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HomeMy WebLinkAbout0100 ANGUS WAY Lti c nL}'. , li a ed SI �'v� '�Y ,Y. «� "t r T il+ � X ,,a C �•' ti ` r$,, ry 1{u'':: 47, Nil Jf !t xlf •� d .) 7 d c , t . , ' it n - ,. '. , : .. _ • � y. i ` u , I 11` , v 1 _ � ,r rc s 5�, •.� h, e e X ,. .'"Ty�d, _'��- :.Y •T -:F of [ '. '�.(,• .i. is• • � .: ., . 'si�: Xr s:. v r ^ �. I l ;. 'v4 :, Vr, tJ. U Y :A, '�;.h F i •� } � it•� X �. { ' ;..,. :{, . .,;. ,. ,'-xaY@t. h �•' ;d,;, ,:': ° , .il , V "� Y F rtn'..:7r.x i.' A"' . q.."�.. •• ,t ..� ,,,. .� di ,. ',,., .,,..'*v � �;;.j, Nr, �F:i iN' _ ,,,"e ..Y` t ':fi, aC+ '�0.��'�`i � '�d ,�;r «d.. 5" « d�.. n o X X•;.', t+, :, v ',:" ".;. " ', R iv k w" ti r "y#,h ';t a.. v o, P .. r d• •, r �., .:a , � d ... a'`"d �.i;;_.M ,i. G � 1} in.. � ^«.�it. a .rt, } n � w .. .. ,. i .. r ,... p .. -� ,... .. .. _.. i q � _ ' � ,. 'a ,i �, i d 3• _ _ ♦ . .,. a ., r �. � �� �.- i u ,. �, � �+ ' ',3. ''... ...r., H � ., f � ^.� ,,. __ � 4.- '' .. .19 . , '�V 11 .. � � � �. 1, � rry �. f _ i 1 ,. 1 a ry _ ,' '1�5. a ' .. .- o'' r ' ]. � I ' F' •� i, e. ,. � , `, r 1� r .. �' �. � , ,� � . '. t _ r �� _ .. ��,. 5 . .. . w s .. '�, [ t er i i d . 'I` t . ;: r � t. _ ._ • tr �. ., a.. _ i �� � �� .,: .f . ,: .. . �. .�. . r - Y i , 'q : .' „ r ,, ;. , ,.� _. ; :: �. ;, ,, - ,, c ., . . • - � �' ,� ' u �J d - - _ �,. � - i1, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ' Parcel ®d Application# Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee C�?o 9, S-C) Date Definitive Plan Approved by Planning Board l Historic - OKH _ Preservation/ Hyannis Project Street Address ``( Qo y tA) 7 Village C% /�-1- V r� Ve Owner �Qt 1 �� L)� � YY�a r\ Address C� �P`Sr �. e�-4P�-v+1� Telephone — �� C Permit °° Request Ad A c�1 1 c K o r\ 1 S�' aar /re\'S�I C? / l ► CA-e-c 6.9 C ge jMa 1-�p_ r,,_ k"v, 4-2r+ ay- ke," Square feet: 1 st tFoor�: ex�s)in prop"sad 2nd floor: existing proposed Total new Zoning District K — Flood Plain INJO Groundwater Overlay Project Valuation g5QC70 Construction Type Lot Size r 3 S AC r-9 Grandfathered: ❑Yes �_,YNo If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family units) Age of Existing Structure (O YrS. Historic House: ❑Yes 2d'No On Old King's Highway: ❑Yes p�lo Basement Type: ❑ Full Vcrawl ,„'Valkout ❑ Other ?JR r- ez Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) cl 2- Number of Baths: Full: existing 2.- new C) Half: existing new Number of Bedrooms: e f existing onew a Total Room Count (not including baths): existing 11�7 new First Floor Room Count Heat Type and Fuel: ❑ Gas +/OII ❑ Electric ❑ Other Central Air: ❑Yes. YNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes O No Detached garage: 10existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: Vxistinq ❑ new size _Shed: existing LYnew size I S 20ther: C-op v 0�- C>c `i S Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ rN Commercial ❑Yes G]'No If yes, site plan review# � r'' Current Use NPS+ c., Proposed Usec 1 t � APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name h6-0 Mee +` YA Telephone Number � �' 2-4 Address C 6 Ce.,-A-e-r- License # CS — 0 Z 6 3 Gj Home Improvement Contractor# ` S� Email ZOO �c `f Q� �06. Cc-"" Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ►e`er IS S I SIGNATURE DATE d f FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. r. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. CL C L �u11 CL SX q k 2.0 1 IBC 20 4 ' d W �r N o 0 1C Ncd VI cn *00tt 2� Ww000 0. Office of Investigations ' 600 Washington Street Boston,MA 02111 = www.mass.gov/dia s ffidavit: Builders/Contractors/Electricians/Plumbers Workers' Compensation Insurance A Applicant Information Please Print Legibly . Name(Business/Organization/Individual): MOHHMED RAHMAN Address: 66 CENTER ST, UNIT 2-3 ' City/State/Zip: DENNIS PORT, MA 02639 Phone#: 201-248-9156 ' 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 construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. Remodeling 2. ✓ I am a sole proprietor or partner- These sub-contractors have ship and have no employees 8. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp.insurance.# 10. Electrical repairs or additions required.] 5• We are a corporation and its 3. I am a homeowner doing 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. y Signature: Date: Phone#: 201-248-9156 Official use only. Do not write in this area,to be completed by city or town off iciaL 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 J Contact Person: t Phone#: ti o MAW. r Town of Barnstable s639. �0 Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder f as Owner of the subject property hereby authorize -0 to act on my behalf, in all matters relative to work authorized by this building permit application for: 100 A C00'4erV (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\DecolliMAppData\Local\MicrosoR\Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\E)PRESS.doc h Revised 040215 CXiV 017ice of Consumer Affairs&Business Regulati n OME IMPROVEMENT CONTRACTOR I License or registration valid for individul use only 4. egistration: ,'173492 before the ex nation date. Type: p If found return to: YO/9 2016 DBA Office of Consumer Affairs and Business Re ALL CAPE r 10 Park Plaza-Suite 51T0 gelation RENOVATION _ I 1, 1 Boston,lVJA 02116 MCHHIVIED RAHMAN 66 CENTER ST UNIT DENNISPORT,MA 02639f'- _ 7 }gam Undersecretary ----- Not valid without signature w Unrestricted-Buildings of any use.group ewhich "contain. ess`than 35,000 cubic feet{991IM).of enclosed space. Massachusetts-Departmen-Vof Public Safety - #,r, Board of Building Regulations and Standards x, ' Construction Supervisor License: CS-105918 { Failure to possess a current edition of the Massachusetts' MOHHNIED S7Ogg�3 State Building Code is cause for revocation of this License. 66 Center Stree t ZZ For DPS Li censi�ng information:visit: Unit 1-2 _ www.Mass.Gov/DPS '',:: Dennis Port M _ ._. - — 4. _ a P%•f;.,.�11�fte�c- )i of Is E.xpiration Commissioner 09/15/2016 Home Energy RaterS LLC info @EnergyCodeHelp.com 888-503-2233 Duct Leakage Test Address- 100 Angus Way Centerville, MA + Date — October 3rd, 2016 Contractor— Cape Cod Central Heating & Cooling Conditioned floor area = 1,944 Sq Ft. Total Leakage-Includes Air Handler/Furnace , To comply with the 2012 IECC Energy.Code in this home the Maximum duct leakage CFM < 77 CFM (1,944 /100 x4 =77.76) Duct leakage tested = 66 CFM 4 The duct leakage tested at this residence complies with the 2012 IECC Code Test Mode - Pressurization Test Pressure = - 25.0 Pascals Equipment - Series B Minneapolis Duct.Blaster Duct Leakage as Percentage of Floor area = 3.39% gU1LD1�1G DEPT. OCR 2 4 2416 1 BAR���P�LE j60N OF Contact our office with any questions, . z Chris Mazzola Home Energy Raters LLC i __-- _---- - -Commonwealth of_:Massachusetts-_.TM -- Sheet Metal'Permit , Map Parcel Date: Permit Estimated Job Cost: � �© ��°U j PerIDlt.Fee: $ • • ���® 01 Z016- Y - Plans Submitted: YES NO . OF BA , a Plans Reviewed. YES NO BL Business License# Appficaut License# I/��� Business Jnformaflon: Property Owner I:Job.,Looation:Snfb=.ation: Name: V"�e l s.�c1 �/ v�1►�'`�''� Street u '� lj ,r►� �� . Street: ` o 11-3 CityTrown: Ci�r own: con Telephone: ?7y �� �� Telephone: � v � l ` V r Photo ID.required/Copy of Photo.I.O. attached: YES NO sir iaifild. 11/M-1-unrestaeted.license J 21 M-2 rest icted•to dwdlings.3-stories or less and commercial up to 10;000 sq. ft /2-stories or less Residential: 1-2 fimily Multi-family ' Condo/Townhouses Other Commercial: Office Retail Industrial Educational' Fire Dept.Approval Institutional_ Other Square Footage:�under 10,000.sq. ft �/ .over,10,000 sq.f. Nuiniier of Stories: Sheet metal work.'to be completed:.. ',New-Work: ' 'Renovation: !/ HV- AC Metal Watershed Roofing. Kitchen Exhaust System Metal-Cbimney/Vents Air Balancing : ! Provide detailed description of work to be done: J d% eel a Gl►^' ' AIL • _ _ r ` _ . i .INSURANCE COVERAGE: (, I have acurrent liability-insurance policy or its eguivaletrt which meets the requirements of PL G.L Ch.112 Yes❑,No [I If you have checked Y_M.•indic ite the type-of coverage.by chedidng the appropriate box.below: - I A liability Insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE INAIVER:9 am aware-that the licensee cfoes.-not have the insurance coverage required by Chapter 112 of the i Massachusetts General Laws;and that mp:signature on'this-permit application'.walves this requirement: Check One Only owner- ❑ Agent ❑ - Signature of Owner or-Owne -z Agent By checking this•box❑,I hereby certlfy that all of the details and information-1 have submitted(or entmed)regarding this applicatlon are true.ihd acwrate to the best of-my knowledge and'.thaf all sheet metal work and installations-performed under the permit issued:forthis..applicatldn win be ` In compliance wftli all pertinent provksioh-of the Massachusetts'Building Code and Chapter 112 of the General Laws. Duct Inspection requlred prior tcrinsulatiori installation:YES `" NO Progress laMectianfi Date Comments FbRI Ins>;iectiOII Date Comments Type cf'License: 3Y ❑Master, 4 r lue ❑Master-Restricted e ❑Joumeyperson . Signature of Licensee permit.# / •❑Joumeyperson-Restricted Ucense,NuMbor, =ee ❑ Check-at www.mass.t*jV1dol inspector Signature of Permit Approval - �#efixt�#r���r�st �Eci�ettts . t ue 170 oars 60 �a meet „ . '4�ar�ers'Crruip��€�,Ins�-an�.E�:�daui�B���-sf�"flg�:�7-�.��ri�iaslPlutubers - - Iu�m�ta-i�am. PleaseY°rnYf . IeTam.� Zed � 77 tyre you employer?Check the appcupriatebu= Type of Poi (�m� , ;_El am a emplayer with. 4- 0 I am dal Confrac�ir and I ❑New�stmct ion. IopeeS(f a andforpait-f=e)-* havehsrvathe uEom I am a sole pmpsietor orpariner- listed on the atumfied sheet 7-.J r!f 7cielxgg ship and have no employees Thew sub-contractors have g- ❑Demoiitiau -wo&:ing far me in any capaci�-- eusplayeea and have wo&=s'.. 9_ F1 Iluildmg addition Wa,ur dmxs'cam{r_instm: ce eomP_fncrtrarr T °ue�l 5:0 We are a carporxEamandits ME]Electi a1 repaia or additions 3-❑ I a=a homeowner 6bing all Mork officers have exec ised their ILO F3umbing repairs or additions..' right.ofelw . anpei mm myself r[No wodzreCD=P- Y 12-0R6afsepam Eat_Insum-nm r5q6re&l '"�IIy E771TI1C8�fI]>�C�]>=l�S bOZ�rI7ffiSt i�58�OT��5fCh9h�'1tTViPeh^�v�1PS�D�CHS�®II7;1L�+hrert� _ i . �oIDffiWIlE3S FCbD SgbL73t'E�S 8t�.307f t�lEy BLE+�v'fil'�R�C 8��$7ffibLE C04hSCiT4S EI�SL�8�ti'&�Sd3Pli ID SaCTL ffi.Yf rT+xic Th15 bCXIDtESt SCHCIIE�aff 3I�7hLiII31 SLePY Sllb'R�gtlse Ta�C of Sae mdSfs�SrhPthe[E7EI1.4L�ttse � m4byaes If the F—Ae t-Y—&--ere Co-7 yolky—zb- 1 axs arr e7�ycs that isFrrrvidfsg t�irri}ers'canaiutr irurtrartc�for m}*cmp£ay�s s Belau is i�iz pat}*raid jnb sits s . Insuance CompaayName:' -. Pafiry:9 or Set ius-Lit. Fxgiratio�Date: ch a capy of the vmrkers'compensatiiM policy tian Page(shwwmg the poficy==her ava erghra^t4an date). Failure to secure canm-rage as nqaire,3nuder SecQmn 25A of t0l.c 152 can lead to the imposition of cdaEaal pmdt ies of a < . fine up to SL50D OD and/or ow-yearin4misamment as weil as civil pemdties in the fb=of a STOP WORK ORDh3Zand a E= ofup to$250-00 a dry agaffisf the viobdur_ Be advised the a czpy of this stgement maybe ceded to the Office of , Iuvestipdons of the DIA€or; =a=coverage v OD- I dd Agrebp Centi u pains Qncl par�ab`iss a ury$raf9�s rfnrrrrtdiaa prat�id £a e"/trua and correct: • SiEnatur�: ^ � �� F3ffZiAL ass at-nT Ua rtat writs in fftis urea,tabs tau ale#ed by city as tvfrzt a i iuL� City or Town: P #iL.ense ' PssuizLg,c'��athnaitg{drele onejt, `` . L Sward 4f Health 2.Bx9ding Ikepartrncut I Cify1rawa Clerk 4.EIectrical fnspector S.Fib ag hLV=tvr Can�ct Ferran: Ph2ane>t#: F • � a Information anal stfuctions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Ptummatto this statate, an errrployee is defined as"__.every person In the service of another under any contract of hire, express or implied, oral or written_" An empL7ye:r is deiced as"aa 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,pminership,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 stales that"every state or Iocal 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 arty 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 chaptei have been presented to the contracting authority_' Applicants ; Please fill out the workers'compensation affidavit completely,by che�cldug the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone number(s)along with their camtificat*)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP.)-vviano 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 i 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 roquested,not the Depa lment of Industrial Accidents_ Should you have any questions regarding the law or if your are required to obtain a workers' compensation policy,please call time 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 tb fill in the permit/license,number which will be used as a rei:erence number. In addition,an applicant that must submit multiple pernitlliceamse appIir ations in any given year,need only submit one affidavit indicating current policy information(ifne�cessary)and under"Job Site Address'tame applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or mazked 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 fiIled.out each year_Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venue CLe.a dog license or permit to bum leaves etc)said person is NOT required to complete this.at$davit The Office.of Investigations would like to thank you in advance for your cooperation and shoul .you have any g� ions, please do not hesitate to give us a call. The Deparhnent's address,.telephone and fax number. aC,Commor WWth of MassachU=ti -, . Depaitme at of Ind al AQcidwts ` GM-Washbom&Z,=A $ z�IAA G21 I I Tel A 617 727-4M QXt 4-06 or 1-W MA�,SA Revised 4-24-07 Fax#6I7-727-T/-49 • gavfdia - - AWE� Town of Barnstable , Regulatory Services s" KAS& Richard V.Scali,Director 6;e►�� Building Division.. - Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstableana.us ' Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete arid,Sign This Section If Using A Builder , I, eel YkCL,_ as Owner of the subject property hereby authorize Cc-°C�COA C►i-C " G� �G v'"P on my b eh4, in all matters relative to work authorized by this building permit application for. - < VI (Address of Job) "Pool,fences.and alarms are the.responsibility of the applicant Pools are not to be filled or udhzed before fence is installed and all,final inspections are performed and accepted. Sigmture'of Owner Signature of Applicant Print Name Print Name = • QTORMS:OWNERPERMISSIONPOOLS s `' COMMONWEALTH OF MSACHUSETTS BQAF'D OF SHEET METALWORKERS �` ISSUES THE FOLLOWING LICENSE AS A ,10UR7NEYPERSON UNRE5TRIETED } BRANDON C CAMPBELL ` l 533 S MgIN ST CENTEFWVILLE,MA ,02632�4(19 Z , a r r� ASSACHEU�SETT \ ( LQ BE_ jUSA END-9 49)f✓ ER t r �V � • • y . ;CaMPhBEL L L f 9RANUON r e 633 SOUTH MAlw.STREE s �, CENTERYILLE MA:02632 3409,E � . JDU 0803-3015 Rev.071S200a I J I r; 7l Ali` oFt „ Town of Barnstable *Permit#�- Fapires 6 months jrom issue date Regulatory Services Fee • BAMSfABIX MASS.039. Richard V.Scali,Director A Building Division ® uay Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 JUL 2 2 2016 www.town.barnstable.ma.us TO1 A, � � � � Office: 508-862-4038 Lo cos. 9�a 6-SoTABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 2�I7o Co'Valid without Red X-Press Imprint Map/parcel Number Property Address I r) ®Residential Value of Work$ 2—ZtOOa'O0Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 04C�-e 1 C �- r - Son Lin, , Co,,-{-e>r v i 11 p Contractor's Name I v t D u u Yin c.D ) A M Telephone Number S 02^ %b CA 6 �Z� Home Improvement Contractor License#(if applicable) 92 Email: Jep V L C,20o o P )°A Woo, Care,. Construction Supervisor's License#(if applicable) ( U gj mv�orkrnan's Compensation Insurance Check one: VI am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ t(check box) V Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to a' y N— -POE C ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) � e-side Replacemen Window door /sliders.U-Value ® U (maximum.32)#of windows Z #of doors: Q_ ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 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. SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.OUtlook\2PIOlDHR\EXPRESS.doc Revised 040215 r f � wetvsrnate, • , , Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, /V76-t1-5-CA MA ,as Owner of the subject property hereby authorize 1"1 o irk a K E i) o.1 to act on my behalf, in all matters relative to work authorized by this building permit application for: 00 t\5 vs . CPr V (Address of Job) oe .. Signature of Owner Date Print Name If Property Owner is applying for permit,please completeAhe Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 Office of Consumer Affairs and B s ReguI tion ; r �'arl� Mai Suite :�17U; Boston; �I�ssach�setts 02116 Larne n p overn t Contra for Re istrat�0 R gistration 173492 po DBA ;1 Exp tation 10/9/201 G Tr# 258098 ALA GAPE RElC?�/`A�T'BON IIJ[ i +swynrr r+WwJ+1 Mb HMED. RAHA V k flp yy 66 CEITR STT UIVI�` 1�2 SPOR MA 0'2639 F. U date Address acid return c r P e and 11�Iark reasan far change, SCA,I ,�J 20M-Mi u Address R nervaa rrpg► oyrnei t [ Lost Card �.T� �aninao�nic�ecr��a�C��aa.c�cc�el� . Office®f CoiBsmcr �ffanrs Business itegalatio� . Lici~esj oregistratiaia:valid f®r ie�divaduls�only OME IMPROVEMENT CONTRACTOR' before the expiration date If fauiid a eturn to agist:anon: 17 92 Type off of Cbmiuner Affairs aiid Bus ness R;eguaatian I4 Park Plaza Suite 5A70 Expiration.- 10f /2Q16 :Dt3A � ��� Bastan,IVIA OZ A 16 ALL CAPE'RENQVR Ril10N } , "M®i-IF'MED.RAhiMAN' 66 CENTER ST DiVIT�12� iJENNISPORT, MA 02639 tTradersecrct.4r valid �viths ut.siguiatur�- i u e i Massachusetts-Department of Public Safety Board of 8uiiding Regulations and Standards Construction Super% sor License CS-105918 MOEMWD S 66 Center.Street ; Unit 1-2- Dennis Port MA d?639 Expiration 09/15/2016 Commissioner 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 UV Name(Business/Organization/Individual): MOHHMED RAHMAN Address: 66 CENTER ST, UNIT 2-3 City/State/Zip: DENNIS PORT, MA 02639 Phone#: 201-248-9156 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 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 working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp.insurance.: required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their, 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signatur Date Phone#: 201-248-9156 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#: t, l f RAHAM-2 OP ID SW DATE(MMfDDIYYYY) INSURANCE.,.,CERTIFICATE OF LIABILITY:INSU N E THIS CERTIFICATE IS ISSUED AS AMATTER 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(les)must be'endorsed. If SUBROGATION IS;WAIVED;subject,to the terms and conditions of,the policy,certain,policies.may requlre.an.endorsement A;statement on this certiflcate:does not confer rights to the certificate holder In lieu of such endorsements. PRooucFR NaME. Rogere and Gra Ins Agency Main Street America Group-So PHo E 866 456 4909' Nc;866-332 4776 Southern Region c No E Po Box 2006 ADDRESs:servicecenteramsa rou .com Keene,NH 03431 Rogers and Gray Ins Agency. INSURERS)AFFoRDING.COVERAGE NAIC.a INSURER A!:Main:Street America"Assurance 29939:: ; iNsuaE� MohhmedAahman msukst s. 66 Center St Apt 2 3 Dennisport,MA02639-1551 MsuRER`C` INSURER D. INSURER E INSURER F. COVERAGES: CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO'CERTIFY THAT THE'POLICIES:OF INSURANCE LISTED BELOW.HAVE BEEN ISSUED.T.0 THE'INSUREDINAMED:AB.OVE,FOR THE POLICY PERIOD INDICATED.: NOTYVITHSTANDING ANY REQUIREMENT,TERM OR CONDRION 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 MALL THE TERMS, EXCLUSIONS AND CONDITIONS:OF SUCH;POLICIES.LIMITS SHOWN,MAY.HAVE:BEEN REDUCED BY PAID'CLAIMS. . LLTTRR TYPE OF INSURANCE.: PIJUCY:NUMBER MM1DD MMIDDTI YYY LIMPTS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,00%00 CLAIMS-MADE:®OCCUR MPT5208P 08104/2015 08J0412016 PREMISES Ea occurrence`, $ 50Q00 ' MED EXP(Any one.person),' $ 10,00 PERSONAL&ADV INJURY. $ 1,000,00, GEN L AGGREGATE LIMIT APPLIES PER,' GENERAL AGGREGATE $ 2,000,00 �.OTHER: POLICY aJECT.' lOC PRODUCTS,:COMP16P AGG 2;00000 $ COMBINED S N LE IMIP: AUTOMOBILE LIABILITY $ x' Ea accdent: .' ANY AUTOBODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS: HIRED AUTOS NON-OWNED PerP,c TY)AMAGE $ AUTOS: Per accidentp. . UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSIAI CLAIMS-MADE, AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION OTH- STATUTE I.ER: AND EMPLOYERS'LIABILITY Y!N`. ANY PROPRIETORIPARTNERIEXECUTIVE E L:EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? N!A (Mandatory In:NH) El.:DISEASE,iEA EMPLOYEE $ If yes,describe under. DESCRIPTION OF OPERATIONS below E:C.DISEASE-:POLICY:LIMIT $ d. DESCRIPTION OF OPERATIONS f LOCATIONS!VEHICLES (ACORD 107,AdAitlonal Remarks Schedule,maybe attached if:more apace is required) *************NO CERTIFICATE:HOLDER LISTED**"*"*"****** ' 4. CERTIFICATE HOLDER CANCELLATION SHOULD ANY:OF THE ASOVE DESCRIBED POLICIES.BE CANCELLED.BEFORE THE::,EXPIRATION DATE THEREOF, N0710E WILL BE .DELIVERED IN FOR . ACCORDANCE WITH THE POLICY PROVISIONS .-.tle7ltHr*U*4.R7f*/rfrtltFlwtlrA�lf*1!'**!t*fk:. Reeeeee**eee*,w*ee* INFORMATION.:. AurHORIZED REPRESENTATIVE PURPOSES*****"`"***" *, *ONLY: -[,,eu,w (y( 01988 2014`ACORD_CORPORATION Aill rights reserved. ACORD 25(2014101) The ACORD:name and logo are registered marks of ACORD --------------------- ---------------- New 2x10 Ridge �12 3 Existing 2x6 Rafters Fill in with 2x4 Studs 16"OC ---------------------------------- ------------------------ J 2x8 Rafters 16"OC ---------------------------------- ------------------------- I Remove Rafter Tails No Insulation Required II II II Existing 2x4 Ext. Wall I Existing House Existing Bedroom i I Existing Closed Porch N CO ► Existing � I I Hallway New Utility Shed i� o I I • -----------------a------------------- ——————————————————————— ------5/4x6 PT Decking— iL 2x8 PT Joists 16"OC with Hangers [7777x8 PT Joists 16"OC Existing 8" Block Foundation 4x4 PT Posts with I Approx Grade Approx Grade the Proper Anchors j j 0 10" Poured Concrete l m 1 16'-0" 1 2'-0° Proposed 10x22 PT Deck 1 1 00 i I — ---------------- 28'-011 10'-0" 8'-0" Framing Cross Sections Melissa Uhlman / Mohhmed Rahman 100 Angus Way, Centerville, Ma. Drawing Framing Cross Section Date 8/3/2016 Drawn By WHE Scale 1/4"=1'-0" -- - - - 14'-0" 19'-011 --------------------------------� Proposed Utility Shed I o I 00 I I b I -' I 1 6'-0" 22'-0" 0 0 N - Garage Hallway ------------------------------------� j I 13'-0" Proposed PT Deck I OP I o `O Bedroom i o I I 14'-0" II Laundry, Bath Kitchen / Dining Den o — -' y N 6'-0" Hallway Living Room o CV N O CO Bedroom Enclosed Porch Melissa Uhlman / Mohhmed Rahman covered Porch 100 Angus Way, Centerville, Ma. Drawing Existing 1st Floor 14'- " 14'-0" 10'-0" 10'-0" Date 8/3/2016 -..nra%tin_Bv WHE Scale 1/4"=1'-0" — 14'-0" 19'-004 4'-0" Barn Doors Proposed Utility Shed Co (On Existing Foundation) - 0 r- 116'-0" 22'-0" o --� 1 —4'-0"—�-I 4x4 PT Posts, N _ o 10"x48" Concrete Footings Garage - Hallway Remove Door ih 7 4 J. T-411 _.. . _ --- _.. . 13'-0" 2 Windows Removed Proposed PT Deck .... ..._ _-......... ...... .......T ..__. ._.-.. ...-.__,.. ._._....... ........- ...--_.. Cp _. N _ ._ .. 9e room •—o 5/4x6 PT Decking co _ .. New 6 0, 6 6 Slider _ .. ... . . .._.._._ ._...._ _... 14'-0" ._..... 3.5x5.5 Paralam Header .... - Remove Existing Door and Picture Window 0 ao Laundry Bath Kitchen / Dining _ 3'-4" Deaf • Cased Opening 3.5 x 9.5 Paralam Header Supported to Basement 10'-0" Newt'1/2 Bath New 2-8L[ x 6-8 Door 0 Living Room o CV N O Enclosed Porch Z Bedroom i Melissa Uhlman / Mohhmed Rahman Covered Porch 100 Angus Way, Centerville, Ma. Drawing Proposed Work (Bold) 14-0 — 14-0 101-01101-Off Date 8/3/2016 kale __ 1/4 -1 0