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1300 CRAIGVILLE BEACH ROAD
No--- E4:C 1,3oo ACTIVE Town of Barnstable 1l 111 Post This Card So:That�t�s'.Uisible From,the StreetApproued,plansMust beRetained on Job and-=this Card Must be Kepfif t '4 RAM Pos#'ed Un`ti1F�na1 Inspection Has.Been Made `' J. `'3 t Permit Where a Cert�ficate'af Occupancy�s Regu9. �red,such Building shall No#be Occup eduntl a Final inspection has been made§ . . f� t o _ _ a ._. A . .. Permit NO. B-20-816 Applicant Name: RICHARD P FOGARTy _ -° Approvals Date issued: 03/13/2020 j Current Use: Structure Permit Type: Building-.Siding/Windows/Roof/Doors Expiration Date: 09/13/2020 Foundation: Location: 1300 CRAIGVILLE BEACH ROAD,CENTERVILLE Map/Lot ,207-073 Zoning District: SPLIT Sheathing: Owner on Record: ELLS, MARKS l Contractor`Name RICHARD FOGARTy Framing: 1 Address: 1300CRAIGVILLE BEACHRD Contractor�2License 1�30373 2 CENTERVILLE, MA.02632 Est Project Cost: $4,500.00 Chimney: t _ Description: 1 DOOR Permit Fe'e: $35.00 - Insulation: Fee Paid: $35.00 Project Review Req: . _ 3/13/2020 � Final: ; Date Plurribing/Gas Rough Plumbing: -• Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by tHis permit is commenced within six`months after issuance. All authorized by this permit shall conform to the approved application,and the approved construction documentsfor which this permit has been granted. Rough Gas: + r , All construction;:alterationsavd changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall.be`displayed in a location clearly visible from access street orroad'and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same: ' Electrical The Certificate of Occupancy will not be issued until all applicable signatures.by the Building andFire Officials ae provided omthspermit. Service: Minimum of Five Call Inspections Required for All Construction Work: -, 1.Foundation or footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection ' 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health, ; Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). _ Fire Department eo Building plans are to,be available on site Final: All Permit'Cards are the property of the APPLICANT-ISSUED RECIPIENT Ci t S( ii - � Application number . 1K1G DE ......................................... NEAR133 2029 Fee ................................................... . ..................... MASS ' �C Vv a �.. ... ..�,. Building Inspectors Initials........i ....................... Date Issued...........:.......... 1.Z.0. Map/Parcel.........z��....�./.�.. .................. TOWN OF BARNSTABLE CANNED EXPEDITED PERMIT APPLICATION: S ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION MAR 16 2020 PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE O 2t3Z Owner's,Name: ,` , Phone Number Email Address: ---EA70` Cell Phone Number '2,,1o0 l Z- Project cost $ SbO Uo Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize f,C 4rl Irda y to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK t D Siding 0.Windows (no.header change)# Doors (no header change)# .2 F—Insulation/Weatherization Roof(not applying more than 1 layer of shingles) E3 Commercial Doors require an inspector's review /,, Construction Debris will be going to T uh tcyu(f-a"11 Certificate of occupancy with no construction(complete below) Occupant/family relationship or business name or Existing amnesty apartment(attach a copy of recorded comprehensive.permit)' CONTRACTOR'S INFORMATION Contractor's name r-� Home Improvement Contractors Registration(if applicable) (attach copy) Construction Supervisor's License# CS— (attach copy) Email of Contractor t - 0 &&o Phone number 0 9- Z�f�:75�� ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR/F THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ ; *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. .j�#,,Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 201bs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes ` ` No' ' 0f yes, a'gas perftiit'is required. If food is being served at your event please obtain a Health Departmeni=approval between the hours x of 8:00am-9.30 am or 3:30 pm-4.30pm. Commercial events may require..Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date .3 All permit applications are su eyiect to la building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia , Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 1( Old lc Address: /DS- geecl1 Wood / t City/State/Zip: �nfiPrt/i��t° -nI�= oZ632 Phone#: S 0 2Nl 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.El I am a sole proprietor or partner- listed on the attached,sheet. 7: .0 Remodeling' ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers' comp.insurance comp. insurande.t required:] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairsror.additions myself. [No workers'comp.' right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.®Other ���. Doa/ comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify %%JJunder e p 'ns and penalties of perjury that the information provided above is true and correct. Si ature: % yl Date —Z : Phone#: _<209,s-2� —`7 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions _ K. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged-in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no.employees other than the members or partners,are not required to cant'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 burn 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 Qmee of Investigations 600 Washington,Street Boston,MA 02111 } Tel.#617-727-4900 ext 406 or 1-877-MASSAFE r Fax#617-727-7749 Revised 4-24-07 .mass.gov/dia F� tap Town of Barnstable *Permit#:,W-1�- ' Regulatory Services fe 1ra 6 months from issue date MMSTABM MAM Richard V.Scab,Director ft#%��,;�� - %6 Building Division _.- _ --_---- -------_--_ ----<.__—___-- Pahl-Roma-Bnildia Comm �issioner 2_�7--_ .. =- -- _, g- N 200 Main Street,Hyannis,M�Al( 'glo1v y� �i www.town barnstable.ma us t'l -Office: 508-862-4038 _ _ ax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (J I I Property Address / 3 O Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address P-4Q Contractor's Name /�i4U l/—D.. J /UlLle /� Telephone Number / �� 0 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) 's Compensation Insurance /�Workman c Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ st(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 7 J� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvemen Contractors License&Construction Supervisors License is required. it .. SIGNATURE: Q:\WPFHES\FORMS\buildingpmmitfomis\EYPRESS.doo. 01/25/17 iIW YOMM07tw o' Mkzv&=e& Department afrad-=ft 690'waskingfon StW- t ' wrvia�mas�g�rP�i�ra . Wwimrs' Cmpensafin.Insurmce Affidavit BagderslCmiraciarslElec€icimsJPqmmbers AM3Hcam#Iuf armaf.rIrVn PleasePxintf ' Name(&Sjn�niTatirm 'rina9r1�/�CII�CJ Ad&c= Are you an emplayer?Checkthe appropriate ba= ' Type ofproject(reT&md): 4. ❑I am a general coafisar and I New amzaacti=eml y pees(aaftr part4ime j.* lave hired the sur � 2.❑ I am a sale orparfaes- lided cache,abrlred sheet. ❑ shy p and bare no emplayees. -c�cac shave . g_,Q Demnliiioa wading Exnz is any capacsfg emFlayew ad have woficers' 9. ❑BuilcrM9 addifica ji�To t camp.' camp. �,ase.a.cf j 5. ❑ We are a•corporatiaaand its 1Q❑Et,eehicai repairs or ad�tioas 3.❑ I am a bomea mer doing alb wask a$cm leave eYRrmed t hak iLE]Phnff--kgrepaim or addi itans, ugbf of eta per M(M ��[Nowoilc� �'"' c.I52,�It4k and�*ebaven�a �Roafnepaiss +nc�niance d.]l l3_❑Ofber emplayem[Na &. cam- Mqdire] �aa�rapgs�6-Id daUmfflmastalsosnouttieme bdar�g&ekwc&ea'�pEas aupor�yi � Er. �n_eat�osnl=E'ftsiiisIrMadliaMcwth dbEpKM3Gh2gHn c aud&MIEMoutQdecaatMcbM—stSaluftanemaffulavtindi sack fCa>drsciuisff>atd�ecl�tba�mrIDaSC�C1tP3�ffiadddlG6®a15be2rSLoRSagY�leL�E4EIbEa4d5t�ESGiIP2��O(IIOCtbG5E�SitT[� ea�loyEes.TftBejnb-c�adasha�•e empTof�s,daegz�gmy�f�ir ando�'gyp.paTicg av�bez • lain are erlfpla icv 9iat is prm i ffrg it arkam'compewm*n itfsriraffrs f br qy eurFTv}wes Serow is the paucy arrd jah sffe kformatfazL TakeCoaq=y Name: ]' ficy orf-ing Iic- � �� Z aDafe: Job 0aAddress t�ifgJSfaier,' p: �ZJ�� �-� Aftz6 a cupp ofthe warke�s'comp 'GapaUrcydeclaratum page(s owing fbe poflcy amber and e=p=abon date). Faftre fo secure coverage as regmred under Se fmn 25A of hfW-c 157—=Iwd to the iffiposi ion of mmmal pena}tses of a fine vp to$L500:0U zallor one-year impdsm=ed as weal as civil peusltirs is*e fb=of a STOP WORK ORDER and a fka, of up to$25(LOa a chip apiast fthe viobafor. Be advised fhat a copy of fbris zbdemed mEry,be Forwarded to tbse Office of BmsEa ofthe DIA far iast¢a�c�cavera�gCe c I rfn[MAY cerf f3 I tits du&f w a f brMian=prmi&ff a€m a h;true and catrert ^sisaatu�er/ Rafe: �`��3 �� D, aL um r�ff� Da oats ff�a uxerr,trt be crrtupfete+d lip r�rtaff�t My or T'ar%a: Feiz�ILiceErse� Isudn uflwrify(ch-de one): L Soard of Bu mg Deparimeat I CdYfrufm Clerk 4.ElecincA hLVc w S.Fbmbimg Inspector 6.Mier ,t. Carlact Person: phone#: Taformation and lastructions Mw=nh=ft Geb=dLzm ffiaptrr M des all -tD IMVi&WM50&camp=SEd=for fheir=EplaYt:�--- Pmstrar� Ir pew is defined as.¢_eveiypetsan.m fie seavim of matbrrmmde=auy mmtract ofFn express or iaipl%e4'omt OrwrifMM." Aa Srrplayer is d as-m p��.assAeiabaa,Corparatian or of legal a y,ar suY two or mtae Of the;ft eg ing��cd m a3o� �me g l o rs Of EL deceased eaplay rr.,or ffie rmczivw or trustee of an individ LL per,association or offiWIegal emli y,employing eanployeCs- HovDverr tha owner of a dweII13c;ghm=hzvmgnot3a=fiamt'h a-BPB nezb aldvifia rcsidwffimcjr,orffim occupant off=- dwalTxag hDuse of a2a6iw who employs pmsans to do m2fitmalma.mmskuctioa or repair work on sarh dwelTng house or on fie gr=2& or bm7dmg appmimantf=ctD sballnotbe�se of surli employm=3tbe d�edin bean employe" MOD duet c r I52,§ZC(6)aIm sites fst"every sfdL-or local Ticensing agency shz wi i.Iiold the is =rp or rmewal of a ccam or permitto operate a jmsmess or to construct btu7dmgs in fie commonw�lfi for aay T applicmtw•Iio has aotprodnced acceptable evidear�of campT-mmwiffi thr-rasm-anmcoyexneregased." AdrT orally,MCrZ�P�I5Z,§25dM sbitrs fije�flie _ nor a¢iy ofits po7i<iral sabdiv%sions shall mnr, FM mtD any contract far tic p ofgublio wofc msbl actable evAmm of caaTh4ncewifh the insaz' . reqa-eI3ie[Iti off3is&VtEahaveTieen=WC03tedID fie aMhLCeMg.a3ffioay." . Agpiicants Please fia Oi± the wDlb='CMnPensafion EfEd&e c=[pletrly,by d=kmg fie boars that apply to your sfnaffin mcd if n= saq,mWly (s)name(s). des)mdphrmennmbm(s)along w&ffi t OCEtfrcste(s)of msm-sin=_ L=mitedLnbil±y Comparaes(ILC crLmntedIhbMfTP igs(LU)•v;r&no=3pIaYc=of m thantbe n=al> is or pa tads,are notrbqaied to cog wadOmm�cmmPenss"'i amum3r _ If m LLC or L.LP does bav e employees,mpolic:yisrmjakv. Bea3Yi=d$df3isaffdaNkmaybemmmith�;dtothoDepaitmea3tofhidnsfrial Amid for comf m9dm of insai�ca mvmmge Alsa be sine to sig�u and dafe�3ie affidavit: Tbn affidavit should beretm edto$ecityortownfiattheapplicsfem.forfiepettaitorIice=isbekgrmq edAnotfieD.partmmdof Rdnstzisl A c:m!=t9 SboaIdyoti havo aay questions fie Ian or ifyon are rec�aired in obtain a wox$rds' ��ead;rrnpoTey,pleasecaIlthcDepatimea�atihenvmbezlis�dbeIow: Self-ins�etica¢�Smmiesshonldeamrti�eir . self-f,, -ance He m3sm nm31=a o fio Iine. Cry or Town Omd.-a . r Please be sore that the affidavit is um�Iete andpriafEd Ie Iy_ Tie Depattmeothas provided a.�sp¢�ac,�e at fhe boffin ofthe affidavitfOr YDutD fll omt mthe a Vm±the Off Tm��ce of �bas to co�stycu max- .{'dam appf'at Please be sure to Olin ffi.O P rnTtlF===mbm v&ich vM be used.as a rt&encx=mben In addition,an opplicad offic fbat must mbmit mzrl bple pc,,tr===applitions in any givenyear,need only sahxait one affidavit indicating crier policy;,,fn. atiCsn Crfn Y)and m>des"lob 5 e� ess"fze applicam shorldv�r>$� Y �o (�Y or edormmimdbyt�e city be videdtntbe - town).'A copy oftbe-affidavitii�athas bey. iaIIy stamp , applicant as proof t3�at a valid affidav$is on file for f�nre'pmmjjp-.on cccnses. Anew affidavkm st be:filled obt e;arh year.Vh=a hoxo a owncr or aiiizen is obiafi3ing a Ttaease ar pew not xelatcd-b?any bvsmcm or cam**»al veof= . a dog license orpemmitta bmnleavrs e�e-)saidpm=is NOT=q=edto ccappIete IE3 affidayk I 'Oice oflnv waald.li-ta diankyonmadvaaca faryaur coopeaafi®and sbavLiyoaI ve�Y '�O • please do not htsftBfz to give ms a cRM �e Dee s address,fdephane and;rzc 3 �crr Zth ofs - �c�f�Acci�nts . . Fax#617=72�7-774 LZevisea�-z4-oT mass gAFM i A.-Office of Consumer Affairs&Business Regulation License or registration valid for individul use only �IMOME IMPROVEMENT CONTRACTOR before the expiration date: If found return to: p`�Registration 120659 Type: Office of Consumer Affairs and Business Regulation Expiration -2l19/2018 DBA 14 Park Plaza-Suite 5170 ' Boston,MA 02116 �LINNELL ENTERPRISES •:.DAVID LINNELL .� -59 FREE BOARD LANE: --YARMOUTHPO.RT,MA 02675 ]Undersecretary _ Not valid without signature Massachusetts Department of Public Safety 'a Board of:BuildingRegulations and-Standards License: CSFA-071507 Construction Supervisor 1 & 2 Family DAVID J UNNELL,:JR 59 FREEBOARD:LAN t YARMOUTH PORT M Expiration: Commissioner o811112017 I �� D� CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD,YYYY) Rift 02/27/2017 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Blackstone Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. BOX 3144 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester, MA 01613 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA A.E.I-C. Linnell Enterprises INSURER B: 59 Freeboard Lane INSURER C: Yarmouth, MA 02675 INSURER D: INSURER E: COVERAGES 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I ION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMIODNY) DATE(AMID r YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ -COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurence $- CLAIMS MADE OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY R PROJECT LOC AUTOMOBILE LIABILITY ANY AUTO CO aBINEDISINGLE LIMIT(Ea g ALL OWNED AUTOS BODILY INJURY S SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO • OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S _ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE WCC50050074472016A 8/1/2016 8/1/2017 E.L.EACH ACCIDENT $ 100.000 OFFICER/MEMBER EXCLUDED? If yes.describe under E.L.DISEASE•EA EMPLOYEE $ 100,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER David Linnell is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 198.8 i Town of Barnstable ` Regulatory Services ` 8•3qS",a Richard V.Scab,Director Kum ►`� ]Building Division. Paul Roma,Sanding Commissioner 200 Main Street,Hyannis,MA.02601 www.town.bamst able.mans Office: 509-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property y // I hereby authorize Z/A' L-�>0 41/ls4fJ/C to act on my behalf, • in all matters relative to work authorized by this buMng permit application for- (Ad&ms of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be,filled or utilized before fence is installed and all final inspections are performed and accepted. i Signs of er Signature'of Applicant Print Name Print Name Date QYORI-M.OWNERPMOSIONP00LS Town of Barnstable Regulatory Services Richard V.Scab,Director Building Division KAM s Paul Roma,Building Commissioner �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXE1V nON 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- f anily 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 ildin Official Approval of Bu g 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. QWPFUUMFORMS\building permit forns\E)TR.ESS.doc 0620/16 oFtNe r Town of Barnstable *Permit !l 1 l EPT' Regulatory Services 'eirese 6monthsfromissiedate '+ BARNSrAB i o Richard V.Scali Director Building Division Y� hj �- A€3N�SALE Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us `Office: 508-862-403 8 Fax: 508-790-6230,. EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address l�Cb �rcti���i���% jild: 02-e Z ®Residential Value of Work Minimum fee of$35.00 for work under$6000.00 ` Owner's Name&Address r , Contractor's Name �i( G d 6,0 6"1 Telephone Number Home Improvement,Contractor License#(if applicable) ISM Email: Construction Supervisor's License#'(if applicable) 16��9 7/ } ❑Workman's Compensation Insurance Check one: P® I am a sole ro rietor P ❑ I am the Homeowner q ❑ I have Worker's Compensation Insurance Insurance Company Name ` Workman's Comp.Policy# s Copy of Insurance Compliance Certificate must accompany each permit. , Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof). ❑ Re-side - ® Replacement Windows/doors/sliders.U-Value r 30 (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. :***Note.. Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is regpired. SIGNATURE:; a � QAWPFILESTORMS\building permit forms\EXPRESS.doC 01/25/17 *. q � r Depar went qfrnd=&idAcdderds 600 Was1rhz&4wz�►rfreet ei Boston,MA 02111 . . k�fvt�nrrt��v�dia Worke& C Insurnce Affi&vit S•mUdeslContmcWrsMec&k ansfPhmihers Amlicaut IlEdor n.atian 1 Ple25ePrint Effie 1 C i C�7 i L Address: 1 Cifyf fi�tx=1 '.�Pd!/3IIL o2 phone Are you an P' r?:iMeckthe aPP' rol tebox: 4 I am a egetal conir$ctor and I Type of project(regn�ed�_ I_❑ I am a employes with � g 6. El New oacEort employees(fall au for pa t6me).* have hired the mb-contactors 2. I am a sale prnprietas orprt lw--. listed an the attached sheet ? ❑ esm &HR9. ` These'sub-cemdractars have sS>£p and have as employees 8_ ❑Demolififla r worming for me in any capacity. employees aced hazre wa&ess' INo Wodm s'Comp.iinsmznce camp_i Msu arxp 1 9..❑B.uiltfmg addition. . recluEM 1 - 5. ❑,We are a corporatien and its ldk❑Elecfical repairs or ad&t ons 3_❑ I am a homeav er doing at vark of have exe=-- ed ffi�eir 1L❑Plumbing repair or additions of es o wor'f= �t empfion per&ftiI: €� - - .. 12.❑Rflafrepairs c:1:52,§1(4),andw'e have no x employees.[No wcdners• j 13.0 flthez cam_iasmanw requited.] ;Any aW&zatemtcbedxb=9l=astalso fin outthesxfi=beiowsfiawin%theTxwcaeecampeBsaff upancy&5-saaa Ida a�aerstrdm sabot dris afiid a indvrrli;tg they axedai�all~ec¢t aadtheah¢e autsideca�ctars�st submit anew sffidnk J"diamea SUCH. ICaattacc=ffiat c —1 Ws b=nicest attached as addiiiooat sheet sfioRiag the name of the snh-ccuscbm snd stite whether arnottvnse emiweoaee Emplwyees.Ifthesub-taatautnubm empIoyw-% Ley=nrpmridethea Radcers'immp.paliy aumbm .Tam arc enziployar fltat is pruuidur varkers'competnsdian hmzrazzm for my=Wlay;wes BetonP is fine paLicy tool job site inn,jormahbn, Insumce,Companyi"Tame: , Paficy or Self--ius.Lice ` manDafe_ Job Sif�Address: CitplState/no: Attach atiapf afore work-ere eozupensationpolicy declaration page(shaving the policy number and expiration date). Failure to secure coverage as required under Section 25A o€MCL a I57—can lead to the ianposition of ctiminai penalties of a fine up to$UOD OU andf'or oti<o-yt rimpdsm=2eud as wcA as civil penalties in the fart of a STOP WORI£ORDERand a fine of up-to$MOO a day a,-:,jfiut the viohtm Be adtnsed'thaf a cap o€this.statement maybe forwarded to the Office of Itzvestigatiom ofthe D-TA for iusmance-coverage won- Ida Jner ry certrfy r0sr t#s pains Pell of pedal y that the info rnzatzmprov-&W abmre%v bus and correct sitmatum- Date: ! �� Phoned a d use and Do zlat arrrta in This area to be compieted by tidy artowvn officraL Cky,or Ttt= Perudff-ieense;9 Issuing-Axtharetg(title one): ^ L B6ard of$•eal& 1 Bwffiring Department 3.City-Mmm Clerk A.Electrical Iuspeetor S.PImbmg Inspecter b.other Contact Person: Phone#: - Taformation and 1hnstractions M&a sz- eft ceeaat Jzws chapter 152 tomes all cmpJay=t[)In M&W06=s'=npMSSfIon fin f Mr employees. PM-B r, t this sfdnfr,as EzvIoyw is dcfined as"...evmy personin tine sm-vicx of another u der any comtract of birr,- express or impHod,oral or writ m-" An.�Ioy�is de fmcd ES*aan ia&yidnal,parfnersbzp,associatiim;corporation or other legal entity,or any two or mare of fire ffiregomg engaged m a joint ,and mcln�g the legal=F==tat V=of a deer sed employer,or�c rece:i or trustee of an mEvidUA partoeasfiip-associafion or ofheslegal entity,emploYmg eMPIOY=S- However the owner of a.dweMnghome,havmgnotmcre than three apartments and Who remdesthezfi3�orfhe occap2mt ofthe - dwnIIjag house of a .ofer who m3pkys pers�s to do mom ma,construction or repair work.on such dwelling home or on the grounds or Tmldmg appm�thereto sball not becm=Of such employment be deemed to be an employer." MM djapter I552,§25C(6)also fiat"every sfate or Ioc21 licensing agency span witbhoIcl fhe issuance or renewal of a license or permit to operate a Tress or to construct bmTdings is the co—onwealth for any _PPlic=i_Who has notproduced acceptable evidence of cnraprance wit$the insurance coverage requn ed." AdcHdonally,MW_chapter�,§25�states-jeftbe:rthe comm�rwealthnor any ofifs poTifrcal subc Suns shaIL enter ofpnblic wozic mzbl accr�fable evidence of compliance with a msuraace. cob any coatcad for the p=Em man cc regLmemeE is of this chapter have been preset d to the confrattmg a3fhO3*:' A.�,pIicaats - Please fill o the�votl�as'compensation affidavit completely,by�g�e babes that apply to your dInafion and,if necessary,supply s)nam*), address(es)andphonenumbm(s)alongwrihtbmr certficate(s)of ms ra[U . Limited LiabMLY Companies(t LQ or Linited Liability Partamsbips(LLP)w&no employees other than the members or partacxz�are not requfird to carry avarice&compensation i r*co mm If an LLC or I I.P does have employees,apolicyisrmpfttd. Beadvisedthat this affidayk maybe snbmif�tuthe Department of Indnsfrial Accidents for conEmnaiion of ins�ce coverage Also he score to sign and date the affidavit. The affdavit should be retuned to me city-or town that the application for the peunft or license is being regneste-d,no t the Depazimed of ; LTdusfrfal Al ci =r[- Shonldyou have any gnEstions rega mg the Iaw or ifyon ate edm obtain a wodCers' Cpmpecatic Policy,please call the Departneotat the nnmber listed below. SeJf-fnsaredcompaoiessbonlden their s elf-insmrr=.ce license zmmbm an the kLP.Pmgriafe line. City or Town officials f Please be sure that the af6davif is complete and prntied legibly. The Depar•mlent has provided a space at the:bottom of the affidavit for you to fM out in the event the Office oflnvestigafions has to contact yoareg-a mg the applicant Pleas e b e s=to f EU m the peamWHceose rnr<nber which will be used as a reference number. In-addhion,an applicant that must submit m.U141e p emmtlicen ce applitaiions m any giveal yea,need only submit one affidavh mdicating car mt policy mf=atiom(if necessary)and under`Job Site Address"the applicant should writs-an106 ati oms in (�Y or_ town)"A copy of the affidavit that has been officially stamped or madced by the cry or town may be provided to the applicant as proo�tbat a valid affidavit is on file for fi tm pem ip or licenses Anew affidavd must be filled.Dirt each 1.year.Where a home owner or citizen is obtaining EL license or peamitnot related to any business or commercial v�(ie_a dog license:or peonrot to burn Ieaves etc_)said person is 1�TOT r r Iete this affidavit T$.e Of oflnvcstigafinns wouldlike.to tTiankyoam advance for your cooperation and shouldyouhave any question, please do not hem to give us a call. The gepartmenfs a:ddzess,tlephune and fax rnmbea_ Diet afhi&Eftiel Accidents QM=of InVeRtikatio= Dos�IYfA E�lIF Tf,-L 4 617E-' -4400=t 446 or 1- 77 MA GAF` Fax 9 617 727 7749 Reviscd424-U7T„ a S Town of Barnstable Regulatory Services ffi Richard V.Scab,Director - ►Na Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must •. :. Complete and Sign•This Section If Using A Builder I ,as Owner of the subject property hereby authorize G, �-A to act on my behalf, in all'matters relative to work authorized by this building pL application for: (Address of job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or ufilized before fence is installed and all final inspections are performed and accepted. Signs a-of er Signature of AppliAt t) 74Print Name Print tne 7J Da e ,a QTORM&OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services . QIFtME Richard V.Scali,Director Building Division snsxerwma. = Paul Roma,Building Commissioner KA 39. 0 . 200 Main Street, Hyannis,MA 02601 i639 ��� www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied 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 constiucts 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 res_ponsible for all such work performed under the buildine permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements.- Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any 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 shalFact 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 I ' Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-063941 I Construction Supervisor RICHARD P FOGARTY _. 106 BEECHWOOD K0,3 CENTERVILLE MA 02632y , Expiration: Commissioner 11/11/2018 1 i V/.Wpam 0mvea ll,o1Q1l &4aduaelb Office of Consumer Affairs&Business Regulation _ HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Individual before the expiration date. If found retum to: Ristrafion �Cuiration Office of Consumer Affairs and Business Regulation , 3.073 02/27/201 S 10 Park Plaza-Suite 5170 -;._ --ar Boston,MA 02116 Richard Fo - i-r 9Y� Richard Fogarty /. 105 Beechwood Centerville,MA 0--- f' y F'� Undersecretary Not valid withou gnat �IWKE, , Town of Barnstable *Permit# -1 Regulatory Services fee 6monthsjrom issue date i BMWSfABLE MASS. Richard V.Scali,Director Building Division`�j1 F • Paul Roma,Building Commissioner • ' � ' 200 Main Street,Hyannis,MA 02601®EC 2 C . _ www.town.bamstable:ma: s. '. Office: 508-862-4038 t � N OF b� Fax: 508-790-6230 t�-,ttx EXPRESS PERMT APPLICATION - RESIDENTIAL ONLY d0j, 0 7 �f Not Valid without Red X-Press Imprint Map/parcel Number l/ J II Property Address_ /Y60 &4L'ide Ile- t?e1 ZC lU. SResidential Value of Work$ , 00, GJ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name t C 7"rc Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) o G S /7 ❑Workman's Compensation Insurance Check one: �.I am a sole proprietor ❑ I am the Homeowner 4 ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to . ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value ,12 (maximum.32)#of windows 6 #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXP SS.doc 06%20/16 - The Commarnreakh qfMaysachusetEr Department cr,f raduskzat Accidm& Qe {� IOTlS ' 600 WasshfzWm Street Boston,MA.02111 -- 1prtnnH1aS&g0V1dlci. Workers' Compensaf M Insurance Affidavit:SuiIdeslCantractit sXlectricians/Phunbers AppUxant Infer iafsan I Please Prat F Iy Naffie Ada /Q,�' gendItyodd Ac[ e city/statel ig rrC �� �1 1�E� Phone: 909--- Are you an employer?Check the appropriate bow: Type of prAect r 1.El am a employes with. 4 ❑I am a general contractor and I 6. ❑New consfructian � employees(full andfor parwime).* have hired lie sub-caters 2.aI am a sole propprietar orpartuer- Usted OIL the attached sheet 7•'❑Remodeling sb p and have no employees These ssosbb-contractors have 9. ❑Demolition. andwaddng farm in any capacity.- employees ance.ve xga s' 9. ❑Building addition � �4 tTdt�e[3'camp.insurance Cccamp-mertrnrp 1 "• . a . required-] 5. ❑ We are a corporation ration and its 1 -❑Electrical repairs or adds 3.❑ 1 am a homeowner doing all work officers have exercised fhesr. I❑Plumbing repairs or additions on myself[NO workm-comp- {" of fi- per MO- lry-❑Roafrepairs c.152, I and we have mo, t insurance i d�! w 13-M 0i ier 67/i employees.[To Wore e Comp-insurance #AnyappUCzUtestchaftboa#1—st Rho outtbeswficmbeioaslumi fiekvialess'mmpensarianpaRLyinibrma au- �a�eoa#aers vrho saint his afiidariE i g Huey aze chin;eIF w and H�]Hse aotside r,�,�rn,•��st submit a new affida&mdicsiina sudL FCa ctoesIR:acbeckWsbox must attachedasaddiB®slsheetshoRiagtheaam�ofthe midsYstew}urthetarnotthoseeatitiesha� employees.7fthem*-ta4tmctae :hm mployw-%dieymusrpnrvidetbek uarErss'mmp.paricFamaber- I am err ecriper flint isprvtciirra ivarkets'caatpe�csirticxrt irrsrrrattce fur�c}a emPF�3nee� Setoav is f7�e prrticy curd jo7a site infOraz ti01l. In sumce:Company Name: P4fiey'A"or Self--inn Ile.;k lmpirationDate: Job Site.tlddress: Cityl5W512* Attach a-copy of the warkere canzpensation.poHey declaration page-(showing the policy,number and expiration date). Fa&m to secure coverage as requiredunder Secdon 25A o€MCM a 152 can lead to the impositiioa of criminal penalises of a fine up to$L,SODOO andfor oni y6irimpsisonme t a,s well as rivi1 penalties is the fiona of a STOP WQFX 01=and a fm of up so 4.0O a dap against the violator. Be ach ised did a cap of this statement maybe forwarded to the Office of Investigations of the DIAL for insurance coverage sedficstinn. 1&0 trerzry certrZ4� " die s idpenal�s afpciUr y thatthe ire,formadouptmidudabm c h hears and correct Date- Phone (1,�at use�rfp: �Jo prat rsrite in fb�area,frt be arrripfeted by catlt ar�rrn a,,�frcrair Cit 3'or TQ'WW FermiffAcense S linning-A.nthaTfty(mule tune):. ' L Bowd of Iieahh �. g Dgmtneat 3.cityamm clerk 4.Electrical Inspector 5.Plumbmg Inslrector 6.Other Camtact Person: Phone#: 6 formation and Instructions M�ear Iirrce#ts G eoeTal Laws I52 req�es aII employers t3o provide waa�ras-'peon their eruployees. � pmm=tto this sty,an erV&Tw is defined as.-_e=y person ia.$f a sCMM of anaffier Mder a¢y c01ftact ofbn-rl =q ress or replied oral or w2ittenf .An err�Iay�is d�fined as"�indryidnal,paxtne$sh�,arrnQa�o1);corPorat[on or ocher legal ey,or any tFQo or mare of ffi=foregoing=agaged im a joint=rr2dm,and inclndmg the legal=es=t&&es of a deceased employer,or the receiver or trustee of an mdividmiL pmtae= .p,association or otherlegal entity,employing emPloyees- However the owner of a.dwelling house having not more than three apartments and-who resides.thm n,or the occupant of the - dweffing house of another who employs Persons to do mamt=ance,wnstart;on or repair wDik.on such dwelling house or on the grounds or bmldmg appMt=aIt thereto s1iall nDt becanse of sorh employment be deed to be an=3ployes." MC$,cbapter 152,§25C(6)also stems that"e ay state or local licensing agency shal[Wiffi-hold fhe issuance or tuZ in the cornmartpPealih for any permit too erate a business or to contract b dings renewal of a Iicease or p p mcnr�ce -ovexa e r " applicant w•ho has notproduced acceptable evidence of cdmpBance with the� g t . . oIhical subTivisions shall ofifs Add.tlanaIly,MGM chapter 152,§25C(7)states`Neither the _ nor uy r mtez min any contract for the prance ofpublic work u 3bl acceptable evidence of campHance with.fhe tune rr,6 regzm ements of this chapter have been presented to the confrarting anthouty" Applicants Please fal D-ot the workeas'compensation affidavit completely,by che& g&e boxes t,:±apply to pour sitnaiion and,if necessaiy.s-apply sob-conractor(s)name(s), addresses)andph=enwbei(s)alongwiththeir certdacate(s)of insurance. Limited Liability Companies(LLC)or Lmnted Liab>lityPartnerships(LLP)w1ano employers other f m the members or partners,are not rbgm ed to caay woike&campensafim insurance- If an I.LC or LLP does have employees,a policy is required. Be advisedthatthis a.ffidaykmaybe snbmrtfrd to the Deparfinent of Industrial Accidents for contamation of msmm=coverage: Also be sure to sign and date the afddagit The affidavit should be mtlm7Bd to 1he city Or down that the application for the permit or license is being r$quested,not the Department of Eadnstri l Aoddents. Shoulclyou have any questions regariEmg the law or ifyou En reqmred to obtain a worms' compensation poficy,please call tha Department at the numbs listed below. Self-rased companies should enter their self-finmimcd license number an the appropriate line. City ar Town Officials Please be sm-e that the a$davit is complete andprmted legibly. The Department has provided a space at the botbom. of the affidavit for you to fib out is the event the Office ofInvestigati=has to cordnctyoa regarding the applicant_ Pleas a be sure to fill in the pen tl cm=mnuber which will be used as a reference number. Iu addition,an applicant inat must submit mul ip10 PenMMice DSe apphtat ms m any grvenyear,need only submit one affidavit indicaimg cusent policy infoLmation(if necessary)and under`Job Site Address"the applicant should write"sII locations in.---(city or town)-"A copy of thec-affidavit that has been.officiany stamped or mucked by the city or town maybe provided to the applicant as prool:that a valid affidavit is on file for fafm a pmmits or licenses Anew affidavitn.ust be�1 vtv�e� t 7afedtn an bn�e or comet .�or no re y e o ea ar citizen is o a h year.Where ahom wn bt�g P�� . (ie.a dog license or permit to bum Ieaves etc_)said person is NOT req�zcd to complete this affidavit The Of oflnyestigaiinas wouIdhkr.t o thank youm advance for your cooper., ion and should you have any goesfzons, please do not hesitate to give us a c•raI L The Department's atidress,telephone and fax rm her: Tha COMMWVMM of MaLI=Ghn ent of lad�t Aooident% Offi=of 1wedkafi=S Boffin=1A CQI 11 T614 617- -4900 mt 4-06 W 1477 MAS&� Fax#617` 27'749 revised 4-24-07 .ma .g�gt } �"E Town of Barnstable Regulatory Services s"MASS. ' ` Richard V.Scali,Director &639.�► Building Division. , Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 �Fax: .508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I - ,as Owner of the subject property hereby authorize C�Gu'�� r,A4rA, to act on my behalf, in all matters relative,to awork authorized by this building permit application for: . (Address of Job) �AA **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signs a of Own Signature of Appliant . ✓ ' lam—(' � L�. �r.,,F- ry e , a- .. Print Name Print Name Date b Q:FORMS:OWNE"ERMISSIONPOOIS i Town of Barnstable Regulatory Services 'THE Richard V.Scali,Director lj Building Division r � tom► . Paul Roma,Building Commissioner A egy. �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862.-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: -JOB LOCATION: number street village "HOMEOWNER": - name: home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied 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 forth acceptable to the Building Official,that he/she shall be responsible for all such work Rerformed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION _ The Code states that: "Any 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 06/20/16 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-063941 ' Construction Supervisor RICHARD P,FOGARTY 105 BEECHWOOD RID CENTERVILLE FAA 026; 2. (� CA,— Expiration: Commissioner 11/11/2018 ,tom Vlre rpo'����na�rtvealC/o�C��crrtJac/aaeCiiJ .. - �\ Office of Consumer Affairs&Business Regulation _ HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Type: Individual, before the expiration date. If found return to: istratlon. Exolratlon Office of Consumer Affairs and Business Regulation —� 10 Park Plaza-Suite 5170 9A37-3 02/27/2018 Boston,MA 02116 Richard Fogarty a _ ) - Richard Fogarty..,,_ 105 Beachwood Ad` �2..GGP. --- Centerville,MA 02632= ..,::;:> - Undersecretary Not valid without signature REVALIDATED LETTERS OF MAP CHANGE FOR TOWN OF BARNSTABLE, MA Case No: 11-01-0521V Community No..250001 July 17,2014 Case No. Date Issued Identifier Map Panel No. Zone 98-01-092A 02/04/1998 SQUAW ISLAND --LOT 49 - 19.ISLAND 25001CO564J X AVENUE 98-01-1020A 12/30/1998 LOT 1, LAND COURT PLAN 2500.IC0752J X 16194-N- 1623 MAIN STREET 99-01-244A 01/06/1999. PLAN 13687, LOT 5 - 215 SEAVIEW 25001C0776J X AVENUE 00-01-0306A 03/28/2000 648 MAIN STREET 25001CO544J X 00-01-0998A 08/22/2000 291 BRIDGE STREET. 25001CO757J X 02-01-0994A 06/05/2002 fB00 CRKIGVILL'E-BEAC O D, 25001C0563J. X CENTERVILLE 05-01-0804A 10/06/2005 COTUIT H'IGHGROUND, LOT 25001CO752J X 152B -- 220 CROCKERS NECK ROAD 07-01-0535A 03/29/2007 CENTERVILLE, LOT 9 - 36 BROKEN 25001C05641 X DIKE WAY (MA) 11-01-1245A 03/31/2011 LOT B ---265 SEA VIEW AVENUE 25001CO757J X 13-01-0725A 02/05/2013 MAP 259, LOT 12 116 SCUDDERS 25001CO554J X LANE 14-01-1368A 04/10/2014 LOT 18 -- 835 SOUTH MAIN STREET 25001CO563J X Page 2 of 2 Federal Emergency Management Agency Q ------ Washington, D.C. 210472 ND July 16,2014 Jessica Rapp Grassetti Case.No: 11-01-0521V President, Town Council Community: Town of Barnstable, Town of Barnstable Barnstable County, Massachusetts Town Hall Community No.: 250001 367 Main Street Effective Date: July 17, 2014 Hyannis, Massachusetts 02601 LOMC-VALID Dear Ms.Rapp Grassetti: This letter revalidates the determinations for properties and/or structures in the referenced community as described in the Letters of Map Change (LOMCs) previously issued by the Department of Homeland Security's Federal Emergency Management Agency (FEMA) on the dates listed on the enclosed table. As of. the effective date shown above, these LOMCs will revise the effective National Flood Insurance Program (NFIP) map dated July 16, 2014. for the referenced community, and will remain in effect until superseded by a revision to the NFIP map panel on which the property is located. The FEMA case number, date issued, property identifier,NFIP map panel number, and current flood insurance zone for the revalidated LOMCs are listed on the enclosed table. Because these.LOMCs will not be printed or distributed to primary map users, such as local insurance agents and mortgage lenders,your community will serve as a repository for this new data. We encourage you to disseminate the information reflected by this letter throughout your community so that interested persons, such as property owners, local insurance agents, and mortgage lenders, may benefit from the information. For information relating to LOMCs not listed on the enclosed table or to obtain copies of previously issued Letters of Map Revision (LOMRs), Letters of Map Revisions Base on Fill (LOMR-Fs) and Letters of Map Amendments (LOMAs), if needed,please contact our FEMA's Map Information eXchange (FMIX),toll free, at 1-877-FEMA-MAP (1-877-336-2627). Sincerely, Luis Rodriguez,P.E.,.Chief Engineering Management Branch Federal Insurance and Mitigation Administration 0 6- Enclosure: Revalidated Letters of Map Change for the town of Barnstable,Massach is t n cc: Community Map Repository Thomas Perry, Building Commissioner,Building Division,Town of Barnstable T i ..J t Page l of 2 t 06g, �129�11 oFTHE Town of Barnstable *Permit# Expires 6 months rom issue date Regulatory ator Services g y v ees Fee ��, - BARNSTABLE, - 9 1639.MASS.� Thomas F. Geiler,Director Building Division X-PRE.SS PERMIT Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 . APR I' oll www.town.barnstab le.ma.,us. TOWN OF BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION' - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number d7 6 Property Address 50 C). Cctti [/Residential Value of Work 30 p 6n Minimum fee of S35.00 for work under S6000.00 Owner's Name &Address V— � � f Contractor's Name C �I d •fir ° Telephone Number r Home Improvement Contractor License#(if applicable) f/ V �,j Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance K ck one: I am a sole proprietor I am the Homeowner X-PRESS PERMIT ' ❑ I have Worker's Compensation Insurance APR 2 Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to I❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ' [ Replacement Windows/doorsAliders. U-Value �77 #of doors (maximum .44)#of window, . *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: fG� Gi i l�GL QAWPFILES\FORMS\building permit forrnsTXPRESS.dol° Revised 070110 The Commonwealth of Massachusetts 1 i Department of Industrial Accidents Office of Investigations 1 600 Washington Street i a j Boston, MA 0211 I r- www.mdss.gov/dia 'Workers'.Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers` Applicant Information Please Print Legibly Name (Business/Organ ization/lndiv'idual): ic 6t/ Address: JS Or11�1u' City/State/Zip: krlJ #s . ./jr'�� Phone #: c Are you an employer?Check the appropriate.box; Type of project(required):. 1.❑ I am a employer with .4. ❑ I am,a general contractor and I 6..❑.,New construction. ,employees(full and/or part-time).* ' have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. # ❑ Remodeling. ship and have no employees These sub-contractors have 8.. ❑ Demolition working for me in any capacity. workers' comp. insurance.,. 9. ❑ Building addition, [No workers' comp. insurance 5. ❑ We are a corporation and its - required.] officers have exercised their 1'0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL IL[] Plumbing repairs orradditions myself. [No workers' comp: c. 152,-§1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers'. 13.z Other I, a 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. IContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees: Below is the policy and job site Information. a. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration"Date: Job Site Address: i _. City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and txpiration 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 der the pa'j s an penalties ojperjury that the information provided abov/e is true and correct. Si atuie: �. Date: Phone#: P! Official use only..Do not write in thisarea;to be completed by city,or town official': , City or Town: Fermi t/License# Issuing Authority(circle one): .1. Board of Health 2. Building Department 3.City/Town Clerk :4.Electrical Inspector 5. Plumbing-Inspector' 6.Other Y Contact Person: -Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on.such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or.to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, b checkin the boxes that apply to our situation and if P by:checking PP Y Y 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 i 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 Town of Barnstable. Regulatory Services Haas g ':Thomas F. Geiler,Director Qj i659- �� ,. Building Division Tom Perry, Building Commissioner - -200 Main'Street,Hyannis,Na 0260Y . www.town.barnstab le.ma.us Office: 508-862-4038 .Fax: 508-796-6230 Property Owner Must Complete and Sign This Section If UsingABuilder as Owner of the subject property hereby authorize y a to act on my behalf, in all matters relative to work authorized by this building permit application for p 3 (.Address of Job) '0 Ste. Owii r to Print Name F . I Pro . e Owner is'a 1 'n for gnnit.'` leasee c f Own orn Iete the P PP Yr g P ._ P . P Homeowners License Exemption Form on .the reverese side. Town of Barnstable yofi�ray o Regulatory Services y fi s r aA 5r Thomas F. Geiler, Director i6 ;1. ,�� Building Division PIED '{} Tom Perry,Building Commissioner 200 Maid.Street, Hyannis,MA 02601 . www.town-barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 110MOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS:- city/own 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. DETINI ITON OF BOMEOWNER 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 constrgcts more than one home in a two-year period shall not be considered a bomeowner, Such "homeowner"shall submit to the Building Official DU.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 minirTmum inspection procedures and requirements and that he/she will comply with said,procedures and requirements. , Signature of Homeowner Approval of Building.Offiicial a Note: Thr--e-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.(Scctian l D9.1.1 -Iaccnsing of construction Supervisors);provided that if the homewer on engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homcowncrs who use this exemption are unaware that they arc assuming the rcsponsibilitics of a supervisor(see Appendix Q, Rulcs&Regulations for.Licensing Construction Supervisors,Section 2.15) This lack of awareness o rrs ften ults 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/herresponsmbilitics,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Superrisor. On the last page of this issue is a,form cutrcntly used by several towns. You may care t amend and adopt such a fom-%ertifieation for use in your community. " ►artmcnt �►f Ruhli� Safct� �l;►,�achu�ctts „►il:►tioil' ;►nd St 1In(1, s 'Bo:u'd of Buildin- Rc- Construction Supervisor License License: CS 63941 v RICHARD P.FOGARTY N. 254 WALNUT ST MARSTONS MILLS, MA 02648: Expiration: 11111/2012 �..� .� � .� V/w lDL✓7'ZO7L0�7b�CQGI�t d������G�k1�'GItI'IJP,�' _ ww°M a y° Office of Consumer Affairs&Business Regulation 7 HOME IMPROVEMENT CONTRACTOR 6 Registratior ,)�30373 Exp ratotT. /ZSf2012 Tr# 291454 e d a ° I TYPe Sri tuai.3 r4 RICHARD FOGARJ Z RICHARD FOGO� - ` U: c 254 WALNUT ST d. d c MARSTONSMILLSithA i12hd8 Undersecretary ,. tj W..w C I Town of Barnstable *Permit#/ae�(��� Expires 6 months front issue date Regulator :IJe vices Fee Thomas F.Geiler,Director 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 PERNUT APPLICATION - RE'SIDENTIAL ONLY Not Valid without Red X-Press 1"rriprint Map/parcel Number. Property Address 1 3 6 C9 CA , I [4esidential Value of Work .�� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address a d o ( ' -2 / _ Contractor's Name F- 6t au` �.,QJ"yt.p VLt e c4ti Telephone Number,J50 Home Improvement Contractor License#(if applicable) 1 ' 0�S 3 Construction Supervisor's License#(if applicable) -PRESS PERMIT (OWorkman's.Compensation Insurance Cheep one: ❑ I am a sole proprietor FEB 2��0 ❑ I am the Homeowner TOWN OF f3ARNSTf4 (,I have Worker's Compensation Insurance Insurance Company Name I ko- - Workman's Comp:Policy#-' _ _ 1.L — 0 3 -1 11'i- - 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 (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:Fonns:expmtrg . Revise061306. RightFax C2-2 9/23/2009 5 : 35: 22 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF INSURANCE DATE(MMWDWY) 09-29-09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE WISE&QUM INS AGCY IN HOLDER- THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 449 PLEASANT ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE BROCKTON,MA 02301 COMPANY 24WCB A HARTFORD GROUP INSURED COMPANY e FRASER CONSTRUCTION LLC COMPANY P.O.BOX 1845 C COTUTT,MA 02635 COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED70 THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT70 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHETERM%EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDWY) DATE GENERALLIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL PRODUCTS-COMPIOP AGG. $ PERSONAL&&ADV.INJURY $ CLAIMS MADE OCCUR. EACH OCCURRENCE $ OWNER'S&&CONTRACTOR'S PROT. FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYEITS LIABILITY UB-0341 M556-09 09-26-09 09-26-10 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 500,000 PARTNERSIEXECUTIVE INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTERCATE HOLDER AFFECMa WORKERS COMP COV BRAGS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FRASER CONSTRUCTION LLC EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT PO BOX 1845 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION ORUABMTYOF ANY RIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES, COTUIT,MA 02635 AUTHORIZED REPRESENTATIVE AGORD 25-5(3193) Rz➢mani Ayer '� w<�5^�' �S �' ✓fie C�a �iuieaL��a�✓�s3� �'d •,.; hoard of Building Regulahon's-aq Standards: {Construction Supervisor License License CS 97668 Birthdate 6/7/1.95:7 is w r Ex iratron %201:1 Tr# 9,7668 Restnietion 00 DEAN FRASER 104 TMNN'VIEW LANE. EAST FALMOUTH,MA 02536 Gom'm&sioner f ��e ilmnvmo�iu�Aea/./f��aerrcalzueefld Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Regist&h 112536 Board of Building Regulations and Standards �Pratu�n: j2S/2011 Trit 281021 One Ashburton Place i2m 1301 r Types Boston,,141a.021011 FRASER CONSTRUCTION GO. DEAN FRASER � 104 TWINN VIEW ISNE E FALMOUTH,IAA 025W Administrator Not 'ure 2f e` iv Boar o w.l �eglwVonAs&an lane g .IV One Ashburton Place e Room 1301 Bostom Massachusetts 02108 Home Improvement-Co"Mractor Reglstxation Registration: 112536 Type: DBA Expiration: 3/23/2011 Tr# 281021 FRASER CONSTRUCTION CO. DEAN FRASER P.O. BOX 1845 COTUIT, IAA 02635 Update Address and return card.Mark reason for change. Address Renewal � Employment � Lost Card Al Co 40M-08/08-DBSUFORMCPa108E12008 k ' _ r . The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations A 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ! LC, Print Legibly Name (Business/Organization/Individual): FAo�C � ClfY�� l L LC, Address: �P 0 9CX, City/State/Zip: C� MA- Phone#: 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 1 6 ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �p�.e CI-r � C Policy#or Self-ins.Lic.#: B�"l_� 1�� `�D� r�l xgi'ra ioi�Dke:=i Job Site Address: 13 o U V t V t 6e� r' l City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer*4 the nd pe Wes of perjury that the information provided above is�trued correctSi ature: 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#: s• w C A 442JA Z- I ; h Fra er Construction, LLC STRUCTION C®--- P.O. Box 1845, Cotuit MA. 02635 s s ' Email: fraser constructi ongverizon.net www.fraserroofing.com FAX 1-508-428-0123 4)a-,428-2292 HICL#112536 CS#97668 RE-ROOFING PROPOSAL December 14, 2009 PHONE: 508-509-7210 mark Ells Ta XIL DDRESS: same 1V1®� VIZESS: 1300 Craigville Beach Rd. Centerville, MA 026632 J R CONSTRUCTION hereby proposes to perform the following services in a neat F ' fessional like manner and in accordance with the manufacturer's sp Pro o ecifica�ons and local building code. _gernove and Haul away all of the old roofing material (2 Layers) _ge-nail all plywood sheathing as needed. 1 alad Install- CERTAINTEED XT AR-25: 25 - Year Warranty, 5 Year Sure Sprotection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self- Start 3-Tab, Fiberglass Based Asphalt Shingle with New England's Exclusive e R/CERAMIC Stones with a Full 10 Year Warranty against ALGA cont��ent. color: PRICE- $8,725 Initial Su 1 and Install - CERTAINTEED XT AR- 30: 30 Year Warranty, 5 year sure start protection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self g 3 -Tab, Fiberglass Based Asphalt Shingle with New England's Exclusive CC g/CERAMIC Stones with a Full 10-year Warranty against ALGAE went. Cori Color: PRICE- $8,875 Initial Su 1 and Install - CERTAINTEED LANDMARK /WOODSCAPE AR 30: 30 -Year Vlarlanty, 5 year Sure Start Protection, CLASS A FIRE RATED, ALGAE Resistant, EWa Heavy Weight, Self Sealing, Multi- Layered, Architectural Style, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with - a Full 1p Year Warranty against ALGAE Containment. 5 year 110 mph wind- . tance warranty with six nails in common bond area, Fraser construction includes six nails in common bond area at NO additional cost. See actual warranty for specific details and limitations. Color: PRICE- $8,600 Initial Supply and Install - CERTAINTEED LANDMARK /WOODSCAPE PREMIUM: Limited Lifetime Warranty, 10 year sure start protection, CLASS A FIRE RATED, A➢:GA.E Resistant, Extra Heavy Weight, Self Sealing, Multi-Layered, Laminated Architectural Style, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with a Full 10-year Warranty against ALGAE Containment. 10 year 110 mph wind-resistance warranty Wind warranty upgrade to 130 mph when CertainTeed starter & CertainTeed hip & ridge are used. See actual warranty for specific details and limitations. Fraser construction includes six nails in common bond area at NO additional cost. Color: PRICE- $10,200 Initial Supply and Install - CERTAINTEED LANDMARK ULTIMATE: Lifetime Warranty, 10 year sure start protection, CLASS A FIRE RATED, ALGAE Resistant, Extra Heavy Weight, Self Sealing, Multi-Layered, triple-layer thickness, Laminated Architectural Style, Fiberglass Based Asphalt Shingle with New England's Exclusive COPPER/CERAMIC Stones with a Full 15-year Warranty against ALGAE Containment. 10 year 110 mph wind-resistance warranty, Wind warranty upgrade to 130 mph when CertainTeed starter & CertainTeed hip & ridge are used. See actual warranty for speck details and limitations. Fraser construction includes six nails in common bond area at NO additional cost. Color: PRICE- $10,700 Initial Supply & Install- CertainTeed Winter - Guard: (ice & water shield) Waterproof Underlayment System (3ft. on eves and valleys, 18" on rakes, walls, and skylights) Supply & Install- Roofer's Select Underlayment Paper (as recommended by CertainTeed) Supply & Install - (Soffit Venting) hick's Ventilated Drip Edge or S" Aluminum Drip Edge with existing soffit vents Supply & Install - Aluminum & Neoprene Soil Pipe Flashing Supply & Install- Ridge dent - Shingle Vent II (as recommended by CertainTeed) Clean & Remove - Debris from work area daily. *4 Star Warranty Upgrade will be applied if proposal is signed and returned within 10 days. (see enclosed brochure) RUBBER ROOFING: OVER LOWER PITCH SUNROOF f SUPPLY & INSTAL L - .060 EPDM Rubber Roofing OVER Tapered ISO BOARD SUPPLY & INSTALL - . 32 White.Aluminum Termination 't PRICE- $3,495 Initial pp Z Railing Replacement / Rot /Frame Work: Replacement of railing plus any rot or frame damage will be bill at time & material. We bill out at $60 per man hour and a 10% markup on materials. Initial 2% Discount if paid by check immediately upon completion NO MONEY DOWN- NO Payment at the start or part way thru Payments accepted are: CASH - CHECK- MASTERCARD -VISA-AMERICAN EXPRESS *Any payments not made within 30 days of completion will be charged 1.5%for every 30 days the payment is late. Possible Extra-After the shingles are removed from the roof, we will lift one sheet of Plywood to make sure that the insulation is not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$6.00 per panel including Materials & Labor. There are 6 Panels per sheet of plywood. Possible Extra -Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$60.00 per hour, plus 15% mark-up materials FRASER CONSTRUCTION Warranties the labor for 12 years ERASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. CERTAINTEED Warranties the shingles to be ALGrAE resistant for the duration of the Sure Start Warranty depending on the shingle that was purchased.d. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary 1 accepted within thirty days may withdrawsthisnproposal ce upon the above work. We, if not i FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available request. upon re P q t. DATE OF ACCEPTANCE: �i eO er Fra on ruc ion, LLC i FTHE Tp� Town of Barnstable *p r`ut# ° Expires 6 months from iss date Regulatory Services Feed •wxtvsrnscE, v MASS. g Thomas F. Geiler,Director1639,- / n ��lFDMptA,� /0U Building Division: Tom Perry,CBO, Building Commissioner 200 Main Street,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 ! �� ,Property Address /*,60 &046016, %`c Ooe Residential Value of Work '� �.Sf�. Minimum fee of$2S.00 for work under$6000.00 Owner's Name&Address �� /�Pi1 t lil4 I vl� o wgfg 2 L . f Contractor's Name / C` T Telephone Number —<O Home Improvement Contractor License#(if applicable)_ Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: , -PRESS PERMIT - I am a sole proprietor, ❑ I am the Homeowner FEB 0 1. 2010 ❑ I have Worker's Compensation Insurance BARNSTABLE. Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. 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 <, #.of doors 0 Replacement Windows/doors/sliders.U-Value ,a�1 (maximum .44)#of windows _ *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\EXPRESS.dO Revised 090809 The Commonwealth ofMassachusetts Department,of Industrial Accidents Office oflnvestigations I'_ r 600 Washington Street c� Boston, MA 02111 . wwm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip:-A f ' y Phone #:` SU V�2 9 - '7 Are you an employer? Check the appropriate box: Type of project(required): 1.❑Tam 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 listed on the attached sheet.- T. ❑ Remodeling 2.00 I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, E] Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp, insurance comp.insurance,t . We are a corporation and its 10.0 Electrical repairs of additions 5 required.] ❑ rP 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.) t C. 152,.§1(4),and we have no employees. [No workers' 13.© Other comp. insurance required.] "Any applicant that checks box 41 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 provide their workers'comp.policy number. I rim an employer that is providing workers'compensation insurancefor 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 maybe forwarded.to the Office of -Investigations of the DIA for insurance coverage verification. 4 do hereby certify r der t pain and p nalties ofperjury that the information provided abov e is true and correct. Signature: Date: � 0 Phone# Offcial use only. Do not write in this area, to-be completed by city or town official City or Town: Permit/License# 'Issuing Authority.(cirele one): 1.Board of Bealth 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other 1--fo of Pnrcnn- phone.#: .._. may. Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the , dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business`or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial to sign and date the affidavit. The affidavit Accidents for confirmation of insurance coverage. Also be sure t shou ld 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 I.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/liceirse 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 fiture'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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like,tothank 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 # 617427-7.749 Revised 4-24-07 www.mass.gov/dia E n 1H r Town of Barnstable ti Regulatory Services ' uxxsrAa , ' Thomas F. Geiler,Director ecass. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 WWW.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using- A Builder I, t4o2iL 4 , as Owner of the subject property herebyauthorize . y� �j p to act on my behalf, a� 9Q/ U in all matters relative to work authorized by this building permit application for: (Address of Job) Ce rest-4 iLk!?-_- " d Z*-�Z 1 Co Signatur of 0er Date_ Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable o Regulatory Services • BARNSTABLE, t Thomas F. Geller,Director g 1 619. Building Division v� ,�� pTfD I��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: JOB LOCATION: number street village "HOMEOWNER": _ name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does,not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official 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 dQ 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 helshe 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 fornVicertifrcation for use in your community: Q:\WPFILES\FORMS\homeex empt.DOC t� ✓/ie F'on��aanuuea t o aaaac�lucaelt >:. Massachusetts - Department,iat Puhi1C 5:atetN Office:.ofConsumer Affairs&BdsinessRegalahon: . Board of Butidin�o Re-uht6o s and Stand.utis HOME;IMPROFVEMENTCONTRgCTOR; Construction Supervisor License Re9istr,,atiort G, 130373 . CS 63941' � License , Expiration 2812012 Tr# 291454: Restricted to: 00 Type�:j� �nda31tlua1 ar RICHARD FOGA�RTY} , Y RICHARD F FOOARTY � 254 WALNUT ST RICHARD FOGAR,TsY' 254 WAIJUT ST'\ '} �- MARSTONS MILLS, MA 02648 q MA RSTONSMILLS MAi0264:8 Undersecretary � � Expiration: 11/11/2010 ....... . ...._......,.; - C'rnnnis�ionirr Tr#: 6193 - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION / Maab'T Parcel 'Application# WW Health Division Conservation Division 1 Permit# Tax Collector Date Issued Treasurer ti Application Fee �-- Planning Dept. Permit Fee ( D� Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis ' Project Street Address 340 C off'' (G V///6- Village CC/J VLV 1 c 0 Z-(-)J? 2— Owner f/q(2 -k ( 7' 1 S Address )36 ® Telephone ( A 2/® Permit Request ; (�;t40 U, �''� J M 10 G^ VCb f Square feet: 1 st floor:existing I vFoodOP10ain sed 2nd floor:existing proposed Total new Zoning District Groundwater Overlay Project Valuatio a Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family U/Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes C/No On Old King's Highway: ❑Yes &1" 0 Basement Type: 4- l ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: f Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use t BUILDER INFORMATION ` Name 0 CAL S Telephone Number Address I 3 Co U u License# C4J M I S pact-, Me 62,6 S I Home Improvement Contractor# Worker's Compensation# k-A (02_15 2 5S _ "—to ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE q- FOR OFFICIAL USE ONLY `b= PERMIT NO. "DATE ISSUED 3 MAP/PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: 11 r FOUNDATION t FRAME INSULATION FIREPLACE r r ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. FLOOD ZONE RE.Y FIAOOIDNE IOCATDNSR1101WI OH THOS MAPARE , / M FLOOO®AATElATIONS OR PIANNTIO N-IN, ONLY AND 5110UlDNOf BEIfSm FOp 61IE 6pECO1C � + ROOD HATARDOETEIDNN1gN. 'W� E ATHESE RDODZONE FDCATRONS WE DEVEIOPEDAT RE — ' { r 1 I SC W1' cDV.T1615 THEY SE CNOiDT ASSUMED TO H-W=ACCURA�Y OFSETfERTNAN aO •. FEET.,TO OTHER ll9yATd16,(EAIA RECOAE.ENDS THAT DETERA@IATE)NS USNG THESE MAPSOENERALLV SE MORE FEET WHEN STRUCNIES _— — S AIEIAtIOED]Sp OR MOTE fEEf OVTbTDE AFLODD 1 ZONE BOUNDARY. _ Q AO.Anene lmmbbdabpapb Cy lODYeer lbod4a Om 0y dimHSawonmW � ` (. j Q XS00-An area AanOHblpy600yaer BlounA;.n mo �``.`` I "�, t:- .:liendvasd 1DDl�rfleodO,DeAM arvap d Is( FROi{�3 D EVE-Aeaw aaeamelq Haay®.aoolwo wilR.aoiay I ' N � H. MAP 2 1 1 '# � s0OL vmwe��p.a.0 aM DIbdnD aplM�hA/o eol D» t oRMel Dyer fIIpW Teem lab tuarot.ANE.For d . IaD eOo�IHD.ordbwaM nwunlln/eb be � i � D.. . - 1�: MbtloeananaemoHbtlpmWnad Raul , # 1'00'WET-LA aS BLI FER:LINE, P 07SRO 1 TRIBUTION/ % I c> \ \ 1 I I 300' BOX 11 \�\ v 1 4 ACRES 1500 GALLON I n SEPTIC TANKONING: RC w r I` MAP 2 . 7 G.M.C. /2EG.LS.UNIT SITE PLAN FOR MARKS. ELLS morkleD=So` G. .C.6L25/Ol markleach.dgn f Board of Building Regulations and Standards License or re gistration istration valid for individ I g u use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 152726- Board of Building Regulations and Standards Expiration: 9/25/2008 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 ANCHOR DESIGN&POOL CORPORATION THOMAS KEARNS r 143 UPPER COUNTY ROAD . DENNISPORT,MA 02639 Deputy Administrator Not valid wit out signature i COPING LAYOUT 17- GRAD.CORN 5'b" �r•3 e 7 JiW PANEL LAYOUT 6`RAD.CORN. lo' FiL L_R(TYY.) K /pr /o / y s DETWL A tupvaL iQ a s+wo, - - t keaiJQNrfIYr WIUIIAL - Pool. Pool PANEL Area Capacity 6 /V ttw GlY MQI➢ Slid li vmaa MSRMalfadl! 3,ons WfnI Sq.Ft. Gallons O) . �, aWpm ���� Heritage STEEL POOLS rpo ALNSERRT at- CoI - THIS BROCHURE IS FOR ILLUSTRATIVE PURPOSES ONLY 18' X 36' RECTANGLE The manufacturer makes only those iepresentaeons which ve slated in its written v urany.Any other yn-..a-nr PMirepresenlalions,stalemenl3•W CC+htaCis matle by the d¢alef and/Or Uhe CWVdclor to the Cuilom¢! rccrast[IOQRA IIE—G J-htr regarding any ma4riab produced by the manufacturer are muibumble to the dealer and/or the conUac• IOn'twu 1 6" RADIUS CORNERS only The deafer a conuactcrwho sells or installs Your pod is an independent yonbactor and not an '�• ti J/e" .J/i agent O employ" the manufactulea The construction methods illustrated are su es ions and apply 9ott RC Y 99 r sormv wtiwL in•.of u w only to normal grou.d conditions.There may be additionalprecaulions andlor methods of r 51(uc:on. F cuvunlWvrctf. ., 1 1/2' 1 1/Y ��N OF NONE 1992 Tine responsibJ.ry is me conitaclors. - cxvvlltmsux[ ��sou.u+E conn[n N+cU = TIMOTHY �9G Siructural Design Approved O WALKER m i only when installed In £ CIVIL P strict Accordance with j �No. 31376/0 N - Manufacturer's Instructions { r T. Walker, P.E. 9� /S'f F' Ffs � 1 / r ANGLE BRACKET TYPICAL INSTALLATION DETAIL THREADED 3' ---- -__ °0 ALL VERTICAL DIMENSIONS ROD -�--•- 2' OVERDID ------ ARE TO FINISH GRADE AND YREVERSE (2) 5/8` NUTS 4" THK. CONCRETE TAKEN FROM LINER BEAD TRACKDECK, SLOPE 1/4` PER ANGLE FT. AWAY FROM POOL.VIEW MINIMUM SLOPE 1/2" PER FOOTRED ROD DFT[ilj _ AWAY FROM POOL FOR. 10' d: SHORT DECK DRACE ANGLE 14_CA. GALVANIZED \ (OPTIONAL) STEEL WALL PANEL 3 MB. �I (OPTIONAL) ONG K BRACE ANGLE (1) DOLT IN IN ALL }IDLES OF INSIDE ROW(NEXT TO POOL) AS A MINIMUN TURNBUCKLE ANGLE \\\\\\ \\ 01iNOTE: OPTIONAL ' TREADED ROD DRIVE STAKE W/HOLES 7-:- UNDISTURBED EARTH 2` BOTTOM MATERIAL � l` 2 6" CONTINUOUS CONCRETE COLLAR 2"x B'x 16` PATIO BLOCK NOTCHED SHORT MOLE AT EACH PANEL JOINT AND CORNER FOR NOTE: BACKFILL TO BE SANG, GRAVEL LEVELING, OR OTHER NON EXPANSIVE MATERIAL.' CONTRACTORS OPT10N ANSI/NSPI-5 1995 STANDARD —� -- --- — f30CA CODE STEEL 7� • 1999. Table 421 . 1 1 (2) S 1 _1',EL �� WTI NT � 1V Anchor Design CO"TION Y 3 3F SWIMMING POOL. CONTRACT Owners:(IV i Ells Date: March 26, 2007 Address: 1300 Craigville Beach Road Phone: 508-509-7210 Barnstable, MA 02632 Pool Size: 18'x36' Depth: 6' Shape: Rectangle Steps: Custom Corner Stairs Liner: TPD Item Price " Pool with complete beck Support System with Lifetime Structural Waranty: $ 24,000.00 Steps- Custom Full End Included Liner-28-30 Mil Vinyl (5/25 Year Warranty) Included Filter-Hayward Pro-Grid'HP-3620 Oversized. . Included Heater-Hayward H250ED2 (250,000 BTU) Included Pump Hayward Superpummp 1.0 HP Included Ladder & Handrail ' Included Rope, Floats & Startup Chemicals Included 1 Underwater Light'-300 Watt / 12 Volt Included 1-Skimmer 'Included 2-Anti Vortex Main Drains Included Solar Cover Included otalPr_ ice-$ 24,000.00 Less Deposit:$ 1,000.00 ✓ Balance Due: $ ' 23,000.00 Balance Payable As Follows: At Permit Approval: $ 7,000.00 At Excavation& Delivery: $ 9,000.00 At Liner Installation: $ 6,000.00 At Turnover& Startup: $ 1,000.00 Note.Price does not include Decking,Fencing,Electrial and Gas Hookups, Tree,Stump and Rock Removal,Haul Away or Fill,and Retaining Wiffs: Credit Card payments incur a 3%handling fee. Signed(Owner): w ADate: - Signed(Anchor):. Date: y / 0`7 � Page i f2. t' 1 x: r 143 UpperfGouniy Road • Dennisport, Massachusetts 02639 508 398 6116 • Fax 5q8 760 3459 z 499 Bearses>Way• Hyannis, Massaciusetts`026g1';0 508 778 6278 � Fax 508 775 5245 , , , 9 °FtNKE r Town of Barnstable Regulatory Services � BM n SS. $` Thomas F.Geiler,Director ArEo;. 6. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Pro er Owner Must � Complete and Sign This Section If Using A Builder s as Owner of the subjectproperty i I, ,�2 J hereby authorize C1,01C s to act on my behalf, in all matters relative to work authorized by this building pewit application for: � 3Z (Address of Job) Olt Signature of 6wner Date Print Name Q:FORM&OWNERPERMISSION ORDER NO. SALES AGREEMENT FULLY INSURED & BONDED �a���QQa�6o�p WWW,profenceco.com DATE 7ATj�`f��/fit® ❑ 133 UPPER COUNTY ROAD•SOUTH DENNIS,MA 02660•(508)394-4800•FAX(508)394-6735 INCORPORATED ❑ 835 WOBURN STREET•WILMINGTON,MA 01887•(781)933-1234•(978)657-5410 FAX:(978)658-9932 NA SHIPTO STREET STREET CITY STATE ZIPCODE 3M V5A-e-, CITY STATE ZIPCODE INSTALLATION HOME_P_HON7 BUSINESS PHONE (2�3 TELEPHONE N D V NOTIFICATION STYLE NO.OF RAILS HEIGHT ft. ON YOUR PROPERTY IN ACCORDANCE WITH QUANTITIES AND LAYOUT SHOWN BELOW QUANTITY DESCRIPTION UNIT TOTAL Ca 6 DEPOSIT TOTAL SALE BALANCE On Completion TAX TERMS TOTAL ONE HALF WITH ORDER BALANCE ON COMPLETION. QUOTE IS VALID FOR 30 DAYS. LAYOUT-INDICATE ON LAYOUT PICKET FACING ON EACH LINE OF FENCE. CHECK LIST CLEAR FENCE LINE TREE/STUMPS IN FENCE LINE 1 ( TAKE DOWN EXISTING N v FENCE STACK BUILD SECTIONS ON JOB TOP OF FENCE TO FOLLOW GROUND RACK SECTIONS p1 STEP SECTIONS CURVE SECTIONS FACE FINISH SIDE BAR B TO P- KNUCKLE TOP UNDERGROUND --g7 PIPES OR CABLES BRINGCOMPRESSOR GATE SCALLOPED GATE STRAIGHT ERECTING CONDITIONS GALVANIZED OR VINYL TAKE AWAY OLD FENCE All quotations subject to conditions beyond our control.CUSTOMER IS RESPONSIBLE FOR establishing property lines and fence lines,and for conforming with local zoning by-laws.Pro Fence Co., Inc.,is not responsible for damage to underground utilities,septic systems,drain pipes,or propane lines,unless notified in writing by the Customer as to their location,before work is started.This quotation does not include costs met in extraordinary conditions-striking ledge which may require the cementing of posts or the use of a compressor for drilling and pinning posts,or clearing trees, brush or other obstructions from the working area.This contract embodies the entire understanding between parties,and there are no verbal agreements or representations in connection therewith. All fence materials remain the property of Pro Fence Co.,Inc.,until final payment has been made.By signing this agreement the customer gives Pro Fence Co.,Inc.,permission to enter the property and remove any or all fence materials if final payment is not received. BY ACCEPTED BY On accounts over 30 days,finance charges are computed at a periodic rate of 1 h per month-Annual rate at 18%-Plus any additional costs incurred for collection;including reasonable Attorneys fees. SALES AGREEMENT ORDER NO. FULLY INSURED & BONDED p �ppp�doap www.profenceco.com DATE A ^® ❑ 133 UPPER COUNTY ROAD•SOUTH DENNIS,MA 02660•(508)394-4800•FAX(508)394-6735 INCORPORATED ❑ 835 WOBURN STREET•WILMINGTON,MA 01887•(781)933-1234•(978)657-5410 FAX:(978)658-9932 NAIhE���` r � SHIP TO STREET. STREET ✓`/,~J` CITY STATE ZIPCODE 13M erg�� v ( Ee, CITY STATE ZIP CODE HOME PHONE BUSINESS PHONE INSLEPHO E 1t! TELEPHONE NOTIFICATION STYLE NO.OF RAILS HEIGHT h. ON YOUR PROPERTY IN ACCORDANCE WITH QUANTITIES AND LAYOUT SHOWN BELOW QUANTITY DESCRIPTION UNIT TOTAL cZ p T DEPOSIT TOTAL SALE BALANCE On Completion TAX tea TERMS TOTAL Y. ONE HALF WRH ORDER BALANCE ON COMPLETION. QUOTE IS VALID FOR 30 DAYS. '" LAYOUT-INDICATE ON LAYOUT PICKET FACING ON EACH LINE OF FENCE. CHECK LIST CLEAR FENCE LINE II TREE/STUMPS IN FENCE LINE G C TAKE DOWN EXISTING FENCE STACK �. BUILD SECTIONS 'r ON JOB TOP OF FENCE TO FOLLOW GROUND RACK SECTIONS BIZ t STEP SECTIONS CURVE SECTIONS FACE FINISH ---` SIDE BARB TOP- KNUCKLE TOP UNDERGROUND PIPES'OR CABLES BRING COMPRESSOR GATE SCALLOPED GATE STRAIGHT ERECTING CONDITIONS 'I t GALVANIZED ` OR VINYL TAKE AWAY OLD FENCE All quotations subject to conditions beyond our control.CUSTOMER IS RESPONSIBLE FOR establishing property lines and fence lines,and for conforming with local zoning by-laws.Pro Fence Co., Inc.,is not responsible for damage to underground utilities,septic systems,drain pipes,or propane lines,unless notified in writing by the Customer as to their location,before work is started.This Tom' quotation does not include costs met in extraordinary conditions-striking ledge which may require the cementing of posts or the use of a compressor for drilling and pinning posts,or clearing trees, brush or other obstructions from the working area.This contract embodies the entire understanding between parties,and there are no verbal agreements or representations in connection therewith. All fence materials remain the property of Pro Fence Co.,Inc.,until final payment has been made.By signing this agreement the customer gives Pro Fence Co.,Inc.,permission to enter the property and remove any or all fence materials if final payment is not received. BY ACCEPTED BY On accounts over 30 days,finance charges are computed at a periodic rate of 1 SS per month-Annual rate at 18%-Plus any additional costs incurred for collection;including reasonable Attorneys fees.- . S [tS • !' � _.fir• - SALES AGREEMENT ORDER NO. FULLY INSURED & BONDED WWW.profenceco.com DATE UATM n® ❑ 133 UPPER COUNTY ROAD•SCUTH DENNIS,MA 02660•(508)394-4800•FAX(508)394-6735 INCORPORATED ❑ 835 WOBURN STREET•WILMIN3TON,MA 01887•(781)933-1234•(978)657-5410 FAX:(978)658-9932 NA WE SHIPTO STREET STREET CITY STATE ZIPCODE 3 CPOi�vt CATTY ttw STAT�E"� ZIPCODE INSTALLATION HOME PHONE BUSINESS PHONE TELEPHONE �lwV I IR 1 " t L NOTIFICATIOND STYLE NO.OF RAILS HEIGHT ON YOUR PROPERTY IN ACCORDANCE WITH QUANTITIES AND LAYOUT SHOWN BELOW QUANTITY DESCRIPTION UNIT TOTAL r w ': f(5 CryE DEPOSIT TOTAL SALE BALANCE On Completion TAX TERMS TOTAL 4 ONE HALF WITH ORDER BALANCE ON COMPLETION. QUOTE IS VALID FOR 30 DAYS. LAYOUT-INDICATE ON LAYOUT PICKET FACING ON EACH LINE OF FENCE. CHECK LIST CLEAR FENCE LINE TREE/STUMPS IN FENCE LINE TAKE DOWN EXISTING F„ FENCE STACK BUILD SECTIONS ON10B TOP OF FENCE TO FOLLOW GROUND RACK SECTIONS STEP SECTIONS POO CURVE SECTIONS FACE FINISH SIDE BARB TOP- KNUCKLE TOP UNDERGROUND 19 PIPES OR CABLES BRING COMPRESSOR yy K GATE SCALLOPED C GATE STRAIGHT ERECTING CONDITIONS GALVANIZED OR VINYL TAKE AWAY OLD FENCE All quotations subject to conditions beyond our control.CUSTOMER IS RESPONS BLE FOR establishing property lines and fence lines,and for conforming with local zoning by-laws.Pro Fence Co., Inc.,is not responsible for damage to underground utilities,septic systems,drain pipes,or propane lines,unless notified in writing by the Customer as to their location,before work is started.This quotation does not include costs met in extraordinary conditions-striking ledge which may require the cementing of posts or the use of a compressor for drilling and pinning posts,or clearing trees, brush or other obstructions from the working area.This contract embodies the entire understanding between parties,and there are no verbal agreements or representations in connection therewith. All fence materials remain the property of Pro Fence Co.,Inc.,until final payment has been made.By signing this agreement the customer gives Pro Fence Co.,Inc.,permission to enter the property and remove any or all fence materials if final payment is not received. BY ACCEPTED BY On accounts over 30 days,finance charges are computed at a periodic rate of 11/2 per month-Annual rate at 18%-Plus any additional costs incurred for collection,including reasonable Attorneys fees. SALES AGREEMENT ORDER NO. wAA FULLY INSURED & BONDED ��D��pQa�60�p www.profenceco.com DATE FENM CO ❑ 133 UPPER COUNTY ROAD•SOUTH DENNIS,MA 02660•(508)394-4800•FAX(508)394-6735 INCORPORATED ❑ 835 WOBURN STREET•WILMINGTON,MA 01887•(781)933-1234•(978)657-5410 FAX:(978)658-9932 NAME, r SHIP TO STREET STREEtT{/ CITY STATE ZIP CODE CITY f STATE ZIP CODE INSTALLATION HOME PHONE BUSINESS PHONE `-E � C• n� 4' �, ELEPHONE PIA { r NTOT FIICAT ON I / STYLE NO.OF RAILS HEIGHT N. ON YOUR PROPERTY IN ACCORDANCE WITH QUANTITIES AND LAYOUT SHOWN BELOW QUANTITY DESCRIPTION UNIT TOTAL i 61 .L i l .a ( s (s ` _. i 4f3!t l, lAk- DEPOSIT TOTAL SALE BALANCE On Completion TAX TERMS TOTAL ~ ~a ONE HALF WITH ORDER BALANCE ON COMPLETION.QUOTE IS VALID FOR 30 DAYS. LAYOUT-INDICATE ON LAYOUT PICKET FACING ON EACH LINE OF FENCE. CHECK LIST CLEAR FENCE LINE TREE/STUMPS IN FENCE LINE TAKE DOWN EXISTING FENCE STACK ... ,, BUILD BTIONS TOP OF FENCE TO FOLLOW GROUND RACK SECTIONS 04 STEP SECTIONS ^ t CURVE SECTIONS FACE FINISH SIDE BAR B TO P- KNUCKLE TOP t UNDERGROUND PIPES OR CABLES `.."^. "4 6 BRING COMPRESSOR `-� GATE SCALLOPED GATE STRAIGHT ERECTING CONDITIONS GALVANIZED OR VINYL TAKE AWAY OLD FENCE All quotations subject to conditions beyond our control.CUSTOMER IS RESPONSIBLE FOR establishing property lines and fence lines,and for conforming with local zoning by-laws.Pro Fence Co., a1{, Inc.,is not responsible for damage to underground utilities,septic systems,drain pipes,or propane lines,unless notified in writing by the Customer as to their location,before work is started.This quotation does not include costs met in extraordinary conditions-striking ledge w-tich may require the cementing of posts or the use of a compressor for drilling and pinning posts,or clearing trees, brush or other obstructions from the working area.This contract embodies the ent.re understanding between parties,and there are no verbal agreements or representations in connection therewith. All fence materials remain the property of Pro Fence Co.,Inc.,until final payment has been made.By signing this agreement the customer gives Pro Fence Co.,Inc„permission to enter the property and remove any or all fence materials if final payment is not received. BY ACCEPTED BY On accounts over 30 days,finance charges are computed at a periodic rate of 1%per month-Annual rate at 18%-Plus any additional costs incurred for collection,including reasonable Attorneys fees. ) } p�S i 7' a `a ' ._ �X � :_ �' MAY�G.�� �r 'l• � 1`la, Az74,r j It Ott yr a.s�A,ts�9\,T{ti<�3'�`f a.�u�,� {II, i - S� \ I f C \\ S �'Jp �p�y I r MAP �0 \ r �L' tlAA' V�.il �� yy 7f1. 141�f��h ,',•,rj'k4t }I', d;. IF.pi1�. .7 {>, rr'i k3e �'c'{J�sq .{ a of-Ji ae+`+ q c Arc i� rt a +d� >k'L�� �'i>:I�? t1.h"'ar f ra alB fd�'n1 r4 �11 rKb ( u i� tir 7� k�d '' brr+'�ft 1 I i { s.' >i�tyt{rb'} alj+iin 4Nii4 �^{3^x'ya } r + ! �stv� ���i. >r ` / � _ 6' ..:i�. s '�f4➢ r�S ": v� ��f�..{,J t.2 r+� \w tt > x ti , \ �.`• ! I �\ I 1 I -zt Akro�''T `��} rNF'i y I ; ` 41�SR+ t ` s�� {. t' �27 �x {1 "tr'isr5 'SAP 207 � �t Y \ {�e•zc \ ` t 9yp�w all n. a:{�;p +1 ry,,l �,k,�4�r�� �•��� f'Y k, �'�s,�>fiCv����"�'N #'mall ����r c's'h5��'�t!���y���s� t'�. ?y��g � p•+"��>�'���rf�'` _ -- -- _- SYRITI 10 OU 0 tlt � �IrpJ �wz, ��I�r �;t Nt t By..` ' _. f`t Y1 1 tis r�rx�}',",y„t, }'r a. r•C�; ,� r { f,, tifrr Gt - 1500 GALLON �... � q�er� { Yet 6'.d nSid i f"• x z S P 1'} y r frx'jjp SEPTICTANK {,��_ .ON I N be• RC r t aJtC {8{x)wa ��z}0r y+ �r s sS4 j }(P �I�Sk Jl ev} s �L i pi� SyS/ry YkKba 1Y4� s 1Mgt �� 1x z +a�Tz q urh.}f.i . „�' i 1qt) ,'St '\'<,'' 5a � fi ai''(.S�xk;lt�4 i t"` IMONO N�3 �J/ n J v ti sn Yw Y' Yr f'I a 4 ,K r py,' - {., ,r �{ad,t..l hy� y. 4{ {'v.°s3gr;$ t ' 1v"' a 6rJ'Y t �I •�t7�,:x -rd'.t� 1, � Z i , x al Jt �IY� g 9 t Ypp �3 Zi rz ,x 2 zrt rf�f i4 aat �d 4 $�F, 4 t t��""/ , 7a at t,sµ`S a t �y9 e31' _ �. ....-' ";'' .. � k,�SS�4f✓dPfis�iF�z" f 1p4dd S111 \r . -�� �� J� _ "" - �, .. (J+•, h e9`�I.f{p7�r 4f��y r`jpy {,(_�e()�r+c�l;7 fl£L �t< f'�t�:Ily`sr"',l{'^�a'��'�t�r�''�vE����t����•sb'�t1 $Z. I T :�s'J�1B}'^ 'i !t ✓<�' f a { f r"V.r � - + I {��'�.GP' J � Y IY .� tFr414 1 4!•�44 DLO f f yy �'� c t- � -.� 1 c '- „ p 'P i' 1I "— t �o-�,s�, �,k�oF'�'XrY '$'r y7 zt) 7t �'ty t '• g ��}t '�3F b �. I A ��h< .r r���.{�f t� ✓ yr I✓v s! {a < r' i j zi" 's y slu 1�1 r �t�� �r t tF7 Pf + key 5 T�t rt g r (GAi&StI� P 7 M a �[ I�t .r P. r}N1�a Jy trt°� v , t 1 tt I nvt3 4 i45 !�- ar4 JaA69i� } t IYd �7 1 P t't' f 1 2 M 6 _ ryd�nf�7r,� .I r 4 lY��✓ate.�s. t`LLr )3t'S}� "}t!ryRi�. i I >.... al P ( 1 d�k6,r..t�;nt Gs,���,<,N�1ti�,� 2a t`M�,la{j,„'�stl a ,�t { W.% i ,a�2, -J ��.•i4tl619t.,nr€�V a M.C.6 25/01s.UNIT SITE PLAN FOR MARKS. ELLS s orMe (h.dgn G.M.C.6/25/Ol markleach.dgn ACORD CERTIFICATE OF LIABILITY INSURANCE CSR CU DATE(MMIDD/YYYY) ANCHO-1 04 06 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kittredge Insurance Agency Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 155B Otis St. , P.O. Box 1129 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Northboro MA 01532 Phone:508-393-7744 Fax:508-393-6983 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Acadia Insurance Company 31325 Anchor Design & Pool INSURER B: Corporation INSURER C: 143 Upper County Road INSURER D: Dennisport MA 02639 INSURER E: COVERAGES 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NS TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY PIRATIO - DATE MMIDDIYY DATE(MMIDDIYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X COMMERCIAL GENERAL LIABILITY CPA0215251-10 04/09/07 04/09/08 PREMISES(Eaoccurence) $300,000 CLAIMS MADE [X]OCCUR MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,Q00 POLICY X jE O- LOC AUTOMOBILE LIABILITY COM $BINED SINGLE LIMIT 1. 000 A ANY AUTO MAA0215250-10 04/09/07 04/09/08 (Eaaccident) ,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULEDAUTOS (Per person) $ - X HIREDAUTOS BODILY INJURY $"' X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY--EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLALIABILITY EACH OCCURRENCE $1,000,000 A X OCCUR CLAIMSMADE CUA0215253-10 04/09/07 04/09/08 AGGREGATE $ 1,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND Al X TORY LIMITS ER A ANY EMPLOY WCA0215252-10 04/09/07 04/09/08 E.L.EACH ACCIDENT $500000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? E.L.DISEASE-EAEMPLOYE $500000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 2 0 DAYS WRITTEN FOR INSURANCE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL VERIFICATION PURPOSES , IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REP TATIVES. AUTH05WD REPRESET1VE v�CP6t.'k rels. ACORD 25(2001108) JnC ©ACORN CORPORATION 1 PDF created with pdfFactory trial version Department of Industrial Accidents Office.of Investigations: 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers kppllcant Information Please Print Legibly Vame (Business/orpnizationan&vidual): AL,� dJ c 16.IV 4— �Q 4 address: 8 O a City/State/Zip:IE/�N S . 0dAA,610 Phone#: ►re y an employer?Check the-appropriate box:. Type of project(required):• I am a employer with Z•L—. 4. ❑ I am a general contractor and I 6. El New construction employees(full and/or part-time).* have hired the sub-contractors❑ I am 7 a sole proprietor or partner- listed on the attached sheet$ ❑ Remodeling ship and have no employees These sub-contractors have 8. Q Demolition working for me in any"capacity. workers' comp.insurance. g. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its required.] officers have exercised their 10.❑ Electrical repairs or.additions ❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself-[No workers' comp.- C. 152,§1(4), and we have no. 12, of❑ epairg insurance required.] t employees. [No workers'' 13.[�Other rSWIMA4 PCOOI comp.insurance required.] . . . ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: N • iomeowners who submit this affidavit indicating they are doing all work and then hire outside cofactors must submit a new affidavit indicating such mtractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information . tm an employer that is providing workers'compensation insurance for my employees"Beiow is the policy and job site Formation. ,urance Company Name: C 4 -+ J'5 Policy#or Self-ins.Lic.#:(,U Q 2/sZ--2— /.t� Expiration Dater 9 10 ,�,b Site Address:[ l 6 it I(1,Q City/State/Zip:C&�vj f ' G 2 6-j Z tach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). lure to.secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition ofcriminal penalties of a e up to$1,500,.00 and/or one-year imprisonment, as well as civil penalties in tie form of a STOYWORK ORDER and a fine up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of restigations of the DIA for insurance coverage verification 'o hereby certi un the pains a d enalties of perjury that the information provided above is true and correct: afore:. Date: l 0- Official use only. Do not write in this area,to be completed by city.or town gfficiaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Information and Instructions Iassachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. arsuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, Kpress or implied,oral or written." ,n employer is defined aS"an?u ana�.Pa?tnershrp,:association,corporation or other legal entity any two or more f the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the eceiver or trustee of an individual,Partnership,association or other legal entity,employing employees. Howev.,er.tbe wner of a dwelling house having not more than three apartments and who resides therein, or.the occupant of the welling house of another who employs persons to do maintenance, construction or repair woik•on such dwelling house ,r on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." v1GL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or -enewal of a license or permit to operate a business or to construct buildings in the commonwealth for any ►pplicant 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 ;nter into any contract for the performance ofpublic work until acceptable evidence.of compliance with the insurance -equirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if. necessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificates) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners; are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should or the permit or license is being requested, not the Department of be returned to the city or town that the application f = Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensationpolicy,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 nll 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 L(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 Me for.future permits.or licenses..Anew 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 burn leaves etc.)_said person is NOT required to complete this affidavit The Of ice.*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 9f Investigations 600-Washington Street- . Boston,MA 02111; Tel. #617-727-4900 ext 406 or-1,877-MASSAFE Fax#617-727-7749 wised 5-26-0 www.mass.gov/dia °FTHE,° Town of Barnstable Regulatory Services • MMST"LF. ' Thomas F.Geiler,Director � •iruss. � 16g9• g .• Buildiri 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 building be done by registered contractors,with certain exceptions,along the,, requirements. Type of Work: Ji 6ka N Sw I ILI M 1AJq P06 \ Estimated Cost 7 W CgA16v wLC QGAC 0 R�Q ; CEO RU11(D , a.24 3 z Address of Work: �y© 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 OBuilding not owner-occupied U []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. SIG D UND R PENALTIES OF PERJURY I hereby apply for a permit as th agent f the wner: Date ontractor Signature Registration No. Date ' v Owner's Signature Q:wpfiles.forms:homeaffi day Rev: 060606 05,109/2O07 08:52 5083986116 ANCHOR POOL PAGE 01/03 i 43 Upper County Roar. Dennisport, MA 32639 54c��760-3459 vrww.anchorpool.corn To-, v. From! R-G/in KcqFax: (1� V 4cs ~� Mane: Fier JL 02� Ln d° f O5/O8/2OO7 08:52 5083996116 ANCHOR POOL PAGE 02/03 _ �zFa "g �t�y p. 19p�,•�.(5y"pb r rq �t� •��� 4�� y , !�Sml�.w'; MAGNA.e tATCH' .''Side Pull ''trtrdo a (ode _ Applications - Color MfSPBX General-Purpose House Gates Black,White B1Cmm _ Description:An ideal general-purpose;magnetic latch for gates around homes and gardens-Suitable for a wide variety of uses where a non-key-lockable latch is needed.Reliable, effective and unobtrusive, GCrmr 21mrn I ' LJ l�\ ! When used on picket-style swimming pool gates,a compliant � h' " l p'<!� f acrylic shield must be used to prevent latch access by toddlers. Consult local authorities for height rrreasurem0/requirement5 on swimming pool gates. Min1 -` 4A'E;Ff21:EGAD 3/6"(9mm) MAGNA*.LATCH .°°lie ficcll Pull°'.madel' (ode Apptications Color -� e3/ I _ MIM20GA Pet,Pool&(hild Safety Gates Black,White Descriptions Q shorter version of the popular"Top Pull' model latch.Shares the soma features and is ideal for safety gates around swimming pools and child safety areas,Also ideal L I ;nam as a pet gate latch for the backyard. r 2famm i' i I, Hi hl child resistant,magneticlotchin (na.me.hanical Ma)NTIAe i I g y9 i WOETS I _ zus° � j � resistance to closure),key lockable for added security,fully —73mn i I °,ram adiUsiable two-pact design that provides easy,accurate '' ` installation and long-farm,reliable psrfarmancs. fits most gates and all gate alateriuls.Ideal for gate/fence I I a I. , , heights of 60 {i SOGmm}or above. ! l•1%3'� AaIUSDAVIT I Ga1E;rENCE up s"•�8—1.7;16 (7-37alt) g STRIKERi ! I —� j Consult local authorities for height measurements requirements on swimming pool gales, 36mm • p e ya... (�ld�l LATCH., s. ;�0� �il�� :miclide0 ,: Cods App;rcatioas Color aa M(iPS2sGA Swimming Pool&Child Safety Gates slack,White WIN _ Description:The most popular Magna-Latch model.The ideal RilEdsf gate latch for safety gates around swimming pools and child KW-6I safety areas such as childcare:enters. tilt °,u Highly child resistant,magnetic lotching(no mechanical UPPER I l Mi5tance to closure),key lockable for added security,fully r+cuNtlr;c j j':j odfusiable hso•part design that provides easy,accurate installation and long-term,rz 1 0 performance. r` rip ' '25mm Ill Fits most gates and all gate mAerials.Fits most gate/fence wn heights but is ideal for 40"(1 Orrim)gates/fences,as the latch MQUN'ING Pk6(KET r �T ' 1 III can be installed so that the release knob is out of reach of 'JAIE 1 toddlers. �AauNtlNa ` '��I� (onsult kol authorities for height measurement/requirements r'a'r I z" I F i�,. an swimming pool gates. l Somm 27/8 l '^� art` �t•1/9�— ealaSTMEr'j GAtE/F NCf Got 1/3"—i.ljE6"f4-3?mn) SIPUEN I l l I dab SSA: (aI0 ,O088 . ;, EUROP�E. =11 (0)30 280 7050 AUSTRALll 1 806 500 103` Vww ddte�ft�Ipbaf cotn s , Ewa ", , 05/08/2007 08:52 8083936116 ANCHOR FOOL FATE 03/03 ETL UsTED rOOL ALARM s 4-E L.Tested To Be In Compliance With Standard for Safety, CLOSED I IL.2017, and Florida Building Commission Code � Requirements, Per"ETl__Li.stirg Number 3035022 *aceeds Opesraiional Requirements of Model Barrier Codes *Microprocessor ColitroUed +Monitors Entry to Pool and Spa Areas +instant.On Or 7 Second Delay Models Available , +Surface or Flush Mount Models +15 Second Adult Shunt -+Low Battery Alert Recessed Surface Mount +Built-ln.Back-up Battem y Capable +May Be Hard Wired To Rernote 12 Volt maximum 500 rnA Source or To Plug in Power Source. Applied Voltage Must Not Exceed 15 VDC. T'},e new GRl DOOR ALERT/POOL ALARM was da;ianed as an aid for prevention of an unattended access to a pool,spa area by a small child. Monitoring all doors or windows with CLOSED LOOP magnetic reed switehes,t>ie DOOR ALERT/ POOL ALARM will sound an alarm should anyone too small to manage the adult pass thru feature attempt access to the pcaoVspe.area. For fnaximum protection all moveable epeninSs should be protected in such a manner by the GRI DOOR ALERTIPOOL ALARM. ASS .1ATED ALARM SYS'�EM5, INC. 1047 FALMOU `H RO.ND 50 -775-3442 800-3212-3339 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , r r � Map ®� Parcel 73 Application# ®` Health Division 60 GWO 1 //34 Conservation Division �o �� EXISTING" C SYSTEM r t# LIMITED TO OF BEDRO _ Tax Collector Date Issued �O Treasurer J 1� A li 00 pp cation Fee Planning Dept. Permit Fee , Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis V' Project Street Address 1300 Cat y i o l, Village C_&n+t.K v!l le, :~ Owner j".: �` r"� Address �3�® jyrl'1d -c3 r!' Telephone OS 50q '72-`v 771 Permit Request Reno.v Ao'vo i5�h �, t;�n��� ��� O..c ,,i`i k x �� �cck arL reAr 0 hem i-w Square feet: 1 st floor:existing � proposed 2nd floor:existing���� proposed Total new -16" Zoning District Flood Plain Groundwater Overlay fV0 Project Valuation 7/D, ®o® a 443 Construction Type Woo d Lot Size �� 14 A CS Grandfathered: ❑Yes Ullo If yes, attach supporting documentation. Dwelling Type: Single Family a_ Two Family ❑ Multi-Family(#units) Age of Existing Structure f �" Historic House: ❑Yes a<0 On Old King's Highway: ❑Yes a< Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) `00a 'Co'. �- Basement Unfinished Area(sq.ft) Number of Baths: Full:existing C✓ new - Half:existing ' new Number of Bedrooms: existing 3 new '19- . Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: �f Gas ❑Oil ❑ Electric ❑Other yp Cenfral Air: ❑Yes o Fireplaces: Existing New Existing wood/coal stove: ❑Yes "o ge: sing P Attached garage:Mexisting ❑new size � _he . Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# ----Current Use , _ _ Proposed Use BUILDER INFORMATION Q� Name v��t B�%! Telephone Number 6v i ¢14 J�1 f Address �� J�'► e"' 4c/ License# 2 6 mr son Home Improvement Contractor# W3 9 1 Worker's Compensation# ALL CONSTRUCTION DEBRIS RE UL N ROM THIS PROJECT WILL BE TAKEN TO f�rv1 �� rAn W SIGNATURE DATE ®� FOR OFFICIAL USE ONLY PERMIT NO. "A ' DATA ISSUED MAP/PARCEL NO ADDRESS - VILLAGE r ' OWNER DATE OF INSPECTION: FOUNDATION (3, `• �� FRAME ISc, v-..� INSULATION •`:, WP«&S .& o 712-1 _ FIREPLACE _ ! n' J r ELECTRICAL: > I bUGH FINAL ' iJC PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r y r FINAL BUILDING , w DATE CLOSED OUT r ` ASSOCIATION PLAN NO. f r+, Town of Barnstable Regulatory Services * B"NSTABM * Thomas F.Geiler,Director y mass. �A�Ec 39. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-8624038 Fax: 508-790-6230 Permit no. Date *Q 10 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: M0A� G��tsT1�9 �) `5�' Estimated Cost Address of Work: ® � (n vii Owner's Name: Date of Application: i� I hereby certify that: Registration is not required for the following reason(s): FWork excluded by law ❑Job Under$1,000 OBuilding 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 E TIES F PERJURY I her by apply.for a permit as the agent of the 2 �/ D to Contractor Name Registration No. OR Date Owner's Name Q:formslomeaffidav - RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE - New Buildings • $10010.0 Residential Addition $50.00 Alterations/Renovations $50.00 • Change of Contractor/Builder $25.40 FEE VALUE WORKS NEW LIVING SPACE ' _square feet x$96/sq.foot= x.0041= plus f mbelow(if applicable) AI,TERATIONSIItENOYATIONS OF EXISTING SPACE y f square feetx$64Isq.foot= A 6�� x.0041= plus frombelow(if applicable) . h S;ARAGLS'(attaclaed&detached) square feetx$32/sq.ft= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35,00 >500 sf-750 sf 50.00 . >750 sf-1000 sf 75,00 >1000 sf- 1500 sf 100,00 >1500 sf-Same as new building permit: , squa=e feetx$96/sq,foot= x.0041= STAND ALONE PERMITS Open Porch ______x$30.00= (number) Decic __x$30,00= (number) PfreplaselChimneT o____x$25.00= IngroundST mmfngPool $60.00 Above Ground Swimming Fool $25.00 1 Relocation/DZoving $150,00 (plus above if applicable) Permit Fee Lh "ajptiro Psakagd for da°and 7w*-Fob Resideatisl Sandia Hated v4 bikx-fmum •He sglCoa>Yng • {ilaz'm� Ceiling Wall Floor Ees=eat eat Fdideae Aria'IVII) U-value= &VAUD, �va3+as� 1;vain &YAW '� FEE �701 to aaoo xe�tfa n n Nomw Q• l2°/a CA 38 i3 i9 iA A �. . IZ IA A32 C�3®' •8g Ate& �13 '19 lA 8 12'/�' 0.30 13 WA WA - - Pl°mot•- - 19 i •,. .tgy. . 0.46 31; . ,.. . NA 'N!A Y;; ' . t.,•1BYa A.4j4: 38 ' 0 AFa- �y► 13'la 0,3t 30 19 14 10 l3 N/A 21 NIA ° ' g 13% ' 032' 38 NIA Noma, Y 12% ' 0,42 3a i9: y NIA 3g 13 i9 10 A �AFtTB ' •1>g°/i 0.42 i 90 AFU . AA 13% 040 30 14 19 10 aqA I.•ADDRESS OF PROPERTY, d _ 2. SQUARE -99 FQO.AGE OF ALLXTE . '3. 6QUiRBFQOTA(3E OF ALL'OLAZING' ; . ' '�, • ' . . ' Vc GLAM(3 AREA(#3 DIVIDED BY#2); — S SELECT PACKArJE(Q•-A.A.see cht above); .. OL'VED METHODS OF DETBMYMi NG Me RG�I P�Q�S ®TREK#�O�ITV ARE AYAILAELE, ASIf VS FORTHIS DTFORMATION,- BUILDING INSPECTOR APPROVAL, q•fat3ns���G3G3a . 730 CMR,APF�ndix 1 ' lass doors, skylights, and Footnotes to Table J&2.1ba assemblies ('including sliding-g ®doorors, the grass wail Blazing area is he ratio of the area of the glazusg baseasent windows If located in walls that enclose conditioned sazp a m bo excla tied om the U-value requiroment. percentage.V to 1 la of the total glazing y area. �e2,,:gXpressed as a p P e example 3 of decorative glass may be excluded from a building design with 3001 of glazing F i 1999, giazsng U-values inttst be tested and documented by the manufacturer in accordance with 3 After lanuarY : test procedure, or taken from Table 11,55A, U-values art for the National Fenestratiori Rating Council t be us ° ' whole units: center-of--glass V=values cannot be used. If.tho b�ula}ion achieves the fltll s 1ne.c8iftg.R values do not assume a raised or oversized f construction. be substituted for R 33 y- . ulatioa m thickness over the•exterior wills without com'insul do R 3fl ins ay ent tbe-sgm..o-cavtty— Insul'ation* R1'i afion may be sti��tiittik eR-49�iasulatibn: ng� - ce between . e ,.���Ypres, •. d — insulation av� sheathing(• used)'For yei�tiiated t:oilings, insulating shea%L m - 4 P� plus WWad ig ' insulation p portion oftheroof, • . Dq not include` the conditioned space and the ventilated p if use .Fcr example,as R-19 requirment could'be metTR Wall.R-Yelues represent rho ,of the wall C vity insulat�oa plus insulating sheathing' 1 to structural sheathing,.and Interior drywall exterior siding, a construction. Wall regaa'etaen apply by R.19 cavity insulation OR R 13 cav'o a lcoonstrucctions 6 domino app1Y ttQ m,et - wood frame or Idi ms{concrete,masonry, g) aces;bzsetnonts, e e floor requirements apply to floors over uracondltloned spaces(such as uncanditloned crawL�g irements- de must or garages��Floors over outside air must meet the calling requ s doors.of conditioned. must, + a entire opaque portion of any individual basomentt wan walls. Windows and depth mgs$� 3000%below gra 'rn cement m,;tt the same R yalua requimment'as above-gra n, rsents must be included with the other glazing. Basement doors must moot•the door Ulalue re4u described in Note b, +.The R value requirements are for unheated slabs.Add as additiaaal A 2 for heated s s'if you Ian to,install more + the building utilizes elebtrlo resistance Beating use compliance approach 3;4,'or S.. i plan with the lowest man one piece of heating equipment or more than one piece of cooling equipment,the'oqu pm efficiency must meet.or exceed the off clone erclosest by or town sat Ta the s;leited ble 152.1arhm . . areas and -values are maximum acceptable levels.Insulat�'olnc maonentse m��acceptabla.leve s. NOTES a)Glazing R valuo requuerhents are for Insulation only and do not Include structural os must ed b)Opaque doors in the building envelope must have a V-value no greater o dur�5orDtaoloc®n fromutha door be ua ' and documented by the M contains r in accordance withe U N� rating for that door is not available,include the in Table 11,5.3b,If a door contains glass and an aggregate detarn�nc glass area of the door with Your windows and use the"opaque door Valuo�greater than 03s)compliance of the door. One door may be excluded from�this wrealq�u amb-eend�,cY�ra l sspace wall component includes two color thdn fl e4u�ito c)If a cei13 � +lever,bas At th or door components comply if the are"welghted averaga U . differeat•ir�ulatiaa levels,the c®rnponent complies �e�®a-weighted average R uo greater the R.valua requirement for that component.Gl g , yllue ®f a1]windows or doors is less than or equal to the ilnvalue requirement(0.35 far doors}. 43 i i4 u • 4 Ft�E t Town of Barnstable 0 ]regulatory Services * a , v 74 MAC'' $ Thomas F.Geiler,Director �'ATF% ►, . 1. Buildlmg Division. Tom Perry, Building Commissioner 20.0 Main Street, Hyannis,MA b2601 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 . Y 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) e /� IL 42* ® Signatur of Ow7f Date Print N Q TO RM S:O W N ERP ERNIIS S IO N Board of Building Regulations and Standards License or registration valid for h HOME IMPROVEMENT CONTRACTOR before the expiration date. If foul rstrat'. .> Board of Building Regulations an Expiration g/3/2007 One.Astiburton Place Rm 1301 Bost6n,4W.02108 4 Type Individual ra y i JOHN C.VIEIRXs, JOHN VIEIRA 32 COLUMBIA AVE MARSTON MILLS, MA p2648 Administrator f Not valid without signat;f - ✓le 1JQ9YI/JYlOI7IlJC2GL1z o��ac`ivaelta. i BOARD OF BUILDING REGULATIONS I icense CONSTRUCTION SUPERVISOR r f � Number CS O42651 F 'i RlrtMt to 12702/j119,60 i rf f . pirk 12AW2b07 Tr:no: 10650 JD/HN C VIE 32 COLUMBIA AV � G MARSTON MILLS,, 02E48 I Commissioner ---.. - - ------------ y " Td), WN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 7:R A Application# Health Division 2i` ' "" ' { 01 ' L ,`' Conservation Division Permit# Tax Collector ' !w'. _ Date Issued Treasurer Application Fee tdd i Planning Dept. Permit Fee 3 0 D Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 13oo vt A4 0 Village 66-0 le.- Va IV Owner M4,-K 615 Address �M Telephone Permit Re uest � � to rr e-C4 641- Square feet: 1st floor:existing L f/ proposed 2nd floor:existing proposed -6- Total new Zoning District ��C Flood Plain JP13 Groundwater Overlay no Project Valuation 000 60 Construction Type 00o Lot Size l% Grandfathered: ❑Yes o If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure P k3 Historic House: ❑Yes ®'No On Old King's Highway: ❑Yes o Basement Type: My'Full ❑Crawl ❑Walkout ❑Other ��ff Basement Finished Area(sq.ft.) 0 Ya, Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing 3 new Iotal Room Count(not including baths):existing new First Floor Room Count .,Heat Type and Fuel: TGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes O'IVo Fireplaces: Existing wood/coal stove: ❑Yes ing newShed-LJ existing n�w si.3e Other Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ -Commercial-.❑.Yes -❑No If yes,.site plan review# Current Use Proposed Use BUILDER INFORMATION Name �I t7i.r Telephone Number ,��yc�_0 �5! Address 0M 6- License# 0 11/-Z fl� "'� /� Home Improvement Contractor# Worker's Compensation# ALL CON TRUCTION DEBRIS RESULTINGTHIS PROJECT WILL BE TAKEN TO j6&/!s 14- le- SIGNATURE DATE A FOR OFFICIAL USE ONLY t PERMIT'NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER ' - -.'" DATE OF INSPECTION: FOUNDATION FRAME x 'i INSULATION i T ' FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL g / r FINAL BUILDING x 'j DATE CLOSED OUT { , R ASSOCIATION PLAN NO. F:- The Commonwealth ofMassachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street fv Boston, MA OZIII kv) www.mass.gov/dia, Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le 'bl Name(Busiaess/Organizatiaaftdividuan• r) Cal Address: la 14t 4je-1 VYI City/Statelip: /646�-1 Phone#: CJV Are you an employer? Check the-appropriate box: Type of project(required): 1,❑ I 2M a employer with 4. ❑ I am a general contractor and I 6. ❑New construction loyecs(fall and/or part-time) art time).* hayehired the sub-contractors Remodeling 2. I am a sole proprietor or partner- listed on free attached sheet# 7 ❑ ton ship and have no employees These sub-contractors bane SS ❑ Demolii on working for me in'any capacity• workers' comp.insurance. 9. ❑ Budding addition S, a corporation and its • [No workers',CamP.insurance ❑ �I are a °� 10.0 Electrical repairs or additions required.] officers have exercised their ll. Plumbin airs additions • 3.❑ I am a homeownea•dog all work right of exemption per MGL ❑ Plumbing repairs or di 52 1 4 and we have no myself:[Na workers comp... c• 152,� t )� 12.❑ Roof repairs insurance required.]t . employees.(No workers' 3.❑ Offer camp.insurance required.] *Any applicant that checks box#1 must also fill out the section below ahowiag their workers'compensation policy informetioa.' ' t Horaeownan who submit this affidavit indicating they are doing 0 work andthea hire outside coatmotors must submit a new affidavit iadicating such. Icon b actvra that check this boa mast attached as additional shoat showing the name of fhe sub-contractors and ibeir workers'comp.policy-kformsiion. ram an employer that Is providing workers'compensation Insurance for.my employees. Below is the polt§ and o ite informadion. �... Inset Company Name: p #or : Job Site Address• City/State/Zip: Attach a copy of the era' compensation oil declaration they oli cumber and iaration da#e op P policy�cy P ig P c3' ) Fai ore to s . coverage as regaired'undei Section 25A of MGL c. 152 w3 lead to osition of criminal penalties of a fin $1,500,.00 and/or one-year imprison ncar,,as well as civil penalties in the.form of a S OPX ORDER and a fine o up to$250.00 a day against fhe violator. Be advised that a copy of this statemea#may ie forwarded do ce of Investigations of the DIA for il= ce'overage verification. I do hereby certify u th ns and penalties of pedury that the information provided above is true and correct; Si tore; Date: 0� { C Phone#: � 20 I �cz es( VK4. Do na to Ms am,to be d &Y or, 1 • l ?e 'ce City or Town: rmit/i.i nse# Issuing Authority(circle one); 1.Board of Health 2.Building Department. 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other 1 Contact Person: ?hone#: Information and Instructions Massaghusetts General Laws chapter 152 requires all employers to provide workers' cormpensationfortbeir employees. Pursuant to this statute, an employee is defined as"...every person in 1he service of another under any contract of hire, express or implied,.oral or written." An employer is defined as."an individual,partnership,association,corporation dr other legal entity,or any two or more G 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 apartiments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work M such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed tobe 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"Neifher 1he commonwealth nor any of its political subdivisions shall carter into amy contract for the performance ofpublic work until acceptable evidence of con�pliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checldng the boxes that apply to your situation and,if necessary,supply sub-contracto-r(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 1 ees a policy is required. Ac advised that this affidavit may be submitted to the Department of industrial �PoY � 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 ftiat 1he application for the permit or license is being requested, not theDeparhnent of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensatimpolicy,please call the Department at the member listed.below. Self-insured companies twuld miter their self-insurance license number on-the ' to line. II �� City or Town Oitdals. e bottom. space at th provided a a a zovi The D artm eat has that the affidavit is lete and printed legibly; ep p 8p , ?lease be sure �! !� , of t�affidavit for you to fIl=,in the event the Office of Invesdiations has to contact you regarding the applicant - Please be owe to fill in the permitlticense number wlach wM be used as a reference number. In addition,an applicant that must submit mnldple Permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job.Sate Address"the applicant should write"all locations in—,(city or town)."A copy of the affidavit 1hat has been officially stamped or marked by the city or town may be provided to the applicant as proof that.a valid affidavit ism file for future permit or licenses, Anew affidavit mustbe filled out each ' year.Where a home owner or citizen is obtaining a license or permit notrelated to any business or commercial venture (it. 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�assa�s Department of Industrial Accidents Of-ace of Inv 600 Washington Street Boston,NIA 02111 Tel. #617-727-4900 ext 406 or 1-877 MASSAFE ' Fax.#617-727-7749 Revised 5-26-05 v wTv mass.gov/dia °Fr Town of Barnstable Regulatory Services &UMSTABM ' Thomas F.Geiler,Director '0�6n •'tA`� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 119-162-4118 Fax: 508-790-6230 Permit no. Date 0 AFFIDAVIT HOME EWPROVEMENT 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: !�D �G/`— Estimated Cost Address of Work: ( � i I j a Owner's Name Date of Application: I hereby certify that: Registration is not required for the following reason(s): OWork 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 PERJL"RY I hereby apply for a permit as the agent of the owner: A �39 D e Contractor Name Registration No. OR Date Owner's Name Q,fotms:homeaffidav °PINE goy, Town of Barnstable , y Regulatory Services BAMMMASS.i.E Thomas F.Geller,Director '°Pen 39. Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstabl e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner bust Complete and Sign This Section If Using A Builder I, ,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. 1,300 (Address of Job) Signature of Owner at S Print Name Q TORMS:O W NERPERMIS SION - Flota .015f IMOR5 Oaf VaR I30AM WCN 1/2 X 5 LAG PR f5 MAW 11 O X 8 O WOC70 Mo, K, ZXI O'516'°OG M9246 FLffA%ONe MCK -- 1 os1:n 16'0"X"'(Y WOOL?MCK 161101 , d - <r i011 c 10�� nr�s y.l/4x 6 ITC K N6 NEW 5a ATLK5 4'0" MOW MlRA NR5 W IC �1,1,5 ( n 1500 CV16W Lt MACH IV. i �or'c n 16 01,03,01, ff W0019 MCK OW U51TI116 FI,AOrONe MCK 36" 6 I T HIGH 4X4 P 2X10' �❑�Zx,�'S LEDGER GRAD S4owe is 1Q" SONA TUBES: 4"0" BELQW GRADS. /L �40� th�O �eS Xk SECTI❑N ✓J2c TDanvnzoozu�ecc a��/�caoa�cc�ucaefl`a ! BOARD OF BUILDING REGULATIONS icen'se: CONSTRUCTION SUPERVISOR Number, CS O42651 Birthd Ezpires 12/02/2007 Tr. no: 10,650 - ROW j JOHN C VIEIR 32 COLUMBIA AVt MARS TON MILLS, MA 02648 f. . Commissioner. i +•'.' ,per �'fze �o?nirrroouirecc� a�..�baaczclauaeCZa . C \ Boardof.Building Regulations and Standards j; HOME IMPROVEMENT CONTRACTOR Registrar; r1.4'38 pia. ° =9/3/200 Type Individual JGII i C VI. IRA - 3k- — f 1OHN VI If3 hr`. lIMBIA AVE`t WIZ\,RSTO F ls11i LS,:MA p2648 hu"ninititratoi Town of Barnstable *Permit# XibSExpires 6 mrjs m issue date ��� egulatory Services . Fee O` SEP � Phomas F.Geiler,Director T ® � 2006 O BuildingDivision c 9 Sled �N Op s BANNS Tom Perry,CBO, Building Commissioner ARV T '9Ste200 Main Street Hyannis,MA 02601 Y 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 r� iap/parcel Number b I ®7- roperty Address 3DO vi ��. SOAC�, P� �—P-I�Yffu l residential Value of Work ®00 . Minimum fee of$25.00 for work under$6000.00 lwner's Name&Address 4-0 C, / -61 JC/ 'LPL f�tlt�J Be"'d. .. 'ontractor's Name J �'►h l l rL� Telephone Number 6 [ome Improvement Contractor License#(if applicable) f ! ��Y ) 4 ]Workman's Compensation Insurance Che one: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance isurance Company Name 6 lorkman's Comp.Policy# 'opy of Insurance Compliance Certificate must be on file. emut Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value. (maximum.44) *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: ePreeer must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. [GNATURE: Forms:expmtrg ;vise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations V 600 Washington Street a Boston, M4 02111 1� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AiDplicant Information I Please Print Legibly Name (Business/organization/individuai): 1('�k n V I Address: ^'� Cd 4'e__ City/State/Zip: �` Y/ e t!�S _ Phone#: �'� Are you an employer? Check the-appropriate box: 'Type of project(required): 1.❑ I a employer with 4. ❑ I am a general contractor and I 6. ❑New construction loyees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet'$ 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required,] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.❑ oof repairs ( insurance required.] t . employees. [No workers' 13. Other' tq coo camp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers Ptpensation insurance for my employees. Below is the policy anal job site informationP',n urany N e: Policy# elf ins.Lic. #: Expiratio Date: Job Site City/State ip:ttach the wor ers' comp sation p.oli declarati page(sho 'ng the p icy numb r and exp' atii®n datailure overage requir under Section 2 of M L c. 152 can 1 d to th imposition f crimii penalties oe up 00 and/or o -ye u�risonment, as w civil penalties in of a STOP ORK ER anda e of day against the violator. Be advised that a copy of this statement may forward Office ®f Investigations of the DIA for insurance coverage verification. I do hereby certify unal t a?in penalties of perjury that the information provided a ove is true and correct Si afore: ''" Date: ? O� Phone#: Official ke 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.Electricad inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: w of�NE T Town of Barnstable a Regulatory Services sARiv ` Thomas F.Geiler,Director 9 SS'MAAW. g' i639• ♦0 9- Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building pemut application for: (Address of Job) -0�Z Signature Oa r Date i --e�;7- Print Name QTORMS:O WNERPERMISSION ell- �nb b'18Wl) Zt:^ b2JG/A NHOI lenp[A[pul 'edAl { LOOC/E/6, :uollealdX3 . ^ L8Sbl6 ;i.ioge�;sr5a� a 8O-LOVNJ NOO LN3W3/IQJdIN13LfdO1s y� sh.[ip[n1s pue suo[ e � �n�aY Dnlpl[nfl Jo [eo�>- - l t — �fze two moau�iecc 'ollcxasccc�uuteC14 BOARD OF BUILDING REGULATIONS icense: CONSTRUCTION SUPERVISOR ' Number:,CS 042651 Ay. BirthdaYe T2/02/1960 , i Exp[res 12/02/2007 Tr. no: 10650 I Restr[cted JOHN C VIEIRA 32 COLUMBIA AVE (::7) MARSTON MILLS,AMA'02648 Commissioner I: License or registration valid for individul us WdY before the expiration date. 1f found ?-turi}to: Board of Building Itegulatio»s and':;i«?i<l '.. One Ashburton Place R.m 1301 Uostori,:Ma.02108 f • h 1 6 F Not valid witliout,signatsre ££ZL-t,b£(088) '2131N3D TIVO 3:IVS 91(1 — \ asueoil siyj Jo uogeoonaa JOJ asneo si apoo Buipp o alelS spasnpesseW ayi jo uo! pa waamo e ssessod of aanpe.� sauaoH 4148J Z'8 I-`Jl lluo�juosew-v[ (109'S Z[vO IsIN) coeds pesopue jo 000'9E-00 Town of Barnstable FtHEo Regulatory Services Thomas F.Geiler,Director RMWSTABM MAE& Building Division i639• ♦0 ArED MA'S 1► Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 �ao PERMIT# I p �0 2. FEE: $� - SHED REGISTRATION 120 square feet or less Location of shed(address) Village Property owner's name Telephone number Size of ed Map/Parcel# qSigna Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? � Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. TIUS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 h c �• �, � � �,�+� ,� -a warn.. TOF ��Jcsi IS O l�77fe I ©rZ G �►�Y�-�4.� z TOWN OF BARNSTABLE BUILDING PERMIT PARCEL_ ` 073 GEOBASE ID 12547 ADDRESS 1300 CRAIGVILLE BEACH ROA PHONE ' CENTERVILLE ZIP LOT 1 BLOCK LOT SIZE t DBA DEVELOPMENT DISTRICT. CO pEgMIT 77 44 gg gg PERMIT TYPE BADSg TIJLEIPTION BUIL�I?ING EXISTING GADDCDECKME FOOTxi'ivi- CONTRACTORS: PROPERTY OWNER ARCHITECTS: Department of TOTAL FEES: $30.00 Regulatory Services BOND $.00 CONSTRUCTION COSTS $.00 dF 434 REBID ADD/ALT/CONV 1 PRIVATE P�, * BAMSTABLE, MASS. AT i639• FD MA'S BYI DI N G D7I3IQN DATE ISSUED 06/22/2004 EXPIRATION DATh$ TOWN OF BARNSTABLE BUILDING PERMIT- PARCEL ID -207-073 GEOBASE ID - 12547 ADDRESS .• 1300 CRAIGVILLE BEACH ROA PHONE CENTERVILLE ZIP - LOT 1 BLOCK LOT SI ZE DBA DEV2LOPMENT DISTRICT CO P RM T TYPE 77409 DESCRIPTION- REPLACE ,EXISTING DECK SAME FOOTPRINT ' P BUILDING PERMIT ADD DECK CONTRACTORS: PROPERTY OWNER ARCHITECTS: Department of - Regulatory Services TOTAL FEES: A $30.00 BOND $.00 CONSTRUCTION COSTS $.00 434 RESID ADD/ALT/CONY 1 PRIVATE BARNSTABLE, Yr s MASS. 039. ♦� BUILDING DIVISI N j" Y ...A._,a. DATE ISSUED 06/22/2004 EXPIRATION DA'C - Vll ,J THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED-PLANS MUST BE RETAINED ON JOB AND WHERE,APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS '- HAS-BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE gNICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. :1013 ® ® o o BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Aug ci%eez" 66M 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HE LTH OTHER: SITE PLAN REVIEW APPROVAL I Persons contracting with unregistered contractors I do not have access to the guaranty fund (as set forth in MGL c-142A) WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HASAPPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY J VARIO US STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. 1; I I 4 A I r 1. f 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �? Parcel _7 S Permit# 7 rI y 0 9 Health Division Date Issued 1 Ala y Conservation Division Application Fee Tax Collector d- . Permit Fee 36 . 00 . OltTreasurer, , Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street A dress Village Q Owner Address S-sUvy Telephon� Permit Request 12ej!�9 ),Do� S 047 Qc -keo Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1,5-00 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family I Two Family ❑ Multi-Family(#units) Age of Existing Structure 421S, Historic House: ❑Yes No On Old King's Highway: ❑Yes 1VNo Basement Type: ❑Full ❑Crawl Walkout ❑Other l Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel<E0 Gas • ❑Oil ❑ Electric ❑Other Central Air: ❑Yes *o Fireplaces: Existing �_ New Existing wood/coal stove: ❑Yes ANo Detached garage existing ❑new size PoolAexisting ❑new size Barn:O existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ -` Commercial.0 Yes 0 No If yes, site plan review# - Current Use Proposed Use BUILDER INFORMATION Name (2, Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT.WILL BE TAKEN TO SIGNATURE DATE a^ r _ i 4 ' FOR OFFICIAL USE ONLY �b PERMIT NO. , i DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER f i DATE OF INSPECTION: 4 FOUNDATION FRAME , INSULATION , FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FT FINAL BUILDING _ 1 DATE CLOSED OUT f ASSOCIATION PLAN NO. T ' r.The tComtnonxveath oftVlassachusetts _ = Department of IndustriutAceident5' � - r~ •�I6elf��d�' 6Qo•Washington,Street _ Boston;Mass, . 02111 ., , p Woxers'.Com ensation,Snsurance Affidavit-General Businesses i • / s -t•�*,;'`'J� • -� :'~tom" ' ' ' :v`ct�t.V'.�a+ir'• ytid,'irtri'•i`Y' ;';; ; - .. � ' ' ,. aIlle: r� •• - ^R •• 5 , address: •, �•. ...• ' . � •.ho•e#•_ ,��` _... ' � state• ' low o>t [] etail uran g Establishmeat wo site locatietor sand have no onb 331siness e R e❑Salmi incl duIg Real Estale,Antos etc.)' X ain•a sole op . 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'' `�'• ��� •4,s..„, ce.cfY:'rl-a'•=r:.,l:_i t?`�V.• �yorkers' nsura • e followin rietor and'h+�ve hired the independent contractors listed below.who i�av�th g I�asoleprop t :. :•r �_ pt;II6atL0npO11Ces: ; riff ' 'ir'' :'i:fp+Hr{f8P`�•`' )d�t::^�'::'.. �` Com _ ) :4 , :,•.. �.'..:•r •hyy ,.',: „t4.1••iat•:J :'t'•jJr/'}},. ;,ft, .S.<,' it• 7: .� •'-P.•rea;t :'�;•tt',•ti:�.,• ''}{.�•�e'�:1• • •'�: t' t'ti:1'1'� i'� .r::t�:� ''« ••• ,:.• I•'•• '� • rr tl�t':•'• 'r,:11i+' t ''•i' ', ti'; t, S t e'y :'t', •J•!1C .f't: t:Pl':ti:r lZ,;�; :t' �' .r•�•!, • t• t r `.`,''•':: •.,':• 'r I':•: 4 J:7if.4{, •',L•}'.r�«t.tnl ::• .'aiC`•L\: .t;a•rht..J:. r• . . a .:... .+ } t.l•S;,t:t\. .1, ' .t:. t. .. ..r ,•t,•VfL .•:.•:'• •. •. •:5'l L' aJt.'•':r'' �.!'•'•i•i:l''t•i t-,/71�' '"t:tF',t ..,: dregs'. 1• : g .fit' 9 :,. t.�r.�r «t•.�' .t '.�5•,:''��th .+";r3�.�;i''ty��'�`•'•�I w,••.y,r:i qi.l..1� .: `tlbiie �.��.y t.•,.i...•.S, •��-, r•r•.t, {J�•};t�`• , '• .� .•t..r: •• r��' 1 ;;. r :j'�: '•« .x.',5' .• };:yM,yll.::: L.1 Mrr.r.,;l:tit1 r��}'ri:i:` .it}�ter��" t'`s'�'«t t• ..1 1 •••.t.. • '• .:••... t 1L ` y4,.. ..r •,•. t. • 5 V t ,,� •\r 1 ri 'G 'i j.,. � 1 • Cl•:. t ,µ .t..� 'l...r .. .rp 'S,5 f'}!S 1y7• I 't4�'•f" \f �.A: r 5U S', trrl4't.L'\ ,' +f'.rn}•.: :i •h•'+: Lti����r:•'���� «tt:l:•'+• }1 'F,r. 3i.'+• �•.4r?'h�,'•t.^\.• ,,,I }''.•R�a •,,.t't ;'. 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" , •. `` rR,+'t-: •I• F�Vt.�l, . •t Tt t7:' ';+:�jt '• 1� t ,.••• •• • , • :f�•:' ,t •.,L.�,•�',jFL'.,71�tt •• /, r•7•y:,1 ,':•4 t•' •t -'t';' '.` lyt?JS i1.1•'�, " •'l.'Q.'S{' it•t i4R.•".l:i :d t', ••'i•r' t•J :,'aL;i•t• •'1 1 ir• r la.,•t.t L« ,,tt�t•••• JL•.i\a0, i�,t, .r ,•. i;•rfp•.}'�.�.,':. f':�'�i' a;'n:, .:�•n• .\„t.::1y•-.�t�+j�.i:°t•''•': }�.i,tiY,S�:tS•„1.0.' OI1Ct'at•i• ,• � _ . :.•:�: b t, t;.•;c,v► i;;•rl,,, •v.,. MUM WIN a to Sl 00,00 an or lASIITSI1Gd=' t�f::'• '4w:: ositioa of crimfnalpenaYtics of a fin up r5 Failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imp r t ent as well as ctxllpenalties in the foi n of 6 STOP WORK 01WER and a fino of�100.00 a day against me, X understand that X one years impri'onm copy o f this statement may be fo,,•larded to the Office of Ynvesflgations of the DTAfor coverage verificaflon P do hereby certi wade sins t; ties o f perjury that the inform provided above is frua and carte I Date CS? Signature Phone# Print-name official use only do not write in this area to be completed by city or town official [Iguildiag Department permitllicense# [Ducensing$oard City or town: oselectmel Office [}checkif immediate response is requtred ❑HealthDepartment , __ []Other phone#; contact per3on: (,vited Sept 2003.) a� • Znformiafioia and Instructions eral L-aws'ch�peer 152 section 25 requires all employers to provide-workers, compensatidh for'their•• Massaclivaett�Geri f v •'i6i employees; As quoted,'from the °Ia.w", an employee is.defined as every person m the service o another under any contract of hire'express or implied; oral or written. s An employer is defined anmdi idual,partnership' association, corp6ration or other legal entity, or any fwo or mare of the foregoing engaged-in a•]oint enterprise,and including the legal representatives of a deceased,employer, or the receiver or arbiershi association or other legal entity, employing employees: 'HoweYei•the owner of a .trustee of an individual,p . Px . dwelling house hating'not'inore than three apartments and-who resides therein, or the mupant of the,dwelling house bf er who persons to•do maintetance, construction or repair work on:such dwelling fiouae ctr on the grounds or ,another .mmloys p oy , , .. building appurteIIint thereto shall not because Qf such employment.be"deemed to be ali 1 er, r ' coon 25 also"states fhat'ever s°tate'or local Incensing agency shah withhold the Issuance dr renewaI IariGL chapter.152 se of a license or pe2'm?t to operate a business or to construct buildings in the.commonweaIth for any a Pp Iicant who has not pro aceeptable•evidence•of coimpliancewith eII����Ce o�tracgfor the rerforinanceoo publi work unflT" not its political subdivisions shall y P acceptable evidence of compliance with t�e insurance requirements of this chapter have been presented to the contracting•. authority: Applicants 4 .. Please frlz iu the workers° eon�pensafim 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 maybe submitted to the Deparment of Industrial Aceidents•for confirmation of insurance coverage. Also'be sufe to sign and date the or town that the application for the permit or license is being davit should be returned to the city pp e affi ••� ; affidavit• � requested, not the Department 6t ladustdal Accidents. Should you have any questions regardnie the `Iaw' or if you are a Workert!•compensationpplicy,please call theDepaztcnent at.the number listed.l�elow. . required to obtain , , Nino City or Towns . - affidavit is cb lete andprinted legibly. The Department has provided a space at tad bottom of the 1'leasebe sure that the � affidavit for�►t tt'fit out in-the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemnA•c=e,number which will be used as a reference number. The.affi.day maybe returned tQ• maj 'per 'arrangements havebeenmade.• - the D ep artnoent by, or unless other . u1d h'ke to thank ou in advance for you cooperation and should you have any questions, The Office of Investigations wo Y please do tot-hesitate itate to uS a caTL ' i hone and fax number: , Ile Department s address,telep - - h Of Massachusetts- onwealt The Comm • Department-of Industrial Accidents . Bye to la�estena . 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 , __ E r Town of Barnstable ' oY °Ky • o� Regulatory Services • Thomas F.Geller,Director � 1619• Building Division 'OIFD h1P'�k • Tom Ferry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508.862-4038 permit ao. Date AF+'MAVIT SOME NMNT MmNT CONTRACTOR LAW SUP TO PERMIT AP11 CATION M(3L c.142A requires that the"reconstruction,ion of an addition ooany preexisting oowrier occupied ion, •improvement,removal,demolition,or constru h bu0ding 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 OIt�U 4--ocLef� Estim4ted Cost . : �g d M - Address of Work: Owner's Name' Date of Application: b •O I hereby certify that: Registration is not required for the following reason(s); []Work excluded by law ❑lab Under$1,000 []Building not owner-occupied [Owner pulling own permit Notice is hereby given that: OWNEg,S PULLING' EIR OWN PEME 1MPROYEMENT DEALING WITH UNREGISTERED NOTCONTRACTORS FOR AYFLICABL ACCESS TO THE AR3ITRATION PRO GRAM OR GUARANTY YUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERMY I hereby apply foi a permit as the agent of the outer; Contractor Name Registrationl�Io. Date A OR • (g• �(�•�4'• ow.r'same • T - I 1 I MAP P 8' H srp" •, I i �100 WET IDS �U FERIIN , 2 � MA FD 1 \ I RIB,TION� / I c' q 1300' , \ BOX \ . 4 ACRES,, \ 1500 G ON ANC �\ N I N G: RC dill t A10 ,i MAP� 7 i ` BARNSTABLEG.I.S.UNIT SITE PLAN FOR MARKS. ELLS SCALE:I"=50' G.M.C.6/25/01 morWeach.dgn a� i i _ 4 `A t ` o � f 12, v I r i wA Y 4 - 41 77 ° z IN I � r Y�'A i W�4 Oy Federal Emergency Management Agency a Washington, D.C. 20472 June 5 2002 MR.MARK S.ELLS CASE NO.:02-01-0994A DEPARTMENT OF PUBLIC WORKS COMMUNITY: TOWN OF BARNS-FABLE,BARNSTABLE 367 MAIN STREET COUNTY,MASSACHUSETTS HYANNIS,MA 02601 COMMUNITY NO.:250001 DEAR MR.ELLS: This is in reference to a request that the Federal Emergency Management Agency (FEMA) determine if the property described in the enclosed document is located within an identified Special Flood Hazard Area, the area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood), on the effective National Flood Insurance Program �NFIP) map. Using the information submitted and the effective NFIP map, our determination is shown on the attached Letter of Map Amendment (LOMA) Determination Document. This determination document provides additional information regarding the effective NFIP map,the legal description of the property and our determination. Additional documents are enclosed which provide information regarding the subject property and LOMAs. Please see the List of Enclosures below to determine which documents are enclosed. Other attachments specific to this request may be included as referenced in the Determination/Comment document. If you have any questions about this letter or any of the.enclosures, please contact the FEMA Map Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter addressed to the Federal Emergency Management Agency,P.O. Box 2210, Merrifield,VA 22116-2210. Additional information about the NFIP is available on our web site at http://www.fema.gov/nfip./. Sincerely, Matthew B. Miller,P.E., Chief - Hazards Study Branch Federal-Insurance and Mitigation Administration LIST OF ENCLOSURES: LOMA-OAS DETERMINATION DOCUMENT(OUT AS SHOWN) c cc: State/Commonwealth NFIP Coordinator . �� Community Map Repository Ae"� C Region 'A flif", a _ e.Lr'>S� rr• ,a� �.,,.w.�,J t lt� , s€amcirJ C 0 Y JIL, ;`i kY ,: 4r` (= -' �yJ'._, f:�,._t.,,tk.A....�.', .. L,'• , .f, i�'. ..F,.�,� �, . .�p '"-'. "d .,r ..' !.1.`i:;-�,'y %� i tSi i�' ht x f. „�:.•3:a rf �f i�a",..�', .. _4 .i:I' '�', :..� ti'. ,,.3.r Page 1 of 2 Date:June 5, 2002 Case No.:02-01-0994A LOMA-OAS Federal Emergency Management Agency a� Washington, D.C, 20472 pro o* LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (OUT AS SHOWN) COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF BARNSTABLE,BARNSTABLE Lot 1, as shown on the plat, recorded in Book 319, Page 41,filed on January COMMUNITY COUNTY,MASSACHUSETTS 3, 1978,by the Register of Deeds, Barnstable County, Massachusetts COMMUNITY NO.:250001 NUMBER:2500010008D AFFECTED NAME:TOWN OF BARNSTABLE, MAP PANEL BARNSTABLE COUNTY,MASSACHUSETTS ATE:0 7/0 2119 9 2 FLOODING SOURCE: NANTUCKET SOUND APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:41.642,-70345 SOURCE OF LAT&LONG:PRECISION MAPPING STREETS 4.0 DATUM:NAD 83 DETERMINATION OUTCOME 1% ANNUAL LOWEST LOWEST WHAT IS CHANCE ADJACENT LOT LOT BLOCK/ SUBDIVISION STREET OUTSIDE OF FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NGVD29) 4t (NGVD 29) (NGVD 29) 1 _ 1300 Craigville Residential Beach Road Structure C. 10.6 feet _ Special Flood Hazard Area(SFHA)-The SFHA is an area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year(baseflood) ADDITIONAL CONSIDERATIONS(Please refer to the appropriate section on Attachment 1 for the additional.considerations listed below.) PORTIONS REMAIN IN THE SFHA This document provides the Federal Emergency Management Agency's determination regarding a request for a.Letter of Map Amendment for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the structure(s)on the property(ies)is/are not located in the SFHA,an area inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year (base flood). The subject property is correctly shown-outside the SFHA located on the effective NFIP map; therefore, the Federal mandatory flood insurance requirement does not apply. If the policy has been written using an incorrect zone,it can be endorsed to correct the zone for the current_policy year and one prior policy term. Please contact the insurance agent or company involved to request endorsement of.the policy. However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy(PRP)is available for buildings located outside the SFHA. Information about the PRP and how one can apply is enclosed. This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at(877)336-2627 (877-FEMA MAP)or.by letter addressed to the Federal Emergency._Management Agency,P.O.-Box 2210, Merrifield,VA 22116-2210. Additional information about the NFIP is available on our web site at http://www.fema.gov/nfip/. Matthew B.Miller,P.E.,Chief Hazards Study Branch Federal Insurance and Mitigation Administration Version 1.3.3 MX173012003K2045LOMAK2045SPF1 Page 2 of 2 Date:June 5, 2002 ICase No.:02-01-0994A I LOMA-OAS C' M^N Federal Emergency Management Agency ab Washington, D.C. 20472 LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (OUT AS SHOWN) ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS) PORTIONS OF THE PROPERTY REMAIN IN THE SFHA(This Additional Consideration applies to the preceding 1 Property.) Portions of this property, but not the subject of the Determination/Comment document, may remain in the Special Flood Hazard Area. Therefore, any future construction or substantial improvement on the property remains subject to Federal, State/Commonwealth, and local regulations for floodplain management. This attachment provides additional information regarding this request. If you have any questions about this attachment, please contact the FEMA Map Assistance-Center toll free at(877)336-2627 (877-FEMA MAP)or by letter addressed to the Federal Emergency Management Agency, P.O. Box 2210, Merrifield,VA 221.16-2210. Additional information about the NFIP is available on our web site at http://www.fema.gov/nfip/. Matthew B.Miller,P.E.,Chief Hazards Study Branch Federal Insurance and Mitigation Administration Version 1.3.3 MX173012003K2045LOMAK2045SPF1 Community Map Repository Federal Emergency Management Agency Washington, D.C. 20472' 0 0 Dear Community Official: Enclosed are copies of recent Letters of Map Amendment(LOMAs)and/or Letters of Map Revision based on Fill (LOMR-Fs)issued to amend or revise the National Flood Insurance Program(NFIP)map for your community. . As you know,the map repository is a local resource for information regarding the risks of flooding in your community. A priority of the Federal Emergency Management Agency(FEMA) =is to ensure that changes to the flood-risk information, such as those resulting from the issuance of a map amendment or map revision,are sent to the repository for the benefit of the public. Please note that NFIP regulations require that the local map repository attach the enclosed copy of the LOMA and/or LOMR-F to the appropriate NFIP map on file. We appreciate your cooperation in maintaining this valuable community resource. If you have any questions about an of the enclosures or if the Y address of the repository for your community , has changed,please contact the FEMA.Map Assistance Center toll free at(877) 336-2627(877- FEMA MAP). Sincerely, Matthew B. Miller,P:E.,Chief Hazards Study Branch " Federal Insurance and Mitigation Administration t j; r u s. Enclosures Town of Bar `eta}ale` ' k:)TABLE GF THE Tp� o Regulatory Safi&s` ` ' 05 i Thomas F.Geiler,Director = IARNSTABLE, 9 �. Building Division— i639• ♦0 �� Argo .�a Tom Perry,Building Commissi �e �s�� 200 Main Street, Hyannis,MA 02661 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $ �✓�� SHED REGISTRATION 120 square feet or less zicz Location of shed( dress) Village 91. Property owner's name Telephone number t /D 1)( J? Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A'PLOT PLAN " Q-forms-shedreg REV:121901 ' m A CD If LrI \ r ' MAP` ,� `;'` ; , r ` y 0 m ,. { l0O Wt; SU FIR LIN A 07 R18�110 �. I,J c' l t'r+ 1300', r \ �;. sal E- y�i �1,�;1 4 ACRE , i% 1500 GAtC N 1 h. 1 �} }NING: RC D tzj MAR, 7 , , 1 # m '. a,�STABIEG.+s.UNIT SITE PLAN FOR MARK S. ELLS sr�iE:i"=so, mallJeah.dgn � &M.(.075/01 tE Of T„E' ir"6 mon"'s from issue dare �c. «` °�1 Fee . '• ► Regulatory Services �- s`BA"grABtL o lI ~ 9� eb Thomas F.Geller,Director ��- '''f0►"°y1619- Building Division Peter F.Di\iatteo, Building Commissioner 367 plain Street, Hya=is.MA 02601w NOV 1 4 2001 Office: 508-862- '038 Fax: 508-790-62:0 TOWN OF BARP1 TABLL EXPRESS PERMIT APPLICATION - RESIDENTIAL ONL Not Valid wishosa Fad X-FrM ImPnw Map.parcel Number Property Address Residential Value of Work Owner's Name&Wdress �•�1� l s5 GP�saltc • C�Zt�Contractor's Name_��,���� Telephone Number Home Improvement Contractor license 4(if applicable) 1 Construction Supervisor's License=(if applicable) ' 1 Ljworkman's Compensation Insurance Check one: QI am a sole proprietor Z1=the Homeonner [f I have Worker's Compensation Insurance Insurance Company Name Workn='s Comp.Policy Permit Request(check box) Q Re-roof(stripping old shingles) Re-ro f(not stripping. Going over existing layers ofroofl Re-side 44 Replacement Windows. U-Value (�• ) Other(specify) �nons.i.e.Historic.Consen�tion. owherc required: Issuance of this permit does not exempt compiiance with other town deparm=t ::=• Sismatu re &OQD - ----- Q:Fomcx 0601 II� .. �TME A Town of Barnstable *Permit# Expires 6 months from issue date • Regulatory Services Fee RJUMSTABIJ& ' MASS. 1639. Thomas F.Geller,Director u .0 l d � Building Division Peter F.DiMatteo, Building Commissioner X-PRESS PERMIT 367 Main Street, Hyannis,MA 02601w COS AUG 1 3 2001 Office: 508-862-4038 Fax: 508-790-62.30 TOWN OF BARNSTABLE EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint Map/parcel Number ;Z a Property AddressEpt- esidential OR ❑Commercial Value of Work bU Owner's Name&Address Contractor's Name -� l v Telephone Number O Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) { 69 orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am_pe Homeowner ave Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) B-ge_ ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic.Conservation.etc. Signature Q:Forms:expmtrg:rev-070601 ``HOBE IMPROVEMENT CONTRACTOR + � p Registration �> ,�:.• - =9 ration, .9/25/O1 k> 1YPe �= Individual Janes..Dooley FW�Mbp h �A'�4�5.6� fi # x�199 Skunknet Rd A .-. ADMINISTRATOR � `` -,� rr q 5,yy; Centerville f NR 02632 1 d iva• STatt V au y ' �4k 1 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 6,�Map � Zvi . Parcel `. � .. Permit# �' TIC SYSTEM V Health Division W c Date Issued Conservation Division sI J SJ 1 v&-- Wt' A TI LS 5Fee+ f C/0 Tax Collector ' IilsfL�3�"e Treasurer - 6 i Planning Dept. ' Date Definitive Plan Approved by Planring Board Historic-OKH Preservation/Hyannis Project Street Address L Village t-IL E:: Owner Address Telephone ero7--- Permit Request Q�i�ra�t .d Fx.l,� C�-ttm�a� p POp I_ 7-�006sp 2A- 4 t Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain C Groundwater Overlay Construction Type Tg�u. Lot Size ( "F Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure d Historic House: ❑Yes 2 o On Old King's Highway: ❑Yes Cho Basement Type: ❑Full ❑Crawl Lavalkout ❑Other ' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: "Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes lINo Detached garage:❑existing ❑new size Pool:❑existing C'new size 4 PeFP Barn:❑existing ❑new size b1t;b%& C-romrt�rj ?st 9-CM?04 r-> Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name � .�� Telephone Number Address License# Home Improvement Contractor# -Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ' FOR OFFICIAL USE ONLY ,PERMIT NO. DATE ISSUED MAP/PARCEL NO. , ADDRESS VILLAGE OWNER _ DATE OF INSPECTIQN:, 1 =, k FOUNDATION FRAME INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL, ' a PLUMBING: ROUGH FINAL' GAS: ROUGH FINAL I FINAL BUILDING ! i DATE CLOSED OUT T ASSOCIATION.PLAN NO. • e o Regulatory Services 1659. o Thomas F. Geller, Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: `7 ' I`� 0 Q (� JOB LOCATION: 1 30 0 �lDr tlo�l l U.fC+ -` -L1 �y+p.0 �,c l l•(>!r^ ' number street village t D 263Z "HOMEOWNER": Sro�'�01 e8 7 fof5 -exoL—4 ce name /1 home phone# nwork,phone CURRENT MAILING ADDRESS: e J t s f 1 f city/town Y! state rip 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 proce ures and requirements. Signat " of HomeovPer 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 E3E11H'nON The Code states that "Any homeowner perforating 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:EXEMM . The Town of Barnstable • Bxsivsrnsr.� - 9� MAM �,�' Regulatory Services 1 ►9. Thomas F. Geiler, Director Building Division Elbert Ulshoeffer, 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 to 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 suuctures'which are adjacent to such residence or building be done by registered contractors,with certain exceptions,:along with other i requirements. Type of Work: "oc.. Estimated Co o b-SoV-�-_ r] Address of Work: l 2�>©c� Cge,o&*k �14_ �� om t 1 t . M� o'�az Owner's Name: l /S Date of Application: i - I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law OJob Under S 1,000 []Building not owner-occupied �wner pulling own permit y Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for ermit as the ent of the owner. �. 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Fame to scene evresage as tsgoasd mnder Secdcu 2U of MQ.=emind to the impoWdm of�pmaid s of a Ban uP to S2300.00 rodi oaw yem,tuspitsonsuent as weR as cull pmaltlrs in the form of a STOP WORK ORDER and a fte of S100.00 a day against ant I understand that copy of this sta—st may be forwarded to the Mee of Iaresd;sdlom of the DlAfor covemP Jr do hexhy certi under the aou mid pataltie:ofpQlWY that d w information prondrd above is grow and coned - Date •/ '7 •O Si�atntr �' Print Z— o t��! --------------- :dn- ED do not write in this area to be completed by city or town omtfal peeadtlllcenae 1! QBu1dLt;Depastn� . 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M •• 1 Y/ UU • •• .0 • •+.•11 • 11 I• :1I 11 II •y•11II Vy• V 1111.1 • -. • II «/ I 1 1 -• _ _ 1 • .1 •••_$1 • • 11 •1 111 w I✓. •��.• I•Y • / .• V • 1 •w / •y.1• •11 •'• 1 • i asks I • • 11 4P.18 • .ItI.-Of 0 S • •I In b•••y .1• •11 .11 • 1• • • • . .11 • w ••• 1 i 11 11 1 1 1 � 1 •• ' 1 1 1 1 1 / 1 1 1 1 1 1 1 1 1 I I 1 11 • of i 1 1 1 1 • / 1 1 1 - 1 ' III � I I • I I 1 05/15/01 TUE 14:39 FAX 905 688 4288 CORNELIUS INDUSTRIES �1001 CORN ELIUS INDUSTRIES INC. ' 15 CUSHMAN ROAD ST. CATHARINES ON C:ANADA L2M 6S7 TEL 9050688e2612 FAX 905.688Q4288 DAa'E i TO _ FAX FROM NO. OF PAGES INCLUDING COVED � r - -C cow C�:39 FAX 905 688 428.8 05/15/%RNjjtj§ INDU4&A NO. 2126 PO1 I INSTALLING YOUR ABOVEGROUND POOL . earth up against the pool wall or frame covering any part of them.The pool must be installed only on level,well-drained,firm (undug, non-filled) earth.We do not recommend backfrlling or gradir -Check local building codes for setback from house and property lines. -Check regulations concerning fence height and position. -Check above and below ground for existing gas, electric, telephone and water lines. ERECTING A POOL ON BLACKTOP,TAR PAPER, ASPHALT, CONCRETE, GRAVEL, OR ANY SOIL CONTAINING SHARP OBJECTS WILL INVALIDATE LINER WARRANTY Sod should be removed to prevent irregular bottom and any unpleasant odor from decaying grass_ -Do not use any oil based weed killer on cleared ground as it could stain the finer, Use weed kilter made specifically for swimming pool base applications. -Material for bottom of pool should be fine and free of sharp objects. RECOMMENDED MATERIALS: -Fine (shell free) sand or vermiculite, FOR HARD BOTTOM: -.6 parts of either material can be mixed with 1 part cement,applied dampened 2"(5 cm)thick, smoothed and packed with a trowel Cove 4"(1 Dom) up wail around post. If NUTGRASS is prevalent in your area(ie.Southern USA) use special chemicals which kill nutgrass in pool areas. Consult your local hardware or lawn care company. NOTE: pH and chlorine balance must be maintained at normal levels. Excessive pH change or chlorine load will result in liner fading,turning brittle and either fading or puckering-This is not covered under the manufacturer's warranty. WINTERIZE your pool by reducing the amount of water in the pool to 1/2, adjust pH and chlorine to proper levels and cover. NOTE:Water must be left in the pool at ALL times,Flemoval of the water from the pool will result in liner shrinkage which is NO covered by the manufacturer's warranty. A STEPS TO INSTALLING YOUR ROUND POOL(following numbers on installation sheet) 6 Tools required. 7- 14 Layout, ground preparation and ground levelling(in areas prone to nutgrass(Southern U.S.)sterilize soil with approved chemical) 15- 16 Check and layout parts. 17-20 Mark out and level area for posts(on patio blocks)and tracks, 21 -23 Assemble connectors and tracks approximately 1/2"(1 cm)gap. 24-29 Add floor sand and uncoil wall into track-securing with pegs and string(or have 5-6 people hold wall), Once unwound, adjust tracks at connectors to make watt bolt holes line up.Secure wall with hardware using every hole and tighten securely with wrench (screw head on water side of wait). 30-31 Layout posts and install on bottom connector while securing top of post to wall with tape. 32-35 Spread, smooth and compact sand on floor with 6"(15 cm) cove against wall. 36-42 Spread out liner in the sun,refold aril ace in place pool overlapping the liner wall over the sleet wait and securing with inner combing. 43 Remove wrinkles and make final liner adjustments, install top tracks and top connectors(at each post).Overlap liner may be folded up under the ledge-do not cut. 44-45 Install top Ledges and top caps. 46 Install skimmer/inlet wall gaskets(not included in all models). 47 Assemble skimmer/inlet, hoses and filter according to separate manufacturers instructions. NOTES: - POOL MUST BE BUILT ON SOLID,LEVEL AND NON-FILLED AREA. -ENSURE:WALL JOINT is BEHIND A POST WITH THE SKIMMER AND INLET POSITIONED WHERE YOU WANTTHE FILTER. -00 NOT ASSEMBLE WALL ON A WINDY DAY. 05/15/01 TUE 14:40 FAX 905 688 -4288 05/15/01 14:45 T%/R% N0. 2126 P02 CORNELIUS INDUSTRIES D03 ABOVEGROUND POOL PARTS LIST* _... 12' 15' - 18' , (►n) 2,40 3,70 4,70 5,50 6,40 7,30 8,� (a) 6"(15 cm)Ledge#6710 08 2321 -3/4"(60,33 cm)...................{ ) 6"(15 cm) Ledge#6710-02"55-9/64"(140,06 cm . . 12......... (a) 6"(15 cm)Ledge#6710.05 ).... _ ...... ....... ....- ....... ...- ............. 12 (a) 6"(15 cm) Ledge#6710-08 45-3�3'2' (118,67 cm}..... ....... .......... .. .... ........... ...... ....12......... .... ..._ ....14 ... . ..1............t. (6) Upright host#67 iB (114,7a crri .. .. .......................... __ ............ .... ....... ........... 20-48/#6720.52 }.. ....... ....... .......... - ............10............... (C) Tog and Bottom C ..........._- .........I Connector#67 ..............................12 ............t 0............12_..........12 40........................................ .14 ..........i 6..........1 (41) Cap#6774-........ ..............24............20..........24.......... 24 l (e) Cap Extension#6776 .................... ......... ...... .......-�..•... ......... .....i2 ....... ..f 0...........12. .12.........28....... .32 . .... 3( .................... .. ......_.. .........14..........16..........1 Top Bottom ................................ f and Trask#6731-00 ........t2 ............10............i2......_....12..........14 (g) Inner Combing " ....24............20 16 ........ (h) -Self-Tapping Screw(#2�x21/2")(12 70 m }........ ' ....... ......................6 ... ,........9....... ...11.. .......13........ 28... .....32 ........ 3� (i) Liner .................... m ....... ..................134 .. ..... .... ....16 ..........17..........is Q) Steel Wall includes joiner screws ...............................................1 ..............111.. ......134.........134..._....158........ 178 ......216 Installation (m)... ........ ...... ....... .....................t ............. .1..............1 _ ....... :j .... ......1 ............t Note:T an sneer........................................._........ _. ......................1 ...............1......... .. ... ....... ..... .... .........---1 ......._. o andI........_... 1 1 P 8ottam Track#673i-00 .. •-•••••.•••-.i............ indicate r y. 1 ............1 ...._.......1 proper radius b inserting code in place of-O0 STgAT ........................... -09..........-01 ..........02 ........-03 .........04 .........05 COUNT YOUR Pi9R'�'8 BEFORRr 1A►G PDOt. 4® ACTUAL SIZE SIZE DIAMETER WALL LENGTH PATIO BLOCKS 8"x 16"x 2" MASON SAND 8.........(2,40 m)..........T 7" ............(2 " (20 cm x 40 cm x 5 cm) 12' (3,70 m " ,31 rn) ....,23 11 ....(7,23 m} ...... )..........12 1 (3,68 m) ..........38'0....... 11 15.......(4,70 m)..........15,0" " ( ,39 m) .................... 10 (4,58 m .... ............................3/4 ......cubic yard IS' .......... )--........47 2 14 38 m .. 5 50 m)_.........17'g'� (5,4t rra ....--( } .......:....:... ... 12--• ( , .............. ..1 cubic yard ......(6,40 m -•..... )..........55'9" (17,00 ttt) 21' ).........-20'11" .......,(6,36 m " .....,( 1-.......... ...................... )..........65 8 20.03 m 1 1/4....cubic yards ' (7,30 m)..........23' 11" ..14 24...... (7,30 m 2 ........ >.........-75't" ...(22,90 m ............................1-t/2 cubic yards ....cu ( 0 m) 26'10 (8.18 m b ) ........................16 .......................... ubic yards .... 8 ....... ... )...... ..84 5 .... .(25,75 m) ... .. . ..........,18 ..............................2..........a . . 2-1/2....Cubic yards OTJE 14: 05/15/01 14:45 TX/RX NO. 2126 P03 40 FAX 905 688,4268 CORNELIUS INDUSTRIES 0 004 '0101-9-1-1! AU - 0 °a O 000,0 „f DUn> 0 (h) 05/15/01 14:45 ' TX/RX NO. 2126 PO4 05/15/01 TUE 14:40 FAX 905 688 4288 CORNELIUS INDUSTRIES Zorn 60 94, tll► � 'y- Ll 1 f~ C R+IV (R+ 1Scm) 10 x 12 X 12 11 0 110 70 \ 2" x (5cm) R+— ! 120 lox (D) c�) ra+�" 2" a'Dla. 3'-9 1/2" 4'-9 7!2" (5cm) 12'Dla, 6'-0 1/2' 6'-6 1/2" 15'via. 7'-6" 8'-0" C 18'Dla. 8'-10 1/2" 8'-4 1/2" 21'Dia. 10'-5 1/2" 10'-11 112" 24'Dia. 1 V-11 1/2" 12'. 5 1/2" 27'Dla. IT-5" 13'-11" (D) (R) R+Wkm) MR 2,40 m 1,19 rn 1.34 m 3,70 m 1,04 m 2.00 m 130 4.70 M 2.29 m 2.44 m R , 0 .71 m 2 B m 6 ,4 M 30 m ,18 m 3,32 m ) 7,30 m 3,66 m 8.20 m 4.09 m ¢24 m C 951- 05/15/01 14:45 TX/RX NO. 2126 P05 05/15/01 71E 14:41 FAX 905 688 4288 CORNELIUS INDUSTRIES 0 006 El 140 All f ' (D.) R i.• (`7•) C ; t•- __ '�\� - • • ,e 7,% \.III kill •• . 200 is � r (b) 6731-00(f} 220 / 6740(c) - r7.) 23`0 1� • . 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SMOKE DETECTORS REVIEWED 3Jz3�ab IMPORTANT } A E 18--ul bEPT DATE TANT ANY CONSTRUCTION THAT INCREASES LIVING SPACE BEYOND 12b0 SQ. FT, PER LEVEL MAY REQUIRE THE -----9IREE DEPART,MENT DATE INSTALLATION OF ADDITIONAL SMOKE DETECTORS. c BOTH SIGNATURES ARE REQUIRED FOR PERMITTING NOTE: A SEP„RATE PERMIT IS REQUIRED FOR THE INS TALLATION OF SMOKE. 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