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0319 BUCKSKIN PATH
a y»- 4�f � � 3 � v. �: �.� � .,. +� y .: � ,,, -!?.',� a _ � S •:- .:._ _ z.. �.� _... v `• - - - � it � e � - '. � - II ,. � - .. _., �� q t Town of Barnstable w !R'bo's* d d So That at�s,V�sible:�From;the Street.,,ApprovedPlanshust be Reta�neddon Job and#his,CardMust be^Kept �;> S eU M te Until F nal�lns o f `Made, n �_ ' .e a I? ct�on Has Been e Where a.•,Cert�fieate:,of..Occu anc s Re red `su�chBuild�n 'shall Not'be;®ccu ied untila;Final Jnspection has been made Registration Registration Number: B-20-538 Applicant Name: RAMIREZ MENDEZ, ROSA E Approvals Date Issued`. 02/21/2020 Current Use: Structure Permit Type: Building Shed-Residential-200 sf and under Expiration Date: 08/21/2020 Foundation: Location: 319 BUCKSKIN PATH,CENTERVILLE- Map/Lot 171 028 Zoning District: RC Sheathing: Owner on Record: RAMIREZ MENDEZ, ROSA E � 4 Contractor,, ame. Framing: 1 Address: 319 BUCKSKIN PATH Conak tractor License CENTERVILLE, MA 02632 � Est ProJt?ct Cost: $0.00 Chimney: Description: 100 SQFT SHED Permit Fee: $35.00 s Insulation: Fee Paid: S 35.00 Project Review Req: x Date 2/21/2020 Final: Plumbing/Gas mps , Rough Plumbing: a m 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. All work authorized by this permit shall conform to the approved applicatidiiand theapproved construction documentsfor which this permit has been granted. Rough Gas All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street.or road'and shall be maintained open for publ!c inspection for the entire duration of the Final Gas: work until the completion of the same. �, Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Burldmg a d F�e OfficlalAz provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or footings }' x 2.Sheathing Inspection � Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed. 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Priorto Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 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). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT. Final: Town of Barnstable �zHE rti Building Department Services Brian Florence,CBO 'L��?p * seaxsresr.F • Building Commissioner X&S& 'rEn 59. w � 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 BUILDING DEPT, MI PERT# : $35.00 FEB 212020 SE[ED REGISTRATION TOWN OF BARNBTAB4._F RESIDENTIAL ONLY 200 square feet or less 319 bvcLski'n -PG11n' Centcr✓► Il e Location of shed(address) Village SCANNED IZ.a.soi Rom irrz-Mcndc z a 12_ qa o 5k 3 0. FEB 2 4 2020 Property owner's name Telephone number loo Size of Shed Map/Parcel# 2 12I 1202- 0 Signa e Date Hyannis Main Street Waterfront Historic District? Old King's highway Historic District Commission jurisdiction? You must f le with Old King's Highway Consetvation Commission(signature is required) Sign off bo'urs for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WrDDN THE JURISDICTION OF ANY OF TBE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST U ACCOMPANIED BY A PLOT PLAN Q-forms-sbedreg r% REV:08/6/17 - i 3 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 10 ve��drpplication Health Division /yqr Date Issued Conservation Division `-%/V, oAe�!(,Cation Planning p �rr��Dept. &4P0' Fee 1 Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation/ Hyannis f� Project Street Address 191 Sr-,A r6r w Me Village a s rSQ W r. Owner POPoW 4' cSOSA J lSzfN Address (gyp 9. Telephone Permit Request Capsr"ct, SWLL 'AO61 Ma , ANO a4M01*L1t-G 6� k Square feet: 1 st floor: existing 7-1I proposed j2nd floor: existing �41 proposed 6,4 Total new 40 Zoning District - I Flood Plain Groundwater Overlay Project Valuation Sao,000 .00 Construction Type Wbed> Lot Size 0,34 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ® Two Family ❑ Multi-Family (# units) Age of Existing Structure T( Historic House: 0 Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: X Full ® Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 420 Number of Baths: Full: existing 3 new Half: existing I new Q Number of Bedrooms: 4 existing U new Total Room Count (not including baths): existing 6 new U First Floor Room Count Heat Type and Fuel: 41 Gas ❑ Oil ❑ Electric ❑Other Central Air: 0 Yes ❑ No Fireplaces: Existing New O Existing wood/coal stove: ❑Yes M 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 C7a>z`1 .J SW7A Telephone Number S aX 424 6,10(,, Address Po fbt x 310 0 3*"iLL6 License# CS - 1,02,79 Home Improvement Contractor# ILI �W Email A4GvLPt4mV Worker's Compensation # (oS�0064Q?;-PZ52_1� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 3WGks SIGNATURE DATE 1�'r6 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. FRONT ELEVATION Addition ROOF TIMBERLINE HD 50 YR- ICE &VgATER 5HEILD 100% 23 ° RIDGE VENT PVC 1X4 P41NDOW TRIM PVC 1 X 5 CORNER BOARD5 °YdHITE CEDAR R&R CLEAR 5" EXP. *HOUSE YVRAP ADDITION *LEAD FLA5HING FRONT DORMER Y41NDOMDOOR 5CHEDULE NINDON5, FELLA PROLINE EXISTING ROOF EXI5TING B A E3 EXI5TINO DOUBLE HUNG• ROOF ROOF A. 29"X53" H . REROOFI G REROOFING B. 58"X 53" • 5" ROLLED LEAD PLASHING 930 nn 13 ED - ATTENTION: _ EXISTING DOUSE MASSACHUSETTS LAW REQUIRES CARBON MONOXIDE DETECTORS IN ALL RESIDENTIAL DWELLINGS. EXI5TIN6 FOUNDATION IN ADDITION TO THE FIRE ALARM INSPECTION,THE INSTALLATION OF CO DETECTORS, IN ACCORDANCE WITH 527 CMR 31.00 WILL-BE VERIFIED PRIOR TO,SIGNING THE BUILDING PERMIT SMOKE DETECTORS REVIEWRD A ILDI G EPT /;S E l ......................................................................... ....................... PROJEGTADDRE55: DuffyConstruction Karen Brown FIR D ARTMENT DATE 204 MooringDrive BOTH SIGNATURES ARE REQUIRE0 FOR PERMIn/NG F0 0'x 366 Cotuit MA _ Curnmaquid MA 02b3'7 t� Proposed 211 FLOOR PLAN f 64'-1 1/16" 14'-1 9/16" 49'-4 5/16" i 2' 2'-$"�E 3" 2'_5" 2' I I Ln `\ 4'-2„ 1 I 00 2x6 plumbing wall - i I. i must be place above ® I i zq ,� OF,EN existing 1btfloorwall N �� 1 1 N Garage Attic STOp,AGE EXISTING OFFICE I i storagecenter I - 4'opening to �- _ — 1 _ existing ridge N O EN LOW RAiuNr ICI I I N 1 II 13'-101/2" 3L-3UT-T' I i - .�-- Existing Computer room 11 stair way00 �I 3 1/2" N 10' 4-2 l Mirror to other R"'" 1 i II �, double window ( Centered inon I I J Center at 14' Window room 1 - -- ------ -- — --- ---- -- - — - -- -- 7 r, N .__---_—..—. --.—._... _.___.--_--._--.--- _ 14'-1 9/16" 11'-1 7/8" 38'-2 7/16" 64'-1 1/16" PROJECT����Im��: Du Construction ' u. BROM, KAREIV FO Box 36a 204 MooRrNo OR - Cu rnmaquod MA 02631 COTUIT MA 50���62®3g3q _ Page 11 EXl ING 15T FLOOR PLAN m EXISTING 5MOKE DETECTORS DECK - ------r----------- FAMILY i E f � ROOM j +, �i ' I i NGSMor-E-A i ! DETECTOR ! UP DECK' 3'-11"x 3'-11-' i ` BATHROOM 13'-2" ` KITCHEN 1BEDROOM GARAGE \\B5EEZEYVAY F EXI5TING SMOKE ® O� DETECTOR ---- --1 LIVING ROOM I r -� 2 BEDROOM EXI5TIN SMOKE DETECTOR5 `BA5EMENT LEVER 1 ................................................................................................................................................... ��oJ�oT ®� �s�: Dui Gonstructio�1l BROM, KAREN Po Box 36b Zoo MOORING OR Gum ma ued MA 02631 GOTUIT RSA Ll I Vice At, wtvvlllc .►39 -- 0�� Second �fo�r �ldt�id� Saco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/08/2016 - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. L IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMECT Rogers and Gray Processing ROGERS & GRAY INSURANCE AGENCY, INC. PHONN Ell: (508)398-7980 ac No: E-MAIL il ma ro ers ra I ADDRESS: � 9 9 Y•com 434 RT. 134 INSURERS AFFORDING COVERAGE NAICN SOUTH DENNIS MA 02660 INSURERA: HARTFORD UNDERWRITERS INS CO 30104 INSURED INSURER B: ROGERS & MARNEY INC INSURERC: INSURER D: P O BOX 310 INSURER E: _OSTERVILLE MA 02655 INSURER F COVERAGES CERTIFICATE NUMBER: 22766 REVISION NUMBER: j THIS IS 10 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD j INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLPOLICY EFF POLICY EXP TYPE OF INSURANCE INSD Wk SUER POLICY NUMBER MM DD/YYYY1 (MM/DDIYYYYl LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ MA RENTED CLAIMS-MADE OCCUR PREM SES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY D PE0 LOC PRODUCTS-COMP/OP AGG $ OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident i ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTO S AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERI DAMAGE $ -- HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ ! EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ `1 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ER _ AND EMPLOYERS'LIABILITY !ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 _ A OFFICER/MEMBEREXCLUDED? N/A N/A WA 6S60UB4977P25216 01/01/2016 01/01/2017 I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B, no authorization is given to pay clairns for benefits to employees in states other than Massachusetts if the insured hires, or has hired those employees outside of Massachusetts. I I This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable Bldg. Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE I Hyannis MA 02601 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRI - , !� O 1988-2014 ACORD CORPORATION. All rights reserved. ACCRD 25(2014101) The ACORD name and logo are registered marks of ACORD I Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-102999 GARY J SOUZA P.O.BOX 310lug s Osterville MA 02355 I I" Expiration Commissioner 08116/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164688 Type: Private Corporation i Expiration: 10/30/2017 Tr# 272021 ROGERS AND MARNEY, INC. - GARY SOUZA P.O. BOX 310 OSTERVILLE, MA 02655 Update Address and return card.Mark reason for change. 5 20M-05/11 Address F-] Renewal ❑ Employment ❑ Lost Card V�6-�C�97UY/YC%7 LG'ECLIC�6�GG�LJJCLC�CCJBIf1 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only c!110ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: (�— Registration: 164688 Type: Office of Consumer Affairs and Business Regulation ;r aExpiration:.-- 10/30620:17 Private Corporation 10 Park Plaza-Suite 5170 - Boston,IVIA 02116 ROGERS AND MARNEY INC GARY SOUZA 445 WEST BARNSTABLE RD c OSTERVILLE, MA 02655 Undersecretary Not val' witho signature I 19•Z SEIAVIEWA V 0sv9Petli1. A NIC Gaide to Would 'fisnv.rg low e ;vs � z .ed"4,s'a 110 u'�ph OU emw. 'Q Check 1.1 SCOPECompliance.. WindSpeed(3-sec.gust)...... ...................................:..................._... .......................:.................... .::110 mph ! / Wind Exposure Category........ .................. ...............__............ ....... ....... ......... B 1.2 APPLICABILIYY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories s.2 stories RoofPitch .........................::....:...........................................(Fig 2) ..................................."....,..� <_12:12 MeanRoof Haight........................................:._........:.........,.(Fig 2)...,..............:..............................i Z ft 5 33, BuildingWidth,W ...............................................................(Fig 3)................................................ ZlIft 5 80' BuildingLength, L .........................................................:.....(Fig 3)......,..".................,....._..._............eft <_80, a/ Building Aspect Ratio(LMl) ..............................:.................(Fig 4)................................................2:15 s 3:1 ✓ Nominal Height of Tallest Opening2.._...............:................ (Fig 4)........................................,...... <6;8" 1.3 FRAMING CONNECTIONS Y' GenFral compliance with framing connections....,....—.....:...(Table 2)............................................................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete................... ....._........ ........................................,. . Concrete Masonry...... ............................................... 2.2 ANCHORAGE TO FOUNDATION' 5/8"Anchor Bolts imbedded or 5/8'Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing—general........... .............,.............(Table 4)......I...I..... ....... 3Z in. Bolt Spacing from endljoint of plate ...............:. ....(Fig 5).................. Bolt Embedment—concrete...... ............ .....(Fig 5) 7' Bolt Embedment—masonry...,._................. ......_(Fig 5)..... ... &1A in.,a 1;5" / PlateWasher............__......... ....... ....... ......(Fig 5)...__...................:... :..>_3".x X x'/4' 3.1 FL Ot.)R33, Fl,r r framing member sans checked ........ (per 780 CMR Chapter 55) i/ Maximum Floor Opening Dimension............ .. .....(Fig 6)..... ,qA ft<12 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6) .....:... ..::..... .:::.............. Maximum Floor Jcist Setbacks `supporting L.oadbearing Walls or Shearwall................(Fig 7).................. ...........................,... ft <_d Mi�ximc.rrt,Cantilevered Floor Joists Supporting Loadbearing Walls or Shearvrall (Fig 8)......................................___........ ft s"d Floor Bracing at Endwalls................. ..... ........(Fig 9)..... .....................:...,..:....:................. Floor Sheathing,ype _........:..... ......... ...............(per 780 CMR Chapter 55) Floor Sheathing Thickness .:......................... .... (per 780 CMR Chapter 55) .... ... -4.5 in. Floor Sheathing Fastening.,_......................... .,......(Table 2).. d nails at 49" in edge/ d_Z"in field _ 4.,1 WALLS Wall sleight r t 7adbeaiing walls ................(€-ig 10 and Table 5)..................... .. ft 5 10' Non Loaobearing�nrailr, (Fig 10 and Table 5) .................. ..$'�ft 5 20, Wall -rr i Spa fiiiG .... .... ..... (Fig 10 and Table 5) ...... 6 in :24"o:c, Wall Store;Offsets ..... ...._...(Figs 7&8).......... . ............................ ft <_d 4.2 EXTERIOR IWAI:.LS—, Woos,Studs Loadbearii rg walls .... :.:. (Table 5) ....2x - in. " €l,n-t.oacberriing wail's....... ............... .........(Table 5). . ....... ...............2x W - 9 ft�L in. Gable End W,:A Bracing' Full Height L n:lwrall Str�ds ..... (Fig 10)... ,AIS'Attic Floor Length ... {I Ig 17}... _.... er} ft?Wl3 XAA C yirsur,i Ceiling Length(if 4VSP not used) ............ (Fig 1.1)... .... .... . ...........E ft>0.9W and-2 x 4 Continuous Lateral Brace @ 6 ft.o.c. .. (Fig 11)..... ........ n''t > ceiling furring strips a@ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays/ Dou° la ,ap Plate Splice Splice Leiif9th t/ _(Fig 13 and Table 6y..................,... ......�ft. ci lira CO,'Irictrtion(m),of 16d common nails)............ .(Table 6)...-.-.......................:... ROGERS & MARNEY, INC. Subcontractor Workers Compensation Page 1 Insurance Policy Report System Date: 04-06-16 Vendor Name WC Insurance Co. Policy Period 256 BAY COLONY CONCRETE FORMS, INC ACE EMPLOYERS ASSOCIATED INS. 03-31-2016 - 03-31-2017 WC-500-5013138-201 268 TIMOTHY D. BRENNAN TRAVELERS PROPERTY CASUALTY 03-07-2016 - 03-07-2017 7PJUB2E77221816 336 CAPE COD INSULATION, INC ATLANTIC CHARTER INSURANCE 06-30-2015 - 06-30-2016 WCE00431901 395 DAVID COX, INC. TRAVELERS INSURANCE COMPANY 07-16-2015 - 07-16-2016 UB910X7422-15 414 JD CUSTOM BUILDING, INC FARM FAMILY CASUALTY INS 09-17-2015 - 09-17-2016 2001W7511 820 ELITE WOOD FLOORING INC HARTFORD UNDERWRITERS INSURANC 02-01-2016 - 02-01-2017 08WECEI0807 860 DAVID HOLCOMB PLUMBING & HEATI MERCHANTS INSURANCE GROUP 01-03-2016 - 01-03-2017 WCA9098376 940 JOYCE LANDSCAPING, INC. HARTFORD UNDERWRITERS INSURANC 04-07-2016 - 04-07-2017 UB-5B916249-16 1012 R&S LAFLEUR, LLC MERCHANTS INSURANCE GROUP 07-09-2015 - 07-09-2016 WCA9097899 1093 MALFY ALARM, INC HARTFORD FIRE INSURANCE 10-06-2015 - 10-06-2016 08WECCK7161 1632 SOUTH SHORE HEATING & COOLING GERLING AMERICA INSURANCE 07-01-2015 - 07-01-2016 EWGCD000093015 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations }' 600 Washington Street Boston, NIA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� Please Print Legibly Name (Business/Organization/Individual): CT�r i J S O U Z A Address: Pa 6ok 310 City/State/Zip: gTUJlt-a A44 O-LW5 Phone #: S-OE 4-1 61b( Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. X I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. X Remodeling ship and have no employees . These sub-contractors have g. Demolition working for me in any capacity. employees and have workers 9., Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 11 Insurance Company Name: F-O" VN4g"x-,T�a_� Policy#or Self-ins. Lic.#: 65 ro 0 U6 4 7 P.2572 1� Expiration Date: [ 1 1-7 Job Site Address: 192 �6A V5ly Aid City/State/Zip: ►6w1" OA 02,(4 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify qer t ins an pena es.f perjury that the information provided above is true and correct 1 Si nature: Date: i Phone#: °$ bl 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#: Town of-Barnstable Regulatory Services BARNNSTABLE, Richard V.Scali,Director AB a�� Building Division Fa M 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 III SOSA]v Mc&aASVO , as Owner of the subject property hereby authorize � to act on my behalf, in all matters relative to work authorized by this building permit application for: (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. 1§1kV.ra re of Ier Signature o Ap c t M0 I i Print Name Print Name 1� Da j' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t �' r S" o Ma Parcel �licatio p pp Health Division Date Issued vZt 3 Conservation Division L Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street AddressCiI Village Owner �.�J�i'G� ��"`-���� �%ti'l�''Z- Address Telephone o '36 Permit Req a SNAM PA(-,5f 1AA ci-ftaku" U)t-JOK Ob-0 boae-,�L J-0 + go .,L-&3 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new ,Zoning District Flood Plain Groundwater Overlay' 'Project Valuatifn � �(,UJ Construction Type � H Lot Size Grandfathered: ❑Yes ❑ No If yes, attach pportinggocuntation. � ,. Dwelling Type: Sin le Family Two Family ❑ Multi-Family (# units)Age of Existing Structure �� Historic House: ❑Yes ❑ No On Old Kings Highway: ❑ es ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other » Basement Finished Area (sq.ft.) Basement Unfinished Area (s}q.ft) Number of Baths: Full: existing y new Half: existing newer'' Number of Bedrooms: 3 existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Pas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes �) No Fireplaces: Existing V New Existing wood/coal stove: ❑Yesv 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# __ - ---- --Gurrent-Use- - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) s� Name .Pi Telephone Number Address �exi�� t a-A-C License # -+( a2� � �22Qz Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1AvWKft&, 46fw -i3x I I SIGNATURE ` � DATE 4 FOR OFFICIAL USE ONLY l APPLICATION# DATE ISSUED y MAP/PARCEL NO. ` y ADDRESS VILLAGE OWNER DATE OF INSPECTION: t. 4-(FOUNDATION f a FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r 1 FINAL BUILDING ,L t DATE CLOSED OUT ASSOCIATION PLAN NO. -fit• I` y The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: 1 r '�(�` � Phone#: �� 43a N6Z Are you an employer?Check the appropriate bog: Type of project(required); 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction ,smployees(full and/or part-time).* have hired the sub-contractors 2.2 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp. insurance comp.insurance 9. building addition required,] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o workers t p c. 152' § O' ❑'co, . right of exemption per MGL insurance required.] y 1(4),and we have no 12. Roof repairs employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors.must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins._Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration-date). .Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains an penalties of perjury that the information provided above is true and correct % � l2 i3 Si afore: - � Date: 0 Phone#: 3�' , `l S 2- 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,: 1�11 6.Other Contact Person: Phone#: `x Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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 02111 TO.#617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 . Revised 4-24-07 www.mass.govfdia / CThe 1porrurrcaruaea o�C��aaoac�ivaetCa 1 Massachusetts-Department of Putiltiaiet; Office.of Consumer Affairs&Busi ess Regulation OME IMPROVEMENT CONTRACTOR l3nar.1 of Builfiing Regutafi3ns ane!Stan lafds egistration f2982 Type r c.CnnsLruetson SuPntsur ! xpiration:;_aai2014 DBA T> License CAS-OT71.67 ANG OIs ANC7 I O KAT BTTTERSR �' 'E 4 ANGELO KALDIS � � �— t HARvvICHr® , 3 BITTERSWEET LAME HARWICH, MA 02645 E l Undersecretary o ?� Cornrntss�oner Expiration• L. . 01/03/2014 oFTME Town of Barnstable Regulatory Services 81►trxcr�tery M►ss �, Thomas F.Geiler,Director 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 -N, If Using A Builder f as Owner of the subject property herebyauthorize �iL�/ .� r i to act on my behalf, in all matters relative-to work authorized by this building permit 51 CIC c L5 kr n P� Crntrrvi e � (Address of Job) J -� r **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. S- ture of Owner ' Signature Applicant N Ad ato f�L U,r4 Print Name J Print Name 8 11 ? 13 Date Q:FORMS:OVa ERPERMISSI0NP00LS 62012 Town of Barnstable Regulatory Services - * sAarvsUUM ' Thomas F.Geiler,Director NAM 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 Please Print DATE: ��i�-7 JOB LOCATION: Q U ✓1 number street village "HOMEWNER": K05 min tt d z of -0) 0-Sb 30 name hoe phone# wo one# CURRENT MAILING ADDRESS: 1 l r 6` C&4"V[•t kA- 02-4 3 Z city/town state zip code The current exemption for"homeowners"was a ded to include owner- cu ied dwellings of six units or less and to allow homeowners to engage an individual for hire who d s not possess a ' use,provided that the owner acts as supervisor. FINITION O OMEOWNER Person(s)who owns a parcel of land on which he/she sides or' tends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures access ch use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a ho wrier. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall res nsible for all such work performed under the buildingermit. (Section 109.1.1) The undersigned"homeowner"assumes r onsibility for co m 'ante with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"home certifies that he/she understands the wn of Barnstable Building Department minimum inspection procedures ents and that he/she will comply with said proc ores and requirements. Si Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be re ed 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 ermit is required shall be exempt from the provisions of this section(Section 109.1.1 Licensing of construction Supervisor 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 personas it would with a.licensedSupervisor. 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\decollildAppData\I•ocal\Microsoft\wmdows\Temporary Intemet Fnes\Contmt0utlook\QRE6ZUBN\EXPRFSS.doc Revised 053012 �i`a III looms is .. looms VT in loom® IN _ . 1 5' ,b• �I m�,.�„G •xc •r�'�'"�R'='- - y�y .��r � +,�:= xr-"e'er. �� �"t�,'s,per +z � - s " F'}°' >Sr•.y^s��'o. C'd�4 �r^ ter- �: �: ��; ,»�:., 3 f'`�"�`�' � � °�_ y"k, i+ ,ra I ,�.•4 aka t.• :. .<:, -, �c 'fig" '� ♦ e _ r- �' t,1Er-.Lj cgRT- Tu?--E Jj i I L i u i I�yj1 � t p c9 � LD C9 C.Q t i 11 I • 1 f � � Rf�U( -- G \ 1 J' lo J 1L I JUL JL '-JL Jl JL JL. J " f CeUrc�ZI N J)P-4w(NG5 CiNc�uJ►ng ait�a�lslons , i o � _ j 5t W tN l C-0,55, TOOV, i i I a it i 1 S PUN V16W SOWS --v c vwk m(TUNG tt�-oo - 's 'PAMET- `,w eb . o c, "7""Ihc kL 1HE Town of Barnstable *Permit# 19*.ires 6 inonths from issue date Regulatory SemeeS Fee RARNBTABLE, MAes. Thomas F. Geiler,Director •�� e ed, Building Division Tom Perry,CBO, Building Commissioner SUN 2013 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us 'OwN Office: 508-862-4038 OL� 0-6230 EXPRESS PERMIT APPLICATION - RESIDENT ABBE Not Valid without Red X Press Imprint Map/parcel Number Property Address Q Residential Value of Work- Minimum fee of$35.00 for work'under$6000.00 Owner's Name&Address JKA Contractor's Name Telephone uu'mber 6by AJI Home Improvement Contractor License#(if apptrcacrnr}- r" Construction Supervisor's License#(if applicable) o i l'`V ❑Workman's Compensation Insurance Che'ck�one: ❑ am a s 7b-pr-oprietor �I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ st(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 #of doors maximum .35 #of windows Replacement Windows/doors/sliders.U-Value r ( ) ❑ 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 Superviso rs.License is ' required. SIGNATURE: / � the Commonwealth wealth of Massachuseus ,Z�tinent of lndusbia]Accid r (?,ice o Inwestigadons fa.600 Washington street Bostr n, 92111 wwrv.xrlrrss.geiv/din Workers' ComperSatiun Insurance-Affidavit- B erslmanta-actorslE-IeCtricians/Plnmbers Appfic=t Information Rease Print 'bl Name(8udxss gaa?zation&diviclual) , W 10 Address: City/State/Zip: 44ATuyi (A M 0UILKPhone# �M— 430'"S�sZ Are you an employer?'Check the appropriate boa: 'Type of project(required): 1.❑ I am a employer with 4_ ❑ I am a general contractor and i 6_ [—.]New ronshuctiorr loyees(full and/or part-ime).* have hired the sub-contractors 2_ I am a sole proprieWi or partner- fisted on.the attached sheet_ 7. ❑.Remodelnng These sub-contract ha ve ave Demolition ship.and have no employees These ❑ - employees and have workers' wotdring forme in any capacity. mP 9. ❑Building addition [No workers' comp_tns�ce comp n,anrarrr�2 5. ❑ We area corporation.and its . 10.❑Electrical repairs or additions required.] officers have exercised their 11- Plumbin airs or additions 3..❑ I am a homeowner doing all wor3r ❑. g mP , myself [No workers'comp right of exemption per IaIGL 1 [,�' of I insurance required.]T c.ISM, 1(4),and we have rzo I�U employees.{No workers' 13. t)ther l comp_insurance requirea3.) `l nn WI did OV6 15 4t,4 'Any apphcmrt that checks boa#1:mast also fill am the section below showing ag the workers'compensation policy infonastion- w 1 Homeowners bo submit this affidavit indicsting they ate doing all veik and then hire ootM&caatracmrs'umst submit anew affidavit indicating such tCautmctors that check this bout mast attached an additional sheet showing the name o#the sub-contractors,and state Whether air not those entities have employees. Ifthe sulr-cmtractors have employees,they irm:provide their *rkets'romp.policy number. I am are employer that is ptvvidfng workers congwrsadon rasa mnc;e for my a pko,ev& Moir is the policy lard job site inforrncrhon , - Insurance Company Name - Policy#or.Self-ins-Lic.#: Frxpirritionl3ate: Job Site Adore z: Citylstawze p: Attach a capy 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.LM can lead to the imposition of criminal penalties of a fine up to$11500-00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK 4ORDER and a fine of up to$250_00 a day against the violator. Be advised drat a copy of this statement may be forwarded to the 01fiice of Iirvestigatiow of the DIA for insurance COOVerage veri&3fi I do.hereby cc Y artder t a pains earl pan 's rrfpe uey�drat the information provided n.bom rs isms and correct Date: o10,� (3 Si tt e- - - - Phone#: © t fI us+ee Drily: Dar not writs in this area,to be compUterd by c or terror ofcialt City or Towne PerwitU sense# S�Authority( , L. rd.of ealth I Bum' Department I Ci#riTowu Clerk Eectrica1Inspec tor 5.1'lumbing Iilspector . :6.Uther . Contact Fer son Phone if. C ie tpo�rurrzaruaecc i o�C �acfu�eGro- Massachusetts-Departmt'nt of Public Safety,, Office of Consumer Affairs&Busi'41's Regulation Sm 'Board of Budding Re ;ulations an0 Standards OME IMPROVEMENT CONTRACTOR egistration: 122982 Type: V aunstxucGittn Su�er�Isar I xpiration: �11'kt Q-14 DBA 8 x`'aLtcense CS-0 7716t7 sC .4WIN O ANG 0'S (h � + ANGELUKA 'S ry 3BTTTMSft*ET ANGELO I(ALDIS r HARWICHA:02ti45 -. rt 3 BITTERSWEET LANE HARWICH,MA 02645 Undersecretary�? Expiration ' Commissioner' 01/03/2.014 n Icz. 0 OF THE Tp� * BARMABLE. 6 SS, ,�� Town of Barnstable ArfD��p Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry,CBO Building Commissioner 200 Main.Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize ! 1 t/1 to act on my behalf, in all matters relative to work authorized by this building permit application for: 319 6u c 6KI'/1 Cct k. Ce�1 f ci�� 11�, MA PZko 32 (Address of Job) Signa e of Owner D to Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 OFtHE r Town of Barnstable. Regulatory Services BAMSTPABLB. " Thomas F...Geiler,Director 4iAl16 39. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office:. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there. is, or is intended to be, a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned "homeowner"certifies that he/she understands the•Town of Barnstable Building-Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official containing 35 000 cubic feet or larger will be required to comply with the State Building Code Note: Three-family dwellingsg g 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 I supervisor.,, i` +' r Li I .• �. 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 fom-i/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 �., /oil sl°v �OFT►+E rqy� Town of Barnstable *Permit# ;7991// Expires 6 months from issue date 8, ,�,�i,E, ; Regulatory Services Fee v� t ,01b Thomas F.Geiler,Director p'�D N10` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 U l; + �' " 2004 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint OF BARNSTABLE Map/parcel Number Property Address residential Value of Work 43 000• Owner's Nye&Address ®oaf-e Ni 1-16 14A, oa(o Pe&t0cg4 CyNb� Y��.A cys Tele honeNumberContractor's NameG P Home Improvement Contractor License#(if applicable) D 14 Construction Supervisor's License#(if applicable) 0 q3515 OWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor Erhave the Homeowner Worker's Compensation Insurance a Insurance Company Name ►�1 l� Workman 2s Comp-P6licy# Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) - ' Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Not,: Properlfpwner must sign Property Owner Letter of Permission. b: 9 Signature Q:Forms:expmtrg Revised121901 °FZHE l°� Town of Barnstable Regulatory Services + BA MA$S.LE, = Thomas F.Geiler,Director y MASS. 1659..�A`` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must.Complete and Sign This Section If Using A: Builder I, 9C& ' PCACOC14..., as Owner of the subject property hereby authorize : G-e U G q 01 (6�,b dL to act on my behalf, in all matters relative to work authorized by building permit application for(address of job) afore of Owner Date Print Name ,ih •y:w: f i iH'I ✓126 f0007YI) /•/ ... . rye t 201tf(JEGLG[/L 0���ltlde�b , C +r BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ` F Numb @ 043556 4 BJXt�`id �a 121131. 62 j 00 Tr.no: 4902 Re 'a v s SCOTT E CROS 62 C,ROSBY CIR OSTERVILLE, MA 0266;L'-=% f{ Administrator 'J . _ _ .,t_ _ Gf1e {,oarnrwozuieal!/ a�,/�aaaac�iuvrl2'a �\ Board or Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 't Board of Building Regulations and Standards Reglst,ItjoP; 131378 One Ashburton Place Rm 1301 Ez ir@tlon_��r713/2006 g 'r��� Boston,Ma.02108 � Ty�t P� te Corporation , PEACOCK& INC. SCOTT CROSBY^ •• �,.-1� `/.J'/ 1112 MAINS E irL�.. u✓ OSTERVILLE,MA 02655-�" Administrator Not valid without signature i i f Q�oFTNETo�� TOWN OF BARNSTABLE fob Oi ¢ BARNSTAHLS, i IL "6 9 'BUILDING � I SPTOR a Yay i, APPLICATION FOR PERMIT TO .......... ................................a..// ..... : .;.... P.................... TYPE OF CONSTRUCTION .....'..........��,. <.'�...... .... X ......... TO THE INSPECTOR OF BUILDINGS: - The undersigned hereby applies for as permit according to the following_information: Location ...:..>e�:..°...::.. � ......../. .: .. .. ProposedUse ... +(ter ° ......f '. .. ......................... ............................................................................. Zoning District ................................... ..........� ......................Fire District .... ....: r Nameof Owner .... ..... ................. . : .. . . ..... ..........Address ........................ .... Name of Builder .' . ...Address Name of Architect ..........: .. ...........................................Address .............. ............................... Number of Rooms Foundation ........... .. `................. :...:....... Exterior ... .... . . .. ...........................................Roofing ... ....... .................................................... Floors .......... rt-........................................................Interior ....... ...... ........ ..... ... . ............................... Heating <....e ................. ........Plumbing . ..................... ....................... .... ..... .. Fireplace ....... :..... ..... .. .. ..............................Approximate Cost ...................... Definitive Plan Approved by Planning Board -------------------_-----------19_ ____. �� Q Diagram of Lot and. Building with Dimensions, ' ' 4 SUBJECT TO APPROVAL OF BOARD OF HEALTH - Y o � � G7 Z ij � ! l f. F (D i `� . - - UJ - 1-0 D, L tc 4 r Ljj rr ? j < I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi g the above construction. Z ' Name .. .. ................................. Smalls Alan E. No 15;?,11..... Permit for ..?Jelling Q.ue..family.. .om..stca7 3r........... . .................. Location ...Buckslfij%••Pa.th................................ ..................Centel' , . . ..................................... r Owner .................................. ' a Type of Construction ....tr .......................... ................................................................................ Plot ............................ Lot ....1.1. ...................... Permit Granted ... 9 Date of Inspection ' Date Completed ..........19 PERMIT REFUSED ................................................................ 19 ............................................................................... t ................................................... ........................ , i ............................................................................... ............................................................................... i Approved ................................................ 19 ............................................................................... ............................................................................... S8, LEGEND c a q i " P,'�' PROPOSED CONTOUR S• nCn TOWN OF U::R�tN1 T,,,`. � � 98 PROPOSED SPOT GRADE Z �J a Q -011 AUG 14 PM 4: 29 % - !2 �� �� ° — gg -- EXISTING CONTOUR � o� 56 �� \� �_\ \73 + 96.52 EXISTING SPOT GRADE z s 0 US ' J 3 i• ��__ \ �' ft W— EXISTING WATER SERVICE FeD r 2 c� � 60 ® kv 4a GSM/ USnG WAYS ®IVISIi'§ % TEST PIT OAR D o� G�'�aI Ro c %, — ——— 4 RDaVI Q �,JE X fi BENCH MARK --- �. j ��. \` -� 2 Z � z � WP o TOP OF CONC BOUND i \ \ o a �, ELEVATION = 52.58 54—�/ ��� p w m wppplA BARN STABLE GIS DATUM j — ` ---- 20 _ 8 LOCUS MAP N.T.S. /2 VE GAs GENERAL NOTES: O G ATE 0 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE'LOCAL 52-1 % E ist. 1,000 I. OR/� %/ BOARD OF HEALTH AND THE DESIGN ENGINEER. 40 Septic Tank I/q % 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS / Y /' OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR / an/ / % TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE (n' DESIGN ENGINEER. O 40 /` �'oter /' \ 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN % /3 \ �V• Q // �Se, c ENGINEER BEFORE CONSTRUCTION CONTINUES. � % ATER (v= 5• ALL ELEVATIONS BASED ON ASSUMED DATUM. N \/W 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 5 ft. Soil Removal /v �� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF (see note 13) __ ! GATE HEALTH FOR .PROPER INSPECTIONS DURING CONSTRUCTION. I- 54 Q 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. / 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED \`� ! O� TO A CONDITION AGREED UPON. BETWEEN OWNER AND CONTRACTOR. Existing Leach Pits i 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THEq . 3 � THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING (Note 10 1 .6 04�. L_ O IT \��I %/ (�� CONSTRUCTION. % 10. EXISTING LEACHING PITS TO .BE PUMPED, CRUSHED AND. REMOVED �t AREA = 150 'j S f f- —7 PER TITLE V, REPLACE WITH CLEAN MEDIUM SAND 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION \ O 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY � �'• / � � AND IS NO TO B CON ID D'A PROPERTY LINE SURVEY . D L �//I�� •�- % T E S ERE P E 13. REMOVE ALL UNSUITABLE SOILS 5 FEET AROUND LEACHING TO / EL. 43.27 — 44.0 OR TOP OF C3 LAYER AND REPLACE WITH % CLEAN MEDIUM SAND PER TITLE V. - % � 14. NO PRIVATE WELLS WITHIN 150 FT, OF PROPOSED LEACHING 'J 15. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 52 SCANNED of M ci FEB 2 4 2020 SCALE: 1 In = 20 ft � R YLR PROPOSE _-4. ^ J - - D SEPTIC SYSTEM UPGRADE PLAN 20 0 20 40 0. 1140 319 BUCKSKIN PATH, CENTERVILLE, MA 0 10 , 20 '�£ClSTE��� m MAP: 171 Prepared for: James S. Peacock & Scott E.. Crosby . SURVEY REFERENCE: S4NITA0* L0T:028 Engineering by: Surveying by: SCALE DRAWN JOB. NO. i���/`� DEED900 K 17969 DARRENM.MEYER,R.S. Eco—Tech Enrkoamenw 1 =20' DMM PLAN OF LAND BY CHARLES N. SAVERY CO. O $� DEED PAGE.•009 PO BOX (508) 364-0894 DATE CHECKED SHEET NO. EAST SANDWICH,MA 02537 DATED: NOV. 9, 1970 j 508-362-2922 04/08/07. DMM 1 of 2 58 i A LEGEND a o TOP� i �' TA: _; i PROPOSED CONTOUR 98 PROPOSED SPOT GRADE rJ co 2011 A.tIG �I FI // \�� \�� \ -- 98 -- EXISTING CONTOUR 56 �� ���\ , \�32; ; + 96.52 EXISTING SPOT GRADE =q v OVUS 3 ME W— EXISTING WATER .SERVICE v` FB r 9 y CD -�_ % . ,. o Still USfiC :DDU DVI i ��,` - -_;,� 60 ® TEST PIT w �: ct � O OAR QAV, h o� 0��ntlET %i ------ ` z RD z Q Vyp� o BENCH MARK ^ - _.1 to o 0 TOP OF CONC BOUND. ^ i e^\ o z CIO, U ELEVATION = 52.58 54—�i___ p w BARNST•ABLE G1S DATUM ---__ i' ao LOCUS MAP N.T.S. / /256 i' GENERAL NOTES: \\ Aq GAS % EO GATE 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 5 2� E ist. 1,000 I. �^ �CJn �Rl�e li BOARD OF HEALTH AND THE DESIGN ENGINEER. 40 Septic Tank CJ �V9 Y_ % 2. ALL WORK AND MATERIALS SHALL CONFORM TO 'THE REQUIREMENTS i, > OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE \ LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR / o (/� �/,/ % TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 4n ( DESIGN ENGINEER. �. O 711 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING •FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Q // �Se��• ENGINEER BEFORE CONSTRUCTION-CONTINUES. ATER �Z 5. ALL ELEVATIONS BASED ON ASSUMED DATUM: N �/� 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 5 f t. Soil Removal __ %O THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF (see note 13) ! GATE HEALTH FOR .PROPER INSPECTIONS DURING CONSTRUCTION. 54 Q _ 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. , / 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED O TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. Existing Leach Pits %/ 9. IT 'SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING (Note 10) 7 % Q CONSTRUCTION. 6 ` O \\1 4 / 10. EXISTING LEACHING PITS TO BE PUMPED CRUSHED AND REMOVED i� �t AREA = 15 C ' 5 S f + - PER TITLE V, REPLACE WITH CLEAN MEDIUM SAND 11. 48 HOUR NOTICEA FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY /'^� AND IS NOT TO`BE CONSIDERED. A PROPERTY LINE SURVEY (: 1 / 13. REMOVE ALL UNSUITABLE SOILS 5 FEET AROUND LEACHING TO / / ^ EL. 43.27 - 44.0 OR TOP OF C3 LAYER AND REPLACE WITH CLEAN MEDIUM SAND PER TITLE V. 14. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING "J 15. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 5 2 fJ Pam\\\ OF 414sci . - SCALE. 1 in 20 ft R � Y�� � J PROPOSED SEPTIC SYSTEM UPGRADE PLAN 0 0 20 40 0. 1140 319 BUCKSKIN PATH, CENTERVILLE+, MA 0 10 20 SjEgEo �/ MAP: 17> Prepared for:. James S. Peacock & Scott E. E Crosby SURVEY REFERENCE: SANITA(� LOT:028 Engineering by: Surveying by: SCALE DEED BOOK., 69 DRAWN JOB. NO. DARRENM.MEYER,R.S. Eco—Tech Environmental _ I DEED PAGE.-009 (508) 364-0894 DATEr-2D' CHECKED SHEET NO. PLAN OF LAND BY CHARLES N. SAVERY CO. PO BOX981 i EAST SANDWICH,MA 02537 DATED: NOV. 9, 1970 508-362-2922 04/08/07 DMM 1 Of 2