Services STAB Thomas F.Geiler,Director MASS' Building Division ATFD""P�s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print iATE: OCAT10N: 3 'n ► yc__ G)C'a �B L � number street villa HOMEOWNER": .name home phone# work phone# ;tJRRENT MAMN G ADDRESS: Ca �IC Z�I Yl —�city/town state zip code Me current exemption for"homeowners"was extended to include owner-occupied dwellings of six units..or less and :o allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as ;upeNisor. 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 oi:two-family-dwelling, attached or detached structures accessory to suchuse 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 wotk 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. ll. L, Si ature of Hom. wner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section.127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1=Licensing of construction Supervisors);provided that if the homeowner engages a parsons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack'of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons.•1n 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 pemut application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns, You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt BEA H ASSESSORS b ASSESSORS MAP, 246-10 7 MAP 246-110 ' LOT 192 R 5 LOT 219 y _ l 100' Z 44,0' n '�, WEST HYAMNIS T' ?T LOT 221 0 , GARAGE LOT 190 L06 S. -MAP Z, PLANV REF 34-23 & 109-49 z ASSESSOR'S MAP: 246-106 LPT.188 cos - ZOXIN ..RB„ SETBACK S. 20'10' 0, 189B —11 ED RE . r ��,. ,; Ty �p MAP 246 106 _ _ ASSE.SS'ORS. 1 ,,,.,,,, 7 LOT 188 0 i PLOT PLAN Off' LAN 1VAP . 4.6-1.�1 -- 2 LOCATED AT 223 i r,./r-, �33 . THIRD A.VENUE' .53.m 0 c�•r.,.,/i/....moo, , WEST HYANIINLSPORT. I 4 .z 4 - h _ jf33 - ,,,< , , PROPOSED �r � PREPARED FOR: ,r,,,r✓✓,,,�'„ 1 DECK o Q� ��tti Jr 7f SSn� JOHN & DEBBIE' LA:NDSIEDE'L - , ^ / ,��. GONG` �.` � - off C'��T �F< ¢Gr 6. 0 , s _ , N SEPTEMEER 28, 2005 PAD - - —� - - - — Cn 20; SE'TB1CK LINE rv'iL A -LO?' 225 0 `o g 7Lot REV LOB' 186 Sz.. leq � 1 RE zlo �97' O R 1` ®` REi vq 100 y YANKEE' L13 AND . SURVEYORS E1 IC SCALD � CONSNTIF PLE ��,� P O. BOX 265 GRAPH - INDUSTRY ROAD zo o T TONS L io ` 20 ao Il1V� " MA' T 1LII LS; MA 02648 - - - -428 0055 FAX 508 42R 5553 TM 508 1 inch 20 - ft. SHEET I OF I JOB # 53969 . JF .. IMPORTANT- UPGRADE REQUIRED STATE BUILDING CODE REQUIRES THE UPGRADING OF SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN = ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. n NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE Q�^ INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL N Q O O 0- d PERMIT DOES NOT SATISFY THIS REQUIREMENT. O 0 6 Q o 11'-7" � Q 23--2" GENERAL NOTES: Q N -0 1n D P ° C � � -_ (Q \ t ALL WORK PERFORMED BY CONTRACTORS SHALL O W Cl) M CONFORM TO THE BASIC BUILDING CODE OF 1- r Cl)16'-91"2 '��1\(►1 , MASSACHUSETTS AND ALL PERTINENT STATE AND co (u LOCAL CODES AND REGULATIONS(LATEST EDITIONS) J 2,THE CO.NTRAC TOR SHALL VERIFY ALL DIMENSIONS, ^ ' �i— ELEVATIONS,EXISTING FIELD CONDITIONS,AND NOTIFY SMOKE DETECTORS �r E IEW-1 THE ARCHITECT OF VARIATIONS FROM PLANS.THE J Iv' U1}Q,J '�.(1LQlul •� CONTRACTOR SHALL COORDINATE AND BE i! -a•''= bl ^ b OF ALL SIBLEPENT FOR THE APPROVED FSIZE LOORS LOCATION OF ALL OPENINGS THROUGH ROOF,FLOORS AND WALLS.FAILURETO NOTIFY THE ARCHITECT OF Lo UNREPRESENTED CONDITIONS SHALL BE CONSTRUED B/YAR ABLE BUILDING OEPT• DATE AS ACCEPTANCE OF THE CONDITIONS TO PROPERLY fl { PREFORM THE REQUIRED WORK 36"W x 6'H OPENING J- INE UP W/EXISTING TUNNEL - 3.THE CONTRACTOR SHALL COORDINATE ALL WORK OF DIFFERING TRADES INCLUDING ARCHITECTURAL, _.. p STRUCTURAL,MECHANICAL,ELECTRICAL,FIRE r � I. i STRUCTURAL, ETC.NO CUTTING OF EXISTING FIRE DEPARTMENT CHANGE EXISTING DOOR w / STRUCTURAL MEMBERS SHALL BE PERMITTED WITHOUT ROVIDE BREAK IN - (Sj TO 1 HR FIRERATED T�) (+ (OLD&NEW FOUNDATION 312"d STD.STL PIPE THE ARCHITECTS WRITTEN CONSENT. �0 ZMTI RES WE Y?EOUIRED Cn .e I�/N^ OR HVAC SUPPLY / COLUMN ON 24"X 24"X 4.THE CONTRACTOR SHALL FURNISH AND BE SOLELY V IJI�'1CCJ IN7L!l ill!Il I�IJ M v &RETURN DUCTS 17 DEEP CONCRETE PAD RESPONSIBLE FOR ALL TEMPORARY BRACING FOOTING(7Y I REQUIRED TO MAINTAIN STABILITY OF THE STRUCTURE /G DURING CONSTRUCTION. EXISTING EXISTING HOUSE FOUNDATION 5.THE ARCHITECT SHALL NOT BE RESPONSIBLE OR EXISTING LIABLE FOR ANY CONSTRUCTION NOT DONE UNDER HIS FOUNDATION DIRECT SUPERVISION. •/ 6.HEADER SCHEDULE ROUGH OPENINGS UP TO 46"(2) 4"CONCRETE RAT SLAB ! 2"X 10"DOUG.FIR 49"TO 72"(2)2"X 17'DOUG.FIR 73" TO 96"(3)2"X 12"97"TO 114"(2)11 7/8"MICROLAM 115" TO 120"(3)11 7/8"MICROLAM 121"TO 144"(3)14" U I } MICROLAM / C b 7.ALL SECTIONS AND DETAILS SHALL BE CONSIDERED _ ro TYPICAL AND APPLY FOR THE SAME AND SIMILAR / I CONDITIONS,UNLESS OTHERWISE SPECIFICALLY F ish el I( NOTED. t 8.THE OWNER SHALL MAKE APPLICATION AND PAY FOR ` THE BUILDING PERMIT: eArchitecture 9.ALL NEW OPERABLE WINDOWS SHALL INCLUDE L fr SCREENS. Residential/Corporate b '3 .N,+ Z jar ,���..•., +:�,;.._.,..3 10.THE CONTRACTOR SHALL DO ALL CUTTING, Commercial _ PATCHING,FITTING OF WORK THAT MAY BE REQUIRED TO MAKE ALL PARTS COME TOGETHER PROPERLY AND FIT TO RECEIVE OR BE RECEIVED BY WORK OF ALL NEED WATER 11- 440 Main Street,Suite P NEED, SLEEVE PROPOSED FOUNDATION PLAN TRADES AS SHOWN ON THE DRAWING OR AS SPECIFIED. Ridgefield,CT 06877 LINE22'-1� SCALE 1/8"=1'-0"see plans for dimensions 8 structure 11.THE CONTRACTOR AND ALL OTHER TRADES SHALL NOT SCALE THE DRAWINGS.LOCATIONS OF ALL Phone: (203)438-6809 PARTITIONS,WALLS,CEILINGS,ETC.SHALL BE Fax: (203)438-0310 DETERMINED BY THE DRAWINGS AND FIELD VERIFIED. ANY MISSING DIMENSIONS SHALL BE BROUGHT TO THE ATTENTION OF THE ARCHITECT. 12.THE CONTRACTOR SHALL PROVIDE THE NECESSARY PROTECTIVE DEVICES WHERE REQUIRED DOOR SCHEDULE AND IN STRICT ACCORDANCE WITH O.S.H.A.RULES AND Landsiedel Residence REGULATIONS.ALL MATERIALS SHALL BE STORED IN 33 Third Avenue ACCORDANCE WITH MANUFACTURERS REQUIREMENTS. SYM. QTY. TYPE DOOR SIZE ROUGH OPENING MFG. MFGAQ REMARKS 13.THE CONTRACTOR SHALL MAINTAIN A REASONABLY West Hyannisport,MA 02672 CLEAN AND DUST FREE ENVIRONMENT FOR THE O 1 GLIDING 5'-11 1/4"x BW 12" 6'-0"x 6'�" ANDERSEN FWG 6068R FRENCHWOOD PATIO WORKERS AND USERS OR THE BUILDING.BROOM CLEAN ATTHE END OF EACH DAY. omw-re. O2 1 GLIDING T-111/4"x6'-712' ANDERSEN FWG806SR FRENCHWOOD PATIO PROPOSED FOUNDATION PLAN& WIND.&DOOR SCHED. WINDOW SCHEDULE SYM. QTY. TYPE WINDOW SIZE ROUGH OPENING MFG. MFG.NO. REMARKS 2 AWNING 2'-11 15116"x T-0 12" T-0 12"x V-9" ANDERSEN AN31. W/PLASTIC GRILLS,TINT&SCREEN B❑ 3 AWNING 2'4 3/8"x T-812' 2'-4 7/8"x V-9" ANDERSEN AN251 W/PLASTIC GRILLS,TINT&SCREEN © 4 AWNING TA 1 15/16"z 4'-W 3'-0'12"x 4'-0 12' ANDERSEN AP32V W/PLASTIC GRILLS,TINT&SCREEN No. Revision/Issue Data Scale Drawing No. ra Data A. 1 OB-1g-0e Drawn By FFL C O � U N O Q) 06 Gl > C p 0� ¢ O CL U) N U) ^Q C C LL O M M M _ C_ 24._p" ,- Q PROPOSED DECK(V.I.F.) b s qin 10'-11"V.I.F. 2 5`112 2 0 0 ; -DEMO EXIS ING CLOSET Y (P N �� BEDR00�1 NEW 4 Fishell 0o E ISTING HOUSE z I 2 BEDROOM Architecture i Residential/Corporate _ 1XSTING GARAGE Commercial zs° 440 Main Street, Suite P Ridgefield, CT 06877 a•.6 ocKEr oc( Phone: (203)438-6809 Z 6 PAN1=L ORS 2 6 H Fax: (203)438-0310 5.CO Yw NEW NE �w _ _ Y U 04' LAYOUT V.I.F 4" Landsiedel Residence 3'-2' g- 33 Third Avenue b West Hyannisport,MA 02672 PROPOSED FLOOR PLAN El ,.. SCALE:1/6"=V-0"see plans for dimensions&structure r-," 6-10" 6'a" s-1o•' z'-,•' PROPOSED 22'-12' FIRST FLOOR PLAN 0 No. Revision/Issue Data Scale Drawing No. ire^.1'a Dra A.2 �,� Drawn By FFL C O ti U Np C � Q C Cl)cn 0 v > SHINGLES&PITCH N LIOMATCH EXISTING o _LL Q MAN ROOF CL VJ (/J 0 r � E ^ 0 W M : Cl) `u cu NEW ROOF TO RE DO GARAGE ROOF J /MATCH EXISTING ROOF /SS ING IF TO MATCH ROOF W EXISTHNG ]STING HOUSE — ® ® XISTING GARAG HIM 111YAlIVY11111111 Al 22'-14- 9 PROPOSED FRONT uotureELEVATION "= - - - -- - - - - - - - - - - � SCALE:1/B1'-0"see plans for dimensions&structure Fishell Architecture Residential/Corporate Commercial 440 Main Street,Suite P _ Ridgefield,CT 06877 Phone: (203)438-6809 Fax: (203)438-0310 ]STING HOUSE Landsiedel Residence 33 Third Avenue West Hyannisport,MA 02672 c C c EXISTING GARAGE 2 1 MMIINH PROPOSED ��mllwg jj� HPR ELEVATION PLANS r — — — —— PROPOSED REAR ELEVATION — SCALE:118"=1'-0"see plans for dimensions&structure Na. R-isionllssue Date Scale Drawing No. va-t•a Data A.3 Drawn By FR ox�mmswwei.�nsrn�am u .mvrm„ s✓ O � co U Np N Q C fn 0 m > O Q a Q Cn N to NOTE TYPICAL ROOF PEAK CONSTRUCTION ° N ~ 1 ROW(36"WIDE)ICE/WATER `'' _ SHIELD @ALL CONTINUOUS ALUMINUM RIDGE VENT u 30 YEAR"ARCHITECTURAL"ROOF SHINGLES 0 Y EAVES,VALLEYS,AND RAKES j TO BE SELECTED BY OWNER Q V.1•F. 15 LB.ASPHALT SATURATED FELT(UNDERLAYMENT) 1/2"CDX PLYWOOD ROOF DECK 2"x 10" D.F.#1 or 2 ROOF RAFTERS 16"O.C. (2)2"X 8"TIE SEAM 4'C.C. R-30 FIBERGLAS INSULATION (IF INSULATED) WITH PROPAVENT TYPICAL SOFFIT CONSTRUCTION CONNECT ROOF AND WALL TOGETHER W/METAL STRAP @ 4'O.C. PROVIDE GUTTERS AND LEADERS AS REQUIRED PROVIDE CONTINUOUS ALUMINUM SOFFIT VENT ° CONCEALED STEP FLASHING(TYP. @ ROOF/WALL INTERSECTIONS) TYPICAL EXTERIOR WALL CONSTRUCTION Fishell CEDAR SHINGLE SIDING(TO MATCH EXISTING) Architecture 50 LB BUILDING FELT Residential/Corporate 1/2"CDX PLYWOOD SHEATHING Commercial TYPICAL FIRST FLOOR 2"x 6°STUDS @ 16"O.C. CONSTRUCTION 6"R-19 FIBERGLAS INSULATION 440 Main Street, Suite P 5/8"GYPSUM WALLBOARD Ridgefield, CT 06877 FINISH FLOOR Phone: (203)438-6809 � 3/4"T&G, GLUED AND SCREWED PLYWOOD SUBFL O Fax: (203)438-0310 g 2"X 10"FLOOR JOISTS 16"O.C.or (2)P.T.2"X 6"SILL PLATE _Z w/SILL SEALER R-19 FIBERGLAS INSULATION 1/2"DIA.X 12"ANCHOR BOLTS-12"FROM CORNERS& Landsiedel Residence o FINISH ALL SURFACES OF GARAGE W/ 48"MAX. O.C. 33 Third Avenue West Hyannisport, MA 02672 5/8"FIRECODE GYPSUM WALLBOARD EXCEPT MASONRY SURFACES PROPOSED TYPICAL BUILDING SECTION TYPICAL BUILDING SECTION @ MAIN HOUSE SCALE: 1/4"=V-0"see plans for dimensions&structure No. Revision lave Date Scale Drawing Na. Da,e /� A Dawn By F1 17-1 GENERAL NOTES: o � :~ ® 1. ALL WORK PERFORMED BY CONTRACTORS SHALL Q) -0 N CONFORM TO THE BASIC BUILDING CODE OF O -0 Q MASSACHUSETTS AND ALL PERTINENT STATE AND LOCAL CODES AND REGULATIONS(LATEST EDITIONS) C a T ? Z. THE CONTRACTOR SHALL VERIFY ALL DIMENSIONS, i ) 2 ELEVATIONS,EXISTING FIELD CONDITIONS,AND NOTIFY O c Cl) EXISTING HOUSE THE ARCHITECT OF VARIATIONS FROM PLANS.THE J CONTRACTOR SHALL COORDINATE AND BE RESPONSIBLE FOR THE APPROVED SIZE AND LOCATION OF ALL OPENINGS THROUGH ROOF,FLOORS AND WALLS.FAILURE TO NOTIFY THE ARCHITECT OF UNREPRESENTED CONDITIONS SHALL BE CONSTRUED AS ACCEPTANCE OF THE CONDITIONS TO PROPERLY PREFORM THE REQUIRED WORK 3. THE CONTRACTOR SHALL COORDINATE ALL WORK 2 2"X 10" 2 2"X 10" OF DIFFERING TRADES INCLUDING ARCHITECTURAL, STRUCTURAL,MECHANICAL,ELECTRICAL,FIRE 00 00 PROPTECTION,ETC.NO CUTTING OF EXISTING X PROPOSED PORCH X STRUCTURAL MEMBERS SHALL BE PERMITTED WITHOUT fV CV THE ARCHITECTS WRITTEN CONSENT. o M U M cv O 4. THE CONTRACTOR SHALL FURNISH AND BE SOLELY $_7 $_4 $-7 RESPONSIBLE NG REQUIRED TO MAINTAIN S ABIILIIT YOFTHI THE STRUCTURE DURING CONSTRUCTION. �,M« Xu 3 2"X 8" 3 2"X 8" iv 3 2"X 8" 5.THE ARCHITECT SHALL NOT BE RESPONSIBLE OR LIABLE FOR ANY CONSTRUCTION NOT DONE UNDER HIS DIRECT SUPERVISION. P.T.6"X 6" P.T.6"X S 6. THE CONTRACTOR SHALL DO ALL CUTTING, Fishell POSTS 26'_0" POSTS PATCHING,FITTING OF WORK THAT MAY BE REQUIRED TO MAKE ALL PARTS COME TOGETHER PROPERLY AND CDArchitecture FIT TO RECEIVE OR BE RECEIVED BY WORK OF ALL PORCH ADDITION-FLOOR PLAN TRADES AS SHOWN ON THE DRAWING OR AS SPECIFIED. Residential/Corporate SCALE 1/8"=1'-0" 7. THE CONTRACTOR SHALL MAINTAIN A REASONABLY Commercial CLEAN AND DUST FREE ENVIRONMENT FOR THE WORKERS AND USERS OR THE BUILDING.BROOM 440 Main Street,Suite P CLEAN AT THE END OF EACH DAY. Ridgefield, CT 06877 8.FROST PROTECTION FOR FOOTING-42"MINIMUM Phone: (203)438-6809 shingles to match existing BELOW FINISHED GRADE.8"MININMUM EXPOSED Fax: (203)438-0310 CONCRETE FOUNbATION FINISHED GRADE TO WOOD _ — CONSTRUCTION. _ =install 2 30"x 40"fixed — = Landsiedel Residence skylights — 33 Third Avenue Hyannis, MA. Lill U PROPOSED PORCH EXISTING HOUSE EXISTING HO ISE �� �u existing wind w and door I Ictd r siding to match to remain I I existing RevisionlIssue Date a. PORCH ADDITION-FRONT ELEVATION Scale Drawin SCALE 1/8"=1'-0" ¥ :5 - .a a Nc. ,m••ra Date A —,o . 1 .. Drawn By FR � U C N IL N 'O C L F— T ^p Cl) LL J 2 3/8"THRU BOLTS AT EACH EXISTING TO NEW 12'-0" JOIST CONNECTION lo STRAP 3 2"X 8"BEAM TO 2"X 10"JOISTS W/ SIMPSON HTS20 OR EQUAL.CONFIRM , CONNECTOR WITH X 16'O G MANUFACTURER 2 AV, BUILD GRIP TO UNDER OF NEW RO JOISTS STRAP KYLIGHT. SIZE AN� P AND BOTTOM TO MODEL TBD. EXISTING AND NEW epiw` 6"X 6"POST CONNECTED TO 3 2"X rV-_V0" 8"BEAM WITH SIMPSON PC66 POST CAP EXISTING F OUSE Fishell N N INSTALL VENT TO 6"X 6"PRESSURE Architecture MATCH EXISTING AT TREATED POST HOUSE to Residential/Corporate Commercial TREX OR EQUAL 440 Main Street,Suite P DECKING(NO GAP) Ridgefield,CT 06877 SIMPSON ABU66 2"x 10"P.T. D.F.JOISTS Phone: (203) -031009 POST BASE 16"O.C. Fax: (203)4380310 BEAM Landsiedel Residence III I= 10"SONO TUBE BOLT P.T. 10"LEDGER III III 33 Third Avenue FOOTING w/BIG FOOT TO EXISTING �t I BASE CONSTRUCTION @ 4' Hyannis,MA. O.C. HANG NEW FLOOR _ I JOISTS W/TECO OR PROPOSED EQUALHANGERS PORCH Mgr, PORCH ADDITION-SECTION SCALE 1/4"=1'-0" - r3 No. RW.I.n/lsaue Date Scale Drowlnp No. Owe ^ ✓ --- Owe Drown By A aL FFL