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1236 CRAIGVILLE BEACH ROAD
,a• R.a 3 y 4, - +':".i '....y,:. �� -F _. 2:.0 f � - -}y. f�. � v _ 1 -'.,,s N, �4t, 5", ,� � �(. �� � _ ++, r�•+ 'fa;,�ri Al I AC VE , .; b ".. ; t^r a'., .,: F c ::3 � • - .� »•;?.,- .i` �`•i. �`.ti": '<�+ v• �8;� c � ice', � ,.�;,. ".Y. •=<45::>-�,._:-., ,..-:<�.ffi ..,•- .�: ;,. 5 a,_ '..�". .. i s<,.'�$ irc+' s� : ,Yi. tew',... t r _ 1'� ° e < : pp c 1 ° - e B 0 croAlv t ► ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 64 M_ap s' �. Parcel Permit# J�Z r� � i Health Division #off)q�Date Issued 0 I ` Conservation Division Tax Collector k-ok 2IO0 (A Treasurer •Z�7� ,..T °`' '"P�q ` °t d '° �"B � >fMICANT MUST OBTAIN F D,, 441 COMPLIANCE A ROAD OPENING PERMIT Planning Dept. ti79TH TITLE 5 FROM ENGINEERING DIV, PRIOR TO CONSTRUCTI�U Date Definitive Plan Approved by Planning Board s :`, � NTAL CODE AND Historic-OKH Preservation/Hyannis Project MStretress o� r Village Owner L � � /�11 Address Telephone 5 p0 ) S" Permit Request �o.� � ��' �'LS 6V &1 6��I l�1 �lA iN d'10 A�0/r� / /�L- � l L` ��I lV x I I Pik '4 Square feet: 1st floor: existing qe� proposed 2nd floor: existing 1Z proposed Total new .� Valuat o `l&W. °' Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 4 Dwelling Type: Single Family MI Two Family ❑ Multi-Family(#units) Age of Existing Structure0 vns. // Historic House: ❑ LA ❑Yes o On Old King's Highway: Yes �No Basement Type: ❑ Full C`Crawl O'Walkout ❑Other Basement Finished Area(sq.ft.) °x t. 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 �J new 3 First Floor Room Count 3 Heat-r'y le and Fuel: �2 Gas ❑Oil ❑ Electric ❑Other Central.Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Colo Detached garage:❑existing ❑new size Pool: Cl existing ❑new size Barn:❑existing ❑new size Attached garage:0'existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Z-No If yes, site plan review# -=--Current Use %6 Proposed Use p BUILDER INFORMATION Name eta Telephone Number�� � Add re ,Q 4—p_ 06 License# Home Improvement Contractor# /M Worker's Compensation# ALL CONST UCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE 1-7/0/ FOR OFFICIAL USE,ONLY ` ti PETIT NO. 7 ' DATE ISSUED MAP/PARCEL NO. ADDRESS r, VILLAGE ` OWNER } r DATE OF INSPECTION: 9 FOUNDATION V✓ FRAME INSULATIONZS FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Q 2—/Z U3 7V DATE CLOSED OUT ►—aeC ASSOCIATION PLAN NO. 'r �= y The Commonwealth of Massachusetts Department of Industrial Accidents ' =°_- •- Oniceof/n�estigations - 600 Washington Street Boston,Mass. 02111 --'` Vorkers' Com ensation Insurance Affidavit ir location• �/��• f/ � hone J ci ❑ am a omeowner performing all work myself. ❑ lamas ole r rietor and have no one worku in ca achy I am an employer rovidin workers' compensation for my employees working on this job. P 3'�P ; Xx tom an name.. gdress: ::.:.. c� insurani e:co. ol Jim, # ❑ am a sole proprieto %eneral contractor,or homeowner(circle one)and have hired the contractors listed below who ' workers' compensation polices: the following w mP..._.._ ..._ P ::::::::::::::.:::....::..::::::::::.. �� ::: .': :. r '/ •� com an name: X. fires�a 2:::::: 2;::::.:::::� ::r' ;::::::•�:�:::.:�:.>:.:�::::: .:;..>� :;::.;::>::>:::;:�:is2%:::i:::�:::5::i;:::cp:;::;i`::i:::�i:;:;�:�:;:::;ii::i::::.i::;::.........t+:# ":::'�:.::..:�,:�::::::: :: .;:::i�.;; :�:�`:..::::::;:Y::;::::. .;;:;;':;:' ::;::;:;:::: 1;:::^%:'Si';) ,rya ii: : :: ::::::::':;i::t.::i:.5':�:. ..:. .:::�:.:::::::.:::.::.;'::;..... .:::;.::....:. .:;.... ................. ;�:.>:.::>::»:.:»;:;;;;i:::5::i5::ii::>:::5;.`;G:%. :�..%..:'.y.: �:::i:i:i:i`:4<i;3 ?:. ;;• ':. `>:::::: iii ::% i'asi`asi';•t;'•::<ii?.:i�i:'.'i%:'<!..::::H� : %:;'..':2:i :". 'i'`:';i:'.{<:.:E%:: .�_:. c: an :name: ; $dilress. ........:::. .... ram X. insarances>co::. �j Failure to secure coverage as required raider Section 25A of MGL 152 can lead to the imposition of uiminal penalties of a fine up to S1,500.00 and/or one yam,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against ma I understand that a COPY of this statement may be forwarded to the Office of investigations of the DIA for coverage verification I do hereby cerdfy under the pains enalties of perjury that the information provided above is truo and correct Signature Date — - FRIME Print name %G/G�e C/ /! Phone# official use only do not write in this area to be completed by city or town official city or town permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 PW ' r � Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation 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 m the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers'compensation affidavit completely,by checking the box that applies to your 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 rer<nmed to 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 Office of lovesdWons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 f 730 CMR Appndit J Table JS=b(eontinaed) Prescriptive Packages for due and Two-Family Residential BrdidhW Seated with FoaW Fuels r" I. V MAXIMUM MINIMUM Glazing Glazing Ceiling Wail Floor Basemeat Slab H m� ling Ates<'M-) U-value R-value R R v -value' ai=J wan sop mew R-velue? 5101 to 6500 Heating Degree Daw 6 Normal Q 12% 0.40 38 13 19 10 Noal R 12% 0.52 30 19 19 10 6 rm 3 12% 0.50 38 13 19 10 6 85 AFUE T 15% 036 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 032 38 13 25 N/A N/A Normal Y 18% 0.42 38 19 25 N/A N/A Normal Z 19% 0.42 38 13 19 10 6 AFUE AA 18•/a 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3 3. SQUARE FOOTAGE OF ALL GLAZING: SO 4. %GLAZING AREA(#3 DIVIDED BY 42): . l")x �—7`g 5. SELECT PACKAGE(Q--AA-see chart above): X �a NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. a BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a ,____ STANDARD LEGEND- NOTE:not all symbols will appear on a map T b GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES p ----------- EDGE OF BRUSH MAI 6 ORCHARD OR NURSERY V—V—T—V EDGE OF CONIFEROUS TREES MARSH AREA 1248 — — EDGE OF WATER ----------------------- _ _ _ = DIRT ROAD DRIVEWAY \, ------------- �—PARKING LOT �—PAVED ROAD — = DRAINAGE DITCH ---------------------- - -- — — — — - PATH/TRAM ------- _ PARCEL LINE** / suPtlo F---MAP# 21-*—PARCEL NUMBER #1860—HOUSE NUMBER 2 TOOT CONTOUR LINE I �.1 10 FOOT CONTOUR LINE # 1236 Elevation based on NGVD29 I >/4.9• SPOT ELEVATION o0o STONE WALL I -X—X— FENCE -------------- RETAINING WALL I -------------------/\—.— —/` " �-`--'----------- ---"------ —f—+++- RAII ROAD TRACK - r rn - r I_ -----------MAP206 © STONE JETTY SWIMMING POOL _9 PORCH/DECK------------11 1 2 U] 0 BUILDING/STRUCTURE t I . I F4+- DOCK/PIER I I HYDRANT t ) VALVE OO MANHOLE i -------------------- ----------- 0 POST 0" FLAGPOLE T O W N O F B A R N S T A 8 L E G E O G R A P H 1 C 1 N F O R M A T 1' O N S Y S T E M S U N 1 T _q SIGN ® STORM DRAIN N PRINTED SCALE:IN FEET *NOTE:This map is on enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 199S aerial photographs by The James 1"=100'scale map and moy NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GE00 0 UTILITY POLE TOWER we = O 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Mop Accuracy Standards e I INCH=40 FEET* enlarged scale. on the map. - at a scale of 1"=100'. Parcel lines were digitized from 2000 Town of Barnstable Assessor's tax maps.. O LIGHT POLE O ELECTRIC BOX f OF tHE ' °� The Town of Barnstable y • + BARNSTABM ' 9�A ��g Regulatory Services 39. TEp A Thomas F. Geiler, Director, Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW' SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: q nr� :yd s/ Estimated Cost 41 —, t� Address of Work: �°� -a('J e Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reasonW: , ❑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: Z�a4 �9 D to Contractor Na Registration No. OR Date Owner's Name q:forms:Affidav:rev-070601 r — RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 - 6 Building Permit Amendment $25.00 FEE VALUE WORKSHEET LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE _square feet x$64/sq.foot= x.0031= o2Q7�o plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $3.5.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x .0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00 (number) Fireplace/Chimney x$25.00= . (number) 1' Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee p� projcost L_ �1ze -�omr�nazuiealtl o��aacxc/auaeltd ' h, Board of Building Regulations and Standards WDME IMPROVEMENT CONTRACTOR Registration: 112977 Expiration: 05/07/2003 ' Type: Individual MICHAEL J DANGELO MICHAEL DANGELO 105 HORSESHOE LN :, ` CENTERVILLE;MA 02632 (:Administrator 44 BOARD OF BUILDING REGULATIONS . License: CONSTRUCTION SUPERVISOR Number:,CS 0413338 t Blrthdate:,01/2ti1954 tplres:01/2 jr.he: 13450. Restricted To: 1G MICHAEL J DANGELO _ 105 HORSESHOE LANE z• CENTERVILLE, MA 02632 Administrator i -.._I"D AYff I, John A. Babbitt, after being dud v j'Y!ern, do depose and say as follows: l. That my wife, Ann, and I were tho ud1finers of property situate at 1236 Craigville Beach Road, Centerville, Massachusetts ,iv-mg purchased the same from Mr. Charles Crocker in 1.982. } 2. That at,the time of our purchase oq"-mddproperty,the property was improved with a sine `».^ �1}' d:;'ellinb?s-well asrr' v nth a two bedroom apartment therein. In additi.ozi to the real estate,we is ' `—, aced the contents of the apartment, including the stove, refrigerator, etc.. 3. While we owned the property, W-V,7md the yearly tax (fee?)of S25.00 levied by the Town of Barnstable on apartments for t;" rtment in the barn;and the apartment was inspected by personnel from the.' ,072:and permits were granted and were posted on the premises so tl�.,we could rent tlw ap-m—ment. 4. When my wife and I sold the prod to Colleen Cahill in December of 1999,the barn was basically as we purchased it... S1313SCRIBED AND SWORN T' '.,=.Inkier the pains and penalties of perjury this day of June, 2001. J A. Babbitt COMMONwE '�,LTH OF MASSACHUSETTS 2001 County of June a,5 Then personally appeared the abcct,� named John. A. Babbitt and attested to the truth of the statements by him above-subscribed,- e me. Notary, Public My Commission Expires: i 1WPOOCSWALviVIL 4fNeRAC'Vabwffl.dec - " I I AFFIDAVIT I, Ernestine Monroe, after being duly sworn, do depose and say as follows: l. That I am familiar with the property situate at 1236 Craigville Beach Road, Centerville, Massachusetts. 2. The house and the barn which are presently on the said property were built by Charles and Etta Robbins. Charles and Etta had two children, Willis and Percy Robbins. Percy married my mother's sister, Sara Jones, and they moved into the "River House" located at 1230 Craigville Beach Road. In the summers, Percy and Sara would rent the River House and move into the barn apartment. I remember this because I used to visit my Aunt Sara and Uncle Percy quite frequently at the property when I was a teenager in the 1940's. 3. My brother, Charles Crocker,purchased the property from my Aunt Sara and Uncle Percy and he continued to maintain the barn apartment. In the 1980's, he sold the property to a Mr. and Mrs. John Babbitt. SUBSCRIBED AND SWORN TO under the pains and penalties of perjury this -�c?, day of June, 2001. rnestine Monroe COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. June , 2001 Then personally appeared the above-named Ernestine Monroe and attested to the truth of the statements by her above-subscribed, before me. Notary Public My Commission Expires: iviy CUMrT1ission E.-pires G ceinber�. ;2,'*,ri.i F:\WPDOCS\REAL\AFFID\GENERAL\emaffl.doe i AFFIDAVIT I, Colleen F. Cahill, of 1236 Craigville Beach Road, Centerville, Massachusetts, after being duly sworn, do depose and say as follows: 1. That I am the owner of the property situate at 1236 Craigville Beach Road, Centerville, Massachusetts, having purchased the same from John and Ann Babbitt in 1999. 2. That at the time of my purchase of said property, the property was improved with a single-family dwelling as well as a barn with a two bedroom�apartment therein. Since the time of my said purchase,the barn has been used and occupied as a separate dwelling unit. SUBSCRIBED AND SWORN TO under the pains and penalties of perjury this o2/ day of June, 2001. Colleen . COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. June jj/, 200T Then personally appeared the above-named Colleen F. Cahill and attested to the truth of the statements by her above-subscribed,before me. 7 0 e ,Notary Public My Commission Expires: F:\WPDOCS\REAL\AFFID\General\cfcaffl.doc I 4'.9i. na.aa La--J L._ - —..._.__ '� 1 �� .>�';'� 9.•- 2ll-�., ... - _ I ... I'9�-la... e _ f I ,Y� FtJ 169K 31v k�+/N �.,, _.I - .``�..$L•h_wn��TDSE .-.I I tt��a �' 7 P - .. C✓MP' 4l�.InR•l1p 'L'�—,� 4 L I r� r, bw�r�o ry q ' r—AS11 - P D•u.4 en"� nl`F P � �. .. _ Fi?.t7wG. I anvwsa _�d �' 'p `� n° �Sn I . up IH'_L•_ n 1I Afw ir.� - .• L ' - n•s'ri{," r+•<''-I$ � � ._::�.:_---'�-F+�u.a..r..n�--v 5�f�u7»D �-'L_002.. SMOKE DETECTORS O.K. BARNSTABLE BUILDING DEPT. . -- _ lz3G..cfZaiyyl 1 f_1-�ZD...C.,tti.. .PKt,J-L. . ..�+.' •. w. p e I , r �1 7M...lT G11w.,4 s c/.✓_ �i j % ./ - — - `\\-- `\. s DN/�.�r s : i — _ • ' ��-� �. Y 9Y4 BEP T:� En Fl�vn 4en . - ._ Bpcp!�i�n '"�(uNC!`TF F.aon�JO•izYPS�.riEfT ,__RP,-w RMzt-O Con:-f��ii6�wr.�.L.i� � � ('-_ _ _ — _ — _ —� �':� TO ma•.�T @L_1'-9°FrIDM SOP OL_IefP I-✓' <<,-o'• w Fu rNcs a i I, ti f_'J�'ct J�;ti���yy' ,rb97�✓3'ry c'-x'�-+ F£� � _ -- � .._ 1 -I - - - - - -- fQ :J N D A�' O M L h 1,-I. ... .. - - - W F 5 T (L—L �/'.d.T-.1.O A-f. _ • - T3Af.Z�i.1��APnRT,u<eM�R=Mr�yo�- ' CEN . • � � - - �. •areoer� r6Pa• I 'ji i II - - - - ._. _ __. 1- .. _ -... «.- — .. .. _. .�• Fa ..L:vo� L I' rJU R'1�-1"1 .E LE.VAT' O f,I .. . • I G¢a� . _ '. .�'=• �" -__`. 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V Ya:re�D,>n �•PR,DneJ H°I'� , M 1XLJPp - v�T.^•4 v ,�a - _ --•—ter -lir ✓WJ✓ � �95/ tPT _BEP 6PY a[srn 4G ��9�D A a¢i ovc � � YY.�JJFF. v�r.r Pe ar rL 1 I 7z-�,c c/uawa HEM" I� #M'W PT.SxL�t?]5 `� 1 -• -�-\ F Y�,..r1 4 9�0�'E.MU/ITw,.. � �J f o- F+✓unw B �µ.�yc. e.'-1 v _ w 1 eA r' E.v.A T 10 1-I s vw-T r o N l — C - � - � - - � 123"-b.G'Rtil6vltl.�..I3r:.n�H-Rb„G'�ur�+v1�•I-F,.vtia. NYa_4H6;.tit&._ 0 1\ / \ I1 II)� • 3� Cru lz 5 G! K 'i �1 2X6 WAL� 151" 9'2" 61/4" 48.96 s ft +1 IWIM r +' . - "� \ _. ��� ., - �6. .'` � � . } y T 9 I` 4W oil! IF s !jp r� i° t �1 _ �. rryy'L':aa C 44 j l� 1 3 °'1 �:: V l�. „4. �� �:. i .. ..- _ �:: J J = J ���� .. S � - �1: � 1. �T ram, Town of Barnstable *Permit# pExpires 6 months from issue date Regulatory Services Fe ` �' • =axxsrnsr.E, ass.1639. Richard V.Scali,Interim Director �0 Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number � [) �� -Z> ' t. Property Address C�2 t�/X- Residential Value of Work$ 5 6W, - Minimum fee of$35.00 for work under$6000.00 ' Owner's Name&Address ` Contractor's Namel(%y/ �� �� o'/G/��(� Telephone Numbe ���� �? Home Improvement Contractor License#(if applicable) 9 7ll Email• Construction Supervisor's License#(if applicable) �"t ❑Workman's Compensation Insurance X® ' 2' - FgiM ff Check one: - ❑ I am a sole proprietor VI APP e g Z�14 am the Homeowner have Worker's Compensation Insurance . r. Insurance Company Name DOL1111,7cl TOWN OF BARNSTABLE Workman's Comp.Policy# Z�C,'7_Q7 7 Z��U Copy of Insurance Compliance Certificate must a -company each permit. Permit Requ t(check box) n /� Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken toy/�' /J/,S ,d ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. IS Electrical&.Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms RESS.doe W Revised 061313 The.Commonwealth of Massachusetts t Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information / / Please Print Legibly Name(Business/Organization/Individual): t c y/ Address: / � 7 City/State/Zip: L11c/i/c°- Phone Are you an employer?Check the appropriate box: Type of project(required): 1.L� I am a employer with A 4. F1 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y aP �'• 9. El Building addition [No workers'comp.insurance comp.ksurance 1 required.] 15. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work � ❑ g P myself. [No workers' comp. right of exemption per MGL 12.0 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 hue outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet show ring 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: It) e e- y U A- Expiration Date: Q Job Site Address: r� City/State/Zip: e YL� P �G�. do��3,'),Ad PW, 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 Signature: ) Date: �� Phone#: S11 7 7S- 3 arr Official use only. Do not write in this areag to be completed by city or town official '.City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other' Contact Person: Phone#: t i F 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 m lie� "oral or written xP or i P 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),addresses)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 (Le.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations wound like to than 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 lnvestigations 600 WashiVou Street. Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727,7749. www.mass.gov/dia Client#: 3860 2DANGELOMI ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1 D 01/21/DD/YVVV) 1/z1/zola 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. 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 CONTACT NAME: Dowling &O'Neil PHONE— 508 775-1620 FAXNe: 5087781218 Insurance Agency E-MAIL ADDRESS:--------.—,.-----...--------.. 973 lyannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE— _-- - _ NAIC# Hyannis, MA 02601 --- INSURER A:Associated Employers Insurance INSURED �.� INSURER B Michael J. Dangelo Building --- - &Rem INSURER Codeling, Inc. -- -- —�------ INSURER D 105 Horseshoe Lane ------- -- ---- -- ------------- -...._---;--- SURER E Centerville, MA 02632 —IN — -----------------------=--_-_. -.. _. INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF'ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 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 INSR TYPE OF INSURANCE INIF SUBR POLICY EFF POLICY EXP LIMITS LTR _ INSR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY --_ GENERAL LIABILITY - _EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY PREMISESa occur ence I$ CLAIMS-MADE n OCCUR ME D EXP(Any one person) $ PERSONAL&ADV INJURY GENERALAGGREGATE I,$ ---- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ JECT, POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY'AUTO BODILY INJURY(Per person) i 5 4 ALL OWNED SCHEDULED - - __ AUTOS AUTOS - BODILY INJURY(Per accioent) —� f NON-OWNED PROPERTY DAMAGE —t �_— HIRED AUTOS AUTOS I (Per accidence- 15 �_._. —�5---- 1 UMBRELLA LIAR I OCCUR EACH OCCURRENCE I$— i EXCESS LIAB CLAIMS-MADE AGGREGATE i S _- - _- —__._.._-_._..... .....�__^.-ETE NTION S__..__ _ ( y.$ .p._ ...: A WORKERS COMPENSATION WCC5OO5O067332O13A 12/19I2013 12/191201 X IwcsrnTu I . IERHr TC RY_LIMII S i AND EMPLOYERS'LIABILITY Y/N -- iANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT 1$100 OOO _- I OFFICER/MEMBER EXCLUDED? �� N/A ------------------"— '(Mandatory in NH) - E.L.DISEASE__-EA EMPLOYEES 51 OO OOO It yes,describe under I DESCRIPTION OF OPERATIONS below I E.L.DISEASE_POLICY LIMIT ;s500,000 -_- DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Michael and Debra D'Angelo are excluded under the worker's compensation policy. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived, or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25( ame and logo are registered marks of ACORD #S12: EAM p t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor 1 &2 Family License: CSFA-048338 AHCHAEL J DAN 105 HORSESHOE CENTERVILLE MA ♦ ,U. - .�rN Expiration Commissioner 01/22/2016 ��le �Oo�run'°reu�eaLC�i a�CJ�lt��ac�2iutelta License or regi$tration valid for individul use only i Office of Consumer Affairs.&)Business Regulation before the expiration date. If found return to: �OME IMPROVEMENT CONTRACTOR Type office of Consumer Affairs and Business Regulation egistration 112977 10 Park Plaza-Suite 5170 Ex pi 517/2015 Individual p x Boston,MA 02116 MICHAELJ DANGELO \I MICHAEL DANGELO 105 HORSESHOE LN CENTERVILLE,MA 02632 f Undersecretary Not valid w' out signature j � E lti Town of Barnstable °i Regulatory Services Richard V.Scali,Interim Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,Na 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 authorize6Z LB C to act on my,behalf, in all matters relative to work authorized by this building permit (Ad `ss of Job) **Pool fences and alarms ate 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. 4tute of Owner Signatute of Applicant kl?kw"T' Da "I e Print Name Print Name Date r' - _ Town of Barnstable - Regulatory Services oFz Tok� Richard V.Scali,Interim Director Building Division , EWRNSMAEM Tom Perry,Building Commissioner 039, ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6250 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 Appi-oval 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,.pa.rticularly 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. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2 C )(P 3(J Parcel Application# Health Division Date Issued O Conservation Division Application Fee Tax Collector '!Permit Fee to •, Treasurer 2/ps)&F. Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 172-3( rCt c� Village C,P�I ►vPt�9, v i Owner sp_v Address Telephone Permit Request Roa-e— Cam. I t Lto �I* ,&C.Pwi.g!A "' 61 U.l�d I�a�-e�l�•�,�� � C kmE�Dr 62 0 a-gin Square feet: 1 st floor:existing proposed 2nd floor:existing proposed 'i To new Zoning District Flood Plain Groundwater Overlay - Project Valuation O � Construction Type 90 w r Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting d umentMn. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 2er>n --- Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: Mull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 2 new Half:existing new Number of Bedrooms: existing_�� new Total Room Count(not including baths):existing ' D new First Floor Room Count (p t Heat Type and Fuel: J(Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes )1NV No Fireplaces: Existing New Existing wood/coal stove: ❑Yes IA No Detached garage:❑existing ❑new size Pool:❑existing ❑new size BarAd existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes )i(No If yes, site plan review# Current Use lGf"M Proposed Use ,�A BUILDER INFORMATION Name--- ��V-�e��W Kew— Telephone Number Address License# Home Improvement Contractor.# A; ��� C o, Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _ r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED k 1 MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: _. FOUNDATION FRAME Q9-, INSULATION FIREPLACE r!'d ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED,OUT ASSOCIATION PLAN NO. - F e , 3, i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ; r ' d 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): �� I Address: 17-3(o �i�!YGILI UtiGIe, • Kt ' , City/State/Zip: 1�4"V It 6" 62&'"Pho en #: S�TjS 373� 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 . employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ORemodeling ship and have no employees These sub-contractors have g, ❑Demolition . workingfor me in an capacity. employees and have workers' Y P h'• $ 9. ❑Building addition [No workers' comp. insurance comp. insurance. 10.❑'Electrical repairs or additions required.] 5. ❑ We are a corporation and its AU 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)aRoof 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 wort(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 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 here erti nder they ins and enal ' perjury that the information provided above is true and correct Signa e: Date: Phone 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 representative's 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." 1 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 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 wwwrnass.gov/dia Town of Barnstable �pf THE tp�� Regulatory Services BARNSTABLE, Thomas F.Geiler,Director 9 MAS& Building Division TED MA'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: 11)7 IDS" JOB LOCATION: 7.3 �/ eia(.G mt e nuppber 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 structuies 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 Dermit. (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 req ments. tr Signature of Homeowner - Approval of Building Official Note: Three-family dwellings,containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control., HOMEOWNER'S EXEMPTION The Code states that: "Any 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 Eti Town of Barnstable Regulatory Services r r • an Le Thomas F.Geiler,Director i63� ��� prF0.3g6 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must -Complete and Sign This Section If Using A Builder 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) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6gob Parcel ''Application# �06Xs Health Division Date Issued 161 Conservation Division A Iication'Fee pp , Tax Collector +. Permit Fee _ K Treasurer D/5/6 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 123 Il LYrt • . Village ei(le V �( • `� Address 11 1 l Owner _ PPS a i �� �G t, Telephone Permit Request Lp,� IiL1 alb �d � - ' Square feet: l st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 5--" Two Family ❑ Multi-Family(#units) Age of Existing Structure 2c�-o -i-- Historic House: ❑Yes S-No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other ":1tt .' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number c4 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: B'Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes Flo- Fireplaces:Existing _ New Existing wood/coal stove: dry6s ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:3/existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size . Other: F Zoning Board of Appeals Authorization ❑ Appeal# -Recorded❑ r , Commercial%JYes -2<oo- If yes;site plan review-# -- �� = - c —• Current Use a ww t,tc� Proposed Use BUILDER INFORMATION Name.Cld � Telephone Number i Addreesss� ;XA 9 License# ( "�L�,�����i� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /`/� � � SIGNATUR DATE /��6 FOR OFFICIAL USE ONLY ' 5 , APPLICATION# •. DATE ISSUED MAP/PARCEL NO. s ADDRESS VILLAGE OWNER , A ` s ' —DATE OF INSPECTION: ; FOUNDATION �7 FRAME INSULATION _ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 01 9-lyt DATE CLOSED OUT ASSOCIATION PLAN NO. c L �oFTHt , Town of Barnstable Regulatory Services ELUMSTABM Thomas F.Geiler,Director MASS. ; 039. " � Building Division ' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsta ble.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ,p Please Print DATE: /lD�G7 JOB LOCATION:��3 /�.1/�l/L`/4Dl�� number ] — / street village "HOMEOWNER": — name hoKe 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. . mi inspection procedures and requirements and that he/she will comply with said procedures and r ature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any 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. P�ppIKETp�'4 Town of Barnstable. Regulatory Services BAR� ' i'Eg Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038' Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: ���f0�/�2� Estimated Cost LV t Address of Work: 123 4f, Owner's Name:! � > Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied POwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED ' CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE.ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. Nate Owner's Name Q:fomis:homeaffidav it The Commonwealth of Massachusetts Department of Industrial nlccidents Office oflnvestigations . d 600 Washington Street Boston, MA 02111 , www.m ass.gov/dia Workers' Compensation Insurance A€fidavit;.Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual):. I Address: City/State/Zip• , -hone.#: 6AAEz ZU Are you an-employer? Check the appropriate box: Type of project(required):, 1.❑ I am a employer with 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the shb-contractors 6. New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. v remodeling ship and have no employees These sub-contractors have g. Demolition working for me,in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp.insurance.$• mired] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.Lff I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance,required.]t c. 152, §1(4),and we have no employees. [No workers' .•13.0 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. tContractors 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 providb 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.M 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 IDIA.for insurance coverage verification. I do hereb c t.e a' n 'Ities perjury that the information provided above is Prue and correct: Siena e; Date: Phone #: 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable *permit#�66-767L4 6 Expires 6 months from issue date X-PRESS PaMiptory Services Fee s 6Y, Thomas F.Geileri Director NOV 2 0 2007 Building Division TOWN OF BARRIftac O, Building Commissioner 200 Maineet,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �03 Property Address 2—_ ®Residential Value of Work�a s-�v Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address (3i bl L Contractor's Name 7" Telephone Number 775-37j3 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) �- ❑Workman's Compensation Insurance check one: L l l am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. 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/doors/sliders. U-Value;S='`j.j-\6 (maximum.44) *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 is required. SIGNATURE; Q:Farms:expmtrg Revise061306 ' The Commonwealth of Massachusetts Department of 1'ndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' . www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auylicant Information Please Print Legibly Name(Business/Organization/Individual):. 0_wle,�4 1-(ya-4111 Address: a-3 e C I �C City/State/Zip: �(®3�Z Phone.#: 7r-3 7��D Are you an employer?Check the appropriate box: :Type of pioject(required):. 1.❑ I am a employer 4. Fj I am a general contractor and I mP yer with 6. ❑New construction . 'employees(full and/or part-time). • have hired the sub-contractors 2 ��aa�sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling and have no employees . These sub-contractors have 8. ❑Demolition � and have workers' QVorking for me in any capacity. employees. a, 9. ❑Building addition [No workers' comp.insurance comp.insurance. re ed] 5. ❑ we are a corporation and its 10.0 Electrical repairs or additions 3. �a homeowner doing allwork . officers have exercised their 11.0 Plumbing repairs or additions ' myself[No workers'comp. right bf exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no o 4 d] : 13.[�Other employees.[No workers' comp.insurance required.] e( a *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation polcy information.. f Homeowoera.who submit this affidavit indicating they are doing all work and lien hire outside contractors must submit a new affidavit indicating'such. tcontrnetors that check this box must attached an additional sheet showing the name of the Sub-contractors and state whether ornot those entities have employees. if the sub-conftwtors have employees,they roust provide their workers'comp,policy number. lam 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 ender Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of.a fine lip 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 maybe forwarded to the-Office of Investigations of the IDIA for insurance coverage verification. I do hereby c ify under t ins aisd en erjury that the information provided above is true and correct Si afore Date: 2� U Phone# CS l/s 7 '—�,�y! Official use only. Do not write in this area, to be completed by city or towmofficiaL 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 I Contract Person: Phone#: v' Town of Barnstable OF THE Tp� P` o Regulatory Services Thomas F.Geiler,Director aARNSTABM ' y MAM& �A 1639• .0 Building Division ren �p 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: 40A c JOB LOCATION: /&d l SD�J /��� � l,ao m&3�—J number street village ..HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRES SGti/LLc�� 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 r ire nts. liginature of Homeowner r 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 F�HET�, Town of Barnstable ti °* Regulatory Services • a r � BARMABLF, Thomas F.Geiler,Director i639. � 'OlFn3..ta Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Se tion If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to w7auth d bythis building permit application for. (Address of Job) Signatur of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM&O W NERPERM IS S ION t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ,�1 Parcel (SAS Permit# S l� _ Health Division ` -•-75'4 V06— Date Issued r Conservation Division 69, 7 � ©� SEPTIC SYSTEtVIr- JST INSTALLED IN CoM�iR1vC Fe � Tax Collector WITH TITLE 5 p ' ENVIRONMENTAL CODE AND 'PPI Treasurer TOWN REGULATIONS Planning Dept. . . Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address j 23 (o 0 J'a:lG VL!1-o,?e" Village ,Owner 16e T: Ca d L Address Telephone 56a- 77S7= 3 73 CD Permit Request b - fez r 4 cl>A 9reV,-,e&ftKn Square feet: 1 st floor: existing ' proposed 2nd floor: existing proposed Total new ljw v u A, i �� ;Valuatio 0��b �+Qq Zoning District Flood Plain ZoKx B•• Groundwater Overlay Construction Type W411 t`OO n- re,0 o Va-frc� [a 5k 149(*-J CC-P-e-- Lot Size . 34'D across Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family O' Two Family ❑ Multi-Family(#units) Age of Existing Structure ZOO -1- Historic House: ❑Yes RNo . On Old King's Highway: ❑Yes �I-No Basement Type: O'full ❑Crawl ❑Walkout Cl Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) '550 Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing JT new Total Room Count(not including baths):existing to new tl First Floor Room Count Heat Type and Fuel: tfGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 5*`No Fireplaces: Existing _� New Existing wood/coal stove: ❑Yes UWo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:existing ❑new size Attached garage:❑existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Flo If yes, site plan review# Current Use SLtvt�M0►M Proposed Use 3uft P&pw,,_ BUILDER INFORMATION Cdevml-F1 nn Name � / Telephone Number Address - License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ZDATE _ I FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. ADDRESS _r VILLAGE � OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION s FIREPLACE S ELECTRICAL-©ROUGN FINAL ' m0 :- t � PLUMBING: 1: O ROUGH FINAL rF r� t> GAS: s ROUGH FINAL FINAL BUILDING �� •Z [, -p S \/ - i DATE CLOSED OUT ASSOCIATION PLAN NO. y ' c I _ i The Commonwealth of'Massacnusetts Department of Industrial Accidents z Office of Investigations ' 600 Washington Street ? Boston,MA 02111 . ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Avoicant Information Please Print Legibly Name (Business/Orpnization/Individual)• l�J�6ee,1 F. Address: V�Ll� Gt-yk City/State/Zip: V �('G - Phone#: 77:�-3 73 (o 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 t Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3. I am a homeowner doing all work right of exemption per MGL 11:❑ Plumbing repairs or additions - 1(4),and we have no ' myself:[No workers' comp: c:152,-� - --- § 12.0 Roof repairs insurance required.]t employees. [No workers' 13.0 Otl er 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 anew 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_-infortnation. I am an employer that is providing workers'compensation insurance for my xmployees. Below is the policy aid job site information. Insurance mpan ame: Policy#or Se .Lic.#: Expiration Date: Job Site Address: � City/State/Zip: Attach a copy of the w rkers' 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 ;fy ;der the ' s apivenalfies of perjury that the information provided above is true and correct Si afar Date: D Phone#: a 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#: I� 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 vl An employer is defined as`.`an individual,partnership, association,in corporation entdr other a deceasedentity,*or any two er,oor more of the foregoing engaged in a joint enterprise,and including g However the r the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the person to do maintenance,construction repair work on such dwelling house dwelling house of another who employs p 1 , or on the grounds or building appurtenant thereto shall not because of such employment be ciE MGL chapter 15 2,§25C(6j 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, § states"Neither the commonwealth nor any of its political subdivisions shall :25C 7 O. . 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 heir certificate(s) of necessary;supply sub-contractors)name(s), addre s(es)and phone number(s)along with t 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 UP.does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for,confirmation ofinsurance 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 orlicense 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 out in the event the Office of Investigations has to contact you regarding the applicant. of the affidavit for you to fill In addition an applicant Please be sure to fill in the permitlhcense number which will be used as a reference number. 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 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia °Ftr+eaq�, Town of Barnstable Regulatory Services . "W"TAa�, • 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 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 build'buildin&be done by registeare4ccontractors,with ce exceptions,along with other requirements. lae-F!al�.! QA ovA Zv I ReguJ01146,5t ch PMCq ype of Work: C` Estimated Cost 0ev Address of Work: Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under$1,000 []Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. d D. e Owner's Name QImms:homeaffidav Town of Barnstable Regulatory Services snxxsTnsre Thomas F.Geiler,Director ' . �� Building Division AIFD �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 ATE: 2 IZ- fG S r� JOB LOCATION: / Lam%[�_ GY��U�SI� �CX�l t,AW 12 f -TTTnumm`ber street village "HOMEOWNER": allfle l r •&,O /;/ ,JY/O." aL�,M36 name home phone# work phone# CURRENT MAU-ING 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 req ' ents lure of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any 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 personas 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:for nis:homeexempt .0�-- SUrn�00Ms:, achus -State uiIdin Co L- : D-9m ' pen ;~ echo The Massachusetts State Building Code(780 CAM) includes provisions to ensure that houses and house additions meet energy efficiency standards. This supplemental .CONSUMER INFORMATION FORM is to be filed as part of the building permit application when a builder/contractor or homeowner, constructing/installing a house addition with very large percentage of glass to opaque wall, seeks to utilize a special energy conservation exemption option for "sunroom" additions to,an existing house (780 CMR; Appendix J, Section J1.1.23.1). This FORM is not intended to prevent a homeowner from selecting a "sunroom"of any size, configuration, orientation,form of construction or percent glazing,but rather is only intended to assist homeowners in becoming aware of some of the important energy conservation and year- round comfort considerations involved in selecting and utilizing a"sunroom"addition. The connection of "sunroom" structures to residential buildings may create comfort and energy consumption issues due to uncontrolled solar gain or uncontrolled radiation cooling of the main house. In the selection and construction/installation of"sunrooms", included below is a non-required, open-ended list of product and design considerations that .a homeowner may wish to consider before actually constructinglinstalling a"sunroom". It is recommended that consumers carefully review these options with their designer, builder, or contractor, in order to minimize potential. energy consumption and/or house discomfort issues. In addition, the qualifications and reputation of the company or individuals to be hired are important considerations. PRODUCT AND DESIGN CONSIDERATIONS RELATED TO"SUNROOMS" • Solar Orientation and Natural Shading - • Type of Glazing • Insulating value • Solar heat gain • Frame materials • Glazing to frame sealing and gasketing materials[seal durability and/or weather tightness of the sunroom • Adequate ventilation Operable windows and fans • Applied Shading Systems • Insulation level in floors,walls,and ceilings • Possible Sunroom isolation from the main house via a wall and/or door or slider • Heating and Cooling Methods: Efficiency,Zoning and Controls Homeowner Acknowledgment The Massachusetts State Building Code, Section J1.1.23.1,..requires that the actual arooerty owner(not the owner's agent or representative)acknowledge receipt of this CONSUMER INFORMATION FORM prior to issuance of a Building Permit for a project that includes "sunroom" additions to an existing residential building. In accordance with this requirement, the undersigned hereby acknowledges that she/he has read the ' ormatio ' th' ocument concerning sunroom comfort and energy conservation. 'gnature of Actualtuilding Owner ' Date Print Name Address of Perfnitted Project 6wner A46=ss(if different than project location) Owner's telephone number i 3 Ct4 WP`pF THE Tp,,�O The Town of Barnstable � ' A N � • BARNSTABLE. • Department of Health Safety and Environmental Services . 9 ,MASS. 0a 4p Heys•'s.0 TEo Mpy Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: C�,� l Map/Parcel: ZCU �n Project Address:1 Z3 Ce ClrQ- pi U j l t c, °Qiuilder: _ ho ►'t'2" The following items were noted on reviewing((: f j ov i cz ,- D Gil Q v C c',"V' Li Y'V l e11 , / i I IAA C—�• Reviewed by: r4"-'19-4 -.4,W. Date: 0 " U #wilding:forms:review r AS/LOT 82. V O ti AIL IL AS/LOT 83 ' �. ARX4-J4.7setsp FT e BEDROOMti i �� AL AL AL AS;'LOT 109 PARCEL 1 ;'..-'�4':b-i—' �'Q!' a'1. AYE J4 A.li. AL v AL WL fOst'c'' @l ��5I440"IY AL. � AL A14 L. h� SSE!'. AID ALLAL A� ® Jr. N a • y�. 0 AS/LOT 109 PARCEL A R ZONE.- 'RD1" This MORTGAGE INSPECTION Plan is For E,S. FLOOD ZONE.- 'B" Bank Use Only 'TOWN: _7NTZ'RE1_4LE------------ REGISTRY OWNER: --------- DEED REF: _44.24/1! -----------BUYER: _COLLEZY-F'_CA&LL---------------------- ----- DATE: _113.f99 --------------- PLAN REF: 148121-------------SCALE:1"= 30 _FT. I HEREBY CERTIFY TO A. Af YANKEE SURVEY ITS SUCCESSORS AND 10R ASSIGNS_ATIMATHAT THE BUILDING CONSULTANT SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS PAUL SHOWN AND THAT ITS POSITION DOES -__- CONFORM 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS. OF THE EW @ P INDUSTRY ROAD TOWN OF ---B.4RNST IRLE_____________AND THAT 1T DOES_ NOL _ LIE WITHIN THE SPECIAL FLOOD HAZARD MARSTONS MILLS, MA: 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED_Z/_'aW2 _ It z TEL: 428-0055 Co - 250001 0008 D FAX: 420-5553 _____ THIS PLAN NOT MADE FROM AN INSTRUMENT ''7930 1F' C'—AUL i R� 'tl SURVEY NOT TO BE USED FOR FENCES. ETC. i Town of Barnstable *Permit# - OF E�Jpy Expires 6 months from issue date .� t ' • Services d•� .. .___ . . - _{- ;:w:•: --jZe ai ory .Fee... � snaNsire�t ' + ::w.. _,Thomas7--Geller,Director Ef S"�' `� _ ..._... ••n i . .. �•� . ..__ �Divisn a _ — �--Tom Perry, Building Commissioner PE B 1 8 2005 - 200 Main-Street,-Hyannis,MA 02601-- TOWN OF BARNSTA8LE Office: 508-862-4038 - Fax:•508-790-6230' O ONLY -•'- XPSERIG�I'r � ;YCA'Y'TN - ItESID�NTIAL Not Yalid without Red X-Press Imprint .lap/parcelN,m1ber c;2e6®,P3 , property Address 3 ©� [residential Value of W Minimum fee of$25.00 for work under$6000.00 Work f Owner's Name 8c Address C�/�l t�P� ( �! / 3 �Q (- /� �d Contractors N � 2 ��. Telephone Number-,- ame ' Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Norkman's Compensation Insurance CC�• Check one- ❑ I am a sole proprietor �] I am the Homeowner ❑ I have Worker's Compensation Insurance . Insurance Company Name Worlanan's Comp.Policy# Copy of Insurance Compliance Certificate must be on fife. Permit Request(check box) Re-roof(stripping 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) *where required: Issuance of this permit does not exempt compliance with other town depmtneni regulations,i.e.Historic,Conservation,etc, ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature Q:Forms:expmtrg Revise063004 r� __ The Commonwealth of Massachusetts _ = Department of Industrial Accidents Dice GlInuesagatfens 600 Washington Street, 7`h Floor Boston,Mass. 02111 Workers' Compensation Insurance Affidavit:Buildin /Plumbin /Electrical Contractors name /� /� address:�1 Z3/6, ( /1CLt'�(I`G�`F' 9L74 /V city sta�!22- zip: ZZ 32—vhone# work site location(full address): OR I am a homeowner performing all work myself. Project Type: ❑New Construction Ptemodel ❑ I am a sole proprietor and have no one working in any capacity. ❑Buildin Addition ❑ I am an eTRloyer providing workers'compensation for my.employees working on this job. - -• �' e 2 S di'� �'"S yt'e i,.R5 j�y v� 9 + s f '� � � . a�di•eS�"..., 4 a a� x�^"u4.�� �J t�.zNr_v.��-ii�`.,:r``�y�2'xS''t 1Y f, r J :.,'a t E x.. ::}, s s p t .p J:.•;, r v � 1.0207� s4` `r'yk+q'+i�5 y T.��ad3�y r-r�A��'�1�J u < � .s.yx-3 3 •iE u t ,x k l ro > .t F�����`'"'•�,�r+ ��`�i- h�'Y..�i' r,�"'�,'"str'•s �^r'r'" F��'�' .� a ric r�,H �iC*,s��*'�fC-''w�'��F�3`�f�f�� �� ��a@�' r,'��,,�� %Ygi �,�� M„���,�'�",�•l g�.7��+f x.. { i AJ` � inslitancc�C7j . .'�..a}4d... �?.-.,rEx3 `F7u',J'rxrwxSa�,(.. 1 J9'G;7tri._arA ;3's',�....,•!...F...,,n� �1C.., :,.. . , .,c., r ).:.. - ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices 9.K r'j• companv name e i t.r•!:._ :,. ...>;.,..� ..«.�.r.. .`'_ .0,. .°r z 1.rE.a-v-+'�. .•-.�: ,.. riti phone# � , T r �nsuranee Co F •:,. ' a y:. xrim pang liat►te 8dzllae§S.:r' k �. W. ! city r nlione# uisttrante:Cb. ... Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby ceptyy gndegr '7nd a of perjury that the information provided above is true and correct Signatur Date Print name 're"Ifs, a?,4x,Gl Phone# InE"27r-3 73 Co official use only do not write in this area to be completed by city or town official city or town: permit/license# OBuilding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised Sept 2003) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire,express or implied,oral or written. An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a . dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant'who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the 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 to 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 Office of Investigations 600 Washington Street,7`h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 '�� 4+;� to _..,..-__ i -. ,'t' a •' ., { , j a— T r ' P i _ . I _. ! i I o WA c2v, t I , L21 _ ,y _ — 13rzA- s_�,' - I� d s :fr1-. C- :I L IZ : . ICI C ---- c2nf_HvvS.., ----��----- � SCALE: I !7j APPROVEDBY: DRAWN 6Y.\ DATE: q ES F r �� t 1lDTL NSV{! (�LaS � A • 7Q s�' -.1 e8l n DRAWING NUMBER HyannLs,Iv1A BARRYJONES=HENRY DESIGNER O F 6 - C N� Z. sc _LD EW - - ------ram- ------ I r 3 z X 4 MOST P v �'r_ z��zY4- ,Pg o I -i=-� � ` z D"„ro 4 � M)cSZOL,A '/� �a2S A�� G t s?p� a osI^ L- (-. ' I c xts nra� ic2`aT.. T1v� l t�ra _FLrZ I�fyi cn��c � tP �{2c8 Ida ;I n t-xc 5S (�-._fit z L x g' s le - L �u3Fuso.� w I IAM Or) ! J D i 3�.'nrr�K x9 ra ��diaLL_aii Esc .iaM V -CRr�' T� : SILL- r..._� - i - P t3 T lr.L NO S 4sELvtrrt` - 5 s�k .I - ? A 4 r J _._ (bLF NMI K AV x<I A 5 1`1e9aD 3y � C LL O �� R.T'I � L t��N C�y aT t d ter 4��•k-t o� - ror_�•�:S.p��l___._._ ,. SCALE: 9. =.. I �:�' APPROVED BY: DRAWN BYIt jt 1 DATE w ..de R Hyannis,MA DRAWING_.NUMBER BA,RRYJONES=HENRY DESIGNER' 2 0F 2 1, _f3 st vvAt kNSM,1� 1 v1I� ? - - nit of M < < --------------- -A T-I WAI 1. - .. I` 1► �t_ .1 J _ 4lo . n i --- -m P _ rid_ttvv.S.F Fovr�nTr,_�r :.t _�. z I ( C - ---- p-�__ tz�.�_� nl �� FL' ���QS_..QN_�_ is ! L.�CCLZA1_G.._�L�LLLI�F �t!_ DC �1_t� .ls� .i I I I TROV.SCALE: 19 BY DRAWN B'Y JI i DATE: q r ` .t � _C �SST 1 cat- LAc poosZ r� �Jc t�o7v v1� �s sa env 1-� rty1. TCD��I . ude R HyannLs Iv1A DRA N BARRYJ ONES-HENRY DESIGNER OE 2 r i i f � L A I ul - \ V�, Pizc=v nORce M1C.fZOL, '/�� a2S A f s ru �rz .-w l �s Q. roo f C-�� : 1_ J��D.- L L , Gn L �/7x •'.' is rates ?•zSF_.. v>\I C� t7_FR 7ff�7 l`�Tlt1" �. -sr-- _ Dob FLIT-C3 -- 3 t"j"(�s tf t ti ("q r'.1 1 i 3 T7 tGK X cJ% ttt /�d2A LL A ii� v IaJoo" J-1 J - I r , AAj S _ • �1_ G= 1vp Rk- _EXis t7i�C.!1 X FoST 615 x �T3�4, 1� -SPe�I — \' SCALE: I. L� APPROVED BY: DRAWN BY �i�y. !` � DATE: q.= .15 • I_g _ LA- Hyannis,MA DRAWING..NUMBER -. . BARRYJONES=HENRY DESIGNER 2 O Z i - t 4 _ • ! # 3 1 I 1, - • ` --- �- i r fv cpw x M i3 �a Lo 1( X t f l 0 N* C r r3 0 �-T '7` r� S 1�A �?' ........... ._._. _i w zp `i fi y f v�i M-.--f-ems I Ewe i I y r 2 �- - H� CA141 FZ�S1p�f�IC� --R I i4 377 ` C SCALE:L E' �' I_Q��'A PPROV ED BY: �'. - DRAWN B'YTcrcy _ .... DATE. .1'-• I.J B1 n e�1 }'IYdrit1L5.MA .. .g .. -' DRAWING:NUM BER BARRYJONES'HENRY l O F DESIGNER 3 : pIle 1a1KS _ w� cla 6� `�A A.J< S � 4s'f`l G u' .L t e F3_-r�•+>GN_�lc�T�.l�.5 ,�' . '� ._ i?� .�?: � ,�. '�" � ,;_'�. a � t�,. � � - it' t� e�-� .}- -- . d , Vs � l x 5 7'Si� ! I511 1 _ �_.— -- � —- ------- -----} I � I jj _ I 6 • , r E S ��.�.n.._.�.s ,_,�. .a<____-a_ _ .._�. ,_.,�,...�._.a.__..,.,�.. sL a tit �+-�` �} .c✓� � - �� ,{� _ Px a , OF_ t,v tZ -V M 1u M r�tT - I t .. !� 'SCALE 2 r� I_ APPRO VED BY:. - - - I O.r DRA VJN B-Y /7_�� DATE. <:'1. IS Hyannls,MA .....g DRA WING_NUMBER BARRYJONES-liENRY DESIGNER.. r2 C>F7 + > y 80 q [ lie ..w 7-3 _ I 2-, r i „ _ y �f 6 DLs'r u Y �ttcalF►+4 U'c 9 c� < 7. ���� �:.a► ,o� Vie.} • �A - r ., �"'„•-� ->._, ._->.,�.-_.,�:�.., �_,.._.......a_�.,_ :..�,�:M___�.�_._._E_. ..w:�.,, _xP ..._ ,.. .:tea_,_.a _._- - • 1 B s v f 1 s i € _ i 1. - , „� � � � • , EE {�33 I s • f , • • i fI i, z F {i • _ :.._ W a. I .- <.,....eiw..-,,•Y�:s-.,•e,.-.�eav .. - v,:. - .:.u.._:.,:x_-,..aoe�-.n..•„+�-..umz-r�,:.•...a.»...-�-Y.>z.me.,xn»:...�.s --'�^�^.a'.•'c-m.-w.s., �___ g e _ CYo� � ?'`J -l2Er'\.c�t�: L ,- q I LKL51 ±._ CA! ILL, l-36 C1z- -Cl-vl-LIE ex�k—t-R- EbTENy1_[_t_ - ;; APPROVED B3Y; S ,t' l PA - - _ CALE. DRAWN B'V C�/ZJ�-. DATE ,1. 15 - a 1.`s e� gn Hyannis.MA DRAWING,NUMBER BARRYJONES'HENRY " c�E` ` DESIGNER' -