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'. ,'•y(�' A. rr "�'' •Lt ' R +.n r 4 x y.IF' 7- ..x�i.,I ,.4. x�: .t..t ,, ,— ,n:r.4`t.... :y'.'', t ._..-:Ff, 4..... _ Cw:.:r _. .� a.,, z ", }lIp.'�tt.., a . r - •: — _.._,n.. it i, � � ashy �\ I r� a/,�P� ,i Town of BarnstableBU Idin Post This Card SoThat rtasiVisible From the Street-Approved Plans Must be Retainetl�on Job and.;th�s-Card Must bexKept£ "'a 9 9AR*itTC+lIIS.E'r. • �£ " emu, z ' b Posted Unti(Final Inspection lias BeenFMatle w • q eat+ Where�a Certificate;of Occupancy�s Required,such Building shall Not be.Occupied until a;Final Inspection has been made e ��:�. , ". .,. ._u_ .. ,.. ;. , a Permit No. B-18-3653 Applicant Name: todd leduc Approvals Date Issued: 11/06/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date:` 05/06/2019 Foundation: Location: 60 BRETWOOD LANE,CENTERVILLE x Map/Lot: 168-130, ' Zoning District: RC Sheathing: Owner on Record: SULLIVAN, BERNARD F&PATRICIA Contractor?Name:' ..TODD,LEDUC Framing:' 1 `Address: 60 BRETWOOD LANE Contractor License, CSSL-106019. 2 4 CENTERVILLE, MA 02632 Est• Project Cost: $1,739.00 Chimney: y . Description: Insulation;See Contract Permit Fee: $85.00 Insulation: Project Review Req: Fee Paid•; $85 00 Date:, 11/6/2018 Final: , Plumbing/Gas . G i Rough Plumbing• r Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six.months after'issuance. Rough Gas: All work authorized by this permit shall conform to the approved applicatj.on and the approved construction documents,'-for which tFiis permit has been granted. All construction,alterations and changes of use of any building and structures"shall be in compliance with the local zoning bylaws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for pubk mspectionfor the entire duration of the work until the completion of the same. Ar . Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are:prov�deYd on this permit.' Service: } Minimum of Five Call Inspections Required for All Construction Work: ~, 1.Foundation or Footing x Rough: F - 2.Sheathing Inspection e 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final' 4. 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rou h: g - 6.Insulation r 7.Final Inspection before Occupancy Low Voltage Final' Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health , - Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT d Lmwt _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l tD -4` - Parcel t 3 0 Application *&Jl Health Division J Date Issued ZN—� Q Conservation Division o Application F Planning Dept. -, Permit Fee Date Definitive Plan Approved by Planning Board s Historic - OKH _ Preservation/Hyannis -�, 37 ib O r Project Street Address (;a Ore rij-wood I_one Village C en fker y t (-�- Owner SLA11 % yeAA-A. Address Telephone ci_16— -72 Q - "2 7 Permit Request 1 6+C-1 AnCQC�rJe�• n�u11 Gc�S-e�� c�i•.�cQa Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total-new Zoning District Flood Plain Groundwater Overlay Project Valuation c O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ci' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name DAL yi cQ ��� Telephone Number 5D8 77C,- !PSFZ(0 Address Z- M2421e_ License# C3 _ 16<:f31 �-'�`►9? Home Improvement Contractor# 17 0 1 1 j Email LWorker's Compensation # A)1A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � xo SIGNATURE DATE `f FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 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AWC Guide to Wood Construcdan in Hfgh Wind Areas:110 mph Word gone• Mnsachusetfs CfieckMt for Compliance(790 CN4R5301a.1.1)1 E�1'Cbeck 1.1 SCOPE - Wind Speed(3-sec,gust)....... _»____..__._.�... _ ._._.. _ --._..___... .110 mph Wind Exposure Category 12 APPLICABILITY Number.of Stories .._... .._.._.._.._ _ ..__. _(Fig 2)....._......_.._._ stories 5 2 stories Roof l3'rtctt .. ........ ____._ _(Fig 2) ... _. _ 51212 Mean Roof•Height._. , .. _...__..._._ _:...... .(Fig ft 5 33' BruTd-mg Width,W.___ _. �__ r _ _ (Fig 3). _.:_._ _ __:_._. _ ft 5 BO' Bw1ding Length,L : .. .......... .. __..._. :..... _ _•(Fig 3)-_........__._ Building Aspect Ratio(IJW) (Fig 4). _......._... __ _. _ <-3:1 Nominal Height of Tallest Opening? (Fig 1.3 FRAMING CQNNECT10N5. •' . General compliance with fining connections._. __....::.(Table 2)........ _..._w. 2.1 FOUNDATIO.N Foundation Walis meeting requirements of 760 CMR 5404.•1 x Concrete........._ ......................_...... .......-........_...............__...... ............... ... Concrete-Masonry........... .... .............. __-..... .......__ _._........_........ _.....__ 22 ANGHOR GETO FOUNt)ATION',3 5/B"Ancf)DrBolts imbedded or 51a"Proprietary Mechanical Anchors as an artematrve in concrete only ` Bolt Spacmg-general.................. ..... Cable 4). _....._....- __ in. Bolt Spacing from-endrjolnt of plate _ ____...__(Fig 5)_ _ _. ...... inr5 5"-12" Bolt Embedment-concrete._.._ ._ _. {Fig 5). -- -._..:_ _ .r_ in.>-r Bolt Embedment-masonry.__._ _.. .. (Fig 5). _. -._-- in.>15' Plate Washer __ ._... r_...:... _(Fig 5)__.. ...._._._ ---.._._- 3.x 3"x'/4 '3.1 FLOORS Floor flaming member spans checked (per 730 CMR Chapter 55)..+_...........: . Ma)dmum Floor Opening Dimension_._..._......._.............(Flg 6)._._._............_ _.,_ ft 51 Z or L12 or W12 Full Hefght Wall Studs at Floor Dpenings less than T from E)derior Wall Fig 6)..................................� .' Ma)dmum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall........... (Fig 7)._-__.:.__�.._._--:.....,.. ..._� ft 5 d Ma)dmum Cantilevered Floor Joists f , Supporting Loadbearing Walls or Shearwall...._..........(Fig B).....................:.:___ Floor Bracing at Endwalls................_...... _..._.�.__ .(Fig 9).__...... ..................... ..5 d Floor Sheathing Type ....._..................... _ ..............(per 780 CMR Chapter Floor Sheathing Thickness...... (per 780 CMR Chapter 55).._............ min. Floor Sheathing Fastening.__ __....... ...... ,._. _.._... ,.(Table Z)-_d nalls at In edge i in field' 4.1 WALLS Wall Height Loadbe:aring walls -. _(Fig 10 and•Tabfeft to Non-Lcradbearing wails _ _.._:. ,.. w ,(Fig 10 and Table 5). .._. _ft 5 20' Wall Stud Spacltrg (Fig 10 and Table 5). _._............_in.5 24"o.c. Wall Story Offsets __._.. .... :_.(Figs 7 8.B) ._._ ... _.._. :. . ft 5 d 42 EDCTERIOR WALLS3 Wood Studs Loadbeadn'gwalls .:-.__:.....__..._......._.._.(Table5)_._ .._.....� _._...Zx =ft IrL Non-Laadbearing walls (Table 5).- __._... _. Zx ft—In. Gable End Wail Bracing Full Heigh Endwall (Fig 10)....__.:_.�.. .. ....... WSP Attic Floor LBngth......_..� ._._ r _......... .(Fig 11)-.-.... ..... _ .... ... ft>W/3 Gypsum Celling Length(d WSP not used)..,_ (Fig -.2 x4 Continuous Lateral Brace @ 6 ft.o.a--(Fig 11). . Double Tap Plate - Splice Length __._._.......... .(Fig 13 and-Table 6)- __.... _._.._. _ft SPlics Connection(no,of 16d common nails). .---------:.(Table 6}. _ , _ ��• F AWC Guide to Wood Corrstructsan ur S194 l-ndAreas:11D Wh Wind Zane - Masisachasef#s Checklist far Compfianc' a po'dwym s3ois.t,>)1 Loadbearmg Wail Connections Lateral(no.of endnalled 16d common — Non-Loadbearing Wall Connections Latarai(rho.of endnar7ed 16d common nails).--:_..-_CTable Load Bearing Wall Openings(record largest opening but check aff openings for compliance to Table 9) Header Spans _..___ __...»._.._._.._ _.(Table 9)_ _ _... ........». _ft____in.S 11' — Sill Plate Spans _ _ ___ ._. .. ..._ (Table 9). !_ .._...». __.._ 7- ft_In.S 1V Full Height Studs (na.of studs)_ _ (Table 9)._ -• — Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans.._.. _..... _. - __ _.._. _..(Table 9)­­:.---;-.--_ft_in.s iZ _ Sill Plate Spans. ..»_.._,.....___-_ -.-.--(Table 9)_.__.._ __, ._.__... _ft_In.!;12 _ Full Height Studs(►ia.of studs}._.....«_______ (Table 9).._. _........... »_ ...... — Ede-dor Wall Sheathing to Resist Uplift and Shear SimultaneausV Minimum Building Dimension,W Nominal Height of Tallest Openingz ....... .._. _ _.__... _ ....... . . . -.. 5 6'a' — Sheathing Type..._.--.___ ._..-..__._w_(note 4).._....__.....___..._ . Edge Nall Spacing.-_....._._... _ ------ •(Table 10 or note 4 if less). ,... -... in. -. Feld Nall Spacing _._.._»_..._.......:...._»....(Table Shear Connection(no.Hof 16d common nails)(Table 1 Parcent FuIl--Hdght Sheathing...-_ - 5%Additional Sheathing for Wall with Opening>6V(Design Concepts)_...--.___._ — Maximum Building Dimension,L Nominal Height of Tallest Openin?--._. ............................_.......... ................ 6'g° — Sheathing Type_____.,_.. .--__----._.--'(note 4)-_-_..--_-__.»_._.. r Edge Nall Spacing ,._ _ �_-_•____-•(Table 11 or note 4 If less)-- - •-_» in. Feld Nail Spacing .�_.__...._».._.__...._..(i able 1 i). . _. . ..» ... .__._. in. — Shear Connecton(no.of 16d common nails)(Table 1 i)._ _-__-..----••.---- D Percent Full-Height Sheathing_-._....-._-_._-....(Table 11)._._._._.._........_..-......___..-----_/° 5%Additional Sheathing for Wall with Opening>6'a (Design Concepts)......... -_»• — Wall Cladding Bated for Wind Speed?» .____. ...».._......----._ .».-...._. _..._» _ -.- • --_... ___ 5.1 ROOFS Roof framing member spans checked? (Far Rafters use AWC Span Tool,see BBRS Wabsite) _ RDaf Overhang _...._.............................._...........(Fgura 19)....._.. _ft-<smaller ofZ orL13 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors (Table 12)._..»_._.-......._.__.-_- U= plf Lateral --..._ .._.. ...........(Table 12)._.._. -»._-..r._L-_plf Shear.--.-------(Tabla 12)_._......_.._.___ --.._.._-- plf Ridge Strap Connections,If collar ties not used per page 21.._.(rable 13). .._......__..._...._.T= plf Gabie•Rake Outiooker._-.. -........................... Figure 20)_ ._. _,ftssmalleraf Z orl-12 Truss or Rafter Connections at Non -oadbearing Walls Proprietary Connectors _ (fable 14)...... _..__..»-• — .Uplift_..._.......:___._...._..._..___.._. .....».....»._.._rU- ib. Lateral(no.of 16d common nails)_(rabic 14)......................_........... k.: Roof Sheathing Type._._ .»....»_. _......._...__.....(per 7BD CMR Chapters 53 and 59}.'............. Roof Sheathing Thick ess in.2:7/16'WSP Roof Sheathing Fastening 2).. ..._.._....._..._.._..__.._»_._._ ____ Notes: 1. This checklist must be met in ifs entirety,excluding the specific exception noted in 2,to comply.wrhh the requirements of 780 CMR 53012-1.1 Item i.If the charJdfst Is met in its en5rety then the following metal straps and hold downs'ars not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. .20 Gaga Straps per Figure 11 C. Uplift Straps per Figure 14 d. • All Straps per Figure 1T e. Comai Stud Hold Downs per Figure 1 as• 2_ ExceptJon:Opening heights of up to B ft.shall be permitted when 5%is added to.the percent full-height sheathing requirements shaven in Tables 10 and 11. 3. The bottom sill plate in wderfar walls shall be a minlMum 2,in.nominal thickness.pressure treated#Z-grade. t .° �4 rC`�rzcrl fa Ft`brfr Garrslrucfiott zrr I Hr=d.&aaY_I10 f� HFru� a{z a Ij s-a.Chu&etts Ic. t fcfr.CoMPH=r- �clr sintfjs)I - ac F=n Tables III and 11 and lmaf=of wag Waaff&U and BLuldmg ApedWa,deftrirtine Ferri FufF-�ieigf cf . S1-ring and Ir�1 facing r�gt �c - � . . b_ -Y�aad 5itudt�I FazSr:Is steal!be nimimtan ffiidaies of 7fi 6`,and ba installed as faISo� - - _ b . Rawls shall be installed wr sb=9gffr azs parallel Tn-t&& a- X hmimri al joink--. Il oast•aver and be rmlled fn fiammg. M. Dn single siufy rs 15t cfbr,panda shall be at t�ed.to bdffnm plalas and fnp•lnamber oPifra cimbfa --- "' �"fs�as�nt3r r t ►mat P , ,� fa$ jnp tneinbe9'- ZaDpper&Uhla fnp-- - plafs and in band jotsf at baffrfrn of panel iJppet ^f of lruier paned shall be trade In band joM and loyeraftmimiar t ma&in loudest pEaia at W$oars¢ v. I far¢xutfal trad sp rig a dmHa by pfaig;band losta,and ifu a shall-be a double rcw t3f End ' . � sbggr-ir=d�t 3 indles on ct=r�'pEs�igttrrs bel'o�.Uetiiral:and Horimt�I t�fa�g fnr Fare!Ai�r3Ttnetrt_ ' _ 5-- Glazhg prufZorr a)'n�botse Drhotzrdalad0m—tagtira ff pro je is i ntife Dr do-sm fz}shore(generall]'.sottdi of Imo.23 or nwi i of Fib 5) ` - b)ue�fir�I addman-rat requlrn�tulles fhaa retrou�on fb$e fist•f wr a)rephMMw t'ivMdovm—trads mmpHy mr� �o n cmnpb inFy{dTap 93) - E Woad Frame Con-Elio dion heal MFM4 for 1 f d MPH,Fxpmia B tray he obYmmd.f Drriffie Ameiimit AbDd Cc>una1 _ {AWb) LtLF -, • - . tl tl t - ' [I Ct • - �- c �Q L q LL ci LL rr - • r [•... - , ri- r � . p « t r ii L 1• . [- .tl Lk is I[ irFl L L ' - Z - 3kat t c n _ 'a • it - Sao 13afEfilp11 Rwd p-ap -I-r-rScal and HoT!zDIT al KwT9V Wnd I fa rdaI Isar • for 1?arial f4E Farrel AfEaclmar Town of Barnstable Regulatory Services Richard V.Scab,Director 6, �`� Building Division Paul Roma,SwTdmg Commissioner 200 Main Street,Hyannis,MA 02601. ' www.town.bmmstable.maxs a Office: 508-862-4038 Fax: 598-790-6230 Property Owner.Must - 4 • . - Cbtaplete and Sign This Section If Using A Builder 11�1 P W I �vl�/✓�� ,as Owner of the subject ptoperiy to act on my behA Y in aU taat t=s relative to work authorized by this buUd g permit application for: (Address of Job) **Pool fences and alarms ate the responsibility of the applicant Pools are not to be £died or utilized before fence is instaRed andaU final. . inspections are petfotmed.and accepted. , ' Signat ate of Applicant: e of Owner Print Name Print Name �312EZ2 d . Date QFORMS,0M=ER=SIONPOOLS 1 V TV it vi J—PGLA JLLP Regulatory Services _ dF Richard V.ScaI4 Director ` Building Division, t t Paul Roma,Building Commissioner XAM 200 Main Street, Hyanuis,MA 02601 65 16 - Mtld www.town.barnstable:ma.us Office: 508-862-4038 Fax: 508-790-6230 r HOMEOWNKRLICENSE EffiY n0N Please Print ' DATE: JOB LOCATION: vwago aombcr• FIOMFAWI TER ome one# work phone# name h Ph . CURRENT M,1JLINGADDRESS: Dity/toaw sl�c zip Dodo The current exemption for"homeowners"was extended to incfide owner-occnyied dweDhlzs of sk units or less and' or hire who does not possess a license,provided that the owner acts to allow homeowners to engage an individual f as supervisor- . DKEM�MON oP HOMEOWNER Persons)who owns a parcel of.land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwain—affached or detached sfractmes accessory to such use and/or f m structures. A '. person who constructs more than one home in a two-year period shall not be'considered a homeowner..Such "homeowner*'shall submit io the BmIling Official on a form acceptable to the Budding Official,that he/she shall be responsible for all such work performed under the building permit (Section l .1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,roles andregolaiions. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Departmei minimma inspection procedures and requfrements and that he/she will comply with said procedures and requirements. Sigi�'eofHomeowner � • Approval ofSmlding Maid Note: 'Three-family dwellings containing 35,000 cubic feet or larger wM be required to comply with the State Building Code Section 12TO Construction Control HOMEOWNER'S EXEMTIDN The Code states that: "Any homeowner performing Work for which a building permit is required shall be exempt from the-provisions of this section(Section 10911-Licensing of construction Supervisors); provided that if the homeowner engages a perso (s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of EL supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that tie homeowner is fully aware of his/her responsibilities,many communities require,' as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. Orn the last page of this issue is a form currently used by several towns. you may care to amend and adopt such a form/certification for use in your community. Massachusetts Department of Public Satety Board of Building Regulations and Standards License: CS-105530 Construction Supervisor DAVID M SMITH 2 MAPLE STREET MASHPEE MA 026' I Expiration: Commissioner 04/06/2018 z. . tie �Po��rrearuuealC�i o�Cc �ccfruseG \ Office of Consumer Affairs&Business Regulation License or registration valid for individul'use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: WE egistration: :;:;;;170173 Type: Office of Consumer Affairs and Business legulation xpiration _z9/23/2017 DBA 10 Park Plaza-Suite 5170 DOVETAIL WOODWORKS ! Boston,MA 02116 r DAVID SMITH Va 1 2 MAPLE ST MASHPEE,MA 02649 Undersecretary Not valid without signature r f i i Dovetail Woodworks Estimate 2 Maple Street tepee,MA 02649 Date Estimate# Phone# 508-776-5426 dovetailwoodworking@yahoo.com 3/19/2017 334 Name/Address Patricia Sullivan 60 Brentwood Lane Centerville,MA 02632 i Project Description, Qty Rate Total This estimate is for the installation of two new construction Andersen 400 casement windows. at 60 Brentwood Lane. Obtain all necessary permits. Measure,confirm,and place window order.Allow 4 week lead time. Remove white cedar shingle siding,house wrap,and plywood siding where necessary. Remove studs for placement of new windows. Install new framing for windows. Remove interior wall board window cavities taking caution not to damage wall paper. Install two Andersen 400 casement windows. Insulate and trim interior to match existing window trim. Flash and trim exterior to match existing window trim.with Azek. Flash and shingle in to new trim with white cedar extras. Building Permits 200.00 200.00 Materials 1,000.00 1,000.00 Two Andersen 400 casement windows,dimensional lumber,Andersen extension jambs,interior trim,exterior Azek trim,insulating foam,white cedar shingles,fasteners,flashing,and misc. Labor 32 75.00 2,400.00 Removal and disposal of construction debris '40.00 40•00f f 0.00 0.00 1 i- ft J Total 53,640.00 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map., Parcel Application # 10ADA Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee J Date Definitive Plan Approved by Planning Board o►c /D1 Z�I/3 Historic - OKH _Preservation/ Hyannis Project Street Address wREI wao-o L 4, ` Village GN - Owner moo( R'�DGi"c. t- .C (LT`/ Address Telephone ( 508 -7 '4q p Permit Request (LFQNkc TT_PC_ k'"Pow 1b 6D04PW W4TW Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation o Construction Type 'Lot Size �� Grandfathered: ❑Yes ❑ No If yes, attach sumo°rting donertion. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) _ Age of Existing Structure Historic House: ❑YespJ No On Old King's Highway: CT Yes 1 No Basement Type: &"Full ❑ Crawl', ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) QP Number of Baths: Full: existing_ new Half: existing newer' Number of Bedrooms: 3 existing.Zhew Total Room Count (not including baths): existing new First Floor Room Count G Heat Type and Fuel: ❑ Gas YUil Electric ❑Other Central Air: ❑ W Yes o Fireplaces: Existing 0 New Existing wood/coal stove: ❑Yes q No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: 2'existing. ❑ new size _Shed: ❑ existing ❑ new size _ Other: . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _ Name Telephone Number 733 '94 E 3 Address License # Home Improvement Contractor# l qq 7 �Z _Emaima sui nn l .- X( :4�P ocwwu r�er's Compensation # ""SODS q 62 o I Z o 13 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO D(/04PVIYO tZ SIGNATURE DATE / 1 / 13 r FOR OFFICIAL USE ONLY APPLICATION# . E .DATE ISSUED MAP/PARCEL NO. t , ADDRESS VILLAGE r OWNER DATE OF INSPECTION: s_FOUNDATION: E FRAME `{ INSULATION r' FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL ! GAS: ROUGH FINAL r• FINAL BUILDING 4 t { k. DATE CLOSED OUT jL- �: ASSOCIATION PLAN NO: r 6 w .7be Conimonweahh of Massachuseffs Department of Industrial Accidents -- Office`ice of Investigations 600 Washington Street Boston,MA 021II ►vFt,mmass.goWdia Workers' Compensation Insurance Affidavit: Bui tiers/ContractorslElectrici-ansMumbers Applicant Information �,�" Please Print Ledb (B Iy Name usiness/Orgmizzat on&dividual): l"ESN NCy + M4Ayg C"P1V �S1q� Address: p col M 6 City/Stat&Zip: A*A&S N ALS I MIS b26` 8 Phone ik Army an employer? Check the appropriate boa: T of project r . 4- I am a general contractor and I p J � �1��= 1. I am a employer with ❑ g 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 slip 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.Z required.] 5. ❑ We area 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.❑goof insurance required.]l c.152, §1(4),and we.have no repass ] employees [No workers' 13:L�'Orher i�1�ND®id comp.insurance required.] •Any applicant that checks box#1 mast also fill out the section below showing the-a workeie compensation policy information. Homeowners who submit this affidavit indicating they are doing allwork and then hue outside contractors mast submits new rude*indicating such. =Cantractors that cheek this boa mmst attached as additional sheet showing the name of the sub-comtractors and stare whether ornot those entities have employees. If the sob-contactors have employees,they mustpmvide their workers'•comp.policy number. I Q!n ar!wnployer tleat is providing rvorke-rs'conipBrtsatfon uis!lrance far rriy Bmptvyem Bdow is t7he policy and job site information. Insurance Company Name: MAIA 5 i . ArtAC1210 A55 u r- - co , t Policy#or self-ins.Lie..#: Wct-J 00 9 4(P Z b 17-D 13 Expiration Date: (P 1 14 Job Site Address: UO BLOOD Ltj c C/4-#J'�XVfL4- _ C ty/Stat&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 tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP R/ORK 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 rrltder tPeepQtns QltdpeleQttres a t�rjrtPy''t1eQt ties irlforrrrntinre prattled above is tong and cnrrat Sitmature• Date: `® I� ' 13 Phone.#: g �}7-9 I y Official arcs only. Do not write in this area,to be completed by city or Joint vfi7l ciat City or Town: PermftUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City town Clem 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 FEE T Town of Barnstable do * Regulatory Services MARNST"MASS.I E Thomas F.Geiler,Director >F1639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, -S®141 I-zCcAl2Ty , as Owner of the subject property hereby authorize A(A,XAfJDEX to act on my behalf, in all matters relative to work authorized by this building permit. Go G ilr wao?) I.N, GwN 'Qc (Address of Job) "Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Sign e of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 Town of Barnstable Regulatory Services s" ASS.Mas' Thomas F.Geiler,Director " $ 1619. m �0rf • g Buildin Division a t� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached,structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any_mmeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q;Rules&'Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the Homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities`require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor: On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc Revised 053012 j� _ .P*TW"l MVAUGHAN CERTIFICATE OF INABILITY INSURANCE 1 gar 126120`13 8126l2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE MStNNG INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT. #the certificate holder Is an ADDITIONAL INSURED6 the pis)must he endorse& It SUBROGATION IS WANED,suwd to HIS fauns and conditWn of the policy,certath potieles may require an endo>sernerst. A sffimnlsnt on thM certilleaft does not confer rights to the Certificate holder In POU of such endorsement(s). PRODUl COWACr Rogers HAM W 7 Ins-Dennis Brand► 5W 398-7M tm,(OM 816-2166 South Dennis,MA 02NO r4yu" WSURIMAFFORONGCOVOLAGE NAtC9 WSURERA:M®In Street America Assurance Ca UtsURE° wsLqmRa:AssociaWd Em ere Insurance Co. Patrick k*m&Atex Ram" MCURER c Carsick Carpentry P.O.Box 816 moo: Marston Mills,MA 02648 WSIIRFJtE A#SI>EtERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE.POLICIES OF INSURANCE LISTED SELOW HAVE BEEN ISSUED TO THE INSURED NAimm ABOVE FOR THE POLICY PERIOD) INDICATED. 6tUit/It HSFANDiNG ANY REWRENIENT,TERM OR CONDITM OF ANY CONTRACT OR OTHER DOCWENT WITH RESPECT TO WCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN tS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. L 7YPEOFUISURANCE PO=WlJOM #.If ys GaasrAL Man" EACH OCCURRENCE S 1,000,000 A X cmazRcv&Gat ro& uu4s w S069 812 =13 W21f8074 PRraelsEs s 600,00 1 CLMISMADE I.^i OCCUR WOEVO «ua a 10, PE13ORAL&AMMURY $ 1,000,001 GOWJVtAGGREGATE 3 2,000,0 WMAGMEGAIEUWTAPFMPM PRooUCTS-OOMFIOPAGG X P%= rl toc 3 AUTOMOM a iMMM Laur ANY AUTO a ocky INSiW tiler pus" s ALLOOWD 1LED AUTOS AUTOS HOWLY MA RYt WwadastIMOYMED s HIREDAUrOS Affos3 3 UU03ELLALM OCCUR EACH AGE $ 4 EXCfSStlfS HOLAOMPMU AGOWOM S RETexrMs 1 3 INDOMMCONPUMMM OTH- B E oacLunEa» Yin NIA 8lBi2073 8f612074 ELEACHACCs W SOFFECERN 100, p fa7 FYIE,LO18EaSE-I s 100 U Rtpnau OFOPERATMMbabw E_L.ONEASE-POLICY Wff Is 600,000 i oEScasP�toF OPEaATI�Isr�s►T�srCLPs tan�eAtIai.atearRs�netsem�ors i i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DE101CRIBED POLICIES BE CANCELLED BEFORE .aSAMPE"* THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE tlM TIM POLICY PROVISIONS. I . c AUnlORMWRlNgUM TAWM 0198B-2"S ACM CMPMATt04ti. Ail stgttts nerve. ACORD 28(2040M) TM ACORD name and loge are regisftred norics o#ACORD' rq'-� RAIfNEY + PO Bx 816 Marstons MiNs,AM 026Q Tel 508.428.7147 oranpaiNGTow mb@1hempecW vpenterscom Fax 50EL42SL7167 ra s rtoass-a ores-CUSTOM HOMES Qctober 4,2013 ESTIMATE Site:6013mtwoM Cen rYMe;John dt Fkwcnw H ;50428 7490 Remove aad rqphwe with to comply with code requia emeatfs • Remove existing window,trim and framing as new to accommodate new larger window-,dispose of waste.......................................................................................... $ 200.00 • Material cost of new meson window as described .................................. $ 433.98 am t CW135W R0SiW=247ArWxTS3frN UhftSiw=r43ArWxT41W1frH L . Peftmwm t Glass W Hkdrars Pa*PSC • Refirame opening to accommodate new larger window;Mall new window,as described.......................... $ . 475.00 Supply,custom cut&install i i"pelcimcd pine interior&exinior trim...... $ 125.00 • Sand,fill,caulk,prime and paint new intenor&exterior trim;note:pamfing of walls if necessary to be detwinined and is not included in this estimate............................................. $ 250.00 TOTAL LABOR& MATERIALS S MO." Balance cue upon completion $ 733.98 NOXAMa"vet is im a� ink. • IDemcdasemffi �ssum� - asmoda �rea:y6®fmammrrp ��m$ mmaaea • e �®ec �mnyr �u �aanay�,m�ee� . Amsaa tm caeamrt5eHamrsSAsm Spamatf1e c �m� ya� a;rarey�em� • 'Nasasrffa ���� Cad=DAAB=MMV&qft SMMA SiDamm dapmPadw&W7M6dWdH0fin4fffiz ®,eOMa . • Re@mrty0aama�e €��gam�a� - si�pl§�. zmmc� �®n � �' argyem�oeaiee . ARM=* aaa®e�a a� eras Ski am9�g mtmamswao�� a we aed.eca ecG ae cam o� pie LVL Roam MAsa • Thepamscp®naw&=AffiNDARY eg0aaF*&emut damAwXG1-c.9A4lkI&GLaWQX9@crXG.LcZW14a mMoc&W Aftw3dips20 d*V*ffi1dfiF=6fi am=pzj=an sAean- • Any Amom crdnw&=fi= aamadm dmlp aamamdabom dwesiapceaMADpwbmpl&s �a�nefc ®dim � - �exireffi8� i �ei�aaamymni� mg pec®�ea�aaete �rox� mraead.wuh eca�� m9r��e �mmffhlGY..e9a����a�b�ooi��s�ema �me�emraasama�samdvs�4+emmgdrled� • lta�4y®wm�'mcs�ma� �rr� ursey �n6maatHr¢ spmm �umer� r�amgl�r9ffiramsde�twattc8am�� umagi�erb am®ies�® ffiaeam��pam�aag mum awe na�ea�e�ea®6ieab�re�em �awe �eaasgha aaay mt�es ant& POD ftw==7 awswka mpearWWis GY c�52A DO NOT SIGN TIIIS COWRACT IF YOU HAVE NOT READ IT OR IF 11HRE ARE A"K ANK SPACES rub ' 10/4113 is ' /3 for Paw"&M*Kjlon Custom Bdders Date 0 3Irk 'H I .. Phrad Umber of qzf##nm BkAfts-Hwze D&Adm Asw=wabn e6 -sue a ofCV90W inn Andersen Windows-Abbreviated Quote Report Project Name: Hegarty �f!•axwev3BF•Y1 • /y 1= .�m.Q.i . 0 Version. ,1890i•i9.o5 _ Print Date: 01/2013 Quote Date: 10/01/2013 i 13.t Quote#: 2385 10/ ,,,,�, Dealer: m a - T Custom-or:�nney&fin Billing Address: Phone: Fax Sales Rep: Tony Malone Contact: Created By: I Trade ID: 954010 Promotion Code: Item ,y ('tom t'41:*�t�poratlon) 400atlon Unit Prlae � Bxt.Prloo wae.,�_��-�a-�smme_r.=+.svl— �..-v.+.F.�xe:v.� ..�a��,+. +—•.=gym,. -..,�..e�+...+P...-....� 4 s 0001 f Owl35(`) 0 340.38 >>i 340.38 Ro8isa®2 a're wx3 a3re M unItShomV43re wxa a13/10 M I'I Unit,White/Clear Pins,L Handing,Straight Arm Hardware,High Performance Low-E4 Glass Grille,Interior,Removable,White/Maple,Colonial,2W3H,3/4",Roman Ogee Insect Screen,Stone Hardware Pack,PSC,Andersen Classic Series-Stone :Zons:Northern U-Fa0tor:0.20, SHGC:0.32, ENERGY STARS Qualified:Yea d� �® Subtotal Total Load Factor Tax(6.230%) =1,T Cusco or iqn ���,13� �� _--. Grand Total, -- �*All graphics viewed from the exterior *"Rough opening dimensions are minimum*and may need to be increased to allow for use of building wraps or flashing*or sill panning or brackets or fasteners or other items. Quote#: 2305 Print Date: 10/01/2013 Page 1 Of 2 IQ Version: 13.1 V F` � a� x► Y f - H 2 oc pus C)Rk W"Ca-� O t3)e�T tvw s> I-N L C rz va&c N � i C416 SS S-COf-Up f--O X N rrW v :- �70 zz 77 12/ �U e12. Fl-i � � AAA c . ........... \_ 1 . � .ti3RTH C PL L. f 7-4=1 M LEVEE r CD Zr Cp un ;�� SM KE DETECT TORS REVIEWED A LE BUILDING DEPT, ID �.? �h DATE ® FIRE DEPARTMENT e 3 . ��Tg'�/NATURES AREREQU/ DATE FOR VIAIC 3 �f M In �_ ..._........ F t 14 ILI S LE u a*fir. t� Slrvl Ukll C_,�71MJE�6, jC7DlU �jv 0 D 'k ON 1011�/.� YqA N X-P PERMIT T * 2U13i73 Town of Barnstable Per # Regulatory Services �e nthsf�eAl'issuedate Ott T ; Richard V.Scali,Interim Director TOW ARNSTASLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / � Not Valid without Red X-Press Imprint Map/parcel Number /C./' I�Q Property Address Lo� Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /'e) Contractor's Name Telephone Number [S j :2 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy#. Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: (�f 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: a Q:\WPFILES\FORMS\building permit fo \E SS.doc Revised 061313 i�1 ,1! The Commo;rnswa th of_Vassachuselys Deparltar mt of liukish i;al Accidents Ojfwe of lit stigations 600 Washington Mreet Boston,MA 02111 YVnw.yna-K&gavIdia Worlrel<-s' Compensation Iu n once Affidavit:Builders/Contractors/F ectricianstMt tubers Applicant Information Please Print Legibly Name(BusmeaslOrgani�ionRndiiridnaq: L7�L17'l� � I YI YI��� AA&ess: E CityfStatefap- Phone 4- 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4- ❑ I sin a general contractor and I employees(full and/or part-time}* have hired the sub-contractors 6 [—]New won 2_X 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 w for me in an capacity employees and have workers' o�wg y � �' t 9_ ❑Building addition txm [No woricers' comp-insurance comp.insura required-] 5..❑ We area corporatism and its 10.M Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_0 Plumbing repairs or additions myself [No wcrkm'comp_ right of exemptioa per MGL 12. insurance 1 c. 152, §1(4),and we have no ❑Hof repairs required,] employees_[No workers' 13_❑Other comp-insurance required- *1Yny appli�at that checks box#1 mast also fill out the:section below shovriug their wosketa'compensation policy informs m �13omeowners wbo submit this affidava indkstmg they are doing all wm-k and then hue outside contractors nest submit a new afidark inilkat ing such- trmtors that check this box mast attadhed an additional sheet showing-the name of tha sub-cant-Actors and state whether orzot these entities have employees. If the snb-caatsactms have employees,they nnrst pmuide their workers'comp.policy number. I am an employer that is prmiNkg workers'compensation insurance for my'employees Below is die policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic-9: 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 c minal penalties of a fine up to$1,500.00 and/or one-year mprismt,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250-0+0 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Iuvestfgations of the DIA far insurance coverage verification. I do hereby certify n the ns id�analties ofperjuty that the information provided above is tyre and correct Signature: V Date,: Phone ©fcraI use only. Do not write in this area,to be completed by city or town q,QScid City or Town: Perndt/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CiVrown Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Usher Contact Person. Phone#: 6 -Information and Instructions Massachusetts_General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employmetit be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depaitment of Industdal Accidents office of fnvestigatFans 600 Washington Street Boston,MA 02111 T61.#617-727-4900 W 406 or 1-877 MASS.A.FE Fax#617-727-7749 Revised 4-24-07 w .mass-govfdia o; oFE T Town of Barnstable • r Regulatory Services t EARNSTABLE, � y Mnss g Thomas F.Geiler,Director $p 1639. lfn,Ka�' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section Jf Using A Builder I, G fd ZA44 %�'/3 T'�/ , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit n (Address of Job) *Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. JPJVVIC Signature of Ow er Signature of licant Print Name T Print Name Date Q:FORM&OWNERPEPMISSIONPOOLS 62012 Town of Barnstable Regulatory Services t `* BARNSTABLE, * Thomas F.Geiler,Director KAM 9q, 1619. 16 Building Division �fD MP't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8 62-4039 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number street _;... "HOMEOWNER": work hone# name home phone#_ p CURRENT MAILING ADDRESS:__ cityltown state zip code The current exemption for"homeotimers"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner'.'assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that be/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or Iarger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\demllik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRFSS.doc Revised 053012 z ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION • gad �, V Map Parcel TOWN OF BARNSTABLE Permit# (2���`�� (� Health Division J 1110 —/ Date Issued 01 - 1 — 2003 JAN 10 AM 9: 53 �O '�DConservation Division U Application Fee Tax Collector Aok Permit %a I Treasurer / D 6� DIVISION ~—"SEPTIC SYSTE6tA MUST BE INSTALLED IN COMPLIANCE Planning Dept. 1lM TITLE$ Date Definitive Plan Approved by Planning Board ENVIROPCMEKAL CODE AN[ TOWN REGUI. I. ONS Historic-OKH Preservation/Hyannis Project Street Address 0 .6B77_Z..,')00z) L/L Village Owner y r—dew y Address Ago X��6 LA) Telephone Permit Request © BAN ' A)A1170AJ //-0 eY!_!;:�11-7eyG /VoY-191E Square feet: 1 st floor: existing proposed _ 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation f 5,( p�'- Construction Type , Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family(#units) Age of Existing Structure c26 )4eS Historic House: ❑Yes CI,146'_ On Old King's Highway: ❑Yes LIAK Basement Type: W'Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new 4� 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 R-151ectric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Cl No Detached garage:❑existing ❑new sized Pool:❑existing ❑new size _ Barn:❑existing ❑new size= -: Attached garage:klexxiiisting ❑new siz� Shed:❑existing ❑new size Other: i Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name . f'� r �'y Telephone NumberO�22� Address PC� _ X �, � License# (no Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM ..-THIS —PROJECT WILL BE TAKEN TO SIGNATURE DATE r' I FOR OFFICIAL USE ONLY y PERMIT NO. DATE ISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE I . 1 OWNER " , r DATE OF INSPECTION: ' FOUNDATION '�UUN c o z N� FRAME 6 6 2-2 'U tzv ��C i INSULATION _ 04" C�3, 1� A � � V FIREPLACE I ELECTRICAL: ROUGH'S ' FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH,? i=: FINALE ' FINAL BUILDING DATE CLOSED OUT ` r . '; T ASSOCIATION PLAN NO. ` The Commonwealth of Massachusetts ...... —' Department of Industrial Accidents _ Office afloyesali foes 600 Washington Street Boston,Mass. 02111 Workers' C m ensation Insurance davit / name ' location: ® �� ®G.d phone# 4 2 f— �! city ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working m 2ca achy rkers' co ensation for mp employees rovidin wo mp 1 .�__,.r�•'•,•:�t'{:•:'•:•$$:!'?J:•,:::'?::$$${{{::i$j{:':;.?•?;.v$ ::{iiiiiij•,:�;Li{:i::,:?ii{:,:!t;:;{: r.:,:,:i?::±:L::::'r-:$::!:::{:::'.:%::::::;}Jr:.'.=��i::}r:>::{'::{•:•:•.,v:r an v nam { •ram i ;•:to-}x?<:• ......,.. .......... ........ .... ....... .. ........... .. .... .n... ........::: v::r;.}'4Y:v.,.:: vh.....nw;;;.;,;.;}}:•}}:aC:;.;:;'r,:i;:•}:•:vv.. .:.n.• ........n.• ......... :....... .. .n.... ... .......�. ... .....v.... n....}... v.v+,'.,•:\.::?vY•:4:^:•,:v::]r•• \Y:`'•]:•+•:?•Ca}.. ...., ........... .:. .. .. ..........� ....:. .. ..:.....:x::r:::r:.••..v...:x{}•..v.....•::•........:::.. •v:.....•v:.ay.:...v:{:;+::•r::.•::.•::::}::�':•i•:,.r..:....,. {....., .... yr v:,.......w:•.,....,....•:.•::..:. ... :::.•::: .. .. .{.........::.... n......,. ...::. ]F Y k iS } :•: ::1•.+vr.v:w::::. > } :::::.:::.:::.... .:.mix:::...............' .... ...::.--.... .:- .; ... ... ❑ 'I am a sole proprietor, geaeral contractor, or homeowner(circle one) and have hired the contractors listed below who have • ' e nsation ohces: co :.}.: n work :::•:::::.,.:........:...;.........:...... ?.:;:.:i.::.::;:.:a:::::.:.t•.:a,....a: ?{}::.:•..::].;;.;.}:.;:.}: the fo ................ ................ .......................:.......::.:::::.�.::.}::':�:::.::............... .v.,.... ,... 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R. . ........... .............. ..,r............................................ ...............v.... v.v•.::......R•x.:r....}.....:..i::}:•.::.::::1:•:v.v:.:t,...;v..v...v...•;\..v.:vJ.:{: X. .... .........:.....::::::::::::::.v:: .................::............;;.:.:....,.,v.•.:.:w..............••;•.v;;:::::•}:?;•}}} :•.:}rv;.{•:L•ri^:+•:...,•.;w.. •}•::vn.Cr.x.}:i{${ti4G$:;:' Bailare to secm'e coverage as required wider Section ZSA of MGL 152 can lead to the ia►position of ertndnal penaltin o[a Sae up to S1,8M.00 and/or rJsonmeat as well as civil penalties in the form of a STOP WORK ORDER and a�e of 3100.00 a day againstmd I understand a onecop yeah'imp copy of this statement may be for*rarded to the cc of Investigation of the DIA far coverage veriffcation 1 do hereby certify under the p ' and p alhies ofpedury that the information provided above is true and correct Date Signature Phone# � 0C Print name official use only do not write in this area to be completed by city or tovm ofncial peraiittlicene# (:]Building Department city or town: LlUcensing Board ❑Selecmen's Office chec if immediate response is required ❑Health Department contact person: phone#; Other Ucvisad 9/95 PJA) Y Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their 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 of 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 s ;s please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and Ym8 su l ' company names,*address and phone numbers along with a certificate of insurance as all affidavits may be 2. PP ents for confirmation of insurance coverage. Also be sure to sign an submitted to the Department of Industrial Accid date the affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the 'law'or if you on policy,please call the Department at the number listed below. are required to obtain a workers' compensati 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 permit/license number which will be used as a reference number. The affidavits maybe retm6aR'10 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 amce of tnvestlDauans 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 no CMR AppaWk J Table JS.Zlb(continued) prescriptive Packages for One and Two-Family RaidentW Buildings Hated witb Fowl Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basem_eat Slab Heating/Cooling Aires'('/o) U.value! R-value' R-values R value' Well perimeter Equipment Efficien cY' Package R-value` R value' 5701 to 6500 Hating Degree Days Q I2% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10 _6 85 Normal . T 15% 0.36 38 13 2J N/A N/A Nomalr U 15% 0.46 38 1 19 19 10 6 Normal V 1S%- - -0.44-^ 38 `_ .. _ _13 -29 -- N/A` _ � N/A 83 AFUE+ W 15% 0.52 30 19 l9� 10' 6 85 AFUE X 18% 0.32 38 13 25 N/A NIA Normal Y 18% 0.42 38 19 25 N/A NIA Normal Z 12% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: E OF ALL EXTERIOR WALLS: � � 2. SQUARE FOOTAGE �! � 3. SQUARE FOOTAGE OF ALL GLAZING: !Y 4. %GLAZING AREA(#3 DIVIDED BY 42): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q4orms-580303a 780 CMR Appendix J Footnotes to Table J5.2.1b: a Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 fl of decorative glass may be excluded from a building design with 300 ftZ of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. •Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement &-scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipme nt with the lowest efficiency must meet or exceed,the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 RESIDENTIAL BUILDING PERMIT FEES . APPLICATION FEE f . New Buildings,Additions $50.00 �� U Alterations/Renovations $25.00 - Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 1 l� square feet x$96/sq.foot= 0 _x•0031= (0 C ' o plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE _square feet x$64/sq foot=4 F d x.0031= ( plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ftt >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >150 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 5150.00 (plus above if applicable) ,� Permit Fee �_ vroicosf BOARD OF BUILDINGREGULATIONS License: f ONSTRUCTION SUPERVISOR Numbers C 009013 : 23498 t Re- rF� Y GREGORY NI CAN L � � ER 33A B°AXT AV r y W YAFtMOUTM, MA 2�26/3 Administrator 1 i � � ✓fie TDarn�no�uuealt�e o�✓�aaaac/ivaelt �l. Board of Building Regulations and Standards HOME IMP EME=NT CONTRACTOR Registr on 6395 3� � -2004 I t ^1_uMvidual I GREGORY M CA ' Gregory Cawley 33 A Baxter Avenue W.Yarmouth,MA 02601 Administrator i L , Q n E T I/V L A IV>E . G 27 —=, 17' 17 ' - d I�Ja � • � �• -� �` (/!' `�Uri� - " M ; 0 o l 5 -2-z-7 S,F. OF M'��s / JOHN ROBERT J/ S S G i uz3 -- � �F= CERTIFIED PLOT PLAN LOT CErl 7 h'V/C_ L_ ^ 7-17777 SCALE: /"_ 3,v ' DATE ='4 /d'3 LDREDGE ENGINEERING CO.IN CLIENT I CERTIFY THAT THE FLI- 'AT`" r '`�v EGISTE E REGISTERED SHOWN SHOWN ON' THIS PLAN IS LOCATED CIVIL I LAND JOB NO. 3_. ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR DR.BYi CONFORMS TO THE ZONING LAWS OF BARNSTABLE , MASS. 712 MAIN ST. CH-By' HYANNIS MASS... SHEET_L.,�F DATE Ed. LAND SURVE` P`OF IHE IO The Town of Barnstable . BARNSf'ABL-E. = Department of Health Safety and Environmental Services MASS. e i639'p�E1639. Building Division 367 Main Street,Hyannis,MA 02601 )ffice: 508-862-4038 'ax: 508-790-6230 PLAN REVIEW Owner: Map/Parcel: 1(9(8 b Project Address: IJ D �Y1 Builder: 1r Ce -Q:"(3 t� The following items were noted on reviewing: 1 4 71' y C.-,Le Y, Z J \J eY-C-� V^c2 o -� E&)C Cc)�cZ 4 S e \S v VV1 1 —tv 1 Y1 n. SJ ru U A-7 Cal i -r nlJ�r Q G(�11(\L+ t�O UL i2-z r Reviewed by: r9340J 0--X 4 Date: q:buil ding:forms:review pp iiS 64-o ocJ (' i. Ce +ex--J r ' fi - °CIME rqs� Town of Barnstable Regulatory Services BAIWSr'^BLE ` Thomas F.Geiler,Director 639. 39y 16, Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ft�_' / A Address of Woz : Owner's Name: Date of Applicatio I hereby certify that: Registration is not required for the following reason(s): FlWork 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 PENA117ES OF PERJURY I hereby apply for a permit as the agent of the er: Date Contractor egistration No. OR Date Owner's Name x - i. 4 ':w -! ..; .. .. a... +•_. T„. �` . F .. -. 1 ,II. .. .. S.. 13eT►.u'n_o,o Lw , 4 40 , 1nW. AF { , . - + . �. P v _ 'S s_ G. ystt- _ . ay. .,:�.t ' ��t�-i4� f7a yy 5P (H "-.X- 11a 1 Y f. t' fI WI 1 2s + . ss L�-r Q �3t-�- 34' < ' r 0'.. , `wlr 1 ` t 4 {, Cp I. } j Y �1 � f ,r, , M 3' o< h N L o - ' Z 7 S Z-2 77 S F, f *�1H OF bf,, o��� :raHPl y 1 � l. -'� 1. 2 f4 Np'cURV�'y . . f,'� . Lo-r; 2 Cp 2E . ' CERTIFIED `. PLOT PI. LAN CS,000 '.s LoT Z'7 �3 c-r'wvvD 'Z -�.H� 41 Q , �' CEO T ire I//L Lam, `20 F S.,& J C� lo' a �:PL s. �. IN .1 I - I �,-��,--,` �.��.,.�.,:�il�-,.;�"."-".,:�;,:��,-..',,��.4; .- :,-,-:.: SAA.4 sl 9 A AS `SCAIEl ,_.30' DATEI4`zh 83` ,I.tr s LOREDGE ENGINEERING COIN �cv,i I CERTIFY.THAT THE ro )ni1 u ( CLIENT . :SHOW ON` -THIS PLAN 13 LOCATED EGiSTEREp REGISTERED °" ` ' 8'3 ¢7 ON THE GROUND A9 INDICATED `AND CIVIL':. :..:LAND ' 408 N0. �...�,�, �� CONFORMS".TO- ,THE,`:' 0"�I?dm Lira ` ENGINEER SURVEYOR ; DR,PY� 0r E, RN£1'ABL E ,. M'A SS: M HYANNIS� MASS ' `- ___..__r._.... s ( Q-- .. : SHEET_L,:OF:____ DATE EG-- LAND SURVEY. ..+ -�Kssor's office (1st floor)-' umber FTHET��` p: ...... ...... Assessor's. ma and lot n �. Board .of Health (3rd floor): INSTALLED INC Q Sewage`Permit number ,' ..V. ..�L. .... ...� •,( }� �y asasTsnLa.in t Engineering Department (3rd floor) ENV, TI Hou ♦� E Defin ti a Plan se rA• ..roved b' Plannin•. Bard`•`. � _____19----- APPLICATIONS ___ . TQ N T Ma �e PP Y 9 PROCESSED 8:30 9:30 A.M. and 1:00.2:00 P.M. onlyf TOWN . OF BARNSTABLE BUILDING.-�.: IHPRECTOR . r APPLICATION FOR PERMIT-TO ... ��'�� .. JL.... .a ................ i TYPE .OF CONSTRUCTION ...............C........C�G.......d........:.....:......................................:..:..:.....................................:...... �J..--...... .................190 TO THE. INSPECTOR OF -BUILDINGS: The undersigned hereby_ applies for a permit according to the following information: Location ................. ..... .....................�.......,...._.............. ... ..... . ......... !.".. . ProposedUse ..................................................:............................................................ ....... t Zoning. District ........ .......,../: .. ....,.Fire District ... �;�.( .... .. ..... Name of,Owner ...lf.....( .�/. T..... �.... .::..:Address ��... /j'4` l tJo® .. .y.1 .....�.n J �y l .&. LI , Name of Builder .......Gf 4,1..... v.l.:# .. ....... .Add...:;. ress 1 .C .G! dl f/�j.. .... Gh fLieG�j C ........ n� 1� Name of Architect ................ .......... ....... .. ....., .....:...Address ........ z . Number of Rooms ... l................ ... .... .. .................. ..`......Foundation .... �oa _ Extenor ...... . ........................................... ........ .... .... ......:Roof,4 .......... ..... ,� Floors / ................................................................Interior Heating .. <� l .G........::.............:.................................::......Plumbing ....... .�......................................... Fireplace ...................................................................................Approximate Cost...�....�....�( } Area �...F... .`... Diagram of Lot and Building with Dimensions Fee .........-,.:: /. . 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. Name . �/....:... ................. y Construction Supervisor'srLicense �C �.. ................ HEGARTY, JOHN 40 Permit.for ADDITION . .... .... . .. SincJle Fami.1X..Dwellinc .... u Location Lot #2 7 , 60 Bretwood Lane .. .. .. ............. i Centerville ,. „•.F. F�- .............................................. Owner John ,Hegar.tX..... M .. ... Type of Construction Frame , , t J f • .... ....................... ....... ................. r oo f Pfot ... Lot ................................. 3 April 25;"m M 88 Permit,`Gran'ed ....:................:................:19 Date oInspection .. ..`� ....19 Date Completed M ....19 k p rK ` in, .. i .vw.. ,�; ,: ;.:«-�::%.:...: H .:r.. 4•ta`-..r 3, :x q rti 3,✓"5:+� +;roaa;r.id4wY. 'i' `1!l.: R.:,. r ti ;x: a, .. Assessor's office (1st floor): Assessor's map and lot number ....//6.�.... �3 U............C'L P of?NE Tod` Board of Health (3rd floor): ` Sewage Permit number ..!.....!.J ...�I �— tJ = BAHdSTABLE, Engineering Department (3rd floor):� moo 1639 House number �e Definitive Plan Approved by Planning Board ________________________________19________ . APPLICATIONS PROCESSED'8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE T BUILDING INSPECTOR APPLICATION FOR PERMIT TO ��� Ol'i �_,'rl.......I ........................................................ �'"D�/f TYPEOF' CONSTRUCTION ..................................................................................................................................... � -..a .................19 h TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following q �information: , / � �` Location ...X.��... ....a 7........�/"�?i�7`L+')dotrx ...�'�........���1 y,.77,(P V/1-,•a�`-=................................... ProposedUse ............................................................................................................................................................................. ! .............Fire District ...�r. ...�(�Zoning District ........ ....................................�........ ...... .............................................. Name of Owner ......... / — ...... Address la.:a... Name of Builder .. a,!7 ,.,, ./l�y.........................Address �� ('Ltt c� G/Jlii y ��1,.,•dCrrn6t'l �cj Name of Architect k.Ci iAn.........lCt`�...............•..........Address ......................... Numberof Rooms ....j..........................................................Foundation .............................................................................. Exierfor ....I'...a0 Roofing �. ..................................................................... ..... '.: ............................................... Floors ......... ..........................................................................Interior .:..��� �. i........................................................... Heating .... L .................................................................Plumbing .......h G.................................................................... 44 n o �-- Fireplace ..................................................................................Approximate Cost .. nl).......................................... Area ..,�t ....�.�......�'..:�. O Diagram of Lot and Building with Dimensions Fee ........ ...".:"................. 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. Name�.. e .......................................... Ll Construction Supervisor's License o../...L... .3.2 ..... .HEGARTY, JOHN A=168-130 No .32.340 permit for .ADDITION.................... Single Family Dwelling..... Location ...Lot #27.,......60. Bretwood Lane Centerville ............................................................................... Owner ..John HegartY................................. Type of Construction ..Frame........................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ....April 25, 19 88 Date of Inspection ....................................19 Date Completed ......................................19 Engineeting Dept.(3rd:floor) Map Parcel )Permit# 1 R House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00- Conservation Office (4th floor)(8:30- 9:30/1:00-2:00) Planning Dept. (1st floor/School Admin.Bldg.) a S ST BE Definitive Plan Approved by Planning Board 19 INSTALLE DANCE i . i ' ` TOWN OF BARNSTABL ®��� ODE AND ` Building Permit Application REGULATIONS Project Street Address A gp�AL /U. ' Village Owner =,l,L/Uf� �7''� R Address Telephone ' S Permit Request C .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 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ull ❑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 c7p-- New l '"Total Room Count(not including baths): Existing_ New First Floor Room Count Heat Type and Fuel: as ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) MA ached(size) ILI)( d- ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - y Current Use Proposed Use Builder Information Name T 'er ���` Telephone Number a ege/0 Address l��^ ,� �.�� License# 00,96 1-3Y Y /-7'/V`/j CS �J'�.644 Home Improvement Contractor# Worker's Compensation# ()60eZ7? 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 SIGNATURE DATE BUILDING PERMIT DEN OR THE FOLLOWING REASON(S) j4di f w FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED - - } MAP/PARCEL NO. ADDRESS VILLAGE Y , r. OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE - ELECTRICAL: + ROUGH FINAL"' PLUMBING: ROUGHt" FINAL ` GAS: ROUGH FINAL r • a FINAL BUILDING t DATE CLOSED OUT> a :3 ASSOCIATION PLAN `0. c� _ In ! � t f 40' wiOCtvf ' v 0. - --- ._. 0171 43 I a O% a\0 \ 113-3 �5± i4' PPo� D 3 BQ. a LCDT Q$' GAIEI L11.16 c 4 %it' IL8. FrJbEL= III.S a' Oq \PIT I / i 2 I 12L'•6hf_ 2 . ' -'" VTGTh.I 4 "\(� 1-16; l01. -)30i � .GILTGH R-All♦✓ 00 8 � uw , 15, 000 Is. F o 100,W I D Tl4 'Lo' Fs. C3. 412 .27 t r� of //S-SS7 M. r _. -5 ! / 2 .3 Ln7 2 o.2N74 a� LEGEND as sua`+�o EXISTING SPOT ELEVATION OxO ?��,��-"OFM�9 oy CERTIFIED PLOT PLAN EXISTING CONTOUR --- O --- s 4.0-r- 2, jj/i G' FINISHED SPOT ELEVATION i�f T L_ FINISHED CONTOUR 0 RSE �, p No.10951�O 4.� IN APPROVED , BOARD OF HEALTH 9- FGISTE� �FSS/ONAL���\ ��1�J`� J •��+i ' .�i J .i� DATE AGENT SCALE, III=- 3o' DATE J3.a2Ns. FLDREDGE ENGINEERING CO. IN CLIENT �O`°�'✓¢ I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB N0. F3 c 47 BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEY R OR.BYt OF BARNSTAS E ASS. 712 MAIN STREET CH. BY! HYANN I S$ MASS. Z 03.29 83 -Y_ SHEET_L OF DATE G. LAND SURVEYOR f P _ Ol __ IV lot ID/ AY� �pc'SpwA .. ' Tw I The Commonwealth of Massachusetts rt Si Department of Industrial Accidents Office of/asesti908fts 600 Washington Street <+� Boston,Mass. 02111 Workers Compensation Insurance davit name: location: /_65 I�T/�� u/o CID A A city phone# ❑ I am a homeowner performing all work myself. 0 lamas I d have no one Tam an employers providing workers' compensation for my employees working on this job. companv name: address. '�..:: city: Z4Y phone#.- ;Z25— insurance co. olicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comoanvname: - address: ::. >::::::< cites phone#. ..:. Insurance caiv# / .. comaanv name. address: dty: phone#. ......;.. insurenceco . :.::: >:;: olicv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under th dins and allies of perjury that the information provided above is true and corrFent Signature Date Print nameZoeeaZ Phone# ofndai use only do not write in this area to be completed by city or town official city or town: petmit/license# ❑Building Department OLicensing Board ❑checkif immediate response is required ❑Selectmen's Offlce ❑Health Department contact person: phone#; Other (crated 9/95 PJA) will The Town of Barnstable MAM• a�sr�. • �0 Department of Health Safety and Environmental Services Eo ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Q�w Eez � C�r,L Estimated Cost Address of Work: 6607-4.200' I/V A51-LA<e11 -e- AY41 Owner's Name: -Eym) 111�€Cd?e,1_111 Date of Application:_ c� I hereby certify that: Registration is not required for the following reason(s): Work excluded by law OJob 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. �NED UNDER PENALTIES OF PERJURY I hereby apply f permit a agent of the owner: Date - ontractor Name Registration No. OR Date Owner's Name g1orms:Affidav I �'. DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nueber Expires: t RestrrcteduTo OO ` r GREGORY,tI;:..C9ULEV AA BqX ER AV{` .,..,x W YARHOUTH; MA 02673 R, i ..r, ' 'aHOME IMPROVEMENT..CONTRACTOR b Registration` 106395 Type FINDIVIDUAL ;� {. kv°Expiration 07/23/O0 its t 4 5 JR y 6RE600Y M CAULEY 3 Bax ert Avenue " y � Yarmouth MA 02601 w ADMINISTRATORcr fi.�d.��i,„ Engineering Dept.(3rd'floor) Map Parcel �,�� Permit# 2 Sta 73 House# Date Issued j f� ,v Board of Health Ord floor)(8:15 -9:30/;1:00-4:30) Fee. /�I /L' S�GU Conservation Office(4th floor)(8:30-9:30/1:00-2:00) //� r 1 / Co. Planning Dept.(1st floor/School Admin.Bldg.) ! opt /� �4/4&,j� Definitive Plan Approved by Planning Board 19 _ BARNSTABLE,1639. ,p v r TOWN OF BARNSTABLE Building Permit Application Project Street Address ' ��� ��/����®�L,t ' Village---`� �i`]�C Owner �'DAA &Er�Kr Address .( n Telephone ?S%�a t Permit Request I;66-e— G A, R / r "First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ U ca Y Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ 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 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) QW ttached(size) ^Jzf,x ❑Barn(size) ❑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 912 -!5— 1Y6 Address�C3 A 5-5 (l__ License# e: 2 0- Home Improvement Contractor# ILI Worker's Compensation# _t(J<�:- t2 --/9"Q ?�� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION D IR S RESU ITL N FROM THIS PROJECT WILL BE TAKEN TO 10, IGNA DATE BUILDING PERMIT DENIED R THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY • PERMIT NO. DATE ISSUED , . '. � .. :: + ,, � .• i f� � .- . j t r MAP/PARCEL NO: ' �-• r -. ., .`, - -. .. ' .� r1� _ , - �-F J ADDRESS r 'i VILLAGE OWNER DATE OF INSPECTION: FOUNDATION /,/Y� - FRAME E"b 22-- (Ft INSULATION ' - - FIREPLACE - ELECTRICAL: ROUGH $ ti` 'FINAL: _ t PLUMBING: ROUGH ! FINAL I _. GAS: r ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. ...�.r.T.W..- ...v... 1-.-. •.. --.�..• :_. �' ..},« _•,- .�. . -,,.TM...-..pw•�...._, „ . '-..-. ...R.:t.ti ... -'w.1,..,�„ .-..�__«- w'•"";...1 1 } tNe►q °• The Town of Barnstable BARNSTABLE. Department of Health Safety.and Environmental Services �Fo,�•° Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 s Building Commissioner Inspection.Correction Notice Type of Inspection Location /n (�. `�2P-ruDcDos Permit Number `�- J Y Owner Builder C A"t t-C c, One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: , u -fin; 's'v- a>©P ra n_61 �14 la, '7n e 41 C1,? tA-, 0 R—C►- 4 1;, �p�cX C 4'?Pq U XZ2 CA W'('40CAJ All Please call: 508-790-6227 for re-inspection. Inspected by A� Date c) l 1(0 l g`7 � r d V '6 27,t 1 ZS - all J � ` N La-r 2 s CQ 0 f1 6rLQ.rtsl= M Oo N Lam- 27 - S,'. ,N OF /0 JOHN RO�IBERT C- 14 C ISTEV� p� CERTIFIED PLOT PLAN 15, 000 5. � LOT Z'�' � ?C- 7 ;.�/u '�✓ •_' .4. hC � CEN Tc-�✓/L_L I N SALMS fASL9,obJASS# SCALE: / 30 DATE14 `2,6/9'3 LDREDGE ENGINEERING CO.1N CLIENT ''��",/ I CERTIFY THAT THE FDuv`:'AT+UN SHOWN ON THIS PLAN IS LOCATED I EOISTEREO REGISTERED S CIVIL LAND JOB NO. ... 0 ¢7 ON THE. GROUND AS INDICATED AND�f ;4,M, CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY+ ____- OF BARNSTA13LE I MASS. 712 MAIN ST. - CH.BYs j•�'�' HYANNIS, MASS. . SHEETLOF DATE OEG. LAND SURVE . J• ,:7;7 j TII•'!4[9 F.- C T - �- -.. CT b0�3��tiT(�vod 1-�U it BudderiGanaral Can;ray�, P.O.Sox 635 Hyannis,MA (6171 778.0429 I j i \�FlSPt)AL —�h I' I ax Till-)cK ax I. iL-?Y -- ,� j- /Olt 6,eFti-maoot, I-A) � ��5, CFiu 7-�,e vi��€,HA The Town of Barnstable • en WW" , �0�' Department of Health Safety and Environmental Services f1619. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissione For office use only 'Permit no. I Date AFFIDAVIT ' HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL a 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. (fi Type of Work: 1i7y � �///'�� � Est.Cost' , Address of Work: ,� 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 S1,000. 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 ermit as t gent of the owner: ate Contractor Name Registration No. OR The ConintottIrealth of Afassachuseas Department of Industrial Accidents A � V Office ofinvestigatiotts • '�\J.' 600 11'a.0ini;Lott Street Bostoir.Afars. 02111 Workers' Compensation Insurance Affidavit �hnitsant information• Please PRINT_ leg'• name; I GAf / ncation- b Q 207—W 006 A-A city ( �tiF/ �/��- nhone tr AIAfr I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working_ in any capacity .. .. 7v- ...._..r�_-;�e�w...tw�.n.T'�+n+l.7A+'r;.7+t�n rr...w�ww. wwy�+.....• �.�..•w..._..,►.wt.•...r.._-_.....w. [-j I am an employer rovidin_workers' compensation for my employees working on this •ob. . cam tam• name: city: /- YAAM I-& Mom. rhnne#• ��� ���J -��� V incurnnce cn. 4� ,, o k) 11v.S&1e eTC nntiev 0 if [� I am a sole proprietor. general contractor, or homeowner circle otre) and have hired the contractors listed below who have the followin_ workers' compensation polices: comn:tnv nnmc: addresc• cite: jhonc#• insurnnce rn. noliey# I .�� .-„�=w.. �. -�.;Y•• � -- _- �r�-•VTR-•1. i7!..l!'1A�1 .��r.:.�_ ...w.ti...�.....r.. - cnmnnnv nnrne: nddresc: rite: phone#• insurnncc co. .policy# Attach additional sheet if neceiiary-i r - + ;_;.- +•�• _ %"'�'=""--�•••• ti �' �" ---" - L-�.. -__ •_--"(�'r�r:irL� ._.:� •' ...�Y �-....,._._-......r�.:,.w._._..Ifsy. �..-a_:-:-__�•�,Y!'�iS�it•.Ws'w.aL Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 andiur une%cars' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I undentand that a COPY of this statentent mar be forwarded to(l !rice of Investigations of the DIA for coverage verification. 1 do herehr certify under the pa' and pet ti• f perjure•that the information provided above is true and correct. Si_natur• —Date i k� 7 Print name I _ Phone# official use unh• du not write in this area to be completed by cin•or town official ` cin or town: permit/license# rtlluilding Department Licensing Huard I] check if imrnediatc response is required DSelectmen•s Office f C311calth Department contact person: phone#; nUtltcr s- `~•.•r.....r�w..w.�.�..._.�.� .�-�.�.w _. _ - mot.-^.'��. . Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the employees. As quoted loom the "law". an enrphoree is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrph rer is defined as an individual. partnership. association. corporation or other legal entity•, or ally two or nor, the foregoing enuaged in a joint enterprise, and including the le-al 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 d%\cllink, house of another who employs persons to do maintenance , construction or repair work on such dwelling_ ho: 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 an• 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 chapte- been presented to the contracting authority. UT- Applicants Please fill in tite workers' compensation affidavit completely, by checking the box that applies to your situation and 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 sin and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required m obtain a workers' compensation police. 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 tite bottom o: the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple- be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned ; the Department by mail or FAX unless other arrangements have been made. Tile Office of Investivations would like to thank you in advance for;you cooperation and should you have any questior please do not hesitate to __ive us a cz-ll. '...y,•-r+•.-.... ..._-._•-v:..... ..�w..w...+•.:e��•. -ta-�....-_._....q..r�w..w..�_.a.....�wne.• ..�._..w..-.�w•r•.as.weri'7f' .. J .. Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406. 409 or 375 say..-ads. '9L+ae�"°w^3 f O ,, r o =� 1� ky J1f6TO697fU1t091IIIEKU/L o�./�.aaeaavr< a HOME IMPROVEMENT C O ONTRACTOR „ t w,. A T ' Registration°''106395. f Type `INDIVIDUAL Y ,Ru a, Ezpiration a 01/23/98 r,f . Yk �[,epj .4ot an ' s � IREGORY�M CAULEY ` M ABazter Avenue �i�fmouth4MA 02601 ,1 :. ADMINISTRATOR 'UfL7C SAP., Mon 1, a�i:ii�995 AV .�•� �� TOWN OF BARNSTABLE Permit No. Building .inspector cash �Yl ,en. �� �) "'''� OCCUPANCY PERMIT Bond _ .. ___7I_�a`lg 4. Issued to 1 ZQren Address T r,+ '�� n r_�:t,--woof' T`riye _ r•,�ni n ,-Vi le Wiring Inspector Inspection date Plumbing Inspector /. ; , Inspection date Gas Inspector Inspection date Engineering Department Inspection date —g Board of Health Inspection date 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. ......................................................1 19............ ............................................................................................................._. Building Inspector r- n l3r�cr'/Vv c w t ', 3 " � ✓ 4 ire y ,r_' OF77 . - ROBERII ISTS CERTIFIED ' PLOT PLAN 15, OocQ ,5. LOT Z7 ,$Xc-7-w o_5 /";i vE IN r SCALE, /"-3v' DATEt LDREDGE ENGINEERING COIN �2Ms, � I CERTIFY THAT THE ` SHOWN ON THIS PLAN IS LOCATED EGISTERED REGISTERED 8'3 a ¢7 ON THE GROUND A9 INDICATED AND CIVIL LAND JO@;I+10. ,,...,,..,.,._ . ENGINEER SURVEYOR ,` DR,DY+ CONFORMS TO THE ZONING LAWS OF i19ARNSTAOL:E , MASS .CH ®Y$ w--. 712 MAIN ST ' • HYANNIS MASS.; SHEET_44.OF DATE E0 LAND URVEY�¢'S r ve Assessor's map and lot 'number :...., /� .. ...... �Ic S a , ��`,y jg\ THE �/,.�✓...... J °� roe♦ 3 ry Sewage Permit number .... `} 339HH9TABLE, i House number ........ .............`............. �'+\A . 014- •y� . '•'. ro ^es � amPYa' TOWN. , OF -BArRNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....`....... . ........:' ° . ..!��:` ..:................ TYPE OF CONSTRUCTION �kl�✓ .... .2.( ................... ............. ........................ �L........... ..........19.r!.,o... TO THE INSPECTOR OF BUILDINGS: ' The undersign h -by app ' s for a permit ` ord' to t-e folio fi information: Location .(.... .................................: � ............ .. . .. ..... �,,. ProposedUse ...r .... .�..... �/e............P .... ........ ......................... .. .............................................. ..... Zoning District ..............T. ...........................................Fire District ............... . ... . Q.0>a.,°!'.. � . ,z& dressz::;...... %ioC o ..G.. 1�rtz2%e _1111q. Name of Owner .:.P..�h.. .�..... .. � �I .... .... .. �.... ....�7©h?.!' Address ... GG...... �Jt .. ..C. r?` ........... Name of Builder ...... �. .................... ,.... ... I.... Name of Architect. _ ...............................................................:......... /� — r/.. ?�c1.r.:. �ddress .....:..... Number of Rooms .......... .......................................:............Foundation .....;............ ��1/�;d C�Ja.� L� . LRoofing ��..,pp /�i ......... 1�'x�� .�.: Exterior ................ �................ ....... ................. /� Floors .....G ....................................................... ............................................ f , .. ................. — _................. --_ � g ..../' �� :.Plumbing /..t?: ap1J Lies�lr.�r� .Fieatin .� C .7........:............ ................ .. ....... Fireplace ......... "'. v�.!............................ .....Approximate Cost ....... : ^': �...........: . ....... . Definitive.Plan Approved 'by Planning Board -________:______________________19---------. Area ...... Q. I ...+r' .:..:........ Diagram. of Lot and Building with Dimensions Fee J 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. } Na ... .;,............... . ......................... ` Construction Supervisor's License .................................... r, HAGGERTY, JOHN & FLORENCE . r 25007 One Story No ................ Permit for ........ ........................... T ` Single 7amily D lling ........................................... ................ . c - Lot 27 60 Bretwood 48g�;ve Location ................................................ Centerville Owner .. John. & Florence Haggerty 4 Type-cif Construction ......Frame.................... ....... ............ ....... :...... ............................................................ Plot „ ......... Lot ..... ........ ........... ,. � ` . i t A ril...28,-.. 19 83 Permit "Granted .. .p.. a , Date of-Inspecti :' ,'.r�.4�...19V 3 Date Completed' ... ..,,Iz.943. ZT9 �D fi r eipL� { Assessor's map and lot number THE TOE Sewage Permit number a . ....0 Z BARNSTABLE. i House number ................................:�.6.©............................ ro 11M6 TOWN OF,BARNSTABL.E BUILDING INSPECTOR r .::....... w _ ,� APPLICATION fFOR PERMIT TO .... c ,.. ... ....�........................ TYPE OF CONSTRUCTION .?. ..: .................... ............................................... ......:................19. . TO THE INSPECTOR OF BUILDINGS: The undersigned h r'eby app ies for permit cord'�to t e follo information: i Location .. .... .�...�.. ...... :......... ..... ...... .. .. ........................................ P l c ProposedUse ...j r..........................................: `a..................................... ......................................................................... Zoning District............. �.... � ...........................:..............Fire District ...............:.a� �y� �... .....:........... of Owner /`.Q-in� 7dress ..(a.... ...A;- Name Nameof Builder,Z,4', '.4.... i'7'l� �"� Address ... ...................................................................,. ...................� ........................ Nameof Architect Address .................................................................................... Number of Rooms ...........).....................................................Foundation . � /!4✓g C J �'� C �' O a�i�r l7 sir // C^ �//.rCJ�' C' Exterior .......... / �� /Roofing .......... .:..........: : Floors ,%.....................................................Interior ..................:................... en 1J Heating i ..... g ...... . r:.:?:.�...�... .. .�:: .z..�':.,/.��+t..�;t.a:...:........ Fireplace ...........:`........................... ...:...,...................:. Approximate Cost 3 .. Definitive Plan Approved by Planning Board _______________ ---------------19________ Area :.........::........:................. Diagram of Lot and Building with Dimensions _.__,� Fee 4 SUBJECT TO APPROVAL OF BOARD OF HEALTH t M -r 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. Nae_ .... ............. ... ................... ...... Construction Supervisor's License .................................... HAGGERTY, JOHN & FLORENCE A=168-130 ) 6g- V 3ck No ...2.5.0.Q.7.. Permitfor ...0.ne-Stary. ......... ......... ...D-Wel-li.nq............ Location 27.r....6.0...B.re.twb.9d...L.qn.e .. .. .. .... ....... Centerville ............................................................................... Owner ....J0.hn...&...Florence. ...H.ag.g.e.i�.ty .... ..... .. .. ....... ....... .. Type of Construction ...TI-KAMQ1.......................... ................................................................................ Plot ............................. Lot ................................ Permit Granted .......April 28, .....19 83 ... ........................ Date of Inspection ....................................19 Date Completed ......................................19 p o UV i�w Y1 .Q C P i fl'*' 1<s N I r� a Sk I I F All M p.-V6 --: ---- __ � 1 , �s r- i , d xnk- CY 3�2 �oQ op p0 LO Av- fq, 4) 1 i 'CAIVV 5 , n QO i � •i /�/'t���J� j ' � ,. - •. # i i .l,'.1. i 1 1 ' • 1. i i l •G ; i x 3 r r 5O fj '' r �n,vc,�✓i, �:� CA-)r1c t f I I i I I' 14 /S T/ L9. 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