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','.�.,,�",.-,i,,,,�,'�,-���,l�,,i�,,�.,�, "I'Agar""', !ii,�".i�,��"",�,�,�,�,�",c,���.�,��,f""4.,�"L�i""�,��,� ""-.-,'�-�,-,--,�"",�,,�,�,�.-i�,ii�,���,,�"!�,�,i'-,�,�,-,�L�.�,���'li��i7.,-f", ;.--,!�'.7��,��l���,�,�"?"�;,,,�,�.,��,,,�, -,Z­ ,i, -,tv'i"i""i�'i -',�l� T,T "" ,� � �,-,,�,l III I 11:�_�,� �,t�, -,_,.,��l�, �,,,`�,i'�f:`;'�l,`";�, i'."',:,� � ,'t it .�,i�,.!,;"","' "ii',�� , ,�,o i,, " ie�T, ,�2�, - I- , �",',"",',,"",',,',,""I'lI������i,,t �- �2 ,-.�� tlr 1 i,t �2 ��, i,t �2 ��, i,t �2 ��, i,t �2 ��, i,t �2 ��,� i,t �2 ��,� i,t �2 i,t �2 ��,�.,� i,t �2 ��,�.,�� i,t �2 ��,�.,�� � � � � _ ,� ,� � A,L "'A&in� 1 � -11 _ U 1 K,"A I 'i";,. ,� ,,��L,�.-, a. t �INE ti ,y Application num . .. ../.&3q 0 p ' ELMNSTAs Date Issued....... f..k.... .........1... ... . o .ti.. ........... i639• �0i' � Bwlding Inspectors Initials.. p� ........................... ?� 201 k g Map/Parcel..... .....R5..........c7 2c�............ \01` °J�' 1301 ( 1 TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: J I NUMBER STREET VILLAGE Owner's Name: ��n�o� C,�n�l�:� 0,j,,2 e l( Phone Number S O i%4 6 L -0 6 c 4 Email Address: 1hca n e� Cell Phone Number Project cost$ _ o Check one Residential V/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding Windows (no header change)# Z, ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review Ell Roof(not applying more than 1 layer of shingles) Construction Debris will be going to G,1 tc s-�e-/�G�1 a P�� - ,,�,�c o/�► /� L CONTRACTOR'S INFORMATION Contractor's name �t�u,, ��n�t;so✓� - �,,�•��� &/ � ICy4 J',,JowS v Home Improvement Contractors Registration(if applicable)# 17 3 2-Ll S_ (attach copy) Construction Supervisor's License# M S 7 O' (attach copy) Email of Contractor SLJea 9q S • C brn Phone number L101' Z 2 R -1900 ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *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. 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 If food is being served at your event please obtain a Health Department approval between the hours 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'gown of Barnstable. Signature Date r: PLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. l i Renewal Agreement Document and Payment Terms Andersen. dba:Renewal B Andersen of Southern New England ".4. Y g Linton&Cynthia Campbell Legal Name:Southern New England Windows,LLC 54 Crestview Circle RI#36079, MA#173245,CT#0634555, Lead Firm #1237 Centerville,MA 02632 10 Reservoir Rd I.Smithfield,RI 02917 - - : H:(508)862-0614 . Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com' Buyers) Name: Linton.& Cynthia Campbell.. Contract Date:11/10/18 Buyer(s)Street Address: 54 Crestview Circle, Centerville, MA 02632 Primary Telephone Number:.(508)862-0614 Secondary Telephone Number:'. PrimaryEmail: lintain@tomeast.net �.: Secondary Email: Buyer(s).hereby jointly:and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement- Document. . and Payment.Terms;any:documents listed in the Table of Contents,and any other document attached to.this Agreement Document, the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,ihis"Agreement'): Buyer(s)hereby;agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount:' _ $5,993 By signing this Agreement;you acknowledge that the Balance Due;and the Amount Financed must be.made by personal:check,.bank check,creditcard,or cash Deposit Received: $1,997 . Balance Due: $3,996 Estimated Start Estimated Completion: Amount Financed: $0 8-10 Wks. 8-10 Wks Method of Payment. Cash/Check We schedule installations:based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.'The installation date that: we:are providing at this time is only an estimate.We will communicate an official date and time at a later date:.Rain and extreme weather are the most commoii causes for delay Notes: 1/3 DP check#3448;;.2/3 balance upon completion ;taxes pd in Barnstable - I Buyer(s)agrees and understands that this Agreement constitutes:the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written'consent of both the Buyers)and Contractor. Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms'of this Agreement,and has received a completed,signed,and dated copy of this Agreetnent;including the two attached Notices of Cancellation,,on the date first written above and.2)was orally informed of Buyer's right to cancel this Agreement: NOTICE TO BUYER: Do not sign this contract if blank.You ate entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 11/14/2018 OR THE.THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN. EXPLANATION OF THIS RIGHT Legal Name:Southern New England Windows,LLC dba:Renewal By p ersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Jack Incollingo Linton Campbell .Cynthia Campbell Print Name of Sales Person Print Name Print.Name- uPDATED: 11/10/18 . Page 2 L g'.. , AZ ' Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS,LLC- Expiration: 09/18/2020 10 RESERVOIR ROAD - SMITHFIELD, RI 02917 Update Address and Return Card. SCA 1 Ce 20//M-05/17 .J�P• TiO/72iJ9./Yl,1CP�Cl�l,�G'�CLiiO,/.//.1W�' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: Reoistrafibn. Expiration Office of Consumer Affairs and Business Regulation 11324-5 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary v .a. without Signature r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Con strUc#Pon`Supervisor CS-095707 = Empires : 09/08/2020 BRIAN D DENNISON 8 BLACKWELL-DRIVE CHARLTON MAr01507 Commissioner The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 �y Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTLNG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): „TS rrFGte� ,f�,/f„/1 S�a�]cY l��dp►t/s Address: City/State/Zip: 4�1-Fie- 2_67 L�7 Phone#: 1-/O 1 -22f1-9�DO Are you an employer?Check the appropriate box: Type of project(required): L�f am a employer with ai O+�employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity_[No workers'comp.insurance required.] ❑3.�I am a homeowner doing all work myself.[No workers'comp.insurance required.] 9. Demolition' 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ]0 ❑Building addition ensure that all contractors either have%vorkers'compensation insurance or are sole I l.❑Electrical repairs,or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.r7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance. 13_❑Roof repairs 6.❑we are a corporation and its officers have exercised their right of exemption per MGL c. 14.QOther 44 152,§1(4),and we have no employees.[No workers'comp.insurance required.] rPp(a c Clvv 0,1 It 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: el C. CDM Qa I Policy#or Self-ins.Lic.m: kVC-A _2 I-5—h 72-Ct Expiration Date:: Job Site Address: t_ /�S'�✓ �f.��✓ �/ City/Mate/Zip: C.Pn�� . ale Attach a copy of the workers' compensation policy declaration page(showing the policy number and expir tion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer#fy under the pai and penalties of perjury that the information provided above is true and correct Siertatur Date: rX Phone#• - �� e. 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#: F- AC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 12/29/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the polity,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CoBiz Insurance, Inc.-CO NAME: PHONE 1401 Lawrence St, Ste. 1200 En.303-988-0446 ac No:303-988-0804 Denver CO 80202 noDAss: COMaiI cobizinsurance.com INSU S AFFORDING COVERAGE NAIC @ INSURER A;Acadia Insurance Company 31325 INSURED ESLERCO-01 Southern New England Windows, LLC. INSURER B:Firemens Insurance Company of WA,D.C. 21784 dba Renewal by Andersen of Southern New England INSURER c:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 1252851165 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR nPOOLLIICY EFF MAOGE EXP YYYlLIMITS LTR POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/12018 1/12019 EACH OCCURRENCE $1,00D,000 GrLAIMS MADE OCCUR PREMISES Ea occurrence $300,D00 MED EXP(Any one person) $10.0m PERSONAL&ADV INJURY $1,000,0D0 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2.000,000 X POLICY JECT LOC _ PRODUCTS-COMP/OP AGG $2.000,000 OTHER $ A AUTOMOBILE LIABILITY N CPA3158728 1112018 1/1201g COMBINED SINGLE LIMIT Ea accident $1 000 OOD X ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per ac'dent $ A X UMBRELLA LIAB X OCCUR CPA3158728 1/12018 1/12019 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $10,0D0.000 DED I X IRETENTIONS 0 1 $ B WORKERS COMPENSATION VVCA3158729-20 1/12018 1/12019 X I PER OTH• AND EMPLOYERS'LIABILITY Y 1 N STATUTE ER ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERWEMBER EXCLUDED? NIA F-L EACH ACCIDENT $1,00D,D00 (Mandatory in NH) IF Yes describe under EL DISEASE-EA EM,PLOYEE $1,000.000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMB $1,000.000 C Pollution Uabddy 793OD73340000 1/12016 1/1/2D19 Each Occurrence $1,000,D00 Claims-Made Polley Aggregate S1,0D0,00D Retroactive Date 06202013 Deductible $10.000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informational Purposes AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable REGEtP! " 200 Main Street,'Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-16-3265 Date Recieved: 11/4/2016 Job Location: 54 CRESTVIEW CIRCLE,CENTERVILLE Permit For: Building-Insulation Contractor's Name: TODD LEDUC State Lic. No: CSSL-106019 Address: East Greenwich, Rl 02818 Applicant Phone: (401)965-8578 (Home)Owner's Name: CAMPBELL,LINTON&CYNTHIA Phone: (508)862-0614 (Home)Owner's Address: 54 CRESTVIEW CIRCLE, CENTERVILLE,MA 02632 Work Description: Insulation and airsealing-please'e-mail copy of permit to cindyrpepin@outlook.com _ EF Total Value Of Work To Be Performed: $4,361.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area i I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership.may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Todd Leduc 11/4/2016 (401)965=8578 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $4,301.00 Date Paid Amount Paid Check#or CC# Pay Type ..x . ..... .. Total Permit Fee: $85.00 11/4/2016 $85.00 XXXX-XXXX-XXXX-I Credit Card 1 1 8065 ....... ......... ..... _. ............................................... ............ Total Permit Fee Paid: ,$85.00 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _ Parcel. Application #6 AlHealth Division Date Issued Y' Conservation Division Goo Application Fee Planning Dept. Permit Fee <r 9 . Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation /Hyannis Project Street Address s Cl Village C- Owner --LA_ Address Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation AM Construction Type Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure I kO+/—10-5 Historic House: ❑Yes g-No On Old King's Highway: ❑Yes XNo Basement Type: 0 Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.)_ Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not inciuding 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 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑ e�is`ing ®;nevV size_ j Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # DO Current Use Proposed Use ` i CD APPLICANT INFORMATION (BUILDER OR HOMEOWNER) i 1�.�Cj�� Name `� �1� .� Telephone Number di s ° C)t S-No Address Akn_ License # C.,5m, t'� Home Improvement Contractor# 12� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO T LL SIGNATURE DATE 04 /b '�-- FOR OFFICIAL USE ONLY E APPLICATION# DATE ISSUED a MAP/PARCEL NO. ADDRESS { VILLAGE OWNER DATE OF INSPECTION: ; FOUNDATION (3)3aNas o1c �/ f FRAME IDI INSULATION'. FIREPLACE ; ELECTRICAL: ROUGH - FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 73 v : DATE,CLOSED,QUT r. ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial kcidents D,fj`ice of fnvgdgatiores ` 600 Washington Street Boston,A" 02111 t. ,. . www.mass.gov/dia. Workers' Compensation Insnrance Affidavit: Builders/Contractors/Electricians/Plmnbers Applicant Information Please Print Lepibly Name(Business/organizationandividuai):T("y—TW Address: 2610 �i1J� l��`: � ► 3 _ City/State/Zip:?C i_AC) o.1 N r 1. �-„' 0-2 hone:#: c 7` Are you an employer? Check the appropriate box: Type of project(required)::_ 1.❑ I am a employer with 4: 0 I am a general contractor and.I * h hired the stib=contractors r 6. ❑New construction . . employees(frill and/or part-time).. .. have _ _ listed�on the-attached sheet:",, 7. Remode'` U 2.K I am a'sole proprietor or partner- ] ` ship and have no employees These sub-contractors have ' to es and have workers' 8. ❑Demolition working for me m,any capacity. emp Ye . [No workers'comp.in� nce comp,ingrance$ 9: ❑Building addition required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions Officers have exercised their 3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions myself [No workers'comp. H&of exemption per MGL 12.0 Roof repairs insurance required.]t c'. 152, §1(4),and we have no . employees,[No workers' 13.❑ Other comp..n+surance required j *Any applicant that checks box#1 most also fill out'the section below showing their workers't compensation policy infarmahon Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit mdicatag such. 1contract ors that check this box must attached as additional sheet showing the name of the sub-contractors aid state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'.comp.poticynumber. I'm an employer that U providing workers'compensation insurance for my employees.`Below`is'the poluy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.# x Expiration Date:a 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 VMPX ORDER and a fine of up to$250.00 a the violator.' Be advised that a copy of this:statement may,be forwarded to the Office of Investigations of.fl,4Tjfor insurance coverage v%glitation, I do hereby ce u r th pa'' -and nald of p jury the information provided above is true and correct attse: Date: - CL Phone#: O i. Official use only.-'Do not write in this area,to be completed by city or town official f City:or Town: Permit/License#'" •Issuing Authority(circle one): rt' -Uip 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Si Contact Person: „Phone#:a IHETo'Wn'of Barnstable Regulatory Services KAM Thomas F.Geiler,Director 639 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_-- 1V�-A®T 4%- ��p����, to act-on my behalf, in all matters relative to work autliorszed by this building permit �t.Lx= (Address of Job) #Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are perfor d and accepted. t Y Signature of Owner Sigua e o Applic t { Print Name - Print Name 10 Date Q:FORMS:OWNERPERMISSIONPOOLS HE Town of Barnstable j `' Regulatory Services t k - IMMSrnare, . Thomas F.Geiler,Director ta,+g3s. $ c i�"•� Building Division Tom Perry,Building Commissioner 200 Main Street,.Hyannis,MA 02601 www.to*vn.barnstable.ma.us., Office: 508-862-4038 Fax: 5.08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village i "HOMEOWNER": name home phone# work.phone# CURRENT MAILING ADDRESS: city/town state zip code t 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 sulpervisor. 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 ' s 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 10M.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 cannotproceed against the unlicensed person as it would with a licensed - Supervisor. The homeowner acting as Supervisor is ultimately responsible. i 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 fomdcertification.for use in your community. Q:forms:homeexempt- , , V I LOT 46 13,300 sq.ft. 0.31 ac. �3�,1 g„E N81 h: ' 107.9 ' . 25• ��o��� o -\a. LOT 4 5 LOT 47 O, �z o6 .5 1 ,224•.43 $'1 .I �OF wc►u►sa+ A. %AXrM +m " - u� I CERTIFY THAT THE FOUNDATION CERTHM PIDT P LAN SHOWN HERON COMPLYS WITH THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN OF CENTERVILLE BARNSTABLE, AND IS NOT LOCATED WITHIN THE FLOODPLAIN. hjGAL& 1"=40' 1DAM JUNE 26,1 DATE: '-.2 LS. RicIPMENM LOT 46 THIS PLAN IS NOT BASED ON AN I STRUMENT PLAN BK. 505 Pc. 78 SURVEY AND THE OFFSETS SHOULD NOT BE USED TO DETERMINE LOT LINES. ��I'LC,IlId� BAYSIOE BUILDING co. I Office of"O'on�mer�lair��u`(iness. egu a"fioNP n HOME IMPROVEMENT CONTRACTOR Registration: 1,29996 Type: Expiration: 1242013 Individual TIM-THY A. MACDONALD_ ,. TIMOTHY MACDONALD 36 BONNEY BRIARDR `A g PLYMOUTH,MA 02360 Undersecretary r i Ut Massachusetts Department of Public Safety IT) Board of 8ui9din6 Regulations and Standards s Cl3nstructi,M SlipeI,%.isor - y License. CS-029853 TIMOTHY A MACDONALD .� " s 36 BONNEY-BRIA$j2360 1: ; PLYMOUW MA �• °%�..q fj3f14 expiration .commissioner 12/22/2013 i z �., � use o - ►stratton valid for mdividul my _.... ., urn to License or reg• �T�o airs n�iness egu a on before the expiration date. If found return ulation Office of"con�sume° er � u� HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Reg Type 10 Park Plaza-Suite 5170 . Registration: 129996 Individual Boston,MA 02116 Expiration: 12 gq/ 13 f - / ACDONALD _ T Y A.My TIMOTHY MACDON�ALD 36 BONNEY BRIAK1DR Not valid without signature PLYMOUTH,MA 0236Q E; Undersecretary 1 L - 4 {J7 } : _ j-"->e z 4 y 1 $ 11 I I ' 24x 017 I y I J i 11 _ . { 17-1 J ( I k __�.�� f�, _.��,, - -�� - -,- - ----,-- } � �� Ia ��. �►.:� ��Cam. ; - �.�� ��. '�+' -- - -.�.. .(_.� _�. . � __ y � _�__ • f 0 t , I , f r - _ 4--f { i t -. -- _. _ _ 4 ._ 4 _.. __., . __ _ t _.±_. - I I�_ _, Town of Barnstable *Permit# Expires 6 "ifffroq,is uedate °r Regulatory Services : Fee BARMABIX � 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 PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address C-A ��►{�� 6 Residential Value of Work © --j Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name O-T�� G �O^l.� Telephone Number y\ Home Improvement Contractor License#(if applicable) L�99 Construction Supervisor's License#(if applicable) �� ❑Workman's Compensation Insurance t` P P Chec one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance OF BARNSTABLE 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 ❑ke-roof(hurricane nailed)(not stripping. Going over existing layers of roofl ❑ Re-side #of doors '� Replacement Windows/doors/sliders.U-Value 2 y (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: erty Owner must sign Property Owner Letter of Permission. A py of the. me Impr a nt Contractors License&Construction Supervisors License is r uire . SIGNATURE: C:\Users\decollik\AppData\Local\Mi rosoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\E)PRESS.doc Revised 072110 n, ti 77te Conrnronstrealth of Massachusetts Deparnnent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 . ft��nr•.nrassgov/�l'in Workers' Compensation Insurance Affidavit: Builders/Contractors/Electiiicians/Plnmbers Applicant Information Please Print Legibly Name musinesvorgmizatiowIndividual): Address. T � 1 City/State/Zip: 1'A -bS Phone 4: Are you an employer?Clheck the appropriate boa: Type of project(required): 1.❑ I am a employer with 4• ❑ I am a general contractor and I r * 6. ❑Neu construction loyees(full and/or have hired the sub-contractors 2.9PIM a sole proprietor or partner- listed on the attached sheet. 7- VRemodeling ship and have no employees Theme sub-contractors have S. El Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp-inaurance.j 9- Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per NMGL 12.0 Roof repairs insurance required.]5 c. 152,§1(4),and we have no employees-[No workers' 131D Other comp.insurance required.] •Any applicant that checks box#1 m=also fill out the section below*showing their workers`compensation policy information. I Homenvaers who subunit this affidavit indicating they are doing all wank and then hue out--ide contractors must submit a new affidavit indicating such =Contractors that check this box must attached an additiont sheet shorting the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must pmadde their workers'comp.policy number. lam an etnpio}wr that is proViding workers'compensation inuirance for niy employves. Below is file policy mid 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. 1.52 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 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 DIA for insurance coverage verification. I do hereby c. under t e pail and rallies 't that the information provided above is byte and correct Si Date: l7 �O 3 N N Phone#: SD) ' 1 Z4,6 Official use only. Do not mite in this area,to be completer)by city or torcrr official, City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i R i NAM Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, .Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder C bN ! ,as Owner of the subject property hereby authorize 1 t.�o i�-1`� "A� I n:,A to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) -3-�� Signature of Owner Date Print Name if Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Locai\Microsoft\Windows\Temporary Internet Files\Content.Outtook\DDV87AAZ\FXPRESS.doc Revised 072110 Massacnuscrts- ucparimcnt or ruonc -mtm Board of Buildin!-.Rc-ulations and Standards Construction Supervisor' License' License: CS 29853.. Restricted to: 00 "' h TIMOTHY A MACDONALD 36 BONNEY BRIAR DR y . PL-YMOUTH, MA 02360 a. Expiration: 12/22/201 t ('ununissionci' Tr#. ''13192: 9 Licedse or registration valid for individul use only. Office of Consumer Affairs a&c Business Regulahon r; before the expiration date. If.found return to: x HOME IMPROVEMENT CONTRACTOR• Office of Consumer Affairs and Business Regulation . Registration 129996 10 Park Plaza_Suite 5170 Expiration r12/972011 Tr#. 291511 F_ Boston;MA 0211E TYPe irJr-Individual TIMOTHY A MACDONAL TIMOTHY MACDONALD - �7 36 BONNEY BRIAR DR" '_ i i PLYMOUTH, MA._02360ti Undersecretary N vale without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel©t7/ Permit# JHealth Division J � Date Issued y,AID� �v I onse �LOI,U Fee VTax Collector + ` SYSfEM MUST ireasure( INSTALLED IN COMPLIANCE • WITH TITLE 5 Planning.D,ept. ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board UfUlONS Historic-OKH Preservation/Hyannis Project Street Address ` . Village Owner ,lr�� � �/��`�Address Telephone R<;,� .Z <—./41 Permit Request `213�_, 1 ;�;)x� Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost 3 0`clln� Zoning Districts Flood Plain — Groundwater Overlay Construction Type 10� Lot Size � Grandfathere El Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family 1 Two Family ❑ Multi-Family(#units) Age of Existing Structure—'a /,s Historic House: ❑Yes L No On Old King's Highway: ❑Yes ❑ I*65 Basement Type: [Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 3 5` Z Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z. new Half: existing c new <�5 Number of Bedrooms: existingJ new Total Room Count(not including baths): existing,,, new y First Floor Room Count Heat Type and Fuel: 06as ❑Oil ❑Electric ❑Other Central Air: 2 es ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes' U�o Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:❑existing ❑new size Attached garage:O4�isting ❑new size v Shed:❑existing Cl new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use Sc v c, BUILDER INFORMATION Name ell Telephone NumberG z c Address_ c% C7� - l cc,l CiLeX- License# Home Improvement Contractor# Worker's Compensation# < 1�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE l { FOR OFFICIAL USE ONLY wt • ` yr12, PERMIT.NO. _ - (J� s . DATE ISSUED MAP/PARCEL NO.'qt ADDRESS VILLAGE � OWNER �' - i • .. " • DATE OF INSPECTIO FOUNDATION FRAME LOP INSULATION FIREPLACE I I g-co 14 q gre " ` ELECTRICAL: ROUGH FINAL• I PLUMBING: ROUGH, FINAL GAS: ROUGH'' FINAL FINAL BUILDING DATE CLOSED-OUT n ASSOCIATION PLAN NO.-,., 1_&49 6 r� E LINTON CAMPBELL 54 CRESTVIEW CIRCLE CENTERVILLE, MA 02632 862-0614 BASEMENT ROOM FLOOR PLAN i AND- -SPECIFICATIONS a • _ E 1205- If 4 co I I C i d j I d . � I 1 E r 1 1 � I � � I i i• , � � — tj - z _ Working Specifications Framm • Partition Walls— 2 x 4" KD spruce 16" OC • Attached framing detail-for gas fireplace, Doors j • Six panel "Masonite" .6`6"x Y-0 • Bifold 4`-0 door at sewing room Ceiling a • Armstrong suspended T-finished height Walls . • 3l8 gypsum-wall board Trim Moldin • 2 1/2" colonial casing Insulation A • Partition walls 3 1/2" faced fiberglass_R-11 • Ceiling (existing) - 6" fiberglass R-19 Heating_("A on plank • Lennox DT/DTH3530 Direct vent gas fireplace A.F.U.E. rated-high efficiency. . To-be-installed-by South Shore:Heating and`CoQling, Inc., S. Yarmouth, MA Electrical -s Existing 200 amp service-panel • Two—20 amp circuits for finished:area;#�1.2 wire gauge, -Plumbing_ �p None FRAMING REQUIREMENTS - INCHES (MM) REAR VENT MODELS TOP VENT MODELS 10-1/2(267) NOTE-Combustible wall NOTE•Combus- x: board can be installed flush with edges of appliance. tible wall board can be installed flush with edges 7 of appliance. (178) .1: 12 e! A 00 (305) A 16-1/2 l (419) A •B C Model No. Model No. A B Inches mm inches mm Inches mm in mm in mm DR/DRH3025 33-1/4 845 30-1/4 768 18-1/4 464 DT/DTH3025 33-1/4 845 30-1/4 768 DR/DRH3530 35-1/4 895 35-1/4 895 20-1/4 514 ✓ 6T/DTH3530 35-1/4 895 35-1/4 895 DR/DRH4035 40-1/4 102 4 1022 25-1/4 641 DT/DTH4035 40-1/4 1022 40-1/4 1022 DR4540 40-1/4 1022 45-1/4 1146 25-1/4 2641 DT4540 40-1/4 1022 45-1/4 1146 i CORNER INSTALLATIONS- REAR VENT MODELS CORNER INSTALLATIONS-TOP VENT MODELS D C E O �. L .: f A A B Span accommodates depth of unit in corner installations. Model No. A B C D E Model No. A DR/DRH3025 30-1/8 56-3116 39-3/4 12-7/8 28-1/8 DT/DTH3025 53(1346) (765) (1427) (1009) (328) (714) DR/DRH3530 30-1/8 56-3116 39-3/4 12-7/8 28-1/8 DT/DTH3530 58(1473) (765) (1427) (1009) (328) (714) DT/DTH4035 63(1600) rDR/DRH4035 35-1/8 f 60-1/8 42-1/2 14-7/8 30 ` (892) 1 (1527) (1080) (376) (762) DT4540 68(1727) /) NOTE—Comer installation requires use of a single 45 elbow and rectangular ter- mination.No vertical rise.Horizontal vent length must not exceed 28 in.(711 mm). a MERIT/Page 6 I► The Town of Barnstable - � •�axarw� Department of Health Safety and Environmental Services Building Division ` 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition, or construction'of an addition to any pre-existing owner-occupied building containing at least.one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,,along with other requirements. / Type of Work: G sus �-'jz 7f" Co,w s Estimated Cost ' Address of Work: e_—47`l/�� Owner's Name: fh Date of Application: I hereby certify that: Registration is not required for the following reason(s): ' Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. R � / Date Owner's ame q:forms:Affidav The Commonwealth of Massachusetts -=� Department of Industrial Accidents ''` Office of/nyesmostions 600 Washington Street Boston Mass. 02111 ///"`��� /"//��•�" / Workers'/// � %% sarion Insurance Affidavit `f'Y////%��%%%O////%//////�/////�� �/ //i / ,• // / / name: /,01 x�:141e- location: city i r 7�l�z- vi Ile, 2— hone# ��/ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in anv ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. compnnv name: - address: _... city phone#: insurance co. olicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the follo«ing workers' compensation polices: companv name: address: city phone#r _.... insurance co. _. . olicv#. companv name: address. city. phone#: ........;:<.;.. insurance co. _- olicv# :... . . ....... .. % / / / ///%%%///r. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 and/or one years'Imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify un r the pains and penalties o 'ury that the information provided above is true and correct Signature Date Prmt name /ems >`�.✓-� [�Ca f ��l�! Phone# a MEN Lwntact nly do not write to this area to be completed by city or town otIIt3af permit/license# ❑Building Department ❑Licensing Board it response is required ❑Selectmen's Office ❑Health Department n: phone tF ❑Other (mma 9i95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th=* employees. As quoted from the "law", an employee is defined as every person in the service of another under any cow 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 receive: trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewa: of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`law"or if you .are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of invesugauens 600 Washington Street Boston-,' Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext 406, 409 or 375 THE o Department of Health Safety and Environmental Services Building Division KAS& 367 Main Street,Hyannis MA 02601 esa 1639. � Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print DATE: /_ ' JOB LOCATION: .541 number //' /street village "HOMEOWNER": �/l2'7' �i rGil�Z d/el( U e,- /� name II home phone# work phone# CURRENT MAILING ADDRESS: /z2t�c>UC% 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. sigdature of Homeown Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:FORMS:F� TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 000 000 055 GEOBASE ID [ ADDRESS 54 CRESTVIEW CIRCLE PHONE (508)771-1040� CENTERVILLE, MA ZIP 02632— LOT 46 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT PERMIT 18304 DESCRIPTION SINGLE FAMILY DWELLING (PMT.#15606) PERMIT TYPE- BC00 TITLE CERTIFICATE OF OQCUPANCY CONTRACTAS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: i BOND $.00 px THE CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY a * HARNSTABLE. � MAW OWNER BAYSIDE BUILDING, INC. , 1639. A� ADDRESS Fpl P.0.BOX 95 BUILDING DIV/�SS/ ' CENTERV I LLE, MA BY DATE ISSUED 10/01/1996) EXPIRATION DATE ., TOWN OF BARNSTABLE . BUILDING PERMIT ARCEL ID 000 000 055 GEOBASE ID DDRESS 54 CGRESTVIEW CIRCLE PHONE (508)771-1040 CENTERVILLE, MA ZIP 02632- T 46 BLOCK LOT SIZE A DEVELOPMENT DISTRICT RMIT 15606 DESCRIPTION SINGLE FAMILY DWELLING (SEW.PMT.095-617) RMIT TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT NTRACTORS: BAYSIDE BUILDING, INC Department of Health, Safety CHITECTS: and Environmental Services TAL FEES: $318.49 �ZME ND $_00 NSTRUCTION COSTS $102,740.00 101 SINGLE FAM HOME DETACHED 1 PRIVATE P A ; ABLE. MASS. ER BAYSIDE BUILDING, INC. , i639. h� DDRESS P.0.BOX 95 . BUILD ON CENTERVILLE, MA B�, DATE ISSUED 06/04/1996 EXPIRATION DATE HIS PERMIT CONVEYS NO RIGHT TO OCCUPY Ah REET,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 LLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHIS 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 M FOR (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. CH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. POST'THIS CARU SO IT ISIVISIBLE FROM STREET' BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 L 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED U IL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. 00 000-0 Assessor's Office(1st floor) Mpaa r Lot Permit# _Is-(,Of., Conservation Office Oth floor '\ al °I Date Issued —4 i _ I 1 Board of Health Ord floor 1 'Engineering Dent. Ord floor) House# !%1S °R � ' Planning Dept. 1st floor/School Admin.Bldg.): US Definitive Plan Approved by Planning Board A lica ns rocessed 8:30-9:30 a.m.& 1:00-2:00 .m. Z6 a e/ Py 'IRON MENTAL ii *2 AND 0 REGULATIONS TOWN OF BARNSTAB � Building Permit Application Project Street Address 6-q r Village Fire District _ //-I Ouner M696 Address Telephone -7 -71 [7 Permit o 1'Re uest: ��� LA, WW '7 7 a �o �.PJ .A-u�il P .O�,r,�-�-�r Zoning District C _ Flood Plain Water Protection W-P Lot Size 1 Grandfathered Zoning Board of ApMls Authorization Recorded Current Use ® � Pro sed Use Construction T 6/ Existing Information Dwelling T Single Family Two family Multi-family Age of structure Basement type OPVL't� Historic House Finished Old Kings Highway �- Unfinished V111, Number of Baths oZ No. of Bedrooms 3 Total Room Count(not including baths),, 42 First Floor Heat Type and Fuel U)OU141 G�1 -Jed Central Air !lQ Fireplaces 1 Garage: Detached Other Detached Structures: Pool Attached 2 Barn None Sheds Other Builder Information Namc ! �� Tele hone number Address License# OOS6 Home Improvement Contractor# Worker's Compensation # WC ( -3 12- Z-2-0 17 $ d 13 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �&4 Project Cost _— 1�!0 8 xSS x c oa 3l Fee � 3 SIGNA BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T FOR OFFICE USE ONLY ADDRESS VII.LAGE OWNER f DATE OF INSPECTION:- - FOUNDATION FRAM INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL , ~ GAS: ROUGH FINAL / f o0 T� v FIN b I AL BUILDIN 0 f } 5.ymi. f a' t f f DATE CLOSED ASSOCIATE PI.AIV146ti } I LOT 46 13,300 sq.ft. 0.31 ac. NaI.30"9"E -1 �0/ .9a, N 76 a .\ 0 5 p` ��\NG LOT 45 2 LOT 47 0 .� 1 � 6 55 224,4 I R � OF g A. - M aw. - I CERTIFY THAT THE FOUNDATION CERTIFIED PILDT PLAN SHOWN HERON COMPLYS WITH. THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN OF WCATMN CENTERVILLE BARNSTABLE, AND IS NOT LOCATED WITHIN THE FLOODPLAIN. ,fAL&1"=40'D A , JUNE 26,199 DATE: �'7Fo�9 C, v0 .L.S. PLAN Rlc w0a NCE LOT 46 THIS PLAN IS NOT BASED ON AN i STRUMENT PLAN BK. 505 PG. 78 SURVEY AND THE OFFSETS SHOULD NOT BE USED TO DETERMINE LOT LINES. APPLICANT: BAYSIDE BUILDING CO. INC. M— SUI�JGL-r- - iT- 1 � I, U _ - .y CtnPP�oec�=I f i=,� -f EotJT I -- f� I I1 I I ji I I� Ulf !� . 1 I i I' - I I i / / A»HALT"1-�Jf•-Ss-:t�+GLES�.' i 73 I � � � I -rjAYSip� e Cr NTc P,J 1 l.-1 w*e D-C 9 ! ��15P.HALT goof SHIniG�`S �" .. �� i I 21-1 � I I Iai 7I - --2EOR'-r��=ul. - 59 5a x G-7 1454 ' Lc+5 i �7• �2�t.>'B3J 0 �ILA-la'LS Toi — — _- � — — -g2KF5T 1.1001'. �M1v •41� et I 1 1 .. r I: � vpu L.T c 17 •38'�z K;t93 �8`c�r'93 I 1 t r - - - -� I m1A IL r: Fl-Ac10 FIY6f) I VPVCTZf) i I t 4' 4'• I I i I t'- I o•• Is`. g•• 14•.2•• i I ow 1 i J IZAY CGILI�G) O O �`� I i N I����TRE OT 2001h to I U I I I I Ilo — J I I .:rL1T G4 r� I N 4 9��' l l °I r � •� � •I Iv 1`4 - tl I N � ml I 0 If I mi �! II —•a• �i l0'�l0' li IJI l'•Z'- v' _C—. 11'•8•• is � 8�Q� 1 - IG n I I � I m beoru^ _ 6t.1C•IN.0 I.IejCT l I I V —� 1 61 2454�4 To cH:,{;—o2 {.1 GlF-110U2 r7Cao lz 0� Y l L /¢- ( Z S z" 22'- o'• s•-c.- I �•_�- -I '�`-¢ 14'•4.. .. �,_3. I �,_3.. --I--- . ...--• ------------- ---.._—�------'---._ tee._._-. . ..._ ..- i• - I I 9 urE a cl h- CONC2E.TE 5t-Av> �pcTG^ 't-- TO 00o2 j � I ! - IS/s Fc.SNEET2ou� o I 1 AS'r o.H._rJ oorL - + CONC2. 4P2o�4 su�e1/4'=1'•c F 5 G'-o•. Lb I. I �' � o Q ➢ ,o A a �l• r Q �' � I 0 �l Q � � ..I .. L 3�'4 , � -,3�� .__...?.• 3 ,..I_. ..._ .. ,�9-- ��• 3 v 1 , i � 'JG• (3) 2xlo3r—. L -� l' P GOL1J/n Ns .2-4' Y24'X is, rcuTiNbr N; Lp z -- I L 4,o.I I j IP 61 - I� � I I I • L., `j 6 I 9 6• I I • I IZIOGE VE1-1T (LIoGE PLANK. /AASTE2 o5EORoo+n_-1jrGKFSZ. - ��'�•p L•T A�ASpN4ts S:-•tINGt_�.^S - 2%-O ((a"-- \� - /�'• COX (Owr SGa ELYTµ lNG 7F ,! .UG:JLIT^_-f> I It I I !' � l II lI ' I.i,�- r�:,' 2..8 d/6" - 1: i.'� \ I (• If ��, i .%Ioof> FUMM,JG @ ICo-OG• I"-COLA"TE cL-%O CEILI CG =11! 6" f 7 I jl Lplo-REG�ac +I _A�u/n Gu Q j Y• - _r/ AASTEI` 07f1 C S(r,, .I,ENTINC� _. :c,G VL. ' 11 �'��Il li : 1 ( 1I: J .2�?I�'�".t� pLJ\..lT to\C_ � I .t.pT-•`�'.--_ . I L 1 ' 17 r' \,Jaon 1 tJ2r"'i (G•. r { N III II@ j �. Imo/ '/2" $t•tE=TROCX � �� C7 -1 dam:-- ��I G iEXTE IL S�u S -5 14-7 cl I i II, 2X G ( 131Ze V L t I T i C Alt j �I 0Y S T11 rN - ' h ; I• if � � _ SGG �,?Au/in 2S 1. a � � •Slo lr.cG- ovE � TYLICG. �_ J CLAP P o I n oS FRcgNI: II N d .Sa1rJbLE SrDEzta tZ6A2 !I `Q{ FINISH_ rLQ7rT. II r 4 '_ I II I, 5/9a FLY 5U05 FLcorz. I � •.2+r U To -,00rr :I!I 1 it t - r. �� '2k 10 �16•- - --- :I A :'.6.:v i: ...L..I—m r•Y f G 1CTQ SILL SI..c. =p�n�AGr' G2AUGL I -AtiCNpr y O 0' O, ILL i v I 3 � '•o I I p11Jlf•)v I' '�So�d rZ A - _ - n Lnn 1�_r4• E5 r71.. DUI L.o I t.1 Cs Co tNc _GEN j I-WtLLE /A-5e �ECr/O/J ��; A/L lJ scut: "m DEc- 94- au J •rY* ' ,� ��e a»rnra�uuealC� c�✓f�auac�useCCt r DEPARTK HT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Taber: Expires: Restricted To: H BRIAR T DACBY 62 FERNBROOK LN CBHTBRVILLE MA e2632 COMMONWEALTH OF MASSACHUSETTS DEj`AFU-,,vENZ' OF LNDUSTRIAL ACCIDE.'vTS 600 WASHINGTON ST= BOSTON, MASSACHUSE'I IS 02111 James Car-100el: ;ornr.,!ssrone• WORKERS' COMPENSATION INSURANCE AFFIDAVIT 16 / � I, . _ (licenscdpermiaee). ' with z principal place of business/residence at: Uc2 6 3 (CstylsrsrCIMP) do hereby certify, under the pains and penalties of perjury,that. [J I am an employer providing the following workers' compensation coverage for my emplovccs working on this job. I-7Y D1 Insurance Company Policy Number (� 1 am a sole proprietor and have no one working for me. ( J 1 am a sole proprietor. ncnl eontmaor r homeowner(circle one)and have hived the contractors listed below who have the following woe z compensation insurance policies: Name of Contractor Insurance Company/Poliry Number Dame of Conrncor Insurance Company/Poliry Number Dame of Conir2c:or Insurance Company/Policy Number Q 1 am a homeowner performing all the work myself. NOT1 .Mew be aware tsst wbilc bomeowncn w6c empiov persons to do maintenance, construction or repair work on a dv,r;iint of not more tD= tnrec units In w wi]Icn the homeoner also resiori or on the Frounds appurtenant wcrrto arc QOI[rOerZI1.' eonsioerrd to be cr_movcn undrr the Q'orxcn' Comaensauon Aa (C' C 152.sect- 1(5)). application by a homeowner fvr a license or permtt may e"Cience Lite ieE31 sums of am empiover under we Workcn' Compensation Act ) understand that : copy of this sett. cnt will be for-arced to the Ikourttent oFIndustria.)Accidents' Office of InsuranQ for mar wr:.'i=-ton an.- -.12: failure to sccure ev.•cras:c as nxuircc undo: Seeoon :5A of VIGL 15= can leac to the imposition of cr-=inL W-2J s eenstsnnt; of: line or ue to S1500.00 and/or 1mprioa=.c.t of up to one Y and ci%ii pen aieies in the form of a Stop Qio-K Ordc and a fine of S100.C.0 a cav a€Lns- mt. J � � f SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W) COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID'S REMODELING: (L) COMMERCIAL UNION - NB F821442 DAVID BIK: (L) MERCHANTS INS GRP- 8CM0278579150 (W) TRAVELERS - 176K337-8-94 OAK INSTALLER: ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652 PAINTING: CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF (W) AMERICAN POLICY - WCC 186604 ROUSSEAU, AL (L) MERCHANTS MUTUAL - 8CM0278570179 (W) EASTERN CASUALTY - ??? GARAGE DOORS: ALL CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301 (W) COMMERCIAL UNION - CBH573757 STORMS & GUTTERS: ALUMINUM PRODUCTS: (L) AETNA MPOO21014146 (W) AETNA - JC89258880 OAK FINISHER: AMERICAN FLOORS: (L) TRAVELERS - 680 342W754-0 CARPET, VINYL & TILE: CARPET BARN: (L) VERMONT MUTUAL - SBP6507393 (W) PHOENIX INS. - 6NUB476J652794 WIRE SHELVING: CAPE COD CLOSETS: (L) U S F & G - BSC146983441 APPLIANCES: KITCHEN APP.L MART: (L) FIREMENS FUND - AZC80453098 (W) HARTFORD INS CO - 77WZNB1603 MIRRORS & SHOWER DOORS: L & M GLASS: (L) COMMERCIAL UNION - CBR409003 (W) U S F & G - 0071439933 LANDSCAPE & SPRINKLER: COY'S BROOK: (L) COMMERCIAL UNION - ABR345850 (W) CIGNA COMPANIES - C41138178 DRIVEWAYS: NORTHERN SEALCOAT: (L) MARYLAND CASUALTY- EPA18716945 (W) THE PHOENIX - UB387K530 f SUBCONTRACTOR'S INSURANCE ENGINEEER: BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866 (W) LIBERTY MUTUAL - WC1312595563023 EXCAVATION & SEPTIC: DRISCOLL, JJ: (L) U S F & G - HGL 110093 (W) U S F & G - 7708711936 FOUNDATION: BAYSIDE FOUNDATIONS: (L) COMMERCIAL UNION - ABR406267 (W) LIBERTY MUTUAL - WC1312201785044 WELLS: DENNIS SCANNELL (L) TRAVELERS - 660873E5627COF92 (W) WAUSAU - 151300062926 CELLAR/GARAGE FLOORS: MICHAEL BROWN: (L) AETNA - MP0023672849 FRAMERS: ROBERT DORRER: (L) TRAVELERS - W680526K991TIA9 (W) AETNA - 006C0023972416C MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL - WC1312492127024 ROOFER & SIDEWALL: JOHN MEE: (L) AMERICAN STATES - 01CD1486783 (W) TRAVELERS - 6NUB448K275894 MASON: SHERMAN, WAYNE: (L) COMMERCE INS CO - N60689 (W) WAUSAU INS - TO BE ASSIGNED ELECTRICIAN: CHAVES ELECTRIC: (L) HANOVER INS. - LHN2964649 (W) MISCELLANEOUS INS CO. - 0708878 91 1 PLUMB & HEAT: WHITELY PLUMBING: (L) TRAVELERS - 660365K1782COF9 (W) EASTERN CASUALTY - POLICY IN MAIL ALARM SYSTEM: BALTIC SECURITY: (L) FIRST FINANCIAL - FF0131 G400831 (W) COMMERCIAL UNION - CB0743379 CENTRAL VAC: VACUUM HOUSE: MERRIMACK MUTUAL - SBP1608045 INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 (W) U S F & G - 7711099932 SI�lGc .F-wtL`{ .3 i3Ev'ti?a mj, .. - �10 l>AtZF3AC�E G1?►IJ�E� - o��N 'PA►��( FLoW jSEpi I c TANV. 336 :xlso�• 5 G -_y -- ---- G� sow lei (000 GAL. _ DlSPoSAI pIT 1- LapD GAL ALA STZNG_ - 51 D E WA LL AReA l Pig 5t'X 2,$ 807om' AaaA -7a sF Dw�Tu�uJ� TOrA L VA I�Y F'L-0}�/.= 3*30 6iD /. tom. no TS2 e)"_ t oN OA;(•E _ � 1 u UIQ/LESS �o_ � l I ak 4S � o o ( F17- io 8AXr�4 TEH a SULI."d; Nazwo t - :TES T' 17-.zy 14- �7 . 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