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Post_This Card So That�t is /istble„From theStreet Approved Plans.Must be Retamed�on Job and,this Card Must be Kept
�rnss Posted Until Final Inspection Has BeenMade ^,_ ; ° ,u, F
�63a ,,p , , Permit
errs' Where a Certificate of Occupancy is Required;such Buildmg shall Not be Occupied un#ilia Final Inspection:has been made; lily
Permit NO: B1719-3311 Applicant Name: Nathan Tissot Approvals
[late Issued: .02/28/2020 Current Use: Structure
Permit Type: Building-Solar Panel-Residential Expiration Date: 08/28/2020 Foundation:
Location: 36 WELLESLEY CIRCLE,HYANNIS Map/Lot: 270-101 009 Zoning District: RB Sheathing:
Owner on Record: 'SHAH,SYED A Contractor Name -TESLA ENERGY OPERATIONS INC. Framing: 1
Address: 36 WELLESLEY CIRCLE w Contractor Licensee, 168572 2
HYANNIS, MA 02601 Est Project Cost: $16,000.00 Chimney:
Description: Install solar electric panels on roof of existmg house with any Permit Fee: $ 131.60
upgrades,when applicable,specified by Design,To be s r Insulation:
Fee Paid S 131.60
interconnected with home electrical system 11 34KW 36Panels Final:
®a'te 2/28/2020
..Project Review Req: J A
Plumbing/Gas
Rough Plumbing:
lz
F �- ��.,,.: ` 5' _ Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authoriied'by this permit is commenced withm'six months after issuance.
All work authorized by this permit shall conform to the approved appli6t on`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 structures shallbe in compliance with the local zoning:by�laws and codes.
This permit shall be displayed in a location clearly visible from access stteet or road'abd.shall be maintained open for public inspection for the entire duration of the Final Gas:
work until the completion of the same. s z
` � Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Buildinjand Fire Officials are provided on this;permit.
� � �
Minimum of Five Call Inspections Required for All Construction Work �' Service:
1.Foundation or Footing
2.Sheathing Inspection Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed
Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.final Inspection before Occupancy
Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health .
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A).
Fire Department
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
SolarCity
January 3, 2017
Town of Barnstable
ATTENTION: BUILDING DEPARTMENT
200 Main Street,
Hyannis, MA 02601
RE: 36 Wellesley Circle, Hyannis
Permit Nos.: B-16-3417
E-16-2420 ZE
Our Job No.: JB-0263238
NOTICE OF CANCELLATION
This letter is to certify that our proposal to install Solar(PV)at the above-
referenced property has been moved into a cancellation.status.
SolarCity Corporation and Syed A. Shah will not be moving forward with the
proposed installation at this time.
If you have any questions or concerns, please don't hesitate to contact me.
Thank you for your attention to this matter.
Sincerely, -
CheryCGruenstern
Cheryl Gruenstern.
Permit Coordinator
Direct Line: (568)640-5397
cgruenstem@solarci. .com
112 Great Western Road,South Dennis,MA 02660 T (888)SOL-CITY solarcity.com
AL 05500.AR M-8931.AZ ROC 243771/ROC 245450.CA CSLB 888104.CO EC8041.CT HIC 0632778/ELC 0125305.DC 410 514 0 0 0 0 8 0/ECC902585.DE 2 01112 0 3 8 6/T7-6032.FL EC13006226.HI CT-29770..IL 15-0052.MA HIC 168572/ -..
EL-1136MR.MD HIC 12 8 94 8/118 05.NC 30801-U.NH 0341C/12523M.NJ NJHIC#13VH06160600/34E8 0173 2 7 0 0.NM EE98-319590.NV NV2012i135112/C2-0078648/B2-0019719,OH EL.47107.OR CB�0498/C562.PA HICPAO)7343.Po
ACO04714/Reg 38313,TXTECL27006.UT 8726950-5501.VA ELE2705153278.V1 EM-05829.WA SOLARC•91901/SOLARC•905P7.Albany 439,Greene A-486.Nassau H240971000Q Putnam PC6041,Rockland H-11864-40-00-00.Suffolk
52057-H.Westchester WC-26088-H73.N.Y.0#2001384-0CA SCENYC:N.Y.C.Licensed Electrician.#12610.#004485.155 Water St.6th Fl..Unit 10.BrooHyn.NY 1120t#2013966-0CA All loans provided by SolarCity Finance Company.LLC.
CA Finance Lenders License 60b4796.SolarCity Finance Company.LLC is licensed by the Delaware State Bank Commissioner to engage In business in Delaware under license number 019422.MD Consumer Loan License 2241.NV
Installment Loan Llcensell.11023/I1.11024.RI Licensed Lender#20153103LL.TX Registered Creditor 1400050963-202404.VT Lender License#6766 -
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' Town of Barnstable REcEiP
MASS 200 Main Street, Hyannis MA 02601 508-862-4038
Application for Building Permit:
Application No: TB-16-3417 Date Recieved 11/18/2016 --+Job Location: 36 WELLESLEY CIRCLE,HYANNIS
Permit For: Building-Solar Panel-Residential
Contractor's Name: SOLAR CITY CORPORATION State Lic. No: .168572CD
a :.
Address: 24 ST MARTIN STREET BLD 2UNIT 11, Applicant Phone: (508) 640-5397 '
MARLBOROUGH, MA 01752
(Home)Owner's Name: SHAH,SYED A Phone: (508)292-6332
(Home)Owner's Address: 36 WELLESLEY CIR, HYANNIS,MA 02601
Work Description: Install solar panels on roof of existing house,with any upgrades, if applicable,as specified,by PE in Design;,
To be connected with home electrical system. 10.395 kW 33 Panels JB-0263477
Total Value Of Work To Be Performed: $15,000.00
Structure Size: 0.00 0.00 0.00
Width Depth Total Area
I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before
he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).
I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by
filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to
accept coverage.
I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have
been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to.violate the
Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and
specifications. All information contained within is true and accurate to the best of my knowledge and belief.
All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24
hours in advance.
Signed: Cheryl Gruenstern 11/18/2016 (508)640-5397
Applicant Date Telephone No.
Estimated`Construction Costs/Permit Fees
Total Project Cost : $15,000.00 Date Paid Amount Paid Check#or CC# Pay Type
Total Permit Fee: $126.50 W
11/18/2016 � $126.50 X}CC{3COOC XXXX Credit Card
8975 § -
Total Permit Fee.Paid: $126.50
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
I Ma � ---�,Parcel (7 / 0 Permit#
Health Division S y 2S '`�Bf-E Date Issued S 7
Conservation Division
(� �: t -t� t1 . f (� Application Fee �LTQ ct a
Tax Collector Permit Fee �•
Treasurer �/ �:` !�f���""�-----_ qpp
�� UCANTMUSTOBT
CONNECTION p OBTAIN A MM
Planning Dept. N ROE"&-(;u0nox� FROM
a im
Date Definitive Plan Approved by Planning Board
Historic-OKH Preservation/Hyannis
Project Street Address _��� �1 Z
Village ]
Owner SG-4�5_e) Address 24P
Telephone 9�9 7 a l/Z3 S
Permit Request
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size f 3�� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 9, Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing new
Total Room Count(not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No
Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size `
Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:
i
Zoning Board of Appeals Authorization ❑ Appeal# Recorded(J
Commercial ❑Yes KNo If yes,site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name Q l 1C) COI/ Telephone Number ,�526a 69-5E2-Z.Z__1
Address " k7- 60A!F_ LS7 License# ®C(p33
Home Improvement Contractor#
Worker's Compensation# /�4, IV 3W (D_C__
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOk��(� !�
SIGNATURE 4A
DATE 5
FOR OFFICIAL USE ONLY
i
PERMIT NO.
DATE ISSUED
r
MAP/.;PARCEL NO.
.Y ADDRESS VILLAGE
s ,
OWNER
'i
, V
DATE OF,INSPECTION:
FOUNDATION
FRAME
INSULATION
-a
FIREPLACE
j ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH c. ;<��'' FINAL
'1 GAS: ROUGH: FINAL
FINAL BUILDING `'
DATE CLOSED OUT ,
ASSOCIATION PLAN,NO.
s
The•Comin6nweajth of Massachusetts
Department of IndusHatAccidents'
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'` Boston,Mass. .02111
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tnsiir�iic -b oo,DO and/or
o as re aired ender Section Z5A of MGL 152 can lead to the impnd a r a of I 0 e ,Y agaIsm I understand that}
Covers 9 O E
Failure to secure 8 enaltfes�nthe fof'm of a STOP WORK RD •
one yearn'imprisonment as well as Ctvilp r
copy o s{atement maybe farv+azded to the Office of Investigation+of the DlAfor Coverage verification.
der th ains and psnait' rjury that the information provided above is ry aL correct
r do hereby aerti,f}' �P
Date ,
Signature --,)?hone#
print name
ofrlcw use only de not write in this area to be completed by city or town Offlcifi)
' parmitllicense# ❑Buildingbepartment
❑Licensing Board
city or town: []Selectmen's Office
[3,cheekif immediate respansr is required ❑Health Department ,
[]Other
contact person: phone#;
(,,Vbzd reps 20� ,
• ' ' . . • '. Z '=r
' Information and Znstz•uctians
aws chaapter 152 section 25 requires all em}�loyers to p3rovidb aworkers' eomp ens 4tidh for'their•.
Massachusetts Gezt `•u'`
r
employees; .4 quotecl'fromthe `1sw., an employee is.defined as every person m the service of another under any confract
Of hire;express orlied; oral or Written.
An empinyer is defined as an individual,partnership, association,corporation or other legal entity, or any fwo or mare of
the foregoing engaged'in djoint enferprise,and including thelegal iepresentatives of a deceased,employer, or the-receiver or
association or other legal entity, employing employees. 'Howevei••the owner of a
trustee of an individual,partnership,
dwelling house havmg' 0t more than three apartments'and-who resides therein, or the,occupanttof the;dwelling hous a bf-
another woo emplo3's.Persbiis to clo main6ince, construction or repair work on such cTwelIing fiou§e.csr on the grounds or
enant thereto shall not because pf such employment.be deemed'to be ari employer. ,
building,APP •..
a the
MGL chapter 152 section 25 also''states fhat'every state or local lzcen�ing a ommonweaIth for any su licant who has
renewal
of a license or pe2'm?f to operate a business or to construct building PP
not produced acceptable•evidence-of compliance with the insurance coverage reil*W—: Aiiditionally;neither'the' '
coix�onwealth nor-any•of its political subdivisions shall enter into any coutract for the performance of public work unti
acceptable evidence of compliance with t�e insurance requirements of this chapter have been presented'to the contracting
authority
MOM
Applicants
Please i the w�c's,.eonpensafm aff&vit completely,by checking the box that applies to your situation.,Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted
to the Department'Of industrial Accidents-for confirmation of insurance coverage. Also'be sure to sign and date the
affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being
requested, not the Aeparhment 6f) dustdal Accidents. Should you have any questions regarding the•"Iaw'*or if you are
requi sled,ed obtain 1 workersr•compensatimpplicy,please call the Departtfimt at the number listtA below•
City or Towns
ab�niplete and printed legibly. The Department has provided a space at the bottom of the
Please be sure that the affidavit
affidavit for you to fill oat in-the event the Office of Investigations has to contact you regarding the applicant Please
be-sme to the pw1itAicensa number which wM be used as a reference number. The.affidayits may be returned tq
mail F FAX unless otheir'ar angemsnts have bem made. '
the Departmentby�' or'
The office of Investigations would like to thank you in advance for you cooperation and sliould you have any 4uestions,
itate to us a•calL•• ,
please do nothes �
/ arEment's address,telephone and:fax number: • '
The Dep '
• The Commonwealth Of Massachusetts
Department-of Industrial Accidents
. Bice of l>�testil�ena .
boo Washington Street
Boston,MR. 02111
i fax#: (617)77,7-7749
.rr_ �i•trn rrn.r. ir%nn __J. 'ADC
RESIDENTIAL BUILDING PERMIT FEES
APPLICATION FEE
New Buildings,Additions $50.00
Alterations/Renovations $25.00
Building Permit Amendment $25.00
FEE VALUE WORKSHEET
NEW LIVING SPACEf
a3 0 square feet x$96/sq.foot= o�� 0 0 x.0031= e�.
plus from below(if applicable) ; y :2 ® u'3
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
square feet x$64/sq.foot= x.0031=
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq. ft.= x.0031=
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf- 1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq.foot= x.0031=
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 $150.00
(plus above if applicable)
Permit Fee �: f
a 0 J;3
projcost 'J ,
I
Town of Barnstable
-�E Regulatory Services
'Thomas F.Geller,Director
i EA.Rt'iSTABLF„$
ss Building Division
pl�D MP�� Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Fax: 508-790-6230
Office: 508-862-4038
permit no.
Date
AFFIDAVIT
R
CTOR LAM
SUPPELMENT TO PERT TM APPLICATION
CATION
iza
er-occu led
MGL c.142A requires that the"rec Ons onstructi n of an addition to mypreexisting oR,r�tion,conversion,
iprovement,removal,demolition,
b'4�g containing at least one but not More registered� contrac ors with unitsour dwelling ertain ex ptions,alo g with o her nt to
such residence or building be done by
requirements,
Rsti ted Cost a�
Address of Work: ,
Owner s Name' •• _ •of kpp -
iication: � ✓ �
Date
I hereby certify that:
Registration is not required for the following reason(s): _
[]'Work excluded by law
❑lob Under S 1,000
[]Building not owner-occupied
[]Owner pulling own permit
Notice is hereby given that: OWN jE�T ORDEALTNG WITkI REGISTERED
0MRS TEMIR
CONTRACTORS FORA.PPLICAB3MHOME R UARMEANTXwFUI�tDUNDERMGL 142A.
ACCESS TO THE ARBITRATIOI`i PRO GRAM
SIGNED UNDER PENALTIES OF PERJURY _
Ihereby apply for aPermit as the agent of the owner:
5 Contractor ame Registrationl�Io.
Date
OR
Owner's Name..,..
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION
Number CS
Expires. 06115 2"'
Restricted: O'D
BRIAN OLSEN
,1,79 MT HOPE ST
N ATTLEBORO. MA ,2760 pam,r);,stra,of
lju4fd Uf hujiding Regul"11011S Ujj(j �jijJjjj:jj kj,
HOME IMPROVEMENT CONTRACTOR
Registration: 104435
Expiration: 7/14/2100,4
Type: Private. Cofporamw
BRUIN CORPORATION OF ATTLE
N(�A OLSEN
479 Mount Hope Street
N. Attleboro, MA 02760
AGREEMENT Job Number
Jos "P+�ct � i In-Home Sale Customer's Initials El Showroom Sale Customer's Initials
`,I�j_�1i1 FOCI
a79 MOUNT HOPE ST •NORTH)442-7 46
S u n ro o m s MA 027D0
MA REG+t0aa39• RI LIC+1627 ---
,
PROPOS SUBMI ED TO NONEE oAlF j CrJ
10 _Ski
9070/
W it/' V r CONSULT S SIGNATURE
w4 NEP,<ar stsNrr AND
PIJAC KASE ffElb)
YEAR NONE PLEASE MARK RATIOSIZE COLORS RMIT
BUILT ALL SIZES PR . WIDTH HGT.
►gyp �7 BUILRDOSM 4 ,S ❑ GDSLB oID ROOF: MOVES----
L ��► � ti am /7 G ❑ TEW POOR �� �3 iXIA(TRIM: ❑ YERYEN,
FOOTING LL ❑ VOCO DEB. ❑BRONZE S4NDSTON
REPS—to FRAME COLOR: ❑
t apt V4us O a 3 ❑BRON DSTD
o �I�crJ T BE=Y0a(_ 2 Off. a E,DGF
�r S 1 s- O ❑ DODR / I, PLAT 2/w PRICING---- -
gREM THRI)4 0 ❑ C�r \ MICROBLINDS(cola)---- ❑ i-- —I
DOOR r STANDARDELECTRIC I GZr /ITT-1
FINISH MCK Wia ❑ SKYLITES—nn_�� ❑•SGI
❑ y.X; ADDITIONAL ELECTRIC 7 n! <i
STEPS—nb _
11 ❑ ��� I^O BAY WINDOW
❑ VENETIANBLINDS
TRANSOMS ❑TOP --
2'WALL =W&City❑ri&-s a OEM Cl ❑BOTTOM
9•WALL 3U Ai,4d\ts fe,Q Y cus MVEs❑ ❑wm❑ cUSTOM TRANSOMS
2 �6)p ---- ---------
OTHER WORK: Gc -q �C�S ! D G vrG — -----` -------_-_._.
f /Cc ESTIMATED PRICE
TOTAL PRICE:
`WE Pt OPOSE hereby to lurnish material and labor—complete in accordance with above specifications for the sum 01: r
�PA. NT DOWN r%UPON JOB START qPo UPON JOB ERECTION %UPGt+j08 COMPLETiON
AMOUNT 7 7J r0 7 S ---
BUYER AGREES TO PAY FOR JOB IN FULL AT TIME OF CONSTRUCTION COMPLETION;
REJECTION OF PROPOSAL
Bruin reserves the right to cancel this order if engineers decide the job as sold will not afford proper installation. -
I
Autrgrized Spnatun Dnu
ACCEPTANCE OF PROPOSAL ❑ Showroom Not Applicable
s
The above prices,specifications and conditions are *u,the buyer,may cancel this transaction at any time prior to midnight of the third business day anef In,
satisfactory and we hereby accepted.You are authorized to dale of this transaction.See !lathed notice of cancelfalfon form for an explanation of(his right. —_
,do the work as specified.Payment will be made as outlined
above.
Authorized Signature
S/ Authorized Signature
Date 0 Acceptance CJ NO VERBAL AGREEMENTS RECOGNIZED
THE FOLLOWING WORK SHALL BE DONE BY PARTIES OTHER THAN BRUIN AND IS NOT A PART OF THIS CONTRACT ?
�— V - INOICAIE TYPE Of INDICAIL TYPE 01 SIOING ON
(Each Square Represents 1 Square Ft.) FOUNDATION ON HOUSE n MAW c ALUMINUM o aRI I:
O BASEMENT 'i CRAWL i.SLAB If SIONE
I i 1 I _ INDCAIE IYP I Of
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PART 1-ORIGINAUOFFICE COPY PART 2•WORK ORDER PART 3-CUSTOMER COPY
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SCALE, / ' r"4o DATE , / 1/s1�3S
fAwBolm �4NC° I CERTIFY. THAT THE Fd�AIOA7 •y�/
GLJiLpiY SHOW) %0N THIS PLAN IS '. : LGCbbT:l�� I
�Y�RED R�Oi$T�R�D -ON THE P�ROUND A3 INDICATED Aft;
;:. ctVll. LAND
• , CONFORMS TO THE ZONI O LAWS
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3' Window 6' Slid Ll
ing Door 6' Sliding Door 3' Window Ln
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SHEET NO.
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Legend Q 4 -,C)
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® Light Q C:5
m Receptacte U O
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Existing Hone
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1 3 8
0
EE Es
Proposed Sunroon on
Existing Deck
Pr osed
iPro osed
a H o° andinp
A 1
6'-72
tv
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5' Window 5' Window 5' Window 5' Window
3'-6 23'-0" 3"-6N n,
8 CD
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1 / 4 SHEET NO.
" = 1 '
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r'AGr OF CXTCr=.ICI2 _L -ice
CD
MIN. 24- SNOW t IC.E - ' - �.�1-
SHIELD
4 METAL FLA.5HIN(5 ----1
ONTO ROOP PArLEL, AND E?_ISTIN6 SOFFIT E:.POSECC
6" ONTO HCX)SE ROOF EXISTING
6F
—� ROOF
METAL FLASHINGNv
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(5EE DETAIL AT LEFT)
EXISTING
1•_O•• HOME
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r ( V4 OD DESK
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Section (7cn _
SHEET NO.
No Scale
dotes
All Strucl rcl Lunber to be Pressure Treated Q fj
mAll Harchore & Malls to be GolvnnIzed o
�= Existing Concrete Footing — Check For Code Conptiance Existing 2' x 4' 11ouse VnN on Conc. Foundation D 0E
4 Rim Joist Lagged To House =
a
Flashing Tucked Under Siding L Vropped Over Ledger s
2' x 8' PT Floor Joist-I6' o.c }' s
lletat Joist Hangers Both Ends OF Joists g
1/2' PT Ptywood On Btn. Floor ,foist cr- +'
R30 Merglass Incl. w/ Vapor Barrier a
3/4' TLG Subfloor
N
N
Q
N
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m 1
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13'-0"
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3/_6d 5,_9a ,5/_9� 5,_9. 5,_9r /_60 .o
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23`-0' Q1 `�
M �
Q 2' x 8' PT Floor JoLst-16' a.c
.. Metal Joist ilarigers W
lT 5/4' x G' PT Decking _U)
Sr . 4' x 9' Flush Girdr 4'e x b' Rai! Columns
4' x 6" PT Column 5, 6 x ' PT R*As ILTop Cop
AdJ. Post Base Bracket 2' x 2' Ballusters S
m 12' Dios Canc. Pier Ftng -36' Above FtNsti Floor d
m MkL 48' Below Grade CTyp.) -Spaced 4' Apart
Foo -ting Frame Plan SHFXT'NO.
1/4" _ 1`
h
K}?�
S
n
REVI noH.'.•�
230 SUN & SHADE ROOM EXPLODEDDAWiNG
10 CC x 5 BAYS w/ ONE: CABLE END SHOWN
4' OR 5 SCREWS WITH WASHERS
LOCATE: 24" O.C. FOR CABLEI(S)
ACROSS EAVE (6) REQ'D e APPROX 8" O.C.
g8 x 1/2 TEK SCREWS- 6' O.C. a (7M980)
(7-150) TYPICAL 5 (7M981) SEE ORDER FORM PATIOC2
FOR COMPLETE INFORMATION FOR
ROOF PANELS & WALL PANELS. '
RIDGE
RIDGE 1/2- TEK SCREWS 3- (A•73RR)
3" (A•73RR) (7.150) - 4 1/4" (A•74RR)
a 1/4" (A•74RR) 12" O.C. ON 'H' BEAMS
4 9 IF APPLICABLE
CUTTER 19 1/2" TEK SCREWS
3" (A•73CC B q (7.150)
4 I/4" (q•74CC; i b® 12 PER PANEL AT RIDGE U v�
1 P (6) TOP & (6) BOTTOM a O
0
p d FASCIA LONG ENOUGH
t p d 3" (A•73RP) TO COVER N
9 p 4 I/4" (A•74RF)ROOF PANEL & GUTTER
ELECTRIC EAVE f p ¢ O
(A7•144) Q �
ELECTRIC BAVE COVER x w
CD ELECTRIC
- (A7B 1441C EAVD C7 -
(A•SGT) )
J
O H-CHANNEL pp al O
(A7•111) pp SILL •
Q, O
(A`7CS
z
� �
�•, 6' TRANSOM z 0 U
SILL 1� t r 0 �
(A•7CS) cn
H-CHANNEL F �j Z
(A•7111) O > y
F \ r F W ¢
SIL \ \ \ / // cl)
(A•7CS) _ _ 6' SLIDER z .
4' x 12" TRANSOM \ Q
d 2'-6 FIXED w
4' SLIDER WINDOW \``` f T 2'-6 TRANSOM
`l SILL
4' x 22" KICK PANS (
CS
ELECTRIC-H-H COVER
(A.5dn, _
H-CHANNEL 0� (A7.111)
DEEP BLEC.-H
O 2'-6" x 12' TRANSOM 5 x 12" TRANSOM (A7.145)
2'-6" FIXED 5' SLIDER WINDOW DRAWN BY: TW
6J 2'-6" x 22" FIXED 5' x 22" KICK PANEL NOTE. CHECKED BY:CM
H-CHANNEL *INDICATES EXTRU91ON COMES IN BRONZE OR
DOWN SPOUT KIT A7•II1 90• CORNER WHITE SUBSTITUTE THE "•' WITH "B" FOR DATE 05-01-02
\\—' (7.999)
(A•7C9 ) BRONZE OR "W" FOR WHITE
SCALE:'NTS
DWG# LTPC33
W
- b
PAGE• OF`.
)
i r
n> 230 SUN & SHADE: STRAIGHT EAVE
? Ire qC�r
ROOF PANELS WITHOUT H-BEAMS X,
ENGINEERING & STRUCTURAL LOADING INFORMATION
-, ,_ `• T, ;NINE IOEIMORIAL HWY.
11741
I .L�... 7 FOOT EAVE HEIGHT 8 FOOT EAVE HEIGHT 9 FOOT EAVE rIDcG.;
MAXIMUM FRONT WALL WINDOW SIZE MAXIMUM FRONT WALL WINDOW SIZE MAXIMUM FRONT WALL 57INDOV:SIZE
ROJr MAXIMUM .'WINDOW !WINDOW V WINDOW 5'WINDOW S•WINDOW V WINDOW 5'WINDOW
I LOAD ROOF WIND D WI
ND SPEED I WIND SPEED WIND SPEED WIND SPEED WIND SPEED WIND SPEED WIND
GOVERNED BY LIVE LOAD EXPOSURE EXPOSURE EXPOSURE EXPOSURE EXPOSURE EXPOSURE EXPOSURE EXPOSURE i EX?OSURc 1
Iwn B C 0 B C D B C D B C 0 B C D 8 C D B C D 8 C D ! 0 1 "`
(mph) (mph) imph) imoh) (mph)(mph) (mph) (mph) Imoh Imph) (mph) (moo)Imoh) Imoh) (moh) (mph) Imnh) (mph) (mon) Imon) Imon) Imon) Imn�Il 1�^„I I^^-II• ^-''•-r-'
I 4 - 69 170 730 115 160 125 110 145 110 100 140 105 95 130 100 90 125 95 85 115 90 80 1151 9G' 60 0 1 =
I k w•- 101 :170.'r130 115 160: '12S'':L10':145,.'110' 100 :140 105 :95 "130 .100' t90 125! '95 85d :115 90:: 80 115 90 80
I 1 188 170 130 115 160 125 110 145 110 100 140 105 95 130 100 90 125 95 85 115 90 80 115 90 60 10cI
�- +�•' 52 160 125 110 160 '125 .110 "145 ;':110:'100 130: 100 ".90`:.130i:.100 ;;90• -125 95, .85; .115, ;90 -80110 :BS .75 100 50 7i1
1
__ 75 160 125 110 160 125 110 145 110 100 130 100 90 130 100 90 125 95 85 115 90 BO t10 85 75 'OCI
i °•n, 79 160 125' 110 160 125 1101':145."4101 A00 130 '100 >90'1301.'.100: :90; 125 (-95- 85 :115 •90 �80- 110 '85 75 1 tOG'I E0 70
i 1 •..,,.•..,_ _40 160 '125 110 160 125 110 145 110 100 130 100 90 130 100 90 125 95 85 115 90 80 110 8� 'o uI
I 58 160 125 110 160. 125, 110 -1.45 '110:.100 130 •100 90';'130 100 -90 �125 95 •'85. !115. '90- '80 170 E, 75 f t 1_
72 160 125 110 160 125 110 145 110 100 130 100 90 130 100 90 125 95 85 115 90 80 110 85 1 75 1 100i c:• 7
32 155 120 105 155 -120 .105 145.:410 lGu 125 c5 85:'125 -.95. 85 '125 95 '85. 110 .85, 75, 110 :8 a 1 0 3 I
i 1 46 155 120 105 155 120 105 145 110 100 125 95 85 125 95 85 125 95 85 110 85 75 110 E 75 I_1 : I
I 66 155 "120 105 155 120 105 .145 :110 100 �125-:9, 185� 125 ':95.• 85: �125. '95 *85 -110 •i85: '!75-. -110 -85 75 I'll 1 F. I
7 26 145 110 100 145 110 100 145 110 100 115 90 80 115 90 80 115 90 80 100 80 70 10G PC 0 � ! ,
_ _ ''38' •145 •.710 100 145 1"10 100:145 :.110 ;100 115' 90 :130-. *115 -90 7180 "115`'>90 =80, 100 40. '70 100 8 �0 _oc -7 I1
u 61 145 110 100 145 110 100 145 110 100 115 90 80 115 90 80 115 90 80 100 80 70 1,30I 8L
21 140 105 :95 A40,•105'';'95:-140���105:��.95 110: �85, :45='110 85 -75�- 110 :185��.75'" "95. '70, 65 '95 70 � L, 1 7, 1 E-
•-,�'�'•«'� 31 140 105 95 140 105 95 140 105 95 110 85 75 110 85. 75 110 85 75 95 70 65 95 7\ 1=
u`E••..�••• 52' .140 'L105 '95 '140 '1D5. 95. 140. �105 •95. '110 "85"•'35'':110'�:85' '�.75�� :110� ':85. ':75: :95' .70. :65 95 70 E5 I 95 7, 1 c:
18 130 100 90 130 100 90 130 100 90 100 80 70 100 80 70 100 80 70 95 70 65 95 1 70,1 65 OD ' - 1 =c
26 1. .130 '100 90 1301 100 -905 '130; 1001.':90 .100::60 :>70,; '100 1'80 1,70. 100, ,80 >70 95 70. :65 "'.95 1 70 C5 9 7L f5
Fice. 411. 130 100 90 1301 1001 90 130 100 90 100 80 70 100 80 1 70 100 80 70 95 1 70 65 95 1 7C 1 65 9� I .11 E
i ur ea 15 125 -95• ,85- -125. 95:"-85: 125 ":95,:.'85- ;:115 90" .:80 ,115 90: 80 115 :90 '80 100 80. 70 100 8'1 1 7t T' '"'
�L4 22 140 105 95 140 105 95. 140 105 95 115 90 80 115 90 80 115 90 80 100 80 70 100 80 1 7G 1051-3T- 130. A00'-:90- '130:"s100 `90.: .130"100 `90, �115 i90 `'80+'•115i':901�:80 �:1151 '9080 100 -80: 70 1DG E0 I 1' 13; - -
J
• 13 110 85 75 110 85 75 110 85 75 110 85 75 110 85 75 110 85 75 100 80 70 100 80 70 :Doi '-
N..w
15 uw uu. 19:..;. .140'.105 :95 140 ;105 :95:::140 ')105':95, :715 90 .115:';90::..80;1115'190 i'80 100. 80 -70; 100 BO .:70'1 70
i + I +°'•= 32 125 95 85 125 95 85 125 95 85 115 90 80 115 90 80 115 90 80 100 80 70 100 80 70 1 IOGI 5 1 70
11: 100. '8070' :100; ,80 '70?:100;:;:80;• 70; 100 ,80 701.'100 ;-80; ;70 .10080 70 195 :70 i65 '95 70,1 65 95 70: 65
16 16 125 95 BS 125 95 85 125 95 85 110 85 75 110 85 75 110 85 75 95 70 65 95 70 E5 95 70 1 65
26 -' .11590- -BO '.11590 -80` .115 '90 80 'A10 t85.':%75> :110 %85 ?.751110'`-85' _75 .95t 70'( 65' -:95 70 65 .95 70 65
1 - 10 95 7D 65 95 70 65 95 70 65 95 70 65 95 70 65 95 70 65 95 70 65 95 70 6_5 c 176 E.
F to 125 1:95 85 '125 95 '65i -125 '095' :85:' 110."85';:<75 '-11075 .110'-'85'•'75': '95..".70 :65 '95 70 ES c 1 7D I
`JH 21 110 85 75 710 85 '75 110 85 75 110 85 75 110 85 75 110 85 75 95 70 65 95 j 70 j 65 , Fi, 7;
r:01 =' EXPOSURE B -RESIDENTIAL AREAS,EXPOSURE C -OPEN TERRAIN AREAS, EXPOSURE D -AREAS WITHIN 1500'OF 0 C E A N
/; Ems.• t �"� /•.C.`� !• J ¢�
1 i.'ei+5ir i l nc 231 i' i'"w"C.YT'4� €
\. <... �,�.aic� \� �r^• '�+. `\\'`T`-' r �,�,.� k"l�If sy�toP^ \y,�:,. .S/x i;�,,.�•/
.P=,NA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAIWARE FLORIDA GEORGIA IDAHU
-p^1 .f0.i 1(�, tnr•y,V f,`.o`r". '"' v `.c� 71. 't
,1 .+•.--a, -icy Nei . ,(( 1 Jn .•,..m�j�err �..,,..,•06�..1.i�, /.��w' 1A. _ ti
-- _^L.. '}• '-1 „err.• `ttv,.,.�/ \^.-;:...•'c::! \o V��.r/e�i• >�� ., t` � ...'
n.:,r,.• �•:- _I" '',;e:�K.� ..-_.�.....•..c:.i 'l�i;�s' f/:..
c. $ KENTUCK.Y LOUISIANA MAINE MAf11'LAND MASSACHUSETTS MICHIGAN MINNESOTA
Fv71
�4u�W'p,N•x_ Ll
E Nec1 P+Yi�>ytr 1�$ \
_ \ � N `t:t�- cti�n° �• e*�CIN� p IN p ?I�.
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•:_5RASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTHCAROLINA NORTHOAKOTA. 0;110 -
\
:.' r ,in 1\` -^'r-•x ! :c�.`F�\`-+i NOTES:
v ALUMINUM ALLOY IS 5005-T5
" :•f:r �\"� I1•-. � .,A,!^may.,,. \�`,.,.-.�-�,r.. 1
" •...,,,,,.... 2) DEAD LOAD OF ROOF SYSTEM IS 2.37 PSF
__'.\S`LVANIA.PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA
3)ALL UNITS SHOWN ON THIS PAGE ARE ACCEPTABLE FOR CONS T tFiON Ill*
ti ^ i�vH ;'44 + 4. ✓a SEISMIC ZONE 4.
1' 4 / � ii•,Y"`t^'+LLr I�. nou � c T,�l 5\vl:
` vAcii/S C.^.��7yi! T18��`ttt' a)A LOCAL PROFESSIONAL ENGINEER SHOULD DETERMIn ,i ci
% r�eae C �'` LOADING AND PERFORM ANY ADDITIONAL NECESSARY L, 1., G'
•pro':"t`••' ''� MAY INCLUDE:MINIMUM DESIGN LOADS REQUIRED BY LCDCAL.r;
Lil AH VERA•ION� VIRGINIA WASHINGTON OR ANY DRIFTING OR UNBALANCED SNOW LOADS PRODUCE D B .,..1
�.> STRUCTURES.
-E i413 ^fi- . ,„�., 5)THIS SUMMARY PERTAINS TO THE STRUCTURAL INTER I
J- V THE CONNECTIONS TO THE EXISTING STRUCTURE AN.,JI• .1` .
.r r - TING 1• R N. THE CONNI. 71 No i0 THE t?;ISTIN :,t.r)':1'::•k; _:•CONSTRUCT U l Q -� C 0 F _ ,
4 0
0 C
A'YOMING p C1 CONSTRUCTION MUST BE ANALYZED ACCORDING TO CG d(i,I ;J N:;.
EACH JOB,BY A LOCAL PROFESSIONAL ENGINEER,
6)ENGINEERS CERTIFICATION:I IAWRENCE FISCHER CER'1-�7Fv.i ""ESE
ENGINEERING SPECIFICATIONS HAVE BEEN PREPARED UND!:R MY
SUPERVISION AND THAT I AM A REGISTERED PROFESSIQN=:L i'iJ';t:•!i= ii I:•: 1-
STATES SHOWN. 56
DATE(p4M1DD1YYY'()
CERTIRCATB OF LIABILITY INSURANCE A MATTERof INFORMATION 004
)U(:ER (508)761-737X FAX (508)761- 817 THIS CERTIFICAT
rry J.
Board'I�tgc9' � � ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOWEPE THIS CC.R78F,k_-AT^DOES NOTAIAENL� EXTEND OR
19 Washington Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
O. 6ox 3Z69 lAkC U
)uth Attleboro, MA 02703-0925 INSURERS AFFORDING COVERAGE
,tct�D 8raja carp o Att rbory INSUREaAenn-America Insurance Co.
479 Mt Hope Street wsJ; ; Pi. Norguard Insurance Company
North Attleboro, MA 02760 INSURER
INSURER 0:
INSURER E
IV RAGES
'HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.CATE MAY BE I SSSUEDSUED ANDI NOTfn
%NY REQUIREMENT,TERRA OR CONDMON OF Am CCKMW.T�' OSF�ER SIC WITH RESPECT 70 WHICH THIS CERTIFI OR
AAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLQ$10N5 mm C 4v,' rZmc�OF v.SGK
Kx.ICIES,AGGREGATE UuuTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Z POLICY NUMBER JA.�/PtF UMITS
TYPE OF INSURANCE
OSWERALUAMUTY PAC6216588 12/04/2003 1Z/04/2004 EAc�+ocCURRENcE s 1,000,000
DAMAGE TO RENTED S 100,000
X oom mER=GENERAL LIABILITY
CLAIMS MADE a OOCUR MED EXP(Atilt one puw)
PERSONAL&ADV INJURY 5 1,000,000
GENERAL AGGREGATE S 2,000,000
PRODUCTS-COMPW AGG 3 2,000,00
GENL AGGREGATE U1NIT 1►PPL7EBp
w
X POLICY MJ l�
AUTOMQIXLSLDt�Itm �NI �SINGLE!LIMIT3
ANY AUTO
100.v0IQDN ms g1�0'puYl R! 3
SCHEDULED AUTOS
BODILY INJURY S
IHKEDAVV6 Asp xr.M�G
NON-OWNED AUTOS
PROPERTY DAMAGE S
Ipw&=idenQ
AUTO ONLY-EA ACCIDENT $
GAg4GEUALULTTY EA.ACG 5
OTHER THAN
ANY AUTO AUTO ONLY. AGG 2
EAW OCCURRENCE b
EXc MWM5MLAUADUM AGGREGATE 3
O=JR D CLAIMS MAOIE s
b
O'eDUCTIBLE g
RETENTION BRWC430130 06/11/2003 06/11/2004 5 we STATU- o
WORKERS
c�ra -
�tT�L.gAnoN AND X
WOREMM t1�iYf1,Y E.L.EACH ACGD&4T 3 500,000
B ANY CAIEMBER IXCLU
RERq =VE EL DISEASE-FA EMPLOYE $ SOO
1!Y� H.L.OISEASE-POUCY UMTT b 50O
SPECIAL PROVISIONS Delv+�
oTHF�
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L L�A[vmf YF1dIC_T N$ADDED BY ENDORSEMENT T SPECIAL PROVISIONS
OUR SFASONS SO PRODUCT'S LLC Ec UR SFASQ j#ARKE1<.IK G4R4. A.6tE LISTED A5 ADDITIONAL INSUREDS
iAIVER OF SUBROGATION Is INCLUDED I
I
I
FAXED TO: 508-699-34S2 -
cErZTTF11CQrE NOM. A CEL T10N
SHOULD ANY OF THE ABOVE Vw$c AIffwrm,l;ws SL,A,Vc&,uF.D EIEFORE THE
-- EXPIRATION DATE THEREOF.THE IsSVINO INSURCR Wiu_ENDFAvoR TO MAIL
Town of Barnstable 30 tiAYB 1iOS10ETOTMEG�tTIFUTATEMOLDER NAMEO Tc THE LEFT, y
200 Main Street 9 URA TO MAL H nc£SHALL IMPOSE NO OEIUOATION OR UABIUTY
>VI?v1�a I JTSA MTS OR REPRESENT TIVQs.
Hyannis, MA 02601 I
OACORD CORPORATION 1988
ACORD 26(2001108)
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
t Parcel /0/ —®� Permit#
Map--t_- T :; >
Health Division 17 e)J T,"' A �� v '` ; STr���E Date Issued 7 / � Q3
Conservation Division 6So 1 /O� ? ' �' f� UO
� �, �: Applications e
Tax Collector Permit Fee of 6• fr
Treasurer
Planning Dept. )MCMMMOBTAINASEWER
CONNECTION PERMIT FROM rAE
Date Definitive Plan Approved by Planning Board ENGINEERING DIVISION PRIOR TO
CONSTRUCTION
Historic-OKH Preservation/Hyannis
Project Street Address �3 6 We ll e_S lies/C°
Village t/ i ,4j
Owner .-i/Pei Address �D• ®X�.?S�i'�i�-�yv /5� 04�6 f
Telephone _ _ �� ��/_/� 3
Permit Request 7/rC/U &26Zo �L•t`eG �f , /47e q6L� &y--I cx_y �
o v S oyVlar
r l _ e
Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation Z$,gam' Construction Type
Lot Size r3/ 3 Z 5' 57/'/7 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family Fir' Two Family ❑ Multi-Family(#units)
Age of Existing Structure` Historic House: ❑Yes � On Old King's Highway: ❑Yes �t or
Type: 4 ull ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: existing new Half: existing 1 new
Number of Bedrooms: existing new ��Arj f f M46e-
4L
Total Room Count(not including baths): existing new z- First Floor Room Count
Heat Type and Fuel: Zas ❑Oil ❑Electric ❑Other
Central Air: ❑Yes &Jo Fireplaces: Existing A/O New Existing wood/coal stove: ❑Yes ® TO-l",
Detached garage:❑/�existing ❑new size Pool:El existing ❑new size Barn:❑existing ❑new size
Attached garage:2existing ❑new size Shed:❑existing ❑new size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes L2�o If yes, site plan review#
Current Use Proposed Use
BUILDER INFORMATION
Name b /":) lt-401,-uoc y> _) Telephone Number -,6"408
Address �4.�D,� Z�l License# ey, Q s�
Home Improvement Contractor#
Worker's Compensation# Sr q lar&.ogkl,y
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE ,/���
FOR OFFICIAL USE ONLY'
7'
P RMI I NO.
4 i i
D 'TE«SSUED
MAP/PARCEL,NO. '
ADDRESS 'VILLAGE--
OWNERI`f •.�: �' ,
i r
DATE OF INSPECTION: '` `• Jf 7 _r
t FOUNDATION
C� 1 5Zc' ��. �1 S�� ky•L. E'i t� J
FRAME Ygo
INSULATION J� tF/C� ZG�
t '
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FIREPLACE
't
ELECTRICAL: ROUGH FINAL J i
6
PLUMBING: ROUGH FINALE r'I
GAS: ROUGH FINAL
FINAL BUILDINGS`•v /� ao
f
r
DATE CLOSED OUT -
c: r •
•
ASSOCIATION PLAN NO. .,
y
,
} - The Commotiwealth'of Massachusetts r
r- - Department of Industrial Accidents
=- = 'OfffCC Of!!lYBSlf1/81f�IIS
_ 600 Washington Street
Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
/—
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I am a ho eowner performing all work myself. ,
I am a sole r rietor and have no one workin in ca acitp
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I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who
have
polices:
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E ILtAran6eC0-i>:>:«}:;:•,:,<•:•>:,.. 00 and/or
utred under Section 2.9A of MGL 152 can lead to the imposition of crlmitud penalties of a Ste up to S1,500.
Failure to secure coverage su teq
one yam,imprisonment��,��dvII penalties in the form of a STOP WORK ORDER atui a fine of$100.00 a day against me. Iunderstand that a
Office of Investigations of the DIA for coverage veriHcat[on
copy of this statement may be forwarded to the
I do hereby certify pains den etjury that the information provided above is tru<and correct
Date
signature ��
#t
Print name T
oMcial use only do not write in this area to be completed by city or town ofSdal
perndtllicense if
❑Building Department
city or town ❑Licensing Board
❑Sdechnews Office
❑checkif immediate response is required ❑Health Department
phone#; Other ' --
contact person: • _
(f""d 9/95 PIN �
Information and Instructions
' for their
o provide workers compensation Massachusetts General Laws chapter 152 section 25 requires all employers t p P
employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract
of hire, express or implied, oral or written.
An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or
trustee of an individual,Partnership, association or other legal entity, employing employees. However the owner of a
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct.buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situationand
supplying company names, address and phone numbers along with a certificate of fimn nce as all affidavits maybe
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
urned to the city or town that the application for the permit or license is
date the affidavit. The affidavit should be ret
being requested, not the Department of Industrial Accidents. Should yqu have any questions regarding the"law'or if you
are required to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the pemutllicense number which will be used as a reference number. The affidavits may be retiuned'tn
the Department by mail or FAX unless other arrangements have been made.
The office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not hesitate to give us a call.
The Department's address,telephone and fax number.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Me at lavesugauans
600'Washington Street
Boston,Ma. 02111 i
fax#: (617) 727-7749
nhone#: (617) 727-4900 ext. 406, 409 or 375
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oF'SHE, Town of Barnstable
y�`' "°•� Regulatory Services
t BMW Thomas F.Geiler,Director
XAM
9�b,TE p►Ai"�4� Building Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Fax:. 508-790-6230
Office: 508-862-4038
Permit no. •
Date
AFFIDAVIT
HOME WROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142Arequires 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: � S Estimated Cost
Address of Work:
Owner's Name:
Date of Application: /U��
I hereby certify that:
Registration is not required for the following reason(s):
rWork excluded by law
❑Job Under$1,000
[]Building not owner-occupied
❑Owner pulling own permit
Notice is hereby given that:
OWnpS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRA 0�ARBITRATION PROGRAM OR GUARANTY FUND UNDER M PLICABLE HOME IMPROVEY[ENT WORK DO NOT HAVE
142A.
ACCESS T
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date'
Contract ame RegistrationNo.
OR
,,,+e Owner's Name
. RESIDENTIAL BUILDING PERMIT ' 'ES "
APPLICATION FEE '
New Buildings,Additions $50.00
Alterations/Renovations $
25.00
Building Permit Amendment $25.00
FEE VALUE woRKSMET
NEW LIMG SPACE
square feet x$96/sq-foot= x.4031=
plus from below(if applicable)
ALTEgATIONSMENOVATIONS OF EXISTING SPACE
`�I d of" square feet x$64/sq-foot=
7/ 2 x.003 1= 1.
plus from below(if applicable)
ACCESSORY STRUCTURE>120 sq.1t
�S. o d
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf- 1000 sf 75.00
>1000 sf-1500 sf 100.00
>1500 sf-Same as new building permit: x,0031=
square feet x$961sq-foot=
STAND ALONE PERMITS
x$30.00=
ppen Porch (number)
x$30.00=
�a o �
Deck (number)
Fireplace/ChimneY —x$25.00=
(number)
k
Inground Swimming Pool $60.00
Above Ground Swimming Pool
$25.00.
Relocation/Moving
$150.00
(plus above if applicable) permit Fee a •��
KII/dr,/LVV _14:4- U4j.; r1UUi5UUN11 Wl"I'lIM.UG:;1LAY VAId, k3j
Town of Barnstable
WLi Regulatory Services
MAL Thomas F,Geller,Dindor
t"P., A. Building Division
Torn Perry, RaMax Commisslacer
200 IYWE Sftce Hyancis,NSA 02601
Office; 508-862-4038 Fax: 509-740-6230
Property Owner Must
Complete and Sign This Section
If Using A Bider
as O%mtr of the subject property
)sere zuthorze_ !s 1tiY1L�a rJ[71�� tf
�'Y 7 _�/ to act on my bCkaAlf,
in 111 utters relative to Wotk authozizcd by this building penft t applicatioft for.
(AddA
t_ ( 7
sigat=0 of Uwarx Date
a,�ora�s:ovsar�ssroN .
-77-----
71. /a �
Board of Building Regulations and Sta idarc4s-
HOME IN- VEMENT CONTRACTOR
Re rstra on §,172
Yi
Ex r ORK I:W2004 i All
it P A,
ATLA'�VT.IC CAPE�1}k�t�� �r'
D&Id Hodsdon II
Yarmouth Port;MA 02675
41
°mom
BOARD OF BU4LDIN RE- j
License. CONSTRUCTION SPA O'IS
.' A SUPERVISOR
Numbers
t ea 069860
E" �C20�5
ossar�oz t I j r.no. 1052
T 2 o-
Resticds� �I
DAWD S HODSDQN _
20 NIMBLE HILL DR\4 �'
YARMOUTHPORT, q `' � '
Administrator
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ew v t t
OF CERTIFIED PLOT PLAIN
s _
v� ROBERI �;, G
tsl;Gi': jt'/ YA rl AI/S
�L id.
IN
7 SCALE, O ''s1.0 ' DATE, /11s1-as'
E'E AIQ CO. ' A°✓eo 1 CERTIFY THAT THEF"dvv4a7 .9 / `.
CLI9Nlr
�" ! S SHOWN '`4'N THIS PLAN 13 LOCATED
�QI;�TEREO RRDI�P I�R E® JOIN �r
`Cl1�11. LAN® '-....�.. ON THE GROUND AS INDICATED AND
:ENOINEI:R BURVEI'01% A CONFORMS TO THE YONIN® LAWS
OF B MNSTA®L e MA88�
P T12' MAIN STRE.ET`.
I
Permit Number
REScheck Compliance Certificate Checked By/Date
Massachusetts Energy Code
REScheckSoftware Version 3.5 Release Id
Data filename:Untitled.rck
PROJECT TITLE: Shah
CITY:Barnstable
STATE:Massachusetts
HDD:6137
CONSTRUCTION TYPE: 1 or 2 Family,Detached
HEATING SYSTEM TYPE: Other(Non-Electric Resistance)
DATE:07/16/03
DATE OF PLANS: 7/16/03
PROJECT DESCRIPTION:
New room
DESIGNER/CONTRACTOR:
Hodsdon Construction
P.O.Box 221
Yarmouthport,MA 02675
COMPLIANCE:Passes
Maximum UA=77
Your Home UA=76
1.3%Better Than Code(UA)
Gross Glazing
Area or Cavity Cont. or Door
Perimeter R-Value R-Value U-Factor UA
Ceiling 1:Flat Ceiling or Scissor Truss 308 30.0 0.0 11
Wall 1: Wood Frame, 16"o.c. 400 11.0 0.0 30
Window 1:Vinyl Frame:Double Pane with Low-E 24 0.320 8
Door 1: Glass 36 0.340 12
Door 2: Solid 6 0.310 2
Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 400 30.0 . 0.0 13
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,specifications,
and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts
Energy Code requirements in REScheckVersion 3.5 Release Id (formerly MECchec�and to comply with the mandatory
requirements listed in the REScheckInspection Checklist. j
The heating load for this building,and the cooling load if appropriate,has been determined using the applicable Standard Design
Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the
design load as specified in S ' ns 780CMR and AA
Builder/Designer Date 4/W/y_S_.
-'REScheck Inspection Checklist -
Massachusetts Energy Code
REScheckSoftware Version 3.5 Release I
DATE: 07/16/03
PROJECT TITLE: Shah
Bldg. I
Dept.
Use
i
Ceilings:
[ ] I 1. Ceiling 1:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation
Comments:
I
Above-Grade Walls:
[ ] I 1. Wall 1: Wood Frame, 16"o.c.,R-11.0 cavity insulation
Comments:
Basement Walls:
[ ] I 1. Basement Wall 1: Click here to select Assembly,0.0'ht/0.0'bg/0.0'insul,
U-factor:0.000
Insufficient data: Assembly U-factor cannot be 0.
Comments:
I
Windows:
[ ] I 1. Window 1:Vinyl Frame:Double Pane with Low-E,U-factor: 0.320
For windows without labeled U-factors,describe features:
#Panes Frame Type . Thermal Break?[ ] Yes[ ]No
Comments:
I
Skylights:
[ ] I 1. Skylight 1:Click here to select Assembly,U-factor: 0.000
For skylights without labeled U-factors,describe features:
#Panes Frame Type Thermal Break?[ ]Yes[ ]No
Comments:
I '
Doors:
[ ] I 1. Door 1: Glass,U-factor:0.340
Comments:
[ ] I 2. Door 2: Solid,U-factor: 0.310
Comments:
I
Floors:
[ ] I 1. Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,R-30.0 cavity insulation
Comments:
I
Air Leakage:
[ ] I Joints,penetrations,and all other such openings in the building envelope that are sources of air
g
leaka a must be sealed.
[ ] I When installed in the building envelope,recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture
and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfin(0.944
L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled.
Vapor,Retarder:
[ ] 'Required on the warm-in-winter side of all non-vented framed ceilings,walls,and floors.
Materials Identification:
[ J Materials and equipment must be identified so that compliance can be determined.
[ ] Manufacturer manuals for all installed heating and cooling equipment and service water heating
equipment must be provided.
[ ] Insulation R-values and glazing U-factors must be clearly marked on the building plans or specifications.
Duct Insulation:
[ ] Ducts shall be insulated per Table MAT 1.
Duct Construction:
[ ] All accessible joints,seams,and connections of supply and return ductwork located outside
conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed
using mastic and fibrous backing tape installed according to the manufacturer's installation
instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted.
[ ] The HVAC system must provide a means for balancing air and water systems.
Temperature Controls:
[ J Thermostats are required for each separate HVAC system. A manual or automatic means to
partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided.
Heating and Cooling Equipment Sizing:
[ ] Rated output capacity of the heating/cooling system is not greater than 125%of the design load as
specified in Sections 780CMR 1310 and MA
Circulating Hot Water Systems:
[ ] Insulate circulating hot water pipes to the levels in Table 1.
Swimming Pools:
[ ] All heated swimming pools must have an on/offheater switch and require a cover unless over 20%
of the heating energy is from non-depletable sources. Pool pumps require a time clock.
Heating and Cooling Piping Insulation:
[ ] HVAC piping conveying fluids above 120 T or chilled fluids below 55 OF must be insulated to the
levels in Table 2.
Table 1: Minimum Insulation Thickness for Circulating Hot Rater Pipes.
Insulation Thickness in Inches by Pipe Sizes
Heated Water Non-Circulating Runouts Circulating Mains and Runouts
Temperature(F) Up to 1„ Up to 1.25" 1.5"to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
Table 2: Minimum Insulation Thickness for HVAC Pipes.
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
Piping System Types Range F 2"Runouts I"and Less 1.25"to 2" 2.5"to 4"
Heating Systems
Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0
Low Temperature 120-200 0.5 1.0 1.0 1.5
Steam Condensate(for feed water) Any J.0 1.0 1.5 2.0
Cooling Systems
Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0
and Brine Below 40 1.0 1.0 1.5 1.5
NOTES TO FIELD (Building Department Use Only)
f
I
07,116;2003 14*4� 5 33 w 048 �4UD' DO`J ;OPdS(Mill:i lUl i rHkot W
l
Town of Barnstable
Regulatory Sercvvtces
f Thous F,04a,Director
Tam Perry, Su0cling Couad inner
200 Maier Safes, Hysaois,MA 02601
Ot�icc: 308-86'2-4038 Fax: 509-790-6230
Property Owner Must
Complete and Sign This Section
If Using A ]Builder
✓I�_ `S � �,. f �/�A' , as Owner of the subject Mperty
hcrebp authoize i/?� Mb6V 1 �r ;7 / to ac:on Tlfty beha.lf,
in all ratters teluave to work authoA2ed by this building permit application tor.
�W.
(Ad ere of Job)
S*=tlaxc of C timer. . Date-
Fart Nun!
sAnvCo�sn�,ux�a�(,�
Q:woc�4:G�w:vEA�aa�sSi�N
Assessor's map and lot number � �i �� /�/�
ter.. v. F?ME t0�
Sewage Permit number ...... .......................................:.........
'\ l' � Z B9B LE, i
House number ........:........:.:.. MASIL. p0 1639' \00�
0 YPY y
TOWN OF BARNSTABLE
BUILDING INSPECTOR
APPLICATION FOR PERMIT .TO Construct Single Famil Dwelling i
TYPE OF CONSTRUCTION ...........OOd Fram..........................................................:........................................ I
September 26 t984:...
I
TO THE INSPECTOR OF BUILDINGS:
The undetsigned hereby applies for a permit according to the following information:
Location ........... #. 9...... 10e .be.5I ey....i .01..P. ............................................................... {
i
Proposed Use ......................................
...........................................................................................................:............................ I
Zoning District R. B. .............Fire District. .. �anni8.............. ...... . . {
Ca ricorn Real Trust 76 Falmouth Road H annis Ma� s
Nameof Owner++....p.............................. !............................Address . .... ..................................... e...... .......... A l.........�.
Name of Builcl rr` .co• Real Est.Dev Co O.JTI 9.ygddress .............Sam@....
Nameof Architect ......................:..:........................................Address ............................... ........... ... (.
Number of Rooms .....:S�.X..................: ...........Foundation .......P.tgx........ . ........ . ....
i
Cla board andor Shin es As a
Exterior .......... ...................... (.................... ....................Roofing ...................p ... -ti.. ,�'f�
Floors Carp@t ...................Interior .5ho.etro.ck.........
--Heating Gas F►W -A I.. .................................................................Plumbing ...........TWQ......:'......�'+oppu.,-o ..............
Fireplace None ..Approximate. Cost �0 000 00 .
f
Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area .955;..QQ i...f t.�.•�l._... .
Diagram of Lot and Building with Dimensions Fee .... ...........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
is
Name . ? �/.., ..� .�r... .n! .. ..... ..�x'��a.
Construction Supervisor's License ...AQ0989..................
CAPRICOFU REALTY TRUST A=270-101
No Permit for ....1 3-2.§.WXY..............
.......... ....................
Location ...Wit..9....... 5..XAkUe-q)-ey..Cix.Cle.
.....................Hy=ivq...........................................
Owner ......Q MWQM. ..Real:ty..TZUSt............
Type of Construction ...Frame...........................
........................................... ....................................
Plot ............................ Lot ................................
Permit Granted ....7aqu.ar 85
y
..301............19
Date of Inspection ....................................19
Date Completed ......................................19
Assssor s ;ap and, lot numbter- :......... .,,...
F tNe t
OK Tv 8dl4L q, PE?eM fT' AA FV&V ER Pic
Sewage Permit number . .: ... uST CONNECT TO TOWN SEW
BABBSTA-D LE
House number .............. �a
.
1639-
TOWN OY BARNSTABLE
BUILDIIGf INSPECTOR _
APPLICATION FOR PERMIT.TO •Constrtxc. „ S tag e...Emily•..Dnlling ........
TYPE OF CONSTRUCTION ......WQ.P.d Fr4AQ ..:. .... .. .. ..............
17
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ...Lil. r. .#....9.. Wellesley...C1e7.e.,. ..iVarax>�.s,. a�as:� ..:.:.. ` . ... . .....
ProposedUse .................................................... ... .. r. ..........
a ,
Zonin District R. A•............... ....... .. . Fire District. .:. Hyaxuli8 .........
Name of Owner.{,,aPr.3.CpTT3..Rg.a1.V.::!rrll$:t. .Address .765..
Falmouth••Road #i axis Mass
Name . Build�tX'ftYlCQ..R@A ..F.'`.B.trDevo4o1•yInd.* ddress ..:........c..,��16...•..
Name of .Architect- ....... .................. .......Address .. t
Number of Rooms, ......S.LX.......
Foundation ........P..lw`y ......: ,....:. ... ....
I
Ex°,erior Clapba.ard:.and,lar...Shingl.®s . � .•: ...Roofing A•sphalthingles•
Inter.ior
rs .,..Carpet............................................................. :......:.Sh@et�'O�k
Floo
H'6ating-`GRQ �, .F.:Id g... ...... . .. .:P'lumbing ...... .. 'iKO . ...
'�P$®1^
Fireplace .NO110..:...................... ................. . ........ ......Approximate. Cost :....
1
Defir''itive.Plan Approved by Planning Board. _ __19 ______ . Area : .I;qy.. f:,�.........
Diagram of Lot and Building with Dimensions Fee �� 7
.4 . • - ...
SUBJECT TO APPROVAL OF BOARD OF HEALTH-.,-.
i
-.
i
7
OCCUPANCY PERMITS REQUIRED. FOR NEW DWELLINGS
I .hereby agree, to conform to all the Rules':and.,Regulations, of-the Town of. Barnstable regar ing the above L
construction.
Name: .. .. • :�X'�B�•
Construction:,Supervisor's License .............
wCAPRICORN REALTY TRUS
27480 12 Story
......... Permit for ....................................
Single
Family..pwaunt......................
Location
Lot 9, 36 Wellesley Circle
.............................................4............
nis an
.........Hy
................................ ............................
Owner .......
Frame
Ty
pe of. Construction ..........................................
............................. .......... .............................
Plot,- lot.................................. .........................
January 30 19 85
........................................
Date of.-Inspection ....................................:19
Date c leted pp . ........ ......
r ry
C-1
ti
C�z
OL
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1(Z N C.
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.101
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CERTIFIED PLOT PLAN
• �,+� R03rii� f� LO
1 1N
SCALE, / ,,_4o DATE, //Xs
I CERTIFY THAT THE
' r 90
13TERE REGISTERfE® G4.9E1�'I' SHOWN ON THIS PLAN 13 LOCATE®
Joe. NOA, ' ,,. ®N 3ME dROUND AS INDICATED AND==C11IIL LAN®
® CONFORMS TO THE ZONING LAWS
ENGINEER SURYEY®R ,SYe i� , �+ ✓
-�...`�"'..., OF ® RNSTAAL MASS
Y62' MAIRI "STRE•E'4 C� Y� 7 ,1., o
I
t ;HYANRI u`
3 :a£ S, .MASS. SHEET ®F�_ 0 TE RE®. LAND 3URYEYOR
},
•. a- .�.�: �• r�`: .� rh, 4., r .��! .. ..,� f ) �i�� ITM /�`r A.. �N:` iifl�� ,r s.d'� -r'�,I :{ � ;w..t,
TOWN OF BARNSTABLE
BUILDING DEPARTMENT
= se8a°T of TOWN OFFICE BUILDING
rua
raj +a�9• �� HYANNIS, MASS. 02601
MEMO TO: Town Clerk
FRW� Building Department
DATE A z d4,4 /ejo�3'
An Occupancy Permit has been issued for the building authorized by
BuildingPermit #.__...».».. o .:.»... ........................»........................»»»...».._............
issued to ... »»...».. ..»....»..»....». �-.......»
Please release the performance bond.
k ..
" > TOWN 'OF BARNSTABLE Permit No" -------27480
i -- - --------
Building Inspector
naurraU Cash
OCCUPANCY PERMIT Bond ----__
------------------------
Issued to Capricorn Realty Trust: Address
Lot 9, 36 Wellesley Circle, Hyannis'
Wiring Inspector „- Inspection date
Plumbing Inspector , �'� Inspection date
Gas Inspector �7�{ � G� � � Inspection date 4 A)b
"
Engineering Department � � � Inspection date
z:;,A'dnv c� j
Board-of-Health i�lGfCt j2!�!!,�/LGL2 Inspection date 712-hr
THIS PERMIT WILL NOT BE VALID, AND. THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
.... ....................... .......... ............::�::-:�.-
(� 0, Building Inspector
►;✓ngineering Dept. (3rd floor) Map ZD Parcel /D/ —q09 Permit# (10
House# �0 5.Date Issued `1—
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) 4/—J'
Conservation Office (4th floor)(8:30- 9:30/1:00-2:00)
wd* OftNE
\ 19
• RARNMOLE.
TOWN OF BARNSTABLEA
MU
Building Permit Application CON&VU P=W an gig
w3 NO To
Proj t St Address
Village f I �v GQ T
Owner Address
Telephone —
Permit Request
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Er'_ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No
Basement Type: p full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing New Half: Existing New
No. 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
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
E ❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes, site plan review# -
Current Use Proposed Use
Builder Information
Name @ Telephone Number
Address License# y4
Home Improvement Contractor# 116 /7�4
i
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO_/4111cy
SIGNATURE /- DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
� dal
� �y f v: G•
FOR OFFICIAL USE ONLY
_.,
PERMIT NO. �eJ CJ
DATE ISSUED
MAP/PARCEL
ADDRESS VILLAGE
,.OWNER
DATE OF INSPECTION:
FOUNDATION —`
FRAME
INSULATION ''
r --
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL'BUILDING
DATE CLOSED OUT -
ASSOCIATION PLAN NO. s
w Beat
�FVE t°w
ti
The Town .of Barnstable
RAMSM9$ 0 Department of Health Safety and Environmental Services
rFo 59. is Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only '
� i
Permit no.
i
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.
r � _
Type of Work: �2G rc.�'Y7 Est. Cost /S 01
Address of Work: �4,/,a D,� .Zf.�'l� C �°6�
Owner's Name
Date of Permit Application:_
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under$1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
f 9 //� /7
Date Contractor Name Registration No.
OR
Date Owner's Name
a..
The Common wealth of Massuc h usetts
xii --= •_�• Department of Industrial Accidents
•.\a=:;"..= r =+` h0!l !f'ashitt�;ton Street
Bmvtott. Alas. 02111
Workers' Compensation Insurance AlMdavit
�1ililic�int information• ^• -_..._ . _ Plc�se I'RIIVT'lebi•i�`•'""-'�•��� '�' ---'~
name:
n�a!121 r, 401?
location- ,VS i21 N E T 72 a q D
city V"✓I'IDGt �. �2 nhonc# 40J-7/2--�Lo?S0
177 1 am a homeowner performing all work myself.
I am a sole proprietor and have no one working in any capacity -
1 am an emplover providing workers* compensation for my employees working on this job.
contnlnv name:
city• 10" BGr'7`0 ohnne .tea .5-0
incarince cn Itoiicv#
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�[i I am a sole proprietor. beneral contractor, or homeowner(circle one) and have hired the contractors listed below who ha.
the following workers' compensation polices:
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tin phone#•
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incurincc rn ._.._
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cmmPln.• n1rnc'
address �
sin• rhnne#�
incarinc co nolic�•# _ w
Attach addition eraal sheet ffnecesia -:.._._• ..^- :i. �"�`�•iti�i.: rr. .`.c:�^'-: a'•"...w�`
_ � � -'..a ram..-�....�._,-._--:aae•...: •..w. --:.:n.
Failure to secure covge:ts required.:undcr Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a line up to S1.500.UU andiur
unc.'cars'imprisonment as%well is civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a
Copy of this statement may be funi•nrded to the omce of investigations of the D1A for coverage verification.
!do herch.r certil•tinder the pains and penalties ojperjurt•that the information prodded above is true and correct.
Signature Date
Print name o >Lt (5;,p Phone#
'•official use only do nor write in this area to be completed by tiny or town official
permitAicense# r *�
city or town
Building Department
• Clucensing!Board �
o check if immediate response is required asclectmen s Office t..
�.. C311calth Department
contact ncrson:
phone is: r lOthcr____� Js.
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers* compensation fo
employees. As quoted from the "fa��". an cnlpl(ree is dcfincd as every person in the service of ::nether under an
contract of hire, express or implied. oral or written.
An rmplorrr is dcfincd as an individual, partnership, association. corporation or other legal entity. or ally two or
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. Howe,.,:
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 dwellin
or out the :_rounds or building appurtenant thereto shall not because of such employment be deemed to be an etltp
MGL charter 152 section 25 also states that eti-cry state or local licensing agency shall withhold the issuance c
renci�ai of a license or permit to operate a business or to construct building in in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Addi,ionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
pertbrmance of public work until acceptable evidence of compliance with the insurance requirements of this chap
been presented to the contracting authorinJ.
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Appiicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not tite Department of Industrial Accidents. Should you have any questions regarding the "taw' or if you are regc
to obtain a workers* compensation policy. please call the Department at the number listed below.
City or-howns.
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottc
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding tite applicant.
be sure to fill in the perm ittlicense number which will be used as a reference number. The affidavits may be return
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for;you cooperation and should you have any que:
please do not hesitate to ;,give us a =11.
7.
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The Department's address. telephone and fax number.
The Commonwealth Of Massachusetts =�x
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Ma. 02111
fax #: (G 17) 727-7 749
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Restricted To: 1G 81231
DEPA9THENT OF PUBLIC SAFETY
%J CONSTRUCTION SUPERVISOR LICENSE 00 - None
Number: Expires:
1G - 1 5 2 Family Homes
Restricted TO: 1G Failure to possess a current edition of the
Hassachusetts State Buiildinq Code
JOHN H HCGARRY is cause for revocation of this license,
37 ASPINET RD
S YP,RHOUTH, HA 02664 ✓
HOME IMPROVEMENT CONTRACTOR
Registration. 116114 I
Type :-, .INDIVIDUAL 1
Ezptroltloh 05/254'
MCGARRY CO.NST CO
MAMCGARRY ;
pINET,RD
ADMINISTRATOR
SO YARMOUTH MA 02664
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