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0080 BRETWOOD LANE
I '{ i. fl ; c i 3 rt• J7 n " . �• s� .r e- t -y.'� �` _ 'g' '` 4' "F''"�"„4s.�K';'' w..°4`y„a.`off"`„1Ms> '"a.ert, t v M .: r-" _ .�---'-',---',,"L-'�,�`NL�,--'-1��-,--.�"�'--,-����-'--�,.�:�''"��'�-��---�,,,"�:-��-:,1i;��',�-1-.��''�-.-,!,.-_"�7,'�--,1���"",,".,=�����—�--.I"I�"�-'-'_,�1-:'--�."-�";�",�'�-'-'-:-"'T:":'-�,--1��,".1.—"-'�:'-.'�--�-�""�-":"�m:-.�,�-.".,-"�"�%�-"'-��-"--"-,,�.�._--kj1,-,7--�'-:I---:-'-�L�''--I-I1,�,�-:�,�.��'--',��-'-�,'--��-�,.,'�,,��-":--�z.';!-"-''"-'L-���:-,��'.,I-,,�-:-.--'-I.,��,��,"-�--�-.:�.�A:.�-�_I.-�-�--.'-?,'111'-,-'-1'-1,�-"'1-:,-"�-.�:.-1-"�-1'::"1L�."�"�"�1*.-,�1-l--1"'":',�--Z-,,j1�'�,,r 7�'�,.�.'"-:-;:-��".,-�",�J.--:.—e,-�B.,�-,1�'-"----,�y-,'�,��-'�-�o�,�L,�.�-,,,'��I:".�--�-"�:.'-"t,--"',�1.-'-'�"---I,---l_�--:':"0---,�",I,-�'�,,1�.S--,""�',�,��I.:",.��l,"-'"�--1,---'�,-�--,'`,: - ,;; „r r ._ - b- ' 4 -, ... - r .. ",i > „ C, r r q .... e- "- _v. ".! z , 4" _ - ...+ , - _ - ..._ .. 1- o ^•r^ F't• ... s_ - :., - _ w .K -' w _ , , r .. - - ..- .. ..'...... . .. w _ - < ..i. ,. t+- ri^ .. y i F .: . '- 4 - E, - .. - ," c S e r_ r - '-- - f .. - - .,, - ,- a'w;'. .. ,,. _ A j y ., _ - n S^ - - .. .,.r.. ... v + .. '.a r...r,., +. v 4 .• r X N p k" 2 �,t. » - - - .- .,'...i. ^_ ,r - ,., 6 C3 - S "I. r L - j' ... - .. - 1f _ s. Fy ZT" T v;f= .. v ..' J L 1 M^ ti g 'v- - ._ _ K r ;[ k _ L � 1' s 4n. 1 F k _ _ 1.4 S - Y » T 1` Z J f.. { � Y t i f; F — - 3.J N' Z „ ,.x x. w May- y zr a '"'x _-+ -w w d S x -~ Y h iaL t �i..@ ft `S '+rc �„ t -K } : y�x� c �;u::r w c ., +F_'"' x>`'�».a�"' .,,t+' +. �„aec ;! r•^^ ,ia{: ".- ,.��ad�,`.€.ic —moo ��q�O_r ram. PERMIT PAYMENT RECEIPT ' TOWN OF BARNSTABLE BUILDING DEPARTMENT 4` 200 MAIN STREET HYANNIS, MA 02601 r� t DATE: 11/O1/06 +;t TIME: 13:05 -----------------TOTALS-----------------'� PERMIT $ PAID 2.5.00 r AMT TENDERED: 15.00 � AM! APPLIED: 25.00 CHANGE: .00 APPLICATION NUMBER: 88056 PAYMENT METH: CHECK PAYMENT REF: 5301 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION l F �'�Map Parcel �02� Permit# � 5 w Health Division loll f 21(�S� ��u1 3- a �U-6Y� o � , Date Issued Conservation Division C7 i oc/ Fee wD T,2x Collector -*pp ri'Fee�5 I Treasurer Planning Dept. Checked in By EXISTING Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis --�_ Project Street Address Q,0 /��r�, 42 C O/6 /y Village CAI I9/ =�, � Owner �� }� W1 M Address SQ e0at) (!�& Telephone Permit Request �` ,�( _�= 4 S77�A in G /ZMAA' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation cymy Zoning District Flood Plain Groundwater Overlay Construction Type ulQae� Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family 0 Multi-Family(#units) Age of Existing Structure / Historic House: 0 Yes �11Yo� On Old King's Highway: ❑ -0 Yes 944 Basement Type: arlaiII 0 Crawl 0 Walkout ❑Other Basement Finished Area(sq.ft.) 4voJo Z— Basement Unfinished Area(sq.ft) � F Number of Baths: Full: existing new Half: existing new J Number of Bedrooms: existing new = - Total Room Count(not including baths): existing new First Floor Room Count,---.,4 aE Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other ) Central Air: ❑Yes 0 No Fireplaces: Existing Ve w 'Existing wood/coal stover 0 Yes ❑ No Detached garage:O existing new siz� Po I:❑existing ❑new size Barn:O existing ❑new size Attached garage:0 existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ s Commercial ❑Yes If yes, site plan review# Current Use / Proposed Use BUILDER INFORMATION Name Telephone Number Address. CIO, icense# �"9012 O ome Improvement Contractor# 10 �5 �i Worker's Compensation# ( l/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PR JECT WILL BE TAKEN TO `� SIGNATURE DATE / C�1. r` t FOR OFFICIAL USE ONLY PERMIT NO. r DATE ISSUED t �� MAP/PARCEL NO. ADDRESS VILLAGE f OWNER DATE OF INSPECTION: i f FOUNDATION P Z- FRAME 61Z j(Sl.,;6106 tl2,71vG Jot INSULATION Y, FIREPLACE i ma's ELECTRICAL: ROUGH v- FINAL PLUMBING: ROUGH FINAL ' GAS: R(JUGH �4 FINAL FINAL BUILDING 1 DATE CLOSED OUT . . v ASSOCIATION PLAN NO. � + ' i f, "E'°��. Town of Barnstable Regulatory Services ` Thomas F.Geiler,Director 9 MA K p`�$ '°�Ec .r Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 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 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: 4_�!�)(r)C.( _961eIK Estimated Cost, 04Jt br' _ Address of Work: LA_1 Owner's Name:lZaP— /4 Date of Application b— :o '6 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑lob Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ate Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaff'idav RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Change of Contractor/Builder $25.0.0 FEE VALUE WORKSHEET. NEW LIVING SPACE 3 square feet x$96/sq.foot= x.0041=o plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 4r . square feet x$64/sq.foot= x.0041= plus frombelow(if applicable) . GARAGES'(attached&detached) '4 1sl square feetx$32/sq.fft = 2. x.0041= S„5 ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving •$150.00 (plus above if applicable) Projcost Permit Fee u�,n�anna Town of Barnstable Regulatory Services HAMS'"M " Thomas F.Geiler,Director 1-6 9. '�Eo roe Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:. 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 Jt 4-V1k( ,as Owner of the subject property hereby authorize Cc. to act on my behalf, in all matters relative to work authorized by this building permit application for: 80 (Address of Job) 6� 4SaSoIfOwner Date Print Name QTORMS:OWNERPERMIS SION Results Page 1 of 1 Licensed Contractor Look Up Select the search method: I Name r Maximum number of matches: 25 ' Enter Search terms separated by spaces. IGREGORY CAULEY Select Search type: r AND G OR Search Search Results City/Town Name Type Lie. Restriction Expiration Street State Zip 33A W YARMOUTH CAULEY, CS 9013 00 OS/11/2006 BAXTER MA 02673 GREGORY M AV Total of 1 Records matched. Back to Home Page BBRS Privacy Statement http://db.state.ma.us/bbrs/contract.pl 10/13/2005 ,Results Page 1 of 1 Home Improvement Contractor Look U = p p Enter Search terms separated by spaces. Search terms can be Town/City,Name, or License number Select Search type: r AND 0, OR Search F Search Results Reg. No. Applicant Street City State Zip Name Title Expiration GREGORY M. 33 A W Cauley 106395 CAULEY Baxter MA 02601 Owner 7/23/2006 Avenue Yarmouth Gregory Total of 1 �/� S l l c— o ct (i- 0 Q �3 Records 1 - matched. Back to Home Page BBRS Privacy Statement I http://db.state.ma.us/bbrs/hic.pl 10/13/2005 O N N6 z ``NI O V'O N N� o O 71 W o m Zoo s� 'p m N - � 255.2a 6' Q � N � N � 61 PROP05ED -.-< � 24' x 24' GARAGE >:s» ` 30 6A BUILDING LOCATION PLAN LOCATION: 80 BRETWOOD LN., CENTERVILLE; MA �p�(H OF Mqs CLIENT: GARY*CHERYL NIEMI 5CALE: DATE: DRAWN BY: c� ST VEN y 1 " = 40' 09-29-2005 TMW G T JOB NUMBER: REVISION: SHEET NUMBER: g R M�B�� 05-067 CPP-I A�oF 307 y W-ELLER * ASSOCIATES ass NQ SURv�`,O� I G45 FALMOUTH RD., SUITE 4C P.O. BOX 4 1 7 CENTERVILLE, MA 02G32 2 WINDY WAY, #232 NANTUCKET, MA 02554 TEL: (508) 775-0735 — FAX: (508)775-0735 1 v_, EMAIL: trl5Weller@comca5t.net �� PROFE5510NAL ENGINEERS 4- LAND 5U.RVEYOR5 i CET-86-8E05 08:e•1 Frorn:f9 T UCAPE 5083984559 To:50877.5080 F'.?/4. i GARAGEDOOR HEADER ® T•J13am�6.1899MRl.Niuplom ooaa'�°°" 2 PCs of 1 3/4" x 91 2" 1.9E Micrc i9am(D LVL LXWJ 1046rocas 902.22 AM ,tee, I ngi>mVooen +.+6.d THIS PRODUCT MEETS ORIEXCEEDS T is SET [DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED pro"a® .tom lea ct ell, WAM Anaiysle Is for a Drop Sean Member. TriWtory Wed Width:1' Primary Lead Group-Residential-Living Areas(psf);40.0 Live at 10G%gjragon,12.0 Uead Vertical Loads: Type claoea Live l0ead L=Wlon Application 4mrnent Uniform(plf) Floor(1.00) 0.0 00.0 0 To V 7• Add*To 4BL,E END WALL I.-C AIDING Vniform(pif) Snow(1.15) ;i0.0 20.0 0 To 1?7" Mde To R XIF LOADING 5t1P. � Input Ding Vertical Raoctlons(IbS) DotAll Other Width Length L{bet1016att/Upliftnotol 1. Stud well 3.50" 1,60' 336/629 t 01984 LI: Bl:cl�ing 1 Ply 1 314"x 1 112'1.9E Mlcroilmn,4 LVL 2 Stuo Noll 3$11" 1,50" 3351829,1 0 i 964 L1:Iloc(C!ng 1 P!,y 1 3/4"x 1 1t2'1.6'E Mirr0am*LVL -see TJ SPECIFIeR'S f elUILL)ERS GUIDE for detail(s):Ll:blocking (I L r iMimlmum Design Oontrol Control � Location Shear(lbs) 030 -746 7265 Passed(10%,) R,end Spnin 1 Mn erSncrw Wding Marne (Ft-Lbs) 2152 m152 13541 Passed 08%). l AMID Spun 1 under now loading Live Load pall(in) 0.027 0:308 Passad(LIg99*) MI6:pan 1 underlSnow loading Total Loed Wi(in) 0.078 0.463 Passers(U999+)I MID Span 1 under Snow loading -Deflection Criteria:SIANDARD(LL:U360,TL:t/240). -13(ACing(Lu):All compression edgea(top and bottom)must ba braced at 9 2"oie uni966 d6l[IlIr 0 otherwise. Propar_ottachmant and posNoniog of lateral bracing is required to achieve meml)er stability. itAPORTANTI It*ana'yale presented is output from software da3velooed by TruS Joist(TJ). I J warrants the sizing of its product®by this aofftwere will oa acwrnpiished In eccadance with TJ product design critsrl@ and code}a'captad design vain s. TNe specific product application,input desbk n kxld5, and stated dimensions have been provided by the software user, This output has net h®sr,rev Nwed by a TJ Astsociate, -Not all products are raadlly avaliaD!ea: Check with your s:appi!er or TJ tbchiicd re piesentat lye r product avtalle9 bit Ily, -THI$A(UALYSiS FOR 7Rl)5 JOIST PRODUCTS t5NL1'i PRODUCTS SSTi T UTIAN VCI THIS A`fALYuIS. -Allowable Stress Design n:attv3dn!egy was:;sed for SuilC!rg Code BC?CA analyzing the TJ(Die ribuWn product listed shove, -Note:Sea TJ SPECIF'IER'$1[5UIW R'.$GVIOeS for multiple ply conne tlon, Pd Qj9CT9NE2BM6TIQh: RAat FQ„4 I. L' GREG CAUI.E i Michael So too 8D t3RENT'.IVOOD RD. ' Mld-Crape. ome Centers GENTERVILL2,MA PO BOX 1 18 465 ROUT 134 SOUTH D NNIS,MA 02660 Preone:50 9986071 Pox 50 3984559 mtuarataet •dnapo.net C'oyyi'Ipf:c ® 2004 by'PCUA 3615t; d uayerhaaunor ikon A1i4RR Kiorollhva 1R tl rat3l i'lRr.tld �CGi11t1„p 1'Y. '7r ?'uP :r�lgl:. C:%Proaram Vila®\true tl43 P':\1U-IriPInlJwb Peioo WAu1.0-nu 0Rnt41{ffX) GA"4A(A V09M Ig}p Yea OCT-E43-2005 08;02 Fran:r'1=DCAPE 5083384559 To:50$77550EO P.3.4 ARA46 BEAM " Ti-BeefreD6.90BalletNaalmer 700f10004109027 r 3 Ptcs of 1 3/4`° x 18-11.9E MIcrallall LVL 66 AM, p� p p� p� T DESIGN - Papa^ am 8rm2I is 5 THIS PRODUCT MSETS ORIEXo EEDS THE SET DESIGN CONTROLS FOR THE APPI tICATION AND LOADS LISTED Pro"Mewerse is ca cti. W&M Analysis Is for s Drop deem Member. Tributary LoDd Wldth', 1:' Primary Load Group•Res denuil.Living Ares(psf).40,0 Live_nt 100 .b d ration,12.J Dwid MURIA, j input Dearing Vertical Reactions(Ids) Datati � Othanr �rldttt Langan Ltvelosadlup18Pt1 otat 1 Stud V*11 3.50" 3'W 5760,120411017001 Li:aloc ing 1 P!y" 1�4"x 1001.3E Timbear$trandS LSL 2 Stud wall 3,60" 3,W 67601204110/7801 L1:Biqa dng 1 Ply 1.114'x 18"1.3E T1mWr$Irsn.5 LSL -See TJ SPECIFIERS 1 BUILDERS GUIDE for 0'0Iocktn0 I Maximum Vastgn Control Control Location Sheer(Iris) 7N3 •0636 17955 Passed(57%) RL and Span 1 under Floor loading Moment(Ft•Lbs) 45516 45516 68130 Passed(78%) MID Span 1 under Floor loading Live Loa.Deft(in) 0.742 0,789 Passed(Lill) MID Span 1 under FW4r loading 'total Load Dafl(In) 1-005 1,183 Passed(L1289) IMir)$Otn 1 under Floor loading Daflectnn Criteria:STAN0ARD(LL:;L1360,TL;LJ240). +I+ -9racrng(Lu):Ail compression edges(top and bottom)must be braced M 7'!7"c1,unieee Cetelled otherwise. Propar citnohimant and pGAltioning of lateral trracin7 is retuirad to achieve member atebl1ty. ; �►�i]_IT9LtldA9.�lOTF.S: `- lMPbRTA'JTi rhs an2tyais presorted is Output from software devalopm�y True Dols:(TJ). TJ warrants the sizing of its produets by thls acftwrare will be r Gcornplished it accordame will~TJ prtrduct design Criteria and code 00copted de-sigr,values, the speaiflc product application,input design loade, and stated dimenslpns have bean prov!ded by the aof mro user. This output hss not been reviewed by a TJ AaamiaW -Fiat ali products are readily avoilabta. Check with your eupp.lar or TJ t6chisIcal reprssontativo for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLYI PRCrioUC'P 3'`$aTrrjTION VOIDS THIS ANALYSIS, .-Allgwable$tress Oesign manodolcgy waa used for Building Cods 90CA Myzing t+te TJ Distribution pro3LICt listed a`J;7vs, -Note;See TJ SPECIFIERS/BUILDER'S GUIDE$for multiple ply conner,lion. i Pi�O.tEGT'.9BNF4F8M�T'IO.N: �,�,� �+ a'<TIOfv; GREG CAULEY I Michael Senlds 80 BRENTWOOD RD. Mid-Cape Home Centers CEN TERVILLE,MA PO BOX 1418 465 ROUTE 134 SOUTH DENNIS,MA 02660 Phuna;5083986071 Fax :6083084550 • msantos(�midre;tps,nel C4'AY�'�til,t: O ahgi �}' TrUo .•o.LaG, s WeysxMeu��r auslnse■ - xicro:Iwa ie a reglaterod trai mark or True (meet I c"f-Jti_ M'12`, T.DCA �' �Ctd 3?e� `'�. 1° :5Mil''i•c," r' P°?'4 AIN f air OvAmigm .�iuAt�6 Eiw�.A+t v�4a�anaGa,afJenarou ruaia�aaa 3 Pea of 1 314" x 'I&'it I.01: i�¢011amt� LVL A g d�"I-106 THIS PRODUCT CT MEETS ORiEXC F D �`1�4 EC' DESIGN CONTROLS FOR IN&APPLE ATION AND LOAM LISTED - i LML i fs,�alypiB IE lrsr s Qdat�k'2a&m?uitl'r;tatAr. TritYuS9ay LAceti`t.�;rt, "i; ' Pnrrwry Lc*zi Croup>Rtaaidant,@t Llrint:i Aa tiuc(p5O:4o J t.Ivra at`00 3 d} OC.ju" ,;.o oayd irr�r�3 i3saSir$1r,� Vevtloa!lisactl�;5;ra 41a�,? ilrytuii � Cagak�ar Width 1.0math 'q# j 1 lud Ali 3,50" 1, v I to I t t:Ol4c�iny 1 v y i." �.i�"'1. ?imCar�9rsndt�Lai. 2 bpi w1411 3.60° W VMJ1 2041 10!WWI LI:ft*.?ng t :'.,: 11@"x 19,{.ATirrlWS1rond6:SL -Sm 7d SPECIFIEWS!$UiLDWS GUIDE AY dmtpif(trj;L°1:W04ir,t, tlRrsa!mucx� tGat;`ipvt Cmvtts°!s9 �ista!►�tt l.t�arDtica:a W unr(lem; 'YOM °0436 171)56 fta, a4(511/0) Ft'..rirst.$.% t'I iera W Fjj)04•load1ri¢ mornent(Ft®ka) edt"s.y'im 41.55A6 518130 WiCi a;tart i ul:ddc NWuriCrati;rp Uya D40 141*1 0.'14" 0,7D9 Poja d(iw:'u3j IhAlti priY 1 1;•t7ar tftr it ira�dirt0 'rotal Load NO(lnl 1.445 1:1R''3 p(mkin,:`,ti�l�n) �h1r>114r:;r,1 uilde Flwnr l ldlil,a -C afloctim Critavia::i'?AN0ARN'LL1;3flG,T L1Z40i. I • -Droc!r° 6.U',Ail('dZnl�l't9osion oc;sl it;p a.rit3�tloln;j frl.rtll U®ta'h f)6 z:ti,l�"�i';uniGltl~etuil®4t+:Ii�V3r'W!:9a. Pr19,?Qi'i7Etp4�1ti10i1i iit9ls:ji'a6brinin,Of luif�lll!t���Girt�iy rt�r�,urarA t17 uch>ndm;r;ranrbtsi t�iatli:ity. ,�,Ct391f1�,4t�'aR,tWCa'1`�.f3: -IMPORTANT! 1'h;t analy;id1 r.vasents i io punut faun 6r.,Nara aa,,alootDd Ly Trr„i5 Ji:4:{'T,10. 'tJ warrartta We taiair,g of its pr�•Juclm by;his ac^.tiwAre vvW tis it=1f1plished sr.&:v irtlaam "44i;Y'J pjnja,t;t desslt;tr n.ritEtla;::d codtb Payacaptra roes:r; muck-s, Yn8 apaalilo produei tigipkalion.irput dasi,n 109do. *W cwbW dimensions navy tsars•r wrr v!aed My Ito acifttv'e:1f97 140t. T1116 out Cit I-Ic&f'U vl tm roviewad lab a TJ Aa Ia�to, .N.*t allprwuctu Am r,�:Ltdily�,variuhlir. Chod wril;h ycur taus ptiar;r'T.1 LDcn1l,:1;iapraw-.:bcv0 tat wradut,t skis 'ic bill ty. -flit,AtmLYI$19 irf,`R`o RUS JOIST PR0DU0`.5 ONL`;i F'h1;%i�l lCv�l'��Yi�,fTtrJw°JD,ttiS'i'Fer� �tS�.l.V(�1h3. -Alh7w'Eble Vass Ousign eMyrtn!aaOiCQy mit usm for Ni m!^.(a r as m 5007\ R4,7'f VS!f;0 1fJ0n r1rf.L1Zt 0518 1 At:tJi6. -Mute;and?J SPECIF(Bri'S!BUIi,P3S1 GllIM f-;wultipho Ply i i L fqi ,6 CAULEY ! td i ! i 6111,11106 at,KIENTWCDD AD. i tc 114 c6alwa C.EKITEAbilL4 MA ?0 BW 1418 4015 ROUTE`134 BOOTH DENNIS,MA 02M ' Pttcic:3;dUL13Bt3�b'�1 Fa1x :dbfadb9AEd� r�l�riicet�rrs�itr�rra.h�4t - mt.-c 1we is k G40dam9rH of vrup I 4u Oct. 25-1 2005 10:5'9 1r:1 R. N.0 t I FA N.U. NO, OTHER FACSIMILE STHk`l' i{'ii !JSHGE i!'iE "100E PHOES RESULT C71 1ct�853i610i Oc 2r 1�3:5C!A[1 Y_1' �JCli__.. 04 �_r� TO TURN OFF REPORT, PRESS 'ME.NLJ' 904. THEN SELECT OI=F BY USING '+1 OR FOR FAX ADVANTAGE ASSISTANCE, PLEASE CALL 1--O00—HELP-M/. (435-7321). I C[l0"I�CC.C�)Y?; :"'.2 "f if 1 - yr,• LSl+.!'�.i+t:ily t;l��rt F?l'r?.i�F,l� T,i•��cs:p9d.;i4:3o+�mlHumlree' �1<57d:t - p9�� 9 ' ;sa CIS PRODUCT ETS R XC EDS THE 'f DESION CONTROLS FOR THE APPO!CAPON AND LOAN LISTED L�cnd ticvl,5p: primary r.,uatd Grau.; � Mix, vortical R004U."m. Y'atal !i.':u: ati! ral 'd�aF., kig�.ai.r:>wti i5aar.irttx L'tr+,;.ht ,lf9 a,�? :w; 1.��",in� i I..CAui.!nu or: all upe:w, i,DF I N; •C t+�•"-a rareiigr: sham t�.l7d: a-1L %ea tllmk S1"roor 1:tra01 C;r? ..w;J`) MCiRt'_��2' RfsCCCa )A1 llboi 9txppcA.cC iiao�ciin': i::c}ral ��i9 i:'y 1 I l 6,osAing wuxt 011 c:> : )»159 a .a. ' - a,()') ?,p Lwl 1. i iflvus: t)as91 t1 'htiav (tS31i i r'i j '• :`Shy. ` . 1 H*MhNee tapwcat :'UtAl ri4i'140t2Uir llti) l'..56 t ax aiwif (D)0) 9]0 -9:W 1 marlboc 1;sSra�! Saar i:c,sa). w.i ti'3 i 1, ^st.lpplcrYt. M4m4n' S.ivc 0711 i i ! 1 W.°jAEN1'S:PI;M RD. � wi a•t;er�W�rnb it9rl;t�ra� B,f i+iT�Rltlt.s ,!b9 ( Pw Box 1.416 rzxkaAts 4 � . + r�1�Ui'4'.0lft��rbtlCd�t1�.;1�1 Cupyt'AAP,r V Ipili we 'l't'n{e !OI®t., C !�r'`rlsreU»a P,i:d lgGLf' j e11 cr.':,;Sa�.H t0 a 1iW5atN8't� ce6+i,r,Wti'% 6i"'.r Ya :T:.A ut' L 111'i pyr 4;d f41e!\FY:ait .'.OnnLl9i.-9uid+Il.lsU/1i.4IIEI)bidl.illy-LL :9it b.:v":5/i/::: .(�,.ua;L' i.�t r'))t..`.l ihar-u�•0 . i gum Oct.. 25 2005 10:57AM ;' i IR LLi'sU GMC (C:UR Fox Ho. : 5087755083 _N0. OTHER FACSIMILE START T i^iE I_I' rAC-'E T F �.ii�-E 1=ODES RESULT 01 1508c:.16101 Oct. 25 l0:5 ;t; 00'400'49~ (1`-N D 01 Opt" -� TO TURN OFF REPORT, PRESS 'MENU" #04. THEN SELECT OFF BY USING '+' OR FOR FAX ADVANTAGE. ASS I STANCE, PLEASE CALL. 1--800-HELP-FRX C4 %5-7329). ' _ , v lll 'o r a ♦� t , y r - 9 y .r y i � �{-:1tt�11T E.l,��lld�•T l�iJ j �. *, � •v � � , T i SCAA.E: A�'e APPROVED BY: DRAWN BYE DATE! REVISED ws R1G► �T CL-VP�`s��N N flh1MVZlO .. , 4 C)o `�'1 L Art,! 9: 2-11 1 11 • f 1 —3 9 `L a 3 12 ig u x H t 30Do �t Si ,I � . • ' ICo N C.2o'E w A-U-- L I , I 241 I � t G� SO"�2a" � `�s� �i=vcn�v c, • � � 4 9 LEVI- I - i Ell - { �i1 o t r' j`.."� t: :.✓�C / P1 a ,i r v7 r �?T N 61 u �p'?C 't 0� C�►1C�t'S a. r � c?�►ate!6i ,. F , zo00. ,r ^ x THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IM ^�CJ- LI DATA N 7 � ` ' '7 r 14 Z�il_ 1 �-= -- QN S 1 c..-c-r p APPROVED BY: - SCALE: X( ` I�`e,xJl DRAWN BY S W2� I DATE:'. Q 2 S OS� REVISED �(.,�/dQno t1 s `3�'��4-v✓��' c'�os5. 5� '�l�►J Z�� 2 J" ONE . QThe Town of Barnstable �,�� ,A� . • Department of Health, Safety and Environmental Sep vices 6 Building Division 367 Main Street,Hyannis,MA 02601 0mc.e: 508-862-4038 Fax: 548-7"-6234 LAN RSV MapfParcel: ___... Project Address.6 1 )r caS"t,?s:3--��- �1 lid r: " C The following itenns were meted on reviewing. Reviewed by: Date- OfVE A own oi i3arnstabie yW °^ Regulatory Services _"MASS. Thomas T.Geiler,Director y �u►ss. $ � `bATEpM;�►`� Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Rce: 508-8624038 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: wig e Estimated Cost SOdO o� Address of Work:. d �i�P7`..✓ou c� P C'e�-•�7�,�.�i,��c� /L1f� �� 3 Owner's Name: <!�s o. 2 Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under S 1,000 []B ilding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date on ctor Signature Registration No. OR Date Own Signature Q:wpMes.fo=:homeaffidav Rev: 060606 IMET�. Town of Barnstable °: Regulatory Services „ I e Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 2.00 Main Street,Hyannis,MA 02601 Office: 508-862-4038 •Fax: 508-790-6230 a - NOTICE TO THE BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR Al s4 , owner of property located at hereby,certify that Gis no longer Construction Supervisor listed on the application for the project under construction as authorized by_ building permit# issued on l 200 ��' I understand that the project under construction must cease until a successor licensed. Construction Supervisor, is submitted on the records of the Building Division. ' OPERTY OWNER DATE q/forms/newcontr reference R-5 780 CMR rev:080102 .. t Town of Barnstable OF 114E 1p� Regulatory Services sextasTaar s Thomas F.Geller,Director 0a 9. ��� Building Division �'0jeo tM't a Tom Perry,Building.Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: G®� y JOB LOCATION: a e P f..imI / Ga.✓cP G��/C/�✓oz% number street village "HOMEOWNER": name p home phone#/ •/ work phone# CURRENT MjkUJNG ADDRESS: /1 D Bee,- fv✓a,��/ Lerde� city/town / state zip code .The current exemption.for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as . supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one of 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. Sign of Horr}e ner �— Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community: Q:forms:homeexempt ' The Commonwealth of Massachusetts Department of Industrial Accidents 1 r Office of Investigations 600 Washington Street ,` g liii� Boston, MA 02111 v . f Iwl www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: �,��f����/e Phone#: �o,�'-`f�2� Y7,7/ Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the'sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. Y" P tY• 9.,E34uilding addition [No workers' comp. insurance 5. ❑ We are a corporation and its mired.] officers have exercised their 10.❑Electrical repairs or additions 3.EK am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions . myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.7 Other comp.insurance required.] ''Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and c rrect. Signature: Date: Phone#: 57 5oa,'- y77 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual.,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall 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 su 1 sub-contractors)name(s),address(es)and phone number(s)along with their certificates)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 ( g i.e.a do 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0-2111 Tel. #617-7-27-4900 east 406 or 1-8.77-MASSAFE Fax fa17-727-7749 Revised 5-26-OS wwwanass.govfdia TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION •o t - Map Parcel Application# ©© Health Division Conservation Division ti y Permit# Tax Collector F�. Date Issued Treasurer Application Fee 'fi7O/69 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village <f_�.1-yAf4 ✓,I/c Owner Address X o r3.c4 it, L.. Telephone - Permit Request A, 14a i z„ �%, X elr Square feet: 1st floor:existing proposed floor: fisting proposed ETotal new t Zoning District Flood Plain Groundwater Overlay Project Valuation 2#52000.0 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: S gle Family Two Family ❑ Multi-Family(#units) ' L� A�;e of Existing Str cture .� vas Historic House: ❑Yes [�No On Old King's Highway: ❑Yes ❑N6 co Bemer�type: �F -s ' II ❑Crawl ❑Walkout ❑Other i baament�Finished kea(sq.ft.) Basement Unfinished Area(sq.ft) l� 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 WI-Electric ❑Other Central Air: ❑Yes f a o Fireplaces: Existing New Existing wood/coal stove: 2/Yes ❑No Detached garage:®"existing 0 new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:1existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 21N0 If yes, site plan review# Current Use Proposed Use r! BUILDER INFORMATIO�N� � 7'7 Name- / U Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE x - 1 FOR OFFICIAL USE ONLY Z 4 Tt PERMIT NO. DATE ISSUED S MAP/PARCEL NO. ADDRESS VILLAGE OWNER s S DATE OF INSPECTION: , j FOUNDATION f s. FRAME � FCC) 11 D 06 INSULATION l FIREPLACE ELECTRICAL: ROUGH FINAL I s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth ofMassachusetts Department of Industrial Accidents �1. 1 Office of Investigations 600 Washington Street 41�dit � g V.. % - Boston MA 02111 t z�y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): j e Address: City/State/Zip: L`c ,&A ; le lYlf D k n#: 5o e . 41'det V 7 7 J Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the'sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.# �• Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. ❑ g workers' comp.insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its —wired.] officers have exercised their 10.❑Electrical repairs or additions 3.V I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions . r myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.] t employees. [No workers' comp.insurance required.] 13.[Y�Othery „.,c /3��� en,/ *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si attire: Date: Phone#: 50 J- - Z,2 e _5!�? 7/ Official use only. Do not write in this area,.to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions t Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of lure, express or implied,oral or written." An employer is defined as"an individual,partnership,association;corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual.,partnership,association or other legal entity,employing employees.,However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)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 Department of Industrial Accidents Office of lavestlgatiGns 600 Washington Street Boston,. 02111 Tel, #617-727-4940 ext 406 or 1-8.77-MASSAFB Fax#�617-727-7749 Revised 5-26-OS w,mass.gov/dia OFTME � own ofBarnstable y Regulatory Services Thomas F.Geiler,Director MASS. $ > �'"lFc �►`0 Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Rce: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMTROVEMENT 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 certa exceptions,clang vc;th o*Wer requirements. k. Type of Work: :�A G el eel, gn Estimated Cost oa, Address of Work: v l3,2�,�`.��� L�. .�e Owner's Name: .6 ek AV/ Petf . - --- Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law Fbob Under$1,000 , MBuilding not owner-occupied [weer pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Signature Registration No. OR Date wne ' Signature Q:wpfiles.f Twhomeaffidav Rev: 060606 i Town of Barnstable THE Tp�� Regulatory Services S Thomas F.Geiler,Director B"AAN5TABLE 9� MASS, ,� 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 HOMEOWNER LICENSE EXEMPTION l Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': �� l,QZYZ, aZ,;Z, :5?f-3`?P-Al77/ 509-��?�-Z, 6 name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code .The current exemption,for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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-familydwelling,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 Towii of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Ho eowner Approval of Building Official e Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section.127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hues 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 forni/certification for use in your community: Q:forms:bomeexempt ® i ®y.��o�/ c��I .PZ��r c✓lA.d �e/L.3 `^df ��'4P ; N6 W &eo I a A 6` 1 �a 11 1` %IC�O.am -ce 24'x 24' GARAGE % 11 o otr 006k ,,' r 30� • _ All✓e SPA �� A.�weer�jr � ®'.� UIL®IWG LOCATION PLAN LOC.ATIOtd. 90 MZTY,OW LM.,CENTeK%nL E,MA r L LIEkT: GAILY 4 CIiEKYL Nit" I?AiG: oRn+m e�. 40' 09.29-2005 TMW O567 YE1/:, 1. �G f)�qE®wad �e.eoysiw�+i}.d 3 �nAe+ce. - snertr�aorae+e• _ GPP-i WELLER 4 A550CIATE5 t4 ` a 645 PALMOL)Tli RD..SOTE 4C•P.O.BOX 4I 7 CeA;TWILLE.vA 02632 2*V4DY WAY,#232 HAW7UCKET..MA 02554 TEL: (SC&775-0735 -• FAx (505)7754D735 PROFE5510NAL ENGINEEK5 4 LAN® 5UKV1`YOK5 a i 9 a �t3e�/ve/�►y At ALA ZoA e r a0►�� Crib �,ia�.aw�i ��✓.se�� /' Jo/0 APPIRWOMM L omwmwswi Wftm:All. M ` (�) ON t . G �} e 4 . \ ,`\\�,• � �� ,,Jf� r l� ����,� ��/�`� � �/� ® JlAre�j��A ...- �..�T bye N Vx 4 bw°N a/ j 6 6/YAP I Town of Barnstable Regulatory Services � aARA1�l'ABt.B. � Thomas F.Geiler,Director 169P A`� Building Division' Tom Perry,building Commissioner 200 Main Street,Hyannis,MA 02601 Office:. 508-862-4038 . Fax:.508-790'6230 NOTICE TO THE BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR , I, //�� property o owner f ro located at --- - p D 13z"�J'"`✓ed Ge�L/J�X y �o ;hereby certify that G �2 is.'o.longer Construction Supervisor.listed on the application for the.project under construction as authorized by building permit# issued on l I 200, . T understand that.the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. PR PERTY OWNER: DATE q/fonns/newconu reference R•3 780 CMR " rev:080102 ZO. 3JCd JNIcruna 0£Z906L8051 6T:9Z 900ZL"Z0/TZ i The Commonwealth,ofMassachusetts Department of.Industrial Accidents i b Office of Investigations rN 1, 600 Washington Street 'dam Boston, M OZIII F s= www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Xnforxnati.ota _ Please Print Legibly. Name (Business/Orgenizatiowbdividual): 4y(�T - Address: 3 ale -,��,� �.,,,�P - City/State/Zip: G e-✓ .�✓,Z/� � 7ag :� Phone#: d � �'7 7/ Are you an.employer?Check the appropriate bog; Type of project(required):. 1.❑:I am a employer with 4. ❑ 1 am a general contractor and I . 6,. ❑New construction employees(full and/or part-titne)a have hired the'sub-contractors J 2.[] 1 am a sole proprietor or partner- listed on the attached sheet._ 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition " U working forme.in any-capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp,insurance 5. ❑ We area corporation and its . equired.] officers have exercised their 10.❑Electrical repairs or additions . LlLI.Z am a homeowner doing all work right of`exemption per MGL. 11.❑'Plumbing repairs:or additions myself..[No workers' comp: . e..152, §1(4),and we have no, 12.❑Roof repairs insurance required.] :employees. [No Workers' 13.Q Other . comp:insurance required.] Any applicant that checks box 01 must also fill oyt the section below showing their workers'.compcaeation policy information. t liomeov;ners who submit this affidavit indicating,they are doing all work and then hire outside contractors must submit a new affidavit mdicadrig such. rcontractors that check this box must attached an additional sheet showing the name of The sub-contractors and their workers'comp,policy information. .r am an employer that is provide)tg workers'compensation insurance fvr my employees. Below is the policy and job site. information. Insurance Company Name: Policy#or Self--ins.Lie.#; Npiration Date;. Job Site Address: City/State/Zip:. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). >~ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50b:00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WOXX ORDER and a fine of up to$250.00 a day against the violator: Be advised that a copy of this statement may be forwarded to the Office of Investigations of the.DIA for insurance coverage verification. . I do hereby cert{fy under thepatns and penal 'es ofpedury thafthe information provided above 7s true and correct 1 store ate / / Q Phone#: U - �� - `�7 Official use only. Do not write tnA&area, to be completed by city or town official City or Town: Permit/1✓icetTse# Issuing.Authority(circle one); - 1.Board of Health 2.Building Department .3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector., 6.Other. Contact Person: Phone#: 60 39bd ONIQ�Ina 06Z906L805I 6Z-9ti 900Z710/IZ i Town of Barnstable Regulatory Services sl sUlmy Thomas F.:Geiler,Director . w►us, ` Building Division &t179 o i41Ri T'ortiTerry,Building Commissioner 200 Main Street, Hyannis;MA 02601 www.town.b arnstable.ma.us Office: 509-862-4038 Fax, 508-790-6230 IiOM>$OWMM LICENSE EXEMPTION Please 1•rint DATE: 108 LOCAnONf /f 0 611� "y��=n( �_N ti G' I�le 1,4 0-;k �oL number street village "HOMFAWNER V /�. y/e. 7�0 - O e ,�5>do> name horns phone# work phone S CURRENT MAII.INOJW171ibSSi � ��� city/town" s zip code .The current exemption for"lht meowners".was extended to include owner-occupied dwellings of sixunits or less and possess a license, ded that the owner acts a rs to. a e an individual for hire who does not ens t allow home pone ,orovi s o �g g P : 9UDCrVi30r. • DEFINITION OF HOMEO'(•vlYTit. person(s)who owns a parcel.of land on which he/she resides or intends to reside, on`whieh there,is;or is intanded 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 titan one home in a two-year period shan.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 respon$ibldfor all such:w4rkperformed under the buildin¢Demtit.. (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 Ba' tablc Building Depattsnent: minimum inspection procedures and requirements and that he/she will comply with.said procedures and i. requirements. Signs f I3o owner Approval of Building Official Note; Threa-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction ContioL SOMEOWNERI hUMPTION The Code states that: "Any homeowner performing work for which&.building permit.is Tequtred shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages,&persons)for hire to:do such work,:that such Homeowner shall act as supervisor., Many bomeowneis:'Who use this exemption are unaware that tbey are assuming the rtsponsbilities of a`supervisor(see'Appendix Q, . Rules.&Regulations for Licemsins Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner lures unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeoAmerac6rig as Supervisor is ultimately responsrbla To ensure that the homeowner is fully.awm of his./her responsibilities,many communities require,as part of the permit application, that the homeowner cortify that he/she understands the responsibilities of a Supervisor. On the lastpage of this issue is a form currently used by several fawns, You rosy care t amend.and:adopt such a fbrut/certification for use to your community: Q:forms:homeexempt 900Z/,Z0/ZZ b0 39dd ONIa-lins . 0EZ906L809T: 6Z;9T Regulatory Services � � t :Thomas R,Geller,blrector ,. �PD ' Building Division Tom.Perry,Building Commissioner 200 Main Street. Hyannis,MA'02601 �www.tovm.barnstablsana.us Fite: 508-862-4038 Fax: 508-790-6230 Permit no, Date AFFIDAVIT HONX IMPROVEMNT:CONTRACTOR LAW SUPPLEMENT TO PERMa APPLICATION NIGL.c. 141Arequiree that the"reconstniction,alterations,renovation,repair,modernization, conversion, irnprovemenx removal, demolition,or construction of an addition to any pre-existing owner-occupied b'Idjug containing at least one but not more than four dwouiag units.or to structures which'are adjacent to nwl residence or building be dane.by registered contractors,with certain.=eptioas,along with other \ requirements. Typo of Work: i N, 5 ��uhG Eetunated Coat Address of Work: ll� fro. e Owner's Name.: 'X. Date of Application 7 _„ I hereby certify that: Registratioa is sot required for the following rcason(e), []Work excluded by law ❑JobUnder$1,000;. ❑ uildiugnot owner-occupied ��\ `' 0owner pulling own permit Notice is bereby given that: O'41'MRS PULLING MIR OWN PERMrr OR DEALING WITH UNMGISTEI2ED CONTRACTORS Foy,APPLICABLE HONZ IMPROVEMENT WORK DO NOT.HAVE ACCESS TO THE ARBIT ATIONPROGRAM OR GUARANTY FM UNDERMGL a 142A. SIGNED.UNDER PENALTMS OF PEP JURY I hereby apply for a permit as the agent of:the owner: Date Contractor SigtiatvQe RegistmtiouNo. :. OA � ,� Date 0 s Sigaatuae ��"'" L17Z . .Q:wyfilo9.famia:homeaffidav • Rar. 060606 90 39tid JNIQ 06Z906L809T 6T:9T 900Z/ 0/TT ypf He r aw 1 TOWN OF BARNSTABLEMUL I 039. MASSACHUSETTS Q OMAI�� U Solid Fuel Stove Permit DATE OF APPLICATION .........1/.. .... .t .....v,3?............:............. FI T�S T 1N-C�-PE, .�........... .......... NAME (owner) ..........G.u.r? ...... ..............lk�.9w.. ....... NAME (Installer) ............. .................. ADDRESS ............�0.......Re.e.7",,..,,..-"e.4,.-xe ADDRESS ...;�� Y�.:��✓e�..................................................................�........ STOVE TYPE ............... ..................................................... CHIMNEY: NEW ........................ EXISTING .....;1............ Manufacturer .......................1�✓zr ✓. .................................................. CHIMNEY: Masonry ...................../...................................................................... Mass. Approval ` �- CHIMNEY: Metal ...............il.. 1 This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed Iaddress in accordance with an application on file with the .............. .................................... Fire Department, and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made under the authority thereof. IssuedBy: .............................................. .........................................................Title ................................................ �.. Date �1........................ ,3 Permit to install expires 60 days after issue date Stove ........................!C1 C�LcJ eaQ��� C�f9: i xi t�J .................................................................. ............................................................................................................................................................................................... StoveClearance ...................... .................................................................................................................................................................................................................................... Floor .......................................................................................�............................. ................................................. ................................................................................................................................ SmokePipe .................................::......G ...........:.......G c C.....-:............................................................................................................................................................................ SmokePipe Clearance ....................4; .......................................................................................................................................................................................................................... Chimney ..................... ........................................................................................................................................................................................................................... SmokeDetector ............................. i*........................................................................................................................................................................................................................... The undersigned hereby certifies that the installation of solid fuel burning stove and equipment made under au- thority of permit dated ...................................................... has been made in accordance with provisions of the Commonwealth of Massachusetts State Building Code now currently in effect and pertaining thereto .............Q. :t.`."e >� Installer INSTALLATION APPROVED ..............T��..y67,..... a�.?....... By:........................ ..`0�1�` ':.c ........ Title: ,..... date WHITE: FIRE DEPARTMENT — CANARY: BUILDING INSPECTOR — PINK: APPLICANT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION: , Map U0 9 Parcel C � Permit# Health Division ? (� TVf Date Issued Conservation Division a ZL Fee Tax Collector 10.o/f'll STALLED IN COMPLIANCE ' Treasurer WITH TITLE 5' ENVIR6NMENTAL CODE AND Planning Dept. TOWN REGULATI S Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address I-= A rJ a Village �Aj W tlGLG # -Owner Address ; Telephone ' Permit Request �fi 'C �x c Square feet: 1 st floor: existing proposed 2nd floor:existing � proposed Total new Estimated Project Cost 30MZoning District Flood Plain Groundwater Overlay Construction Type_42000 Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes W kT On Old King's Highway: ❑Yes Basement Type: ull 0 Crawl ❑Walkout ❑Other r 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: Q,5a's . ❑Oil ❑Electric ❑Other ' 'Central Air: '❑Yes 0 No Fireplaces: Existing New . Existing wood/coal stove: ❑Yes ❑No ,petached garage:0 existing ❑new size Pool:0 existing ❑new size Barn:❑existing 0 new size Attached garage:❑existing ❑new size Shed:Cl existing ❑new size Other: Zoning Board of Appeals Authorization .❑ Appeal# Recorded❑ Commercial .O Yes ❑No ,If yes, site plan review# Current Use /G j( Proposed Use BUILDEWINFORMATION Name Q. C=31±L441,C Y Telephone Number22 Address PQ 60 }C, CQ—O>S' License`# b o 59 ol_ l'/ d� /U/ S -Home Improvement Contractor# /D&3 s- S Worker's Compensation#' U) C na g-2 ALL CONSTRUCTION DEBRIS RRE•,S1 T OM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE .%'f, "` �- 'FOR OFFICIAL USE ONLY PERMIT NO. 1 - DATE ISSUED MAP/PARCEL NO. ' t. ADDRESS . ? - VILLAGE OWNER _ m f DATE OF INSPECTIO FOUNDATION FRAME � '•�•' -' ,- •- # .t - _ .. INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL + PLUMBING: ROUGH ~ 4 ' FINAL GAS: ROUGH FINAL, ' FINAL BUILDING DATE CLOSED OUT . • - ' ASSOCIATION PLAN NO. A)�)- InspeCC10ti PIIn' U � MOM � � loeahott, of4mopert : C¢n>f3'cvil goo -2 7 O . O Cat Z6 lvt. 24 t, • �.e8.2s' �s f I, Cannom de& N tOt Z5 t1a8o + s Ar> = S2,217 ,F. b 1.ve 'Tr`ust Y+Q,f 3153 2C -'iood pancf: 25o col 001G D oo&eme: C ++�1.1 116% OF PAUL' L ,�,•,. ?� T. J hereby cwrify if ct U UJ�t10t' Qge i1spW60 Z.11 q's-pm T` u OROYER tatty. 1Viiliam 13oardman x Financial Mtge. Corp- no 31311 She dwelkng shown. hereon,OW3 notcfaU im a sowiacl TE31A4LOod hma rz aria with.can.eWecttive date of 7-2-92 and.q t 10=hb � �s the dwetung does co lfom qv the local pn ng 6y laws im T ,� , aatthe tune oFconstrt,texim with. respectto horisontud dirnerVstorta� Scale: V =60 setback re or is MMVr4rom. Vtblatti7M erlf oreetiumt' Date: r. 19-9s at1 ot1, under Mass. GeneraL laws Ou(#W40 X•_5Wt1bTV 7. File No.� -16±1: PLEASE NOTE: The structures as shown on this plot plan are approximate only. An actual survey is necessary for a precise determination of the building location and encroachments, if any exist, either way across property lines. This plan must not be used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes. This plan must not be used to locate property lines. Verification of building locations, property line dimensions, fences or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon. Please note that this is "NOT A BOUNDARY SURVEY" and is "FOR MORTGAGE PURPOSES ONLY". COLONIAL LAND SURVEYING, .COMPANY) INC. 269 Hanover Street . Hanover, Mass. 02339 . Phone: 617-826-7186 . Fax: 617-826-4823 SPILLER'S 573241 41 i f CX) . o i ptTak Y - ()-Po F . �,�ie �anvnzoozu�eai a� ac�i '.; DEPARTMENT OF PUBLIC SAFETY }F CONSTRUCTION SUPERVISOR LICENSE Nu®berK Expires. f Restcted To 00 a G EGOS R Y M CAULEY 33A a YARMOUTH, MA 02673 ' H9ME XMPROVEMENT CONTRACTOR , Regisfratlon,. 06395 PeINDIVIDUAL� ' ' `4� Expiration 07/23/O0 k '� 9azter Avenue �� r ce�n a o7"� F y �MINISjRA,T�,ggpq .� YaCwouth MA 02601 :.�;�,.P�•.� _ .:* icy'.-.:.L.i rr.a2'•.g�Y•-t.,` a�sxsr,►szE, L The Town of Barnstable 9 MAM Department of Health Safety and Environmental Services zes� ,0 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:�� f1� �U PC/V Estimated Cost Address of Work: t-® 7W-0®i /V Owner's Name: eJ- L JV 1 Cam. Date of Application: d- '' 2 s 9 I hereby certify that: a Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. sap- �f� �/V Date Contractor Name Registration No. OR Date Owner's Name q:fbrms:Affidav :- - -- The Commonwealth of Massachusetts Department of Industrial Accidents �E ':_- Office oflnyestigatfoos 600 Washington Street '/ Boston Mass. OZlll �w i Workers' Compensation Insurance Affidavit name: �/ ( �V���1 r-- location: city ohone i1 ❑ I am a homeowner performing all work myself. ❑ I am a sole proDnetor and have no one working in any capacity am an employer/providing workers- compensation for my employees working on this job. company name address: /— '60 city! 1 /tf`/�! S' 144 phone:#.: _.. insurance co. nlicv# C2 �� ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the folloning workers' compensation polices: company name- address dtv phone#• .. ... ........................:::... _. ........ insurnnce cn. oiicv# %// camnanv names address: city. phone#: Insurance co. oiicv# M / Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to 51.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One 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. 1 do herebv certify under the pains and enalties of rju�,hhe information provided above is truce and correcct Signature Date 2 / �� _ Print name � r�+— C�-i �� Phone ?� t official use only do not write in this area to be completed by city or town official city or town: permit/license# fC003He1a71th ng Department g Board ❑check if immediate response is required n's Office epartmentcontactperson: phone#; w::.:........::. .. (mvaea 9,95 P1A) 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 co=-"- 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. c: 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 renews: of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. , Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the 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. 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 may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Imlesugadons 600 Washington Street Boston;Ma. 02111 fax#: (617) 727=7749 phone#: (617) 727-4900 ext. 406, 409 or 375 NNo OO 0 1 SIO � 1 0 P o o 71 20. 0 N 28a'Za EX15TING i` FOUNDATION ' '30 ti BUILDING-"LOCATION PLAN LOCATION: 80 DRETWOOD LN., CENTERVILLE, MA �H OF CLIENT: GARY$CHERYL NIEMI Ss. SCALE: DATE: DRAWN BY: �y 1" = 40' 1 1-29-2005 TMW STEVEN �, JOB NUMBER: REV1510N: 5HEET NUMBER: g UMB 05-067 CPP-2 v .35 1 WELLER * ASSOCIATES �O 1 645 FALMOU2 RD., WAY, #232 P.O. MA 02554 ROCKET E, MA 02632 SU�v TEL: (508) 775-0735 — FAX: (508) 775-0735 EMAIL: trl5weller@comca5t.net PROPE5510NAL ENGINEERS LAND SURVEYORS -4 ;ks-Vassor's map and lot number .... ........................ . . m y 11 Ttoffy Sewage Permit number . q.-. ........ ........ . SEPTICSYMFM D IN COM 90 .. INSTALLE MARNSTABL .... E, House number ...... ............. ....................... .. I................ ......... W-M,frITLE MAS& 039. LENMRONMENTAL CODE AN 0 Ar. � TOWN OF BARNFrX "ONS BUILDING, 1#11SP E C T 0 R APPLICATION FOR PERMIT TO ...... ................................. ............. .................. ................................ 4 TYPE OF CONSTRUCTION .............................. ... -e-;p� ................... f e ...... ........... .... . ......... .. . ............. ..............19.. ............... TO THE INSPECTOR OF BUILDINGS:` ......... The undersigned hereby applies for a permit according to the following information: .a�e�.w.. zx�l .................................... ...... .... Location .....i, ......... . ...... .......... .. ProposedUse ��Z............................ ................... Zoning District .........................................................................Fire District ........ ... ............................................................ Nameof Owner ... . . ................. ........I. ..... ....Address .................................................................................... Name of Builder . . ... .. . ... ... ..Address ...........I......... ...r ..A .. 0 ....................... A .............Z .......... Name of Architect ...................... ....... .. ............:.Address ........ ...0.�..�W. a Number of Rooms ....... ... Foundation ...... .. ........ ..W 0, Exterior ...�.k ...... .......4-.W.......................Roofing ......0.4 ........................I. . .. ... lllq Floors .... ..11r/40 ...............................................interior .....00... .... .....;V...... . ................................. ............. ........ -H .............................................:Plumbing'..... .... Fireplace .............................................................. ...................Approximate Cost .............. ..................................... Definitive Plan Approved by Planning Bo6rd --------------------------------19--------- Area ........ ........................ Diagram of Lot and Building with Dimensions Fee .......... ... ......./001� SUBJECT TO APPROVAL OF BOARD OF HEALTH kZ , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..........a.. ......................... ........................................ Nji.EMI, GARY PAR. & MRS. 44o 2 .7.51.... Permit for One.„1/2 Sir•R ' Single Famil DWelli ....................... . ....Y................... 9.................. Location ....LQt... 25....$.Q...-9r.taW.Qgd...Road a ................ Cent.R V.7. .a............................... Owner ...Mr.r....&. Mr.S.....Gi3 .y...N.iem.i....... Type of Construction ...Fsame.......................... ....... ........................................... .... .......... Plot ......................... .. Lot ................................ Permit Granted Dec.ember. ...'11. .�.. .19 80 ....... ....... .... ... . Date of Inspection ............................. ......19 AY Date Completed /. ..... . . r:19 JTERMIT REFUSED a .......87..R ."''...................................... 19 S. r r fro ;k. ............................................................... _ r: ... L�. ."-ter +" /; � .� ,.• � , .. .'`................................................................ ......-,.•. ................ ............................................. r , Approved 19 r� . ...........................'................................................... ��f •' - .. .. .... .............................................. ........ ' < j - �w s Assessors ma and lot number f +p ....:%1:.............``......�.....' • Bpi THE Swage Permit number '% /� Z MAWSTADLE, i C1+J House number ...... ............................................................... yO i6391639 o� O • 9� s a MAI a\ TOWN OF BARNSTABLE : aF BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... �. & TYPE OF CONSTRUCTION ... -'-' . . •. t .?. . .................... .................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... .......................................... . ............... .�.. ' �?c�+ � ;,?•? ! ............................ ICA Proposed Use .........�..................... i .! r..fir �!* `', - "".r.. .".... ......... ... ... Zoning District ..Fire District ....... .... .. .............................................. Nameof Owner ... c ��... ..�.... ............ •.... •..Addreess.................................................................................... Name of Builder ........ ............. Address Name of Architect ..... ...............................°' ,r r F? '�' +'' .Address .f:�l i }... ...�I !/� . �`. ......... / r Number of Rooms .................................................Foundation ....... ...... Y ..c..L. `°11c r Exterior .. .... ?- �- .: ' �'�`:c .'..-7 ....Roofing `` e . ................ } Floors sf Interior - ""� *� ef' .�� r Heating ............. ..................Plumbing .. ................. ... ....... Fireplace .........................................' .......................................Approximate Cost ...... "c ' ................................................. Definitive Plan Approved by Planning Board ________________________________19________. Area .........?.f`4........................ Diagram of Lot and Building with Dimensions Fee r 4d ...............i. ...... .. ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH % 1 1 JJJJJJLLLLLL"''''+ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... , .` ... :: -r ......... x NIEMI, GARY MR. A=168 23 149 No 22.75.1... Permit for .... y ........$ingle...Zami.ly...Dw.e.11ing............. 6 Location Lot 25 RP..,,Vr'....qtwood...Rd... Centerville ............................................................................... Owner ............Mr ...................& Mr -/(�4.-Ky,..Nieml ................ Type of Construction .....FXOW.e........................ .................................. ............................................. Plot ............................ Lot ............ ................... cember/l, Permit Granted ..,,De...............................19 80 Date of Inspection ............. ..............19 Date Completed ............ PERMIT REFUSED ....................... ... ...... 19 ... tw .......... ............ ........... .... ........ ...... ...................................... / ................ .0....................il..(.. ............./...............- r .................... ........ .... ............................ Approved ......:......................................... 19 ............................................................................... ............................................................................... „�•'"” TOWN OF BARNSTABLE 2�7�' � Permit No. �'`^ e Building Inspector - --- i swn�c Cash OCCUPANCY PERMIT - Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to 11r+ & Mrs,. Gary Niemz Address lot #25 80 Bretwood Road, Centerville Wiring Inspector Inspection date Plumbing Easpeotor ��#� A Inspection date Gas Inspector f Inspection date �O Engineering Department Inspection date Ci (j 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. r =' Building Inspeector M C»� t Hl�1 S-,tL-V;t-'E- t76MtC-! - 3T:5tM;,eooAA% t i Lt0 C,�ArCFiAr�• COCCI�.IDES� rnt- �� �� `' /1 ' dal Lam! F=t.aw 1• -41 9 Srj; WA GA :z- W3aF' tL\A•p,0 TOTAL T7E-SIGN '= .tS •�y,RD. p q3t ptST�ol'a ! ���90 E�TP �W 6�PD. f MfzCoL&TIov zwre : Cw Smlu'orz lE t""' r.a`. o lat. t Per �prt"th*lY G w/a•s�v�rr � �', ke wig ffILLIAM At :i 2� NrM i^7e �� •f jy� •. � Jr i s � 4 . -r . '^ ucx' �>G.7 'i7 C. �'�'...�:i" TIT. „ ..a:-,-w*• ^CST" d,. � • --....__� ;aox ,• �.6 SEQnc to 600 tob �t 6 p i.r_ N I 8S•� ;i F,T A� W I r&4 i e � .� 3 I • CEtZTl1=lFD pl_�`r' j' --�--••- LOCATto4 C Vl too u�b i8� IZ• 0.80 G l�i2 T 1 4= •! T 14 AT' T t4 r__ Tc�Qrt*ro Q 5 t4ouJ u ��� t•-ls.t?c::.ryt�1 �.c�,.�i't_�!s u!t�t-t Tt-�` St�E.Lt►J� �,•,OT' ZS -� A►Jt� �;CT1',.i�Clc, QGME-wT; lei= T µG; -ro V F3 iJS Tvs� TI 7-7 f oc-AT o aTEf�'V1Ll.J~ U /�(�Ls�j• ! tt.lst'�?:J:.r�C:l.i i ��Ui:�/1,•{ x�. 't"�tLs UFt=�R�C•�i SI�GtJt1J ��l?l..t CA.1.l T 6xe-\,f Q tcl-Y' u,.--c:l fb t�c.'�'t:t�klt� = LET t_lWia, �Ii iGLf--- t✓AMtU-! erooM twto U o,tzAr t-�t'�r F.ro�.sz. GQl___ tc Tit tiL 3�c�� ( % • .l~ t>f70�Af ��tl"` uSc: jyf_JF!3_6_tL Qa'r 1p TO To CAL Litt f Ft �w �' Aso OloERP , �aD Nxr!D. �vaA •} i t�Go�bYIo�.J t 4T� CIO Thu'r �` f,�o G A L.Ft r - tUt Rttt _ -max�_` - ...�. �` ��•�4` � � �. 429 4•,Y,yy • 4'a' y �e f jjj } 1 e T. `t!4 K • 'yam lV G 40 � � ^CTL�.%/'i%�C,'T.'i• //�_/nS+'.CraiY�ti�.F� f�' • '.^ate s..Vi. i b..••-�.�,,,,�..^�" - 1S.1q`r$6.r ��+'"� � � �+%,�• �y"1.,,4 �� ^��_...1� �.l�fl{ `"f'"etc. f� � 85 � ' a ( qJ T17-7 - � 16 - a.,'?-4tL 1� � GL,.t�`t"tt= -! •Tk-fA.T' '"'t-�•r ' tDC.Li►-AC-: S WZ �� 'St.ln�v►J - i + T -Tow►, o+- 6, �.F (fit 1. R yp, �G� �'C`{ I-PU$T IL tzart,rtr l[> t..�.r~.to, )vzv&.�fo4 I :0 �� �s A4J o>TEt;.Vrit,..t..i= U ht,LSi+ ttJ y fl-?;J:-t C�t.I i' 'itJ;:�/t�`i' ,� 't`�tl:;.: CiF=t= .-�r�,. ,t•lrt�t..t> A_F�4�t..t C:A.t,.l T •���„� ��L��'''�I �. 4•.F3 t" £�',L-: U•.>C:4> t'�:> l:l s.t �i�rl,-f i+-•:t� 1�"C•" . 1..I E•.:+�a.� ,---•- f � Assessor's office(1st Floor): l�� Assessor's map and lot number �e: ���' �!�°� °"'". ��-' '�, �� o�TN¢>o y Board of Health(3rd floor): Sewage Permit number DMUS AXLE. i meerin Department 3rd floor �i House number p fI0 ( )' d ')l1 �(9 EN Ili 0-N � Via' �� ri"� $� Boa 039- 0� e Definitive Plan Approved by Planning Board 19 T®WH REGULATIONS �orar d� APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE , BUILDING INSPECTOR APPLICATION FOR PERMIT TO (�d f6 TYPE OF CONSTRUCTION s'/,,ale- 11" /G, 0%��//i/�Gr 19 8 9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location L D e 5 -06 01-df4,62vn Proposed Use /�do/yoorri. Zoning District (' Fire District �d�/wvi//� .D.f�G`y�//� h/2`51-"9175 Name of Owner 2n. /V/6-M / Address ?o Bi-,Z(wood zaanl Name of Builder OWI?,ZY Address 5am4_ Name of Architect N`A Address Number of Rooms 04 2 Foundation p064. - GOn(7- 61 r42. Exterior Guooe--/ .5hh-h7 Zk) • Roofing S,oha,/1 Floors c-ry Interior Heating N Plumbing Fireplace A//!i Approximate Cost 74000. 00 Area Aao 3 -r - 00 Diagram of Lot and Building with Dimensions Fee r o P � � J 0 _ o 0.. o P °Q Ll lT A � ADDS finy�` O at, 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 ✓ Construction Supervisor's License NIEMI, GARY M. z, No 32883 Permit For ADDITION z' a Single Family Dwel1 ;•ng Location Lot #25, 80 Bretwnn(l T.a e Centerville Owner Gary M Niemi Type of Construction Frame . Plot fry Lot Permit Granted• May 10, 19 8 9�1 y Date of Inspection 19 . � D e�mple�d 19 %: 6Ui j -i •� � �. _ r' r� .,,ytr•ta-r t 'r'"�r y` y{'C w-•':-,+ i. 11 y~+ .1r+:� •w�r,�,v ,t5 .,r.i'.r.«:..D: ,, +f'`s a ..a�:'.. Assessor's office(1st Floor): Assessor's map and lot number Bo,'rd of Health(3rd floor): t"t'"S Sewage Permit number -121A/ Z BABdMALE. i Eigineering Department(3rd floor): v rasa 4 House number AD i639-�®� Definitive Plan Approved by Planning Board f 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00 2:00 P.M.only f I. TOWN OF BARNSTABbi, BUILDING INSPECTOR C APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ,S//1Gr��` �/i rni/ice rylo& J ' 5//a 19 8 9 I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location LO A.5 RQ 01-d74tllond LQr7a (et A21, Proposed Use Zoning District R�' Fire District .01f/v�i//� 1i/v�Ston5 271" CS Name of Owner Ga. ?n. m '/ Address Name of Builder hd N' Address SCLIYIl1 f Name of Architect Address Number of Rooms Foundation Nvic�- Exterior 4019Oe'/ .5'h11) Arc Roofing r S1) /-74 Floors / Interior ,��� Heating Nb9 Plumbing NIA Fireplace N/f9 Approximate Cost 7000. a Area a �' ®d Diagram of Lot and Building with Dimensions Fee 0 P � 0 O , 0. P . ADD/fio�f n � a I 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 4,..� /�.y�+.� i Construction Supervisor's,License V-�� NIEMI, GARY M. T A=168-128 f No 32883 Permit For ADDITION Single Family Dwelling Location Lot #25 , 80 Bretwood Lane Centerville Owner Gary M. Niemi Type of Construction Frame Plot Lot Permit Granted May 10 , 19 89 Date of Inspection 19 Date Completod 19 ,46U,- v< 7 Liq Iv, 7b / rzWfbe:,®cam!/- e0z# 1#1 PERMrr '70 COMPLETE PERMIT CONiPLETED