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Home My WebLink About0067 CRESTVIEW CIRCLE 4 Il fi a. A a f�`i its � Y h f ,kM'+'_ .d x'!Fr , t � I da � } .�r k h kIF9 1 rvLYlu Fr. �1�1. .n+a _ r .. "t �s.'rj. �. ;'", .: .s.— „,p.n, r ri" .r. <ry, �, r fi"" q. :+., ,:»4 n:x,µ :.ip'°'•!i" ,;da; :�, y „ ,;.: !! 'lFy' '4l .i7d,�;', i •: c .x ,..- 1 dr, . .5' _: _i. :, f/ �k rx•..i,Ry, ae2n• � .1: ,1��P�,�Y'+'r,, iti-�: '�y 'n, a d elf..+:, L Fo. r 'e��.� �: :d}�Y�'�,. #Ntrii N,. •.i.,�', •f�� J'k„:. 'I.:�'h'-"�. , 4.,� v' ,y�.: .i:a�' �. :�. % ,rf? :r:. �i. w ' '�s}�� •r�� ,�•P",t�,apt, .�,a., J.i ,�;y S'�,,,,,,,..� �s1;: '1y�.,<F�,i �, �Y� yj .�4 ,,:r' �a� 4 v, 3.u, .� ';r, �..;� xF`.� P ;�,;,.r ntrv. �,r ,i•1,... a.,.n.^��.,-f'., �„ ,� It:�. '�t1`'MYh�� ,K"��q` j��''rya;A �.4 ;;"r �°f.�:,r� �� `�;','yn ,i�� ,. �..,J` "4r r�j�'q�!.�•r,'"' - .. `I:t ;a*.il� .4 rfl'.i0,hr'sr�"r fi f•.:� s+ ,. .. i'.. ! Kul, o- , 4 rx: . t t .F i !i •v. OWN A. fi s f.t� { py ; a , Ir r Town of Barnstable ' L.1 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-2039 Date Recieved; 6/29/2017 Job Location: 67 CRESTVIEW CIRCLE,CENTERVILLE Permit For: Building-Insulation-Residential Contractor's Name: TODD LEDUC State Lic. No: CSSL-106019. Address: East Greenwich, R1 02818 Applicant Phone: '(401) 965-8578 (Home)Owner's Name: RIMER,HYMIE&ANGELA Phone: (508)771-9636 (Home)Owner's Address: 67 CRESTVIEW CIRCLE, CENTERVILLE,MA 02632 Work Description: Air sealing and insulation of attic flat and kneewalls. rn Total Value Of Work To Be Performed: $3,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area 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 6/29/2017 (401)965-8578 Applicant pate Telephone No. Estimated Construction Costs/Permit Fees ' Total Project Cost: $3,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 6/29/201T $85.00 7XOC-XXXX-XXXX- Credit Card 8065 Total Permit Fee Paid: $85.00 01 '(11VISS �Wm 1 Town of Barnstable Expires 6 months from issue date Regulatory Services Fee w snaxsrABLE, 9� 1 $ Richard V.Scali,Director ArED��p 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 (' Got Valid without Red X-Press Imprint Map/parcel Number � /J a (70 � 9 Property Address al residential Value of Work$ ,� Minimum fee of$35.00 for work under$6000.00 nn a Owner's Name&Address �t p�£ �1/ct, /4 M<it. �f ('✓�S� lrl 4p,,ve Contractor's Name c Fay „Ne, Telephone Number Home Improvement Contractor License#(if applicable) /51:f Email: Construction Supervisor's License#(if applicable) orkman's Compensation Insurance S r R IB' Check one: ❑ I am a sole proprietor f MAY 27 2014 ❑ I am the Homeowner RTfave Worker's Compensation Insurance Insurance Company Name 17�,tn m !` / r, ® BARN WN STABLE Workman's Comp. Policy# Gib sir Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(aheck box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 01rv�/ /tW,6u Z ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side replacement Windows/doors/sliders.U-Value (maximum.35)#of windows—z6— #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 required. i SIGNATURE: Q:\WPFILES\FORMS\building permit form XPRESS.doc Revised 061313 i 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): Address: 6 0 Rom; City/State/Zip: ,/k AN j.2 Phone#: Are you an employer?Check the app6priate box: Type of project(required): LLE 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.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y p h'� 9. ❑Building addition i [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.0 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�of 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: F��-_ );;,,Ml Policy#or Self-ins.Lic.#: l!Aw 6V 2Sd/ Expiration Date: Job Site Address: City/State/Zip: e;l Attach a copy of the workers' compensation policy declaration page(showing the policy num er and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pat and penalties of perjury that the information provided above is true and correct. Signature: Date: ` Phone#: Oc? 17ya 163f' _ 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#: • AC 0® DATE(MMIDDIYYYY) � CERTIFICATE OF LIABILITY INSURANCE 10/07/2013 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 INWRER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Debbie FAX Mark Sylvia Insurance Agency,LLC PHONE 404 Main Street E-MAIL o 508 957-2125 A/c No): 508 957-2781 MAIL ADDRESS:mark@marksylviainsurance.com Centerville,MA 02632 INSURE S AFFORDING COVERAGE NAIC q INSURER A:Farm Family Casualty Insurance ' INSURED INSURER B: D&T Construction,Inc. INSURER C PO BOX 168 Centerville,MA 02632-0168 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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 I TYPE OF INSURANCE ADDL SUER POLICPOLICY NUMBER MMIDDY EFF MPM POLICY EXP LIMITS LTR A GENERAL LIABILITY 20OIX0485 7/21/2013 7/21/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE (R TED PREMISESS Ea occurrence) $ 50,000 CLAIMS-MADE ❑X OCCUR MED EXP(Any one person) $ 5,000 li PERSONAL&ADV INJURY $ Included GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP16P AGG $ 2,000,000 X POLICY PRO cT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS raccident) $ UMBRELLA UAB HOCCUR EACH OCCURRENCE $ EEXCESS L.IAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ A WORKERS COMPENSATION 2001 W7501 7/25/2013 7/25/2014 WC STATU- X OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED9 N I A (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORb 101,Additional Remarks Schedule,if more space is required) Carpentry The workers compensation does not provide coverage for Troy A Thomas and Shawn M Doyle: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE D&T Construction Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 168 ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD C��ie.�powvnaoouueaCC�o�C�cr�taac�cateCY�J- T _.,___ .. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ egistration: 145954 Type: Office;of Consumer Affairs and Business Regulation xpiration 3/15/2015_ Private Corporation 10 Park Plaza-Suite 5170 DOYLE+THOMAS CONST INC r Boston,MA 02116 TROY THOMAS 499 NOTTINGHAM CENTERVILLE, MA 02632` - Undersecretary N t v lid without signature Massachusetts _ Department of Public Safety Board of Building Regulations and Standards Construction Supervisor..Specialt� License: CSSL-�099913 TROY A THOMgc 499 NOT TTNG CENTERVH,LE J �41A 10 Commissioner' Expiration 04/13/2016 506-326-1635 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyleandthomasconstruction.com P.O. BOX 168 Bea CENTERVILLE, MA 02632. Fully Licensed & Insured Construction Supervisor Lic# 99913 Doyle and Thomas Inc. Proposes to perform the following work: Location of proposed work: Mr. & Mrs. Rimer 67 Crestview Lane Barnstable, MA 02630 Date on which construction should begin: May 2014 ' The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the.existing structure which must be. repaired,creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of completion may differ,and that such variation.is not to be considered a violation of this contract. The total cost for labor and materials under this contract: $19,989.45 Proposal to install 14.Ultrex Integrity by Marvin windows in openings as discussed Proposal to install 2 Marvin Clad windows in kitchen areas as discussed Thank. You For Giving Us The Opportunity To Help You Improve Your Home -Remove 16 windows in the home and install with Marvin windows -Interior wood trim to match existing trim in the home ready for paint -Exterior Azek PVC trim to be installed ready for paint -A 5 yard dump trailer will be needed on site and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BYLAW With the agreement of the contract 1/2 of estimate total is due. Further payments under this contract are as follows: 1/4 of the estimate due at the start; and remainder will be due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this.contract. Payment as agreed upon shall be made when due. Any payments which are . delayed shall be subject to a finance charge of 1.5%per month: The contractor warranties the work completed under this contract for a period.of one year from the date of completion. During the stated warranty,period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor.shall be passed directly to the homeowner. The homeowner may required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall 'be at the discretion of the contractor. The homeowner acknowledges that the form, content, and notices contained in this. contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A; and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder-of this contract shall be in full force effect. In addition, any such portion not in compliance shall be read and interpreted so as to have its intended meaning to,the maximum extent allowed under,such law and regulation. Signed as a sealed instrument on this date: Date: �. Homeowner Contractor I/e 0 s o . 50 -323®1635 SPECIALIZING IN ALL FORMS OF ROOFING & SIDING doyleandthomasconstruction.com RO. BOX 168 sBB: CENTERVILLE, MA 02632 Fully Licensed & Insured a Construction Supervisor Lic# 99913 Doyle and Thomas Inc. Proposes to perform the following work: Location of proposed work: Mr. & Mrs. Rimer 67 Crestview Lane Barnstable, MA 02630 Date on which construction should begin: Late Spring 2014 The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that cannot be avoided by the contractor shall not be considered as a.violation of this contract. The contractor agrees that when such delays become known to the contractor,the contractor will advise the homeowner as soon as possible. The homeowner, hereby acknowledges that in certain remodeling work,the demolition process may reveal defects in the existing structure which must be repaired,.creating additional work which may need to be carried out in order to complete the work described in this contract. In such case the homeowner agrees that the duration of the work and the schedule date of.completion may differ,and that such variation is not to be considered a violation of this contract. The total cost for labor and materials under this contract: $ 14,4641.55 30 yr. GAF/Elk Timberline HD.Architectural shingle(Life Time Limited Warranty) In the event that while stripping the roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$45.00 for a carpenter and$30..00 for a carpenters laborer, plus the cost of materials. Thank You For Givinq Us The ODDortunitv'To Help You Improve Your Home - -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier, Synthetic roof underlayment, and installed with Timberline architectural shingles using galvanized nails. (Storm nailed) -All new 8 " drip edge and pipe flanges to be installed -Cobra ridge vent to be installed on all ridges -Timberetex premium ridge cap to be installed -A 5 yard dump trailer will be needed on site;and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of.the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are. delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse, and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form, content, and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A- and regulations promulgated there under. In the event of any instance of non-compliance, only such portion shall be invalid and the remainder of this contract shall.be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent.allowed under such law and regulation. Signed as a sealed instrument on this date: . Date: Homeowners Contractor. I t. ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �o-13b3 .3 Map Parcel r � Application # Health Division Date Issued 1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board (20�lylr3 Historic -'OKH Preservation/ Hyannis Project Street Address Village M21/ld�. L Owner -1,4 i i� /e(..5 ryel Address G � � ,�� 61le 6vzeour Telephone /S 3/ Permit Request CY. t5 j�V � B47219040,411 `1—i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,�� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family r' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kira' Highwy: ❑4s ❑ No w c) Basement Type: U Full ❑ Crawl ❑Walkout ❑ Other cra x Basement Finished Area (sq.ft.) Basement Unfinished Area q ft) �c CD w Number of Baths: Full: existing new Half: existing µnew Number of Bedrooms: existing _new 4. Total Room Count (not including baths): existing new First Floor Room Coui18 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: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ , Commercial ❑Yes ❑ No If yes, site plan review# - -- Current Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ZI)AI/ �� Telephone Number /' SOS' jS 31 Address i% 6eNL 6-1 License dq&,-7-0,J INA MO zr Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE FOR OFFICIAL USE ONLY `'APPLICATION# r DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE o w OWNER ti DATE OF INSPECTION: r,r t; FOUNDATION,— t j. FRAME ��6Z�13 INSULATION �y -7 FIREPLACE FINAL ELECTRICAL: ROUGH r , r PLUMBING: ROUGH FINAL .r GAS: ROUGH FINAL pp FINAL BUILDING ® ZU r DATE CLOSED OUT ' t � ASSOCIATION PLAN NO:. _ = The Commonwealth of Massachuseft Department of Indusrizal 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/Organiin iandndividuai): Address: ll� i✓�i 57— j City/State/Zip:-. /117-D rJ d"1 Phone Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.�I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition_ working for me in any capacity. employees and have workers' comp ir,�rrrAr,�e.# 9.. ❑Building addition [No workers comp. insurance P• required.] 5. ❑ We are a corporation and its .10.❑Electrical.repairs or additions 3.ElI 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 . camp.insurance required.] *Amy applicant that checks box P-must also fill out the section below showing then-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 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.Liic.#: Expiration Date: yn Job Site Address: (✓ �c�5��/c �%�2 City/State/Zip ��=K �''�� _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 ofMGL 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 violatot. 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 hereb ,certify under the pains and penalties of perjury that the information provided above is true and correct ---Si tore: Date: l� Phone#: Official use only. Do not write in this area,to be completed by city or town.official City or Town: PermiVLicense# 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: 4. Phone,#: Information and .Instructions Massachusetts.General Laws chapter 152 requires all employers to provide workers' compensation for their employees, Pursuant-tn this statute,an employee is defined-as"...every person in the service of another under any contract ofhire, 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 Iicensing 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( )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(m)and phone nuinber(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 enterthei.r 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 peri.it/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"ail 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 obt.ining 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. i The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of lnvestigations 600 Washington Street Boston, MA 02111 Tel. #617-7274900 ext 406 or 1-9-77-MASSAFB Fax# 617-727-7749 evised 4-24-07 www.ma.ss.gov/dta of T Town of Barnstable Regulatory Services MAE& Thomas F.Geiler,Director ATE Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, r r� � , as Owner of the subject property 1 P Pay Hereby authorize_DA/J �C13 W/ 1 i to act on my behalf, in all matters relative to work authorized by this building permit r ll 67 l../eC5/ 1///lam (fl�e LZ /0?4 (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools. are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. S'g�e of Owner Signature of Applicant N Law -2- Print Name Print Name Da Q:FORMS:0WNERPERMISSI0NPP00LS 62012 Town of Barnstable Regulatory Services Thomas F. Geiler,Director MASS Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax:.508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCAUON: number street village "HOMEOWNER": name home phone'# work phone# CURRENT MAIIdNG ADDRESS: city/town state zip code I 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. (Section1.09.1.1) 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 i 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, j 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 i several towns. You may can t.amend and adopt such a fornVaettification for use in your community. i Q.fomns:homeexempt v m '►1A�iac 'utitti�r °Fail en iiflE:i alirS tcais CL �d�s?tI-of.'Sv s 44 ia�t�r► UtensE:"CS 92572 DANlr=L-A 1,E8OLVfT?- - 9 LIINCOLN ST CANTON,TAA 02021 Expiration. Sr"ll . C'.Irumi4w�+suer Trsl. 21323 - O ` a w z 00 co N N 04 >. cn s a ..aCD m . - - - CD .. - 00 GO kD W `O[tice RF "�xror caasvhtergffairs$� OWE IMPR rfae ' 8ist OV MENT colyyft,,0 egulahao License or r — i6783t N before the �rstration valid far rndivrd �'Wration: T_tfa►209 tlANJEL L€J3 4' Type. Office orca OW1J7Z rvrdua) nsumerAffairs anatl Elud retuto.aul ni Park l3v Y Jnd Su 17A1Vr $d tan,'VIA 02libite sinessRegulatioa as 5170, �z LJJ�i . cot T. z CANTON Ida 17 ,,e s erPt Zrn . 4 . - withoat gna D ary - . _ � fat valid r si a t , d s" . cn LO C'4 osED CL _. - -- KDP -1y w - ,i Cn �-, m "MISIAL® en AVM aZ LO 31TViSNV9 O Nmol. LO m m tea,,,� .;.v,�.�_..,-...�..��..._._:_..... _ .. _�_ .. -• -_ ._ _ ... ..- ' ' -- � ._ _ _ __ � ti ..-- �_.. ..: I �e 1d�/► ' � If' .S -' - e, -— - ... �.._gyp_... + .•_ _� � ' cn 04 OD OD co CD CN 04 LO m i T B CAPECOD QVb'� 0, �A INSULATION 213 MAY 23 AM, 8: 54 14� 714b N F9 PIMAR GLASS SEAMLESS SPRATAOAM SUSPAN CAO BAITS OUTTfiRS INSULATION CULINOS p 47' 1 1-800-696-6611 !(faj Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 r Date: �<11'/13 Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls A Sincerely hECasJr, President on, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel V 1Y Application # Health Division Date Issued e Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Villaget'v Owner-A f �ilMiP�V Address Telephone 6 77 Permit Request1GcZI� i'Z��(i' J'► � � G � Square feet: 1st floor: existing proposed 2nd floor: existing propose(P I _Tft I.ne8 LAJ Zoning District Flood Plain Groundwater Overlay " 4 Q Construction Type Project Valuation � yp Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s porting:ddocur ntation. c.� Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) c �Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highwayws❑Yd,; ❑ No Basement Type: ❑ 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 including batt-.,): 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: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes a o If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name lew Telephone Number Address d 0g"Pt -t(�vdie,l License # . (.Od W Home Improvement Contractor# Worker's Compensation # ' 00Q__V O ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO w hJ . �"o� K SIGNATURE DATE i FOR OFFICIAL USE ONLY "s t APPLICATION# DATE ISSUED MAP/PARCEL NO. u ' ADDRESS VILLAGE t= OWNER !e ( r "t D r DATE OF INSPECTION: ~ FOUNDATION FRAME R F E INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL `r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL k' FINAL BUILDING { I' DATE CLOSED OUT ASSOCIATION PLAN NO. r . ,4 " 1 _ Massachusetts - Delru-thncnt of Puhlic �afctN Board"of Builiting Regulations and Standards. I Construption Supervisor License Licen •CS 100988 HENRY CASSIDY 8 SHED ROW 4 A., WEST 'JARMOUTH, MA 02673 Expiration: 11/11/2013 ('nuuiivxiuncr Tr#: 7620 =�---- C��e• �t��y��yyc•c��n-IC�P.�c/f`r� r�� 1-�c�c�z�C�i1•�"�� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Hanle Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2t)14 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE ----. ..-----.. - .. . - SO. YARMOUTH, MA 02664 Update Address and return card. Mark reason for change. ❑ Address L� Renewal (� Employment Lost Card :il;:i I .:J 20M-(6'11 . ,,, ��%�' i(•orrarrenrecr.ea/Cl n�C>"l(rrdJaeftu:,e� " .,.\ Office of Consumer Affairs& Business Regulation License or registration valid for individul use only. b OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: = e istration: Office of Consumer Affairs and Business Regulation ulation 9 153567 Type: i; 4•' xpiration: 12115/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION, INC. HcNRY CASSIDY - 18 REARDON CIRCLE S0 YARMOUTH, MA 02664 —� ��-- -- — — --------- Undersecretary of val• witho t Rat re The Commonwealth o 'Massachusetts Print Form Department of Industrial Accidents lr •r` , ' Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (t3usiness/Organization/Individual): ' a Address:_ 0- City/State/Zip: _ V I/Iti IMp' Phone #: �D�— Are you an employer? Check t1le appropriate box: Type of project(required): l. I ant a employer with 20 4• ❑ I am a general contractor and I employees (full and/or part . * have hired the sub-contractors 6. ❑ New construction -time) �.❑ I am a sole proprietor or listed on the attached sheet. 7. [] Remodeling partner- shipand have no employees These sub-contractors have ' 8. ❑ Demolition working for n:e in any capacity, employees and have workers' I No workers' comp. insurance comp. insurance.: 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof re a'rs insurance required.] .t c. 152, §1(4), and we have no rf 1 l D employees. [No workers' 13.� Other l/" Tk h comp. insurance required.] "Any applicant that checks box#I roust also till out the section below showing their workers'compensation policy inronnation. I 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-convactors 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 inforrrtation. Insurance Company Name: 'o h, auvh - Policy #or Self-ins. Lic. #: WGA OD *Z''2 01 Expiration Date: Job Site Address: k7 6,w/n/ j fv 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby certif^`nller the pains An d enalties of er'ury that the information provider!above is true and correct. Si mature: / __J Date:l (/ Phone UZI Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing inspector 6. (Other Contact Person: Phone#: Iv i�. I Vl1;7 I C<IlenUl: +15ll7 AO DI, E:C:IN;'UL. CERI-IFICATE OF ae . _.. LIABILITY INSURANCE u 11 L.(nu uuurri(,I Il i l k I It It'A 1 I c..lti rllL Cl ALi A Imgl1 k11 oN OF INFORMAlIJN uIvL1'ANLI CC)NPEI29 NO Rluh{i$UraQN TIiL- ClNRTIFI( ATt IiUG t11.J1)r1201 l I1131 — Ll.l lhl( F1TN Ll(�I. ; NU 1 \I f ll<(VIA l IVI.I_Y OR NEGATIVI;I.Y ANik IJ1) FXI'ENU DR ALTER TI-IL COVL I:ACQ AFFOIZDGq UY"1I II: tq 4C I'QL.IIaE,S VV. 11IIJ CLRtIFIGATE, (;)F IWWRANCE DOES N0TC0N,,Ihu1'L A CON I'RACTBETWEEN'I'HE I�,;$;UING INSUl\l: (�),All l'll(11thkD II-I'i<LI I.NIAIIVI*. -)FZI I!(1OEIL[-F', ANL) THE L:k Hl'l1 Il Alk 11liL.iJ I, i1 P(n<I \I!1 It tlru l l;II IItlrntu llul lur ie an Al>UI I'ILAAL INti61�t I lhv puhCyj!cl)uulyl be enrlorxcd 11 a'UUII,IG+\TIUN I;i WA(VC,1:1,xulrl.lcr to Of(I,c L?ullcy, G,nr t yhl IJallclau Judy Iqy all aliilnruamm�L.A u(utf>ulenL tim(liu;cf rl;llc:Lila:(H;Iru of l cunlvr uVlua 1„p,y..... „ilUl�,„1, II„I�ie,r ill Iu�U �-.Ir,�UGh CIl(IUIJ 4111 a111(;f�. � ICSATa�7—l..n,!.' , n,l;r:,y I„y. _;i+r. I,1clIlU(hl NahIE NI.II�I,C(YulJll�-- •i)•:I;.IIi(V l.1•I - -(Ni4Na ._ ... _ l.4/1•ill(i•:dl:)u , , ul IJunlu,., IVIf\ U:_'LiUCI 1 t,iU l Ll ' I!.)'.1u /;ii;U irvaunrrtuOArru1(I!wucC+vEIIAuI: _ INGLIIILI./l,I�4(I lG�;) IIl';ll raHL.u ' III.(., ( ,If;v. i;ocl Insul,.>r.fs,n Inc; wsukrR4 L•vun�lon 1116L11':IIIL:fJ C:dnllJauy -. . AEI' _.... ..... - IN51JftE1:C_ �lllll4 LalJ.l l'Lgl III..... IIIL:f: lyululitt IVIA 02 61)1 NYUNIHU:4011111I4rce 11'1(wrd11Cc CO111) 1111 INyunrit r; --—--- - Lh l IFICA I L NUMUER: - — 1:�r RL VI ION NI,JIVIIJI 11 r�N(� (Ij(4LI ,1-,.,,1 riaa UtLNwauLD 1GI IIIL INJVflI'D NAAIL:L)AllOV1, I OIt IIIL:.POLII-Yr(J,un, �i J�nVn11I:IrAJVUuv(: wNl r,r_,:(Lnl�enq(:N1, ICHNI OF (VNI- 10HUF ANY CONIFACI OH OTHER D0CUMEN1 WITH Jtf.� I"(.) ,(II h.l•�, IS[ I;i L1L.L) UF: IN1Al I'L'RIAIN, 1HC INSUR W:l: ,(rnu,(I D (11'•rHE POLICIES DESCRIOED IIEREIN IS SU0jL.(;I I'lJ A1.1.. T11L 1llfNC;. •...ur�I,.iI'J;� AND C':)NUI IT ION OI SUCH POLICIES LIMIT; sHC?v,r1 lµ'�i IIAVF L161i a I,..i, - --._ ;r--•-----....._...-.-. N hEDUCLD U1' I AICI ('.EAIN13. ...... . .. . ..... ........._.........._.marl,: CRPd263U8:c 4l0112012 041U lQU"I:; E.4r,;rl oC(°luara:;1, w'I IIUU UIIU I.gA;V.l l Nl`.ItAL(IABUly -------, ..-..---..._.___,-. .u__......,.___. I nu_Dr.xr`/I15r1V+ulu,1wunn1 y'il)UD ._ ...._.. ... f'kHBpPIAL.6 AOV INJUI(Y 1'1,000(!00 "-" -."-.L.,HII 111 UI p,Yl LIE,iI NLH 1.9t.I4Lh11L.A(11111k U1116 6 1 UUII Ulf(I „i ...I I I ri l I'JtUgLrl I ti•r L]h1f Il)r'Af L.,, y-'j)0U I)IIII _- 1 .._— (ClhllJllll l)51NGLr'l lhlll 12MML1LKVIluN 4101/20-12 041U ll rU1: G,, drrV_ -__ !,Ul1U UUu I � - ! k1G01L1'IIJJLIRI'(I>k,P•:':••"') '1' Xi . X0N.14535I.' — 141t1'I1,U1d U410'11.'U1' V,CJ1l)L:i:L11t121ZNi::1_ :4�I.,UOQ,,UUU.. . i c.l �:In1,..n1AQ li JI-I LIULI U(IU . . ':�' ! lIu irl+lrarl', IUUUtI "� (unlrUv</AIIUN - - - 1 �nII IAt 1 ))LJ(:s 1IAnulty WC;AOl1U2;;)u; 6/3U12U92 1I619U12U'1' h w( SrAiN Iiltil �•,,,, n I irt;l �'-t1��.:rir� ti .,.I I IVh 1, .,.LCI\ ........ . I'..rt;nit-MULICLrI'. n�a9 N NIA GL,L.ACIJAC:(.li!r;rtl IUUl1UUU' C.L.I11sI,uzG-r,L 6r un..nvuL •I"I UUU UUII ' •. {:�:rvYflarl IIN,.)I'l:•ItAlli)IV t,Ilgluw J.1��,'i,,,N(!I tll'i'r:i111i1Nti I l+l l:IL 1'IllNti/VL'IiICL.Lti(A,laon ACgRU IU I,A�1JI,I•,,,.:�.,,,+,.�q li uul I 1 V tl,I I IVIV VpNQV Ib fVQIIII VU7 lw,l,!,L, IfIPU Yfri allurt ln,'I,µlvil(ITTI(;vl'4 C+1 I'1'Q1?YI(�tiJf`i - -" Inn,: (r; I lull r i:L IIIQlLIdQLI xri Lill ucl(liliuntil inSul'a(t uni(ul (;unural LI0Ullity WIIUn relquIrdd lay wrlttoll �.,n!(r,lcr,ir,1ylr(>4rt)i:•I1L j _.._...._ ...._ ..... "..............___.__...._.___ CANCELLATION U'llx) G(.IL! llliiLlldlt101t,hic SHOUWANYOFTHCA(1QVr U t4CfiltSijr)r'f1LIC:IfliI:Ih AN1:171,Lia11JI;IOiC THE EXPIRATION DATE THERECIF, NCITICL WILL HL: I,)r:LlVl:kttl IN i ACCORDANCE WITH THE PCJI,ICV PRUVIJll."M3. i autnur,Ituu etPJces,:Nla'Hve 01111 -2,010ACORD CORPORA All il!]Ill,)wv i,lovd. IU1UJj I of q 11w ACORL)llama antl IL)OO 1(lt rI,ylls(Ilrad rlwrks ufACURO G:;d:t i�U/MIU30rIU IVI 1�1'Y I r� PAMCPATUM mass save cownu=" ..nao:anown nM„ov r.Kroxr PERMIT AUTHORIZATION FORM I, �� , owner of the property located at: (Owner's Name, printed) (Property Street Address) (CityfTown) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature Date —r FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following:Mass Save Home Energy Services Participating Contractor to the above referenced project: Sri y�Lh3 Part' ipating Contractor Date Rev.12132011 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �e1 Parcel < l6 AppPicatio?# Health Division Date Issued Conservation Division Application Fee q Planning Dept. w Permit Fee Date Definitive Plan Approved by Planning Board cg� I�S'�r2 LIV Historic OKH _ Preservation / Hyannis Project StreetA�ddress Z Grca iLy i e W C;-/Vl� C Village 1f"&+P,0,V1)I e, Owner Address &7 Crew Telephone Z 607 Permit Request on Q � l�i� S� s k s ot S r� Weir �'Q Square feet: 1st floor: existing JJ ropos 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation OUP Construction Type EI,vcH,7�i Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ;(No On Old King's Highway: ❑Yes 5(No Basement Type: ❑ Full ❑ Crawl XWalkout ❑ Other Basement Finished Area (sgft) 740 Basement Unfinished Area (sq.ft) IM Number of Baths: Full: existing new �_ Half: existing L new Nun - er of Bedrooms: 3 existing new Total Room Count (not including baths): existing b new First Floor Room Count Heat Type and Fuel: X Gas ❑Oil ❑ Electric O Other Central Air: )(Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: Y s ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn existing I-® news size_ Attached garage:A',existing Li new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ R: F Commercial ❑Yes ❑ No If yes, site plan review # .F_- � Current Use Proposed Use 8 u APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name FA � + 4S i Telephone Number AddressA �/ License # 7TVP C w VA[e,: l�V�b r7� Home Improvement Contractor# l 6-7" Worker's Compensation # y 'py��9'60 J ALL CONSTRUCTION,DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN To' klieotUag k � ff SIGNATURE DATE l� 7 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED z y { -MAP/PARCEL NO. ADDRESS VILLAGE•.'• f OWNER f DATE OF INSPECTION: fOUNDATIO.N',r "'J • is f^ FRAME _: INSULATION 1 �t FIREPLACE ELECTRICAL: ROUGH FINAL - ?' PLUMBING: ROUGH FINAL--, . GAS: ROUGH a. FINAL t"FINAL BUILDING:`i , LS <. ki _ --DATE CLOSED OUT +.� . ASSOCIATION PLAN NO: '' The Commonwealth of Massachusetts Department of Industrial Acciderans Office ofInvestigations .. 600 Washington Street Boston,MA 02111 Www-mass govldia Workers' Compensation Insurance Affidavit: Builders/Contract-ors/Electr-icians/Plumbers Applicant Information Please Print Legibly Name pusiness/oTanizafimvfndividmn- ir,4 GG y,-ASS Address: u 1 U f W City/state/Zip: l An�v one Are you an employer? Check the appropriate box; q 4. I am a enType of project(required): 1. I am a employer with i� ❑. g eral contractor9aadIemployees(full and/or part-time).* have hired the mA>--contra6. ❑New construction 2I am a sole proprietor or partner- listed on the attached she7. NZ:od�mg ship and have no employees These sub-contractors have g olition working for me.in any capacity. employees and have workers' [No workers'comp. i surer ce comp, insurance,$ 9• []Building addition required_] 5. ❑ We are a corporation and its Electrical repass or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I. Plumbin repairs ❑ g epairs or additions myself [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we,have12° no ❑Roof repairs employees. [No workers' 13:El Other comp.incura„ce required] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all wow and thin hire outside contractors mast submit a new affidavit indicating such�Contractms that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employers. If the sub-contractors have employers,they most provide their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for my employees, Below is thepoliicy and job site information. Insurance Company Name: Policy#or SeIf--ins.Lic. Expiration Date: $41—- Job Site Address: City/State/Zip: ✓VY �. 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 crmminal penalties of a fine up to$1,500.06"and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER of up to$250.00 a and a fine day against the violator. Be advised that a copy of this statement may be forwarded to'the Office of lnvesiagatims of the DIA for insurance coverage,verification I do hereby certify under the pains and penalties of perjury&at the information provided above is tr correct 0 Signature: Date: 7 l Phone# Official use only. Do not write in this area; to be cnrripleted by city or town official City or Town: PermitUcense# ° r Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: i DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE [2/8/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Eastern Insurance Group LLC - Commercial PHONE FAX A/c,No: — — A/c Nox 233 West Central Street E-MAIL Natick MA 01760 ADDRESS: selectwork@easterninsurance.com PRODUCER CUSTOMER ID#: — _ INSURER(S)AFFORDING COVERAGE _ NAIC# INSURED INSURERA:COlonV Insurance Company EA Barsness & Co Inc INSURER B:Continental IndemnitV Com an 54 Angus Way Centerville MA 02632 INSURERC: INSURER D: - INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:2092323967 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. ADD SUBR POLICY EFF POLICY EXP INSRLTR TYPE OF INSURANCE D POLICY NUMBER MMIDD MMIDD LIMITS A GENERAL LIABILITY GL3857351 2/7/2012 2/7/2013 EACH OCCURRENCE $1,000,000 ' DAMAGE TO RENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE X OCCUR MED EXP(Any one person) -$5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY JECTPRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) - ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION 4684239601 8/2/2011 8/2/2012 X WC0S TATU- B O R i AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N - E.L.EACH ACCIDENT $500,000 - OFFICER/MEMBEREXCLUDED? FN NIA 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below —1 L DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) - - For information purposes. 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. EA Barsness & Co, Inc. 54 Angus Way Centerville MA 02632 AUTHORIZED REPRESENTATIVE � r - ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ri y . \I 1 ? iChu�cty 13cjtca tntc of��1 PulilatafcFv 6o.trcl t?f BuilclFn l Rhlulittirsiiv tntl StanFi.trri, 3sst t� ttolt 5upery 'p, L rcense License:ES 79883 ,ERICA BA�l?SNESS a a 54 ANGUS WAY CENTERUILLE NI7�02632 s w. 77 F_may ExriiraF�on 8/27(2013 t aHnnilalrernc�`' 7fi 20116 > 1 �� Office'of Consumer Affairs aril usmess Regulation 1,0 Park Plaza Suite 5.170 L Boston,�Nlassachnsetts.02116> Horne;Improvement Coitractor'Regstration >Registratton: 141078 Type. Private Corporation Expiration: 1/6/2d.1.4 Tr# 220903 - ERIC BARSNESS 54.ANGlJS WAY CENTERVILLE - MA 02632' - -- --- Lw Rl UP date Addre r and eturn c d•Mark reaso n for change.. al �rEinployment LostCard _ Address '`Renbw DPS-d4l 4p 50M-04/0MGJ01216' �y ''��:� Office`ofonn'ie' airs ;u"FnessY£egufaa License or regFsfr"atFon valid for indFVFdut use only - O ' before the expFratmn date. Iffound return.ao HOME€lM PROHEMENT;CONTRACTOR r F Office of consumer Affairs and=austness Regulation "Registration' ;441078, Type r Expiration 176l7014 PrNate Corporation IO ParkPlaza Suite 5170 Boston,MA 02M '� ARSNESS_&C� lNC# •: 54 ANG;US WAY � i x �� .�p ^CENTERVILLE MA 02637 Unde— rs—cer�eta Not•valid witNout'signature . rr HETown of Barnstable Regulatory Services s�xxsrns[.g, M+aq.39. Thomas F. Geiler,Director. i6 `� nuu�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,Na 02601 www.town.barnsta ble.ma.us Office: 568-862-4038 Fax:.:..508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I fir as Owner of the sub)ect property herebyauthorize �lP to act on inp behalf, in all matters relative to work authorized by thin building pensit (Address of Job) *Pool fences and'alarnis are the responsibility,of the applicant. .Pools are not to be JE41ed before fence is installed and pools are not to be utilized un ' final inspections are performed and accepted. Signature of O er Signature of Applicant P • t Name Print Name Date Q:FORMS:OWNMERMISSIONPOOIS THE Town of Barnstable T� Regulatory Services snarrsrear.E, Thomas F.Geiler,Director 1639. a m Building Division rEo n� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 W"Aown.b arnstable.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: J city/town state i 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 1� Approval of Building Official t t `�;*• ',t` 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 ifthe 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 s 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 fomi/certification for use in your community. Q:forms:homeexempt Home Energy RaterS LLC BTorrey @EnergyCodeHelp:com Box 989,E.Sandwich,Ma 02537 888-503-2233 Duct Leakage Test r , Address 67 Crestview Cir Centerville; Ma Date — May 11, 2012 Test Type — Rough-In — Total Leakage Conditioned floor area =945 Sq FT. -(2". floor only) To comply with Section 403.2.2 Of the 2009 IECC Code in this home the Maximum duct leakage CFM = 56 CM (945/100 x6 = 56) ' Duct leakage tested = 35 CFM This Home complies with Section 403.2.2 Of the 2009 IECC Code Date of Test: 5.11.12 _ Technician: Larkum Test File: Untitled Customer: Plumb Rite Building Address:' 67 Crestview Cir Centerville, MA Phone: e Fax: Test Results 1. Measured.Duct Leakage: 35.0.CFM 14.6 sq. in. (+1-0.0%) 2. Duct Leakage as a Percent of System Airflow. 3. Duct Leakage as a Percent of Building Floor Area 3.7% , 4. Leakage Split: Supply Side: Return Side: " 5. Duct Leakage Curve: Flow Coefficient(C): ,5.1 ; Exponent(n):, 0.600 (Assumed) 6 Test Settings: Test Mode: Pressurization• Test Pressure: 25.0 Pa Equipment: Series B Minneapolis Duct Blaster r Test Type: Total Leakage (Duct Blaster Only) Contact our office with any questions, Bruce Torrey, Certified HERS Rater Home Energy Raters LLC Commonwealth of Massachusetts Sheet Metal Permit C 5/Z-h Map g a Parcel O S I Ib Date: d I a ;Permit# Do(, Estimated Job Cost: $ 5_0 y Permit Fee: $ ! -Am � Plans Submitted: YES NO Plans Reviewed: YES NO, Business License# (n [ 7 Applicant License Business Information: Property Owner/Job Location Information: Name: M R. ?10(A (3,t1 r 11 WAI P Name: 412 P me f2 Street: _276 o OTT"i 1\9 k A A-( Street: V 7 C.r e s,u i e w City/Town: Cen%C r u'( k1,� cyi A City/Town: C '•� U \fie (n.A '' Telephone: S'0 8 g— 4 I y ;.- delephone: '7 7�F d 938 00Photo I.D. required/Copy of Photo : attached: S NO Staff Initial J-1/M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less, Residential: 1-2 family Multi-family Condo/'Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional_ Other Square Footage: under 10,000 sq. ft. over 10000 sq..ft. Number of Stories: Sheet metal work to be completed: New Work:. Renovation: HVAC Metal Watershed Roofing : Kitchen Exhaust Systems Metal Chimney/Vents 'Air BalancingnE Provide detailed description of work to be done: e 7`rvn W6 �'� l ► (Z 1�1 Ott c t� 6 i h� , 6� r•- v ; l INSURANCE COVERAGE:'` . I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes❑ No El If you have checked YM, indicate the type of coverage by checking the appropriate box below: A liability insurance policy [ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement.. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owners Agent By checking this box ,1 hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments c!,I1z Type of License: 3y ❑ Master title ❑ Master-Restricted 'ity/Town ❑Journeyperson Signature of Licensee 3ermit# ❑Joumeyperson-Restricted License Number: / :ee$ ❑ Check at www.mass.gov/dnl nspector Signature of Permit Approval - I —� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. 600 Washington Street,- Boston,MA 02111 www.mass.gov/dia Porkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Legibly Nam oe(Business/Organizati andividual): /�� r/un�l7 Address: WA- Ll r City/State/Zip: C e n�\Q Wf M ll—. Phone.#: Are you an employer?Check the appropriate bog: Type of project(required):; 1. 1 am a employer with 1L— -4. I am a general contractor and I employees(full and/or part-:time).*. have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity, employees and have workers' 9 Building addition [No workers' comp.insurance comp.,nsu ce.�- required.] 5. ❑ We area corporation and its ME]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. 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 cbeck 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'conip,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self ins.Lic.t Expiration Date: lob Site Address: l9� i�Ps� 4 C'� C�o<�� City/State/Zip: [ Attach a copy of the workers' compensation policy declaration page-(showing the policy number and expiration date). Failure,to.secu re coverage as regained 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 un er the gins and penalties of perjury that the information provided above is true and correct, Si tire: - Date: `y4ul/a Phone#: SOF (102 W 9*1 Official use only. Do not write in this area, to be completed by city or fawn ociaL City or Town: Permit/License# Issuing Authority(circle one):. A.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector `6. Other Contact Person: -.Phone#: Ila Town of-Barnstable - Regulatory Services 4 MAIM Thomas F.Geiler,Director 1639. + 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 .: as Owner of the subject property hereby authorize /✓i�� IC'i.f C, J`l�!r� to act on my behalf, in all'matters relative to work authorized by this building pemait 6 C 1^eS%u`,C w C C(gin 1 C(`u �t P (Address of job) Pool fences and. alarms are the responsibility of the apP licant. Pools are not to be filled:before,fence is'installed and pools are not to.be utilized until..all final inspections are.,performed and accepted. Signature of Owner Signature of Applicant Print Name. Print Name Dad WORM&OWNERPERMISSIONPOOLS .' - } k C'1 THE Town of Barnstable �.• Regulatory Services aAatvsrAt�r , : Thomas F.Geiler,Director MAM ,� Ao Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 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. 4 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 i ' i 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 1 Q9.1.1-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 P P Y when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To-ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she,understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt - i i WILL114 OP ID: TP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 04/26112 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. IMPVRTANT: IT the cemncate nolaer Is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer,rightsAn.the certificate holder In lieu of such endorsement(s). PRODUCER 781-914-1000 NOAME TGA Cross Insurance,Inc. PHONE 401 Edgewater Place,Suite 220 FAX rC No E AIC No): Wakefield,MA 01880 amass: Chris Hawthorne s INSURER(S)AFFORDING COVERAGE NAIC 8 INSURER A:Peerless Insurance CO INSURED William Fitzgerald dba INSURER Br Peerless Indemnity ins.Co. '• 18333 Mr.Plumb-Rite 376 Nottingham Drive INSURERC: Centerville, MA 02632 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 'INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 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 LTR TYPE OF INSURANCE N POLICY NUMBER MMIDDrrm MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CBP2240275 10/16/11 10/16/12 PREMISES Ea occurrence $ 100,000 CLAIMSMADE OCCUR MED EXP(Any one person) $ PERSONAL 2 ADV INJURY �$EA2,OOO,00 X NOAH-$1,000,000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: t "POLICY R� LOC PRODUCTS-COMP/OPAGG $ Emp Ben. $ NON AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ i - AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNEDX PROPERTYDAIvIA'G AUTOS Per accident $ $ X UMBRELLA LIAB XI OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE CU8733556 10N6141 10/16/12 $ 1,000,00 AGGREGATE DED X RETENTION$ 10000 $ WORI(ERSCOMPENSATION TWO EMPLOYERS'LIABILITY X TO Y IT R B .ANY PROPRIFTOR/PARTNFRIFXFC:IMVF Y 1 N C876666$ Q4108,11Z' 04108/.1:3: E.L.EACH ACCIDENT $ 500„!1O I and OFRCERIMEMBER EXCLUDED? N I A Mandatory In E.L.DISEASE-EA EMPLOYEE $ 50(),000f yes,describe under � _ ' � DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT, $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION BARNS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FAX: 508-862-4717 ACCORDANCE WITH THE POLICY PROVISIONS. 230 South Street AUTHORIZED REPRESENTATIVE Hyannis,MA 02601 Chris Hawthorne h y O 1988-2010 ACORD CORPORATION. All rights reserved.' ACORD 25(2010/05) The ACORD-name and logo are registered marks of ACORD £ � ., -.\ raiV1Y11VIVgV VVCML l f7 ur IYIM.7JMl.I-iucM,1 I J �,(�� _: s • e e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- + Parcel 5b plica ' # Health Division Date Issued t tQ Conservation Division 4 Application Fee Planning Dept: Permit Fee Date Definitive Plan Approved b Planning Board I k) . . pp Y 9 Historic OKH _ Preservation/ Hyannis Project Street Address' Village ze'o ea_i/, /`C Owner e4- f�L � /.L� Address Telephone�'Sfh � -ry G 3 Permit Request Jb f T/deig 14 r!P /" Li x 0 4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ._I To%newt Zoning District Flood Plain Groundwater Overlay _ Project Valuation Construction Type -, Lot Size Grandfathered: ❑Yes Ll No- If yes, attach sullporting dcurri tation. Dwelling Type: Single Family 200' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic Houser ❑Yes a<o On Old King's Highway: ❑Yes d-No Basement Type: ❑ 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 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: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization U Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 140,1 Telephone Number if Address fv/l, License#,`Ddtfor _ Home Improvement Contractor# /cf- XZ 7 _ -Worker's Compensation#,lyL,�640��l ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE � DATE 9 ).P 3 /Z- ;6 - FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED f.• , : - MAP PARCEL NO. ADDRESS VILLAGE r OWNER — z DATE OF INSPECTION: FOUNDATION FRAME s . _INSULATION`,' ` FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL . i � •GAS: ,,,. : ROUGH FINAL -,;FINAL EtUILDING';' ` z ' DATE CLOSED OUT ASSOCIATION PLAN NO. 1 ; ,a r 10 Park Plaza - s to 5170 Boston,-MassLicllll,ms.O?116 1.0111e IrllproVernent C(.)pIj.;:.ti:torRegistrati.on ` Redistl a:ti0rt: 153567 I VPe Private Corr. of Ition i;,•'I'f: COD INSUI_,Al ION, INC ti Expiration:" 12/15/2012 i'rlE '206433 W IiLNt�Y CASSIDY 4 5 YAR MOUT1-I RD. t F HYANNIS, MA 0260-1 .Llpdute ',ddrrss;ultlreluirlcurd Mark roasonlurcluu,l( �, + l."I lddres --I'ltenew:il L Villpinyme.nt I lil.o5r(',inl F, 41 n n,uui, :�rl.rirs1�ltus.yuc)).'//. ltct ul iliuu L runic 01 li litrauun rlid Inl'c; r i uLu!a t ! r Huy IfVll'RbU��VIElN`1`�tJN1ACIbt�- urCli ' O�lulcthre.�prr;tlron'iir�te lfCauudreturntn. h,eyutraUoit I'_>:a5fi7 Type: O I'd ee u(t riiisunru<.ltfairs and Business Regulatiuu t I Expir,raun: I2/1/2012 F'rlvale Corporatlnri lU Pill k I'I iza Suite;170 ` DA) Al il!N, INC Boston, liA 01116 :Ut f , r' - PJA / �Z k� l.It(letsectetllr'Y ' dlld Ith Sit lUr[' ' NI i.,.,achu,ctt.- Drli;u uncut ul Pttlllic .Salct)t • Duartl`ii( Buil[Irn" hi. ul Iii�us,;utrl til,intlartl�: ,� ` � ,•� w Construction^SU_p rvisor,Licerise' 'License••CS 100989 HENRY CASSIDY' a SHED ROW WEST..YARMOUTH; MA 02073 Fxprratron: '11/11/2013 ' Trq:'36 0 A , - �`, r.�. ..,- '4 �� :. � :., -.. ~ n� �� r �,_ � r « f` •;.�.. • ..dab ' • - r � .. a _, ,}.,. • � . Chent#f: 4597 CCINSUL ACORD �, CERTIFICATE OF U'ABILITY MURANCE4 r DAI'E(MMfDO/YYYV) 2/02/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY4AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFliATE 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. e ce I Ica e older IS an iICy les mus be endomed. ,Su JeC 0 the terms and conditions of the policy, certain policies may require ar endorsement. A statement on this certificate does not confer,rights to the certificate holder in lieu of such endorsement(s). PRODUCER Margaret Young Rogers&Gray Ins NAME:. -So. Dennis j NAME. ` PHONE FAX, 434 ROLIte 134 r I uq,No,Ext:508-760-4602 (ac, Nq): 877 816-2156 E-MAIL ____. _.._-_;. P.0. Dox 1601 - PROD SS: ?Oungma@rogersgray.com UCE ,. South Dennis,MA 02660-1601 CUSTOMER ID INSURER(S)AFFORDING COVERAGE - 'NAIL N INsuHen INSURERA:Peerless Insurance 4. ., 18333 Cape Cod Insulation Inc 455 Yarmouth Road INSURER a:Ohio Casualty Insurance Coinpany ' ' Hyannis, MA 02601 t 1NSURERC I Atlantic Charter Insurance r INSURER D:Commerce Insurance Company 34754 INSURER E • a ., INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TtilS I:;10 CF11-111 Y I'HAT TFTE POLICIES OF INSURANCE LISTED BELOW HAVE BFI_N IS;:(JEO TO THE INSURED NAMED ABOVE FOR Tt-IE POLICY PERIOD INDICATED. NOTWITII5I ANDING ANY REQUIREMENT•TERM OR CONDITION OF ANY CONTRACT'ok OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY HF ..- ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE;0 i-iEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCFI POLICIES LIMI I S SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ' NSR t ADDL SUER .TRH TYPE OF INS I nra; - I POLICY EFF POLICY EXP ` �...--. INAR �,R- P[lI Iry NUMBER_ ImuloryYYY LIMIT4 _ A GENERAL LIABILITY CBP8263063 04/01/2011 04101/2012.F.AcH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL t_IABILIT'Y r � . DAMAGE TO RENTED * ' "+` NREM.ISE$(Ea occoryrke) $100,000'. ._.,...__. CLAIMS-MADE X OCCUR t - ;.. :.r- I • - MED EXP(Any one person) ? 's 5,000 PERSONAL S ADV INJURY $1,000 000 GENERAL AGGREGATE s2,000,000 CStNt AUGHEGAIL. LIMII APPLIES PER. .f• - "•,PRODUCTS-COMP/OPAGG "s2,000 000 � - F RO.. --•F�Ni-fHV dtF31 D AUTOMOBILELIABILIFY' + 11MMBCKVMK yLL •" 04/01/2011 04/0112012 COMBINED SINGLELIMIT'-. ANrAuID (Eaaccidenq s1,000,000 - a• , •• • e s aBODILY INJURY'(Pel pelsun) $All (-1WNFh AUTOS , . y 9 X BODILY INJURY Per accldariq :$ . ;l;tlr U1111�11 A1J1'OS _ s - X hllRla)Atl l US PROPERI`Y OAMAGL r (Per accident) X Ni)N IIWNErI At1105 ,• r $ , B UMBRELLA UAB X OCCUR 0001254514645 �, 04/01/2011 04JOl/2012 EACH OCCURRENCE . �.` $1,006,000t. ' . EXCESS LIAB CLAIMS-MADE - , +• °. t AGGREGATE X W..I I:N HON $ 10000 G WORKERS COMPENSATION WCAOO52S9O2 306l3OI2O11 WC SrATU. OrFI- AND EMPLOYERS'LIABILITY Y/N 0613012012.X TORY LIMITS ER ANY F'ROPHIF r FtT UR/PANtR1EXECUTIVE r EACH ACCIDENT $500,000 0IT_ICFHIMF uMRER FXCLUDED-? N ,N/A. - (Mandatury ,NH) Is E.L.DISEASE-EA EMPLOYEE$,500,000 4 yea lien nuu unuc+� � � - � DC C.RII'I ON ol-t�«,B�INti 1-1ow '3• ti. _, DISEASE .I. -1.- ° � r� •x e . . F s 1. _ I )ESCRIPTION OF OPERATIONS f LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remark Schedule,if more space is required) • ,,: - .. ' Norkers Comp Information Included Officers or Proprietors :ERTIFICATEHOLDER CANCELLATION - - 44 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOHE'THE, , t ;'EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN " ACCORDANCE WITH THE POLICY PROVISIONS. x AUTHORIZED REPRESENTATIVE 'I 01988 2009 ACORD CORPORATION.'AII rights reserved. CORD 25 2009/09ACID •� r. " ( ) 1 of 1 The RD name and logo are registered marks of ACORD - NC774CO/nAC0�7n The Cornrn'onwerrlth of Massachusetts R. Department,0j,bridustrial Accidents e - Office oil lrrev stigations .„ 600 Wav,,,i Eton Street Boston il;i 02111 wvr w nVdca a V / ,•� `Yorkers' Compensation Insurance Afti(-Iit •, , Builders/Contractors/Elect tcians/Iilumkacrs Applicant Information F. _ '[e asc Print Legibly ` N1unN ([3usiness!Organization/lndividu`i1); CA e-e ; /p.�`(. , ,� Mch I � 7h.— p( l Arc you an employer'. C1 ck the appropria .Type or project (required): : I X I dill a employer wittl_ �� 4. Q tam 1 tl cont'actorand a ernpluyees (Dull and/or part-time).* have huc,i ut suf�contractors 6. ❑'New construction r ' 2.❑ I'ant a sole proprietor or partner- .listed on thk attached sheet 7.q[� Remodeling; , ship and have no employees These suh contractors have s „F 8. 0 Demolition p... wcirking for me in any capacity employees titd have workers'.�I r (No workers' comp. insurance comp, uistijI ice.$ 9. [] Building addition" required.] 5: [� We are a corporation and its 10.E] Electrical repairs or additions I.❑ I aln a homeowner doing all wort 4 officers li c exercised their "' 1 l.❑ Plinlibing repairs or additions rnyself. [No workers' comp. right of cc,nption per MGL ' t ,c. 152,•` e 12:0 Rciof repairs insurance required.] �If l; and we have no i � , a employees. I No workers-' 13:0 Other, ' comp. in u ;nce required.] - - � 3 *'�nyapplicant that checks box#I must also till out thesectionbelow-showin ihcir workers'compensation policy intonnalion t Homeowners who submit this affidavit indicating they are doing all work and ilicn hire outside contractors ntusl subiiti[a new affidavit indicating such. tCoouactors that check this box Hoist attached an additional sheet showing tlr unite of the suti-contractors and state whether or not those entities-have eniployccs. Irtlic sub-ctmtracloi-s have employees,they must provide their w "er'comp.policy nuiiiber. " ., I am an employer that is providing workers'competsation ireiurance for my;eirtployees. Below is tine policy acid job'site inf�rntutiurt. Insurance Company Name:_ (' --��nttr��;� Policy it or Self ins. Lic. Expiration Date`_ 3QI`� - — Job Site Address: City/State/Zi Attach a copy of the workers' compensation policy decl tr itlon page 060W'ing the policy number and expiration date). failure ro secure coverage as required corder Section 25A of MGL'c'Y152 can lead to the irnposition of criminalpenalties of a A fine up to$I,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDEW,and.a rule z of up to$250.00 a day against the violator. Be advised that a.copy of this'statenient may be forwarded to the Office of - Investigations of the DIA for insurance coverage verification. a 4` I do hereby certify u e t pains rid pehallies, f perjury tint the information.provided above is true iind,correcl. " n Date-16 f hhUllB 0lrcial use only. Do not write in,'tliis area,.to be completed av city or town'official. A -- City tr'Cown: Pe rin it/License# Issuing.Airthority (circle one): 1..Buari of Health 2. Btiitding Department 3. City/Town Clerk•4. Electrical luspector;5. Plumbing Inspector 6. Other - - Contact Person': - Phone OWNER AUTHORIZATION FORM a64 (Owner's Name) , owner of the property located at " x 4 k 3 � (Property Address), Os-6 3 Z (Property Address) hereb authorize a La, a,J. � '{I,q v � Y (Subcontr or) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. ` Owner's tignat r x Date, y y ttt � 'MAR 6 Ai2 :a �J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_'Z5 0- - Parcel CD S(.� d ��.� g��°°off, (� 3 R f 6LEermit# Health.Division ° 47 ate Issued 21 a. 2MAR 25 AM 8* 30 ConserVatioo Division ,3/ Fee Tax Collector I I' EI 6� �T BE Treasurer �ALLEDCOMPLIANCE VWTH TITLE 5 Planning Dept. 0 ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 7 G26-, i✓%QL) Village 60VJ—16-Pej t ( Owner tLl 1M 16F C72 _ Address G-7 (f& 7'✓f EC ) Telephone i f Permit Request o 0 zc)nK\ Square feet: 1st floor: existing proposed ZSo2_ 2nd floor: existing proposed o Total newzsz, Valuation 16--,� 11 2-c,� Zoning District Flood Plain Groundwater Overlay Construction ^Type �9 i0o O �La� Lot Size 1 6Ew Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure :;2�0 Historic House: ❑Yes '4No On Old King's Highway: ❑Yes 4No Basement Type: �9 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) YJ G Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new c�:) Half: existing new O Number of Bedrooms: existing 3 new e�:) Total Room Count(not including baths): existing ! new I First Floor Room Count Heat Type and Fuel: '14 Gas ❑Oil ❑ Electric ❑Other Central Air: '®.Yes ❑ No Fireplaces: Existing j New (f) Existing wood/coal stove: ❑Yes 'ILNo Detached garage: O existing ❑new size Pool: 0 existing ❑new size Barn:❑existing ❑new size Attached garage:V existing ❑new size2saA Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes KNo If yes, site plan review# Current Use P �� Proposed Use BUILDER INFORMATION Name PEreY2 �; ( Telephone Number-�5 Q2 '7 Address License# ®o 2-632:7 d5 "U✓1 �� i'1�!g— Home Improvement Contractor# _115 SO Z Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOA 2 tiJ�i4? SIGNATUR - DATE �2 — z _ Ir a FOR OFFICIAL USE ONLY :7 PERMIT NO. r DATE ISSUED, M MAP/PARCEL NO.. ADDRESS VILLAGE OWNER <..w c DATE OF INSPECTION: FOUNDATION FRAME s INSULATION FIREPLACE E • rl ELECTRICAL: ROUGH 3 FINAL 1 PLUMBING: ROUGH * FINAL � a �r- `' C; GAS: ROUGH- FINAL FINAL BUILDING L trf* C3 C2 Q `cl DATE CLOSEAU'—T i ` ASSOCIATION PLAN NO. - RESIDENTIAL BUILDING PERNIIT FEES .' APPLICATION FEE J j New Buildings,Additions $50.00v�G'- Alterations/Renovations $25.00 Building Permit Amendment S25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031- plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031— plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. >i20 sf-500 sf $35.00 >500 sf-750 sf 50.00 >150 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 - >1500 sf-Same as new building permit: square feet x$961sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool . .$60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee 'I projcost The. Commonwealth of Massachusetts -Department of Industrial Accidents exce otlavOsM 9811 fts 600 Washington Street s; Boston,Mass. 02111 Workers' Compensation Insurance Affidavit ,e: YO—E Ic-- �CI J itlOn' �� C..-� �(--�� 1 V f L(JV C-�� 1'"-t•�a..�� tihone I am a homeowner performing all work myself I am a sole iietor and have no one workin in anca achy %/%%/////%%%%/////%//%////%O ///////% /% /%/%/%/%/%//%%//////%%///////%%%/%/%%////////%///////,%%/%%%%%/%%/%�%%///////%/////%/%//////%// I am an employer pro iding workers' compensation for my employees working on this job. Xx npsny`riam f<::-^: ..::>:�:.,jii:;:;j;:;.;:;:}y:;.jj::ij;::+vii:i?{:�{i:;:;i:::�:::$^%:%?:�.?:-is%.'-:%?'�i .................... nv:::::::.v:•::::::::::::::.v::::.::::•::::::::::::::::::.i..v..e.....,::::::::n•:v:::.... ....rt.y... i}:v.v::.v:::::?•::?ri':'::.: �,:::{{{•}:.,...n?:.::.:.:.�:.v??:.}:.•w::•}:?�i:{.:{!{ dress.................. .............. ........ ........... .... .::...,:•::.::.......:.::.....,. _....::.::.:::':'.}}:.:::.:.:. p liras I am a sole proprietor general contractor, r homeowner(circle one)and have hired the contractors listed below who ve the following workers' compensation Polices: ' > MO. ;i ORC ;:`. s:f:;•::::n. rnra3tceca. � �............. � . ..:.............:.... ..:....:..... ...... �any'}.name_...........::,:.:.:::•.:..........:.....: ??;,.s:. .}...:.............•.:::::::.:._.......,.......::::.:::•::•:::.. ............::.::::::::•:::..�..r....... ir:{vh%1:::::%ii.'-:ti:}iv:•}v::::nv::::r.- :^Y•:•.-�•::{::::vnv:::�•:�v�%'';.i:i?.�:�i::%iiiii::ii:%i::::.v.::%:iv::� : 0 �:♦f:•:%ii:r:�'t,:%:::::%i:':%'%:%i:%i:::%r:%:{y%:%•Y•::% !::!:r.:%+�':%::%!'?,':jti.{i:%:};��:!i'{:::%::�!:::::i�::j:�:�4i:.i'}:{%"+'ti`:_++:•'�i�� . •}:•i:•:?:}!{{?-i:•}:'i:i?::}}:•:•::•i::•::}i•I.,....,.•.::v..,...::..t.:::::v:::::::y:•::•J:•:{•:-iti•{•}:{{i•i•}i:•}:•i:4:`••}y.}:?ii'i}'.v:::}:•i:::.i.:. r::::. 'j :{��;•};v`>}i�::^:i!:}}{{.}:;iY.;!i::ii::::v�:{�::ti%{:i:}.;:!i::�:{:{};::J'r,;:;:::•i'-:?'�?hr:%j,'?{.y::;{.Y.•}}:v{?:ti:ti;?: ii:;:;j::::: >:.:}��}•.:}?jv} �j I.OrBIICC :•: :..: hue to secure coverate as required tinder.Section 25A of MGL 152 can lead to the imposition.of criminal penalties of a Sne`up to S1;500.00 and/or years'imprisomnent as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me..I tmderatand(W a iy of this statement may be forwarded to the Office of Inicidgations of the DIA for coverage veriffcation. v her by ce order pasns pe 'es of perjury that the information provided above is ttiue and correct nature Date �- int name Phone# 4 8 OF official we only do not writs in this arsa to be completed by city or town billcial city or.town: peiinit/liceme# Building Departrment (:]Licensing Board ❑checkff immediate response is required .. ❑Selectmen's Office ❑Health Department contactpenon: _ phone#; ❑Other liri�ed 9/Q3 PJJa - . Information and Instructions . sachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their ovees. As quoted from the "law'; an employee is-defined as every person in the service of another under any contract re, express or implied, oral or written. mployer is defined as an individual,partnership, association,_corporation or other legal entity, or any two or more of oregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or ee of an individual,partnership, association or other legal entity, employing-employees. However the owner of a ling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of her who employs persons to do maintenance, construction or repair work on such dwelling house or on the.grounds or ling appurtenant thereto shall not because'of such employment be deemed to bean employer. L chapter 152 section 25 also states that every state or local licensing agency shall withhold the.,issuance or renewal license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has produced acceptable evidence of compliance with the insurance coverage required. Additionally,.fieither the monweaith nor,any of its political subdivisions shall enter into any contract for the performance of public work until ptable,evidence of compliance with the insurance requirements of this chapter have been presented to the contracting onty. )licants ise fill in the workers', compensation•affidavit'completely,by checking the box that applies:to your situation and ?lying.company.names, address and phone numbers along-with a.certificate of insurance•as all affidavits maybe Witted to the Department-of Industrial Accidents for confirmation of insurance coverage: Also be sure to sign and. the affidavit. The affidavit should be returned to the city or town that the.application for the permit or license is �g requested, not the Department of Industrial Accidents. Should you have any questions.regarding the"law"or if you required to obtain a•workers':compensation policy,,please call the Department at the number listed below. i or Towns L.se be-sure that the affidavit is*complete and printed legibly. The Department.has provided a space at the bottom of the iavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please ure to'fill in the peruutlliceas 'number which will be used as a reference number. The affidavits may be returned to Department by mail or FAX unless"other arrangements have-been:made:w_--__.....__ Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. use do not hesitate to give us a call. Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investl0atlons 600 Washington Street Boston,Ma. 02111. fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409..or.. 375. °F THE The Town of Barnstable RARNSTAIBLL MAS& g Regulatory Services 039• �.• Thomas F. Geiler, Director, rF0 MA1 Building Division Peter F. DiMatteo,Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: X � l`�y rM Estimated Cost 4 ' A e � Address of Work: l f Owner's Name: 44t l (Y1E Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law OJob 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 CONTRACTOR FOR ARBITRATIONAPPLICABLE ACCESS TO T PROGRAM OR GUARANTY FUND UNDER MGL cK DO NOT E.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: �- Z � 0� P� �� i0 11 raS C�2� Contractor Name Registration No. Date OR Date Owner's Name q:forms:Affidav:rev-070601 r Bilodeau Builders Inc. 83 Bunker Hill Road Osterville, MA 02655 (508) 428-2978 Peter J. Bilodeau, President March 22, 2002 TO: Town of Barnstable Attn: Mr. Peter DiMatteo, Building Commissioner 367 Main Street Hyannis, MA 02601 RE: Energy compliance for 67 Crestview Circle, Map 252 Parcel 51-16, Centerville, MA The sunroom is not applicable due to the glass area of the walls. _Y .. M", ,. � '� � .. ti .. ' �, 7 t KJ Ain ,�,,B,,�, r Department of PubLc or KAS& ram` 05 Engmeenng Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4086 Thomas J.Mullen,Director F#.x:.. 508-862-4711 Robert A.Burgmann Town Engineer DATE: March 22, 2002 TO: Peter DiMatteo, Building Commissioner FROM: Stephen Seymour, PE, Project Engineer SUBJECT: 67 Crestview Circle, Map 252 Parcel 51-16 In response to a request from the property.owner to permit an enclosed sunroom extending approximately 18 feet into the drainage easement in the rear of the house. I have no objection to the granting of a permit for the enclosed sunroom. There are no drainage structures in the easement in the rear of the house. The easement is an overflow area that was designed to provide a route for stormwater in the event of a 100-year frequency storm. As long as the sunroom will be on sonetubes that will not interfere with the passage of water there will be no conflicts with the present use of the drainage easement. The property owner should be aware that he is installing the sunroom at this own risk and the DPW would not be responsible if floodwaters damage the sunroom or if at a later date the drainage easement needs to be used for other .2 drainage related structures. Copy to: Robert Burgmann, Town Engineer SGS: File:J;sub/sub697c 03/19/2002 09:04 15084283750 BAXTER,NYE&HOLMGREN PAGE 02 Foundation Certification in Centerville , Ma. Prepared For ; Hymie & Angela Rimer Assessor's Map : MAP: 252 Parcel 51.016 Baxter, Nye Hoimgren, Inc. Community Panel Number 250001 0005 C Registerel Professional F.i.R.M. Map Zone: C Engineers and Land Surveyors Plan Reference Book; 505 Page: 78 812 04oin Street Owner : Hymie & Angela Rimer Ostervill , MA 02655 2002-018 Scale : I" = 40' Date : March 18, 2002 CRESTVIEN CIRCLE LOT 49 CB FND 0 tdSQ �a C � )S 5 , � pti 0, 1 C8 FN a G' Sry 50 9Q ny"h 14,687 sq.ft. CR CB FND 0.34 ac. o Ek '�tM`i � gS �$r 3y r�cQtro 4w11rr%)y +"a 0.'YO h Q iQ�r -g dat'�. LOT 51 a4p 8 w a a I59. $ OPEN SPACE re�a3• i 1 C8 FND I CERTIFY THAT TO THE BEST Or MY KNOWLEDGE THE EXISTING STRUCTURE AND PROPOSED ADDITION SHOWN HEREON ARE IN COMPLIANCE MTH THE APPLICABLE BARNSTA LE a ZONING DISTRICT SIDELINE AND SETBACK 'REQUIREMENTS (e 30/10/10' CLUSTER), AR LOCATED IN RELATION TO THE. MONUMNENTS SHOWN, AND ARE NOT jo LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. I : R THIS PLAN is.N07 TO BE RECORDED NOR IS 17 TO BE USED 70 ESTABLISH PROPERTY—L*S. i fGiSTLR Pot -�o� L�►Mis R ISTERED ROrESSIONAL LAND SURVEYOR. DATE -�� V F 9 i h � IX z ` AgZr G 0 Nk �Alr`` u ��.Q� �^ s '� ix•ut,. a ,� 4 -...+ � �� 'S�wr . VV 'e Pam_- � o 7z b j -- � Z F jv. Awl WE ✓fze Uanvnza�reurea/,�z a��l/f asaclucvella . - Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 115502 Expiration: 3/8/04 Type: Individual PETER J. BILODEAU PETER BILODEAU 83 BUNKERHILL RD. OSTERVILLE, MA 02655 Administrator ✓fze ZJanvrrzaruire¢cc�t a�✓ stuae4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 002827 Expires: 12/06/2003 Tr'.no: 12016 Restricted: 00 PETER J BILODEAU 83 BUNKERHILL RD OSTERVILLE, MA 02655 Administrator TdWN OF BA.RNSTABLi , t CERTIFICATE OF OCCUPANCY r PARCEL ID 252 051 016 GEOBASE ID 43451 ADDRESS -6�7}CR,EnSTVIEW CIRCLE PHONE ZIP LOT ' BLOCK LOT SIZE DBA :DEVELOPMENT DISTRICT CO j PERMIT 36828 DESCRIPTION SINGLE FAMILY DWEtiLING (PMT.#34091) PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: s SINE BOND $.00 . CONSTRUCTION COSTS $.00 Q� t 756 CERTIFICATE OF OCCUPANCY ; BARNSTABLE, MASS. 059. A� FD MA'S BUIL G DIVrSJDN BY DATE ISSUED 03/03/1999 EXPIRATION DATE r � ��_ '} t 6 } � ...d�. �" 6. �! I �: ` f I ram' lit_ �f � ,.11.� �-k�� iS i .� ��qr TY "':, r r o �, .+. �� L_ . . . r wt ' � •-z —. - t `' . � . ) .' i^- � '�J - t.�' a t e •• y t V. B� I LT�7�+iG PERMIT :=•ARCEL ID 262 0 1-`01.6` GEOBASE ID, 43461 -CP.*9S VIEW CIRCLE PHONE IP 13LOU LOT SIZE °)SA DEVELOPMENT DISTRICT CO ERMIT 34091 DESCRIPTION SINGLE FAMILY DWELLING SEPTIC NO 8 -678 `ERMIT TYPE BUILD TITLE NEVI RESIDENTIAL BLDG PMT "ONTRACTORS: 13AYSIDE �C:ILDIuG, INC Department of Health, Safety ' RCHITECTS: and Environmental Services DOTAL FRES: $356.35 :AND NE $.00 �� • ')NSTRUCTIOR �:O�a'S $11.4,950-00 1.01 SINGLE FAM. .HOES D {TACKED a. Pk?IS�A"CE K, * BARNSTABLE, • MASS. 1639. �® BUILD, N► DIeyISIO BY /r I DATE ISSUED 10/1 /1998 EXPIWATION 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 0' ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROIN*HE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OFTHI; 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- (READY TO LATH). PANCY IS;REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MESH,- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATh" - 4.FINAL INSPECTION BEFORE OCCUPANCY. me BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVAY-t ELECTRICAL INSPECTION APPROVALS 6Q�� 1S 1 4� Iv 2j 2( } I f» 1,2 if 3 1 HEAT' INSPECTION APPROVALS ENGINEERING DEPARTMENT F ` N ,S- 2 ARDD OF1i OTH R: A SITE PLAN REVIEW APPROVAL j gz=z ; WORK SHALL NOT PROCEED UNTIL PE IT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE 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- TI N. NOTED ABOVE. TION. k +r r � I { f t I � a ti 's r i fir"' The Town of Barnstable BARMSTABLE. •MASS. Department of Health Safety and Environmental Services g \\ f%6.N. Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection -- + ti/ A I Location C t2(-'T-r(/r P ct/ Permit Number 3 Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: 4- c ILL) (A) nC-J IUPk `T C) f(OT# r RJQ h a f t -� o < 2 .� �,4u n. (o S P r i 4 S Please call: 508-790-6227 for re-inspection. Inspected by Date i F:•b,�..Mrc z..W-.;,A.:,u-e-..:......c-v1.++-=..'Rr-r,..»-.r.,-9+Z-s.....�s.-..,..-.?_s5;-,,:.v^.,.,,.-.-..M,;,w.p.-:,.,... .:...,r,r..-va..m;,,,. _ _ r __. .-�. -.--••- INEipy The Town of Barnstable . BARNSTABLE. MASS Department of Health Safety and Environmental Services g 1639. �0 Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice r ' l Type of Inspection � V Location ��. Permit Number Owner V9 � Builder PA-- S'A ()�� v a y One notice to remain on jobsite, one notice on file in Building Department. _ The following items need correcting: 0- T�A IVAW Please call: 508-790-6227 for re-inspection. Inspected by L , Date C7 CresLv,eo Ov e- �eidenGG 5,� e t�v�%r3''t ✓- _ �Xld c.Gi�,f _ Cl �Y Ckk s v: a xlv Db,40 ql �) <ts And2�Y 8e-3 To B� L�8, DW L /nec-A FA6�� 10 � �f •L� .� 11�� its� �, ¢ � `� i s tea;- 7 7 777,777,77 v n z t MICHELE CUDILO .PEa.; C.on%,.uItimg Structorai.,Engine;er ' A..• - +xl S .,y... -. a +. '. _ Centerville,Massachusetts 02632-19.79_�(508)771-7601 Fax(508)771 ,_163 mcudilo@comcast net f Decemb r 19201 e 1 Town of Barnstable A •..a u Building''Departmenf x r 200 Main St. Hyaruiis,.MA 02601 Attention Mr.�Thon as'P6rry/,Jeff Lauion ' 'ADVANCE COPY VIA FAX: 508.790-6230� Building,Commissioner/tnspecror :,. gi". RE: PROPOSED Additions to Rimer Resd ., Closet/Deck.{ CENTERVILLE, Dear Mr.Perry,Mr.Lauzon; � w At the prior request of my cherit'l'reviewed the above'cgptioned:project AS,BUILT-.construction;for the putpose_of addressing the_structural load requiremepts per 780 CMR' I was informed that the'Town of Barnstable requires t(att =. the structural requtrements''be`revewecl by 1, :Strap substitutions the Exteraox deck is attached to the,adjacer enclosed closet via a'PT 2X.10 ledger` usuiga'-Timbe lok at 16_j o/c Engineering analysts and`calculations indicate a;350 pound load-to be taken tip by-the rrttalled:wrapped(2)`Stmpsgn CS20_,"straps,„with a 1030 pound allowabie'each,to th:isBL ledgers p - F to the=adlect post to'add bearing to thi'ledger connec on,Msm e3 ttmberlokscrewss 5',Jo be conitac"t tTktts"•will alle'vtate the concetn-forle'dger a splitting at the Tunberlok locations at"•16"o : 2. Ganged edge beam of'enclosed closettu post detail note that tie exterior 2x10 will be`seated nzi a"post -x =_ bracket at the knee location reviewed in item 1 Thts w11 provide the required:connection fastening of the i addition beam;to the post4; } Y - With the above substttutions the as built conditions are compliant wyttt the structural,loal.requirements of�80 CMR f , _ for structures•constructed in the-110 MPhT Exposure B Wind Zone E ` f; inc ere ly, _ 1 . Mic ele:Cudila o�� M1CtiELE C. %2011 11 182° " CU[SILO cc ,E.-Barsness a �. o Mo 34774 x STFIUCTURAL 4 Fkv _ �tr � •i c - �� r t 4 i S %�' i Aa9ra& y �r e:[a xdY ' .Ak _ _ *"xw �` fi ? w. N, .,tx,. N "ro°,*" r T'C` ^e•'� +'�" ar s s 4, 5A d A a sY�� -^ b.. t,.;r.�..,.L,..-..�": a ..:-.-..-'-_...,£�� .. '.'.s. �,r,.m; .. "``...n��:-.;�....r."r_,.�, i.��'',r; "-.tea w ,..qt�.�.r�-�`:- �,..,.,.k..Faw.::4u:...a.., hk.-.,.,,•.....a.-. w. .,�ri p TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map .2sa Parcel LT / a I Application # 0 0 5� Health Division ate- 3 � Date Issued Conservation Division ��/(� Application Fe S� Planning Dept.. Permit Fee Date Definitive Plan Approved by Planning Board /0/24 hI Historic - OKH _ Preservation/Hyannis Project Street Address �0 7 d'e 4U Village � ,eu of ' l I I e- Owner 14,4 YA ' m e-1 Address 0 reg-ty(em ne, Telephone 11 7 00 b rery� lt'_ Oa� Permit Request c ^wii m4G �(X)9'bu-m 0 arc,I C lose l,I. As �� Oy Square feet: 1st floor: existing proposed MI-2nd floor: existing_proposed Total new Zoning District kD J Flood Plain C Groundwater Overlay Ldf Project Valuation 3,1160 Construction Type Oved4nakle, Lot Size a `f LieW�s Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family L Two Family ❑ Multi-Family (# units) • .o -- a :Z" Age of Existing Structure 13 vrs Historic House: ❑Yes X,No On Old K0 s Highway. 0 Yes XNo Basement Type: ❑ Full ❑ Crawl Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (slq.ft) -- Number of Baths: Full: existing new Half: existing news Number of Bedrooms: 3 existing -new 00 AawYe 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: ❑ existing ❑ new size_ Attached garage:)(existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION y (BUILDER OR HOMEOWNER) Name E Ka E �" ' Telephone Number _U �c C�1''S S g �) C, p Address WC4 License # -7 / 98 3 _Pf v de Home Improvement Contractor# / O '-?V 0 Worker's Compensation # 7,V / fJ-0`G l ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A,e ow&'_ SIGNATURE DATE .I k FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r,• MAP/PARCEL NO. t ADDRESS VILLAGE OWNER r t DATE OF INSPECTION: 4 FOUNDATION L, FRAME Z'H'trk `t!« 01 N INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL' GAS: ROUGH FINAL r FINAL BUILDING I S ltboll) DATE CLOSED OUT ASSOCIATION PLAN NO. �d The Commonwealth of Massachusetts >^j~ Department'of Industrial Accide, t i ' Y Office of Investigations 600 Washington Street Boston,MA 02111 e www.mars gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibty Name (Business/organization/Individual): � �. $ C® M, (r' � a Address: City/State/Zip:_— I 'v Le, 0o lPhone #- 7bl-- g S b c 3 Are ou an employer?Check the appropriate box: 1. I am a employer with 4. ❑ I am a ge Type of project(required): nera] contractor and I employees(full and/or part-time).* have hired the subcontractors 6. O New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t : 7• Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp. insurance. ` 9' [No workers' comp, insurance 5. ElWe are a corporation.and•its Building addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t. employees. [No workers' comp. insurance required.] 13.❑Other Any applicant that checks box#I must also fill'out the $xtion below showing their workers'compensation policy infozmaiion. t Homeowners who submit this affidavit indicating they are doing ell 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. ram an employer that isproviding workers'compensadon.insurance for my information, employees Belo.w is the policy and job site Insurance Company Name: Policy#or Self-ins. Lie.#: � k 1'f 3 fb— 0 Q Expiration Date: Job Site Address: /4l 7 ' City/State/Zip: e 'Vt 1. e Oc -&3a- Attach acopy 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, I do hereby certify er the p and penatles of perjury that the information provided above is true and correct Si are: Date: Co- Phone#: Q 6 (�' 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): - L Board of Health 2. Building Department 3. City/Town CIerk 4. Electrical Inspe.ctrlr 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information. and Instructions + Massachusetts General Laws chapter 152'requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do mairiteaance, 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 apptcaat'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." f , r 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 - 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 permitllicense 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'prgof that a,valid affidavit is on file for future permits or Iicenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le. a dog license or permit to 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: a , tl 4 The Commonwealth of Massachusetts h' Depar imnt of Industrial Accidents Mee of Investigations 600 Washington Street ` B,oston,MA 02111 Tel. # 617-727-4900 ext406 car 1-977-MASSAFE Revised 5-26-05 Fax# 617-727-7749 www.Mass..gov/ilia A-rT)J 1�ebe.e e a DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE oB�o3�2D11 AC®RD' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS' 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. endorsed.be — to the term and conditions IMPORTANT:B the certificate holder is an ADDITIONAL INSUURs�m ( )m wd On this �te does not confer rights to the cerdflcate hold subject w such endorsement(s)• of the policy,certain Policies may require an endorsement CONTACT PRODUCER NAME: - PHONE FAX AiC,No): 877)234-4421 EastaYa,Iasuranoe Group I+r+C (A/C, MA 877 234-4420 E-MAIL 77 AoaorYl Park Dr Ste Bl ADDRESS: Norwell, MA 02061-1623 PRODUCER CUSTOMER ID S - (781)261-2000 INSURER(?;)AFFORDING COVERAGE NAIC� — _�_ INSURERA: Contjn2 ntal Indemnity Co. 11 28258 INSURED i INSURER B: E.A. Barsness & CO., Inc- INSURERC: -- -- c�a E.A. Barsaess & CO., Inc- -- 54 Angus Way INSURER D: — Centerville, MA 02632-1802 INSURER E: CTL 1273 576523 INSURERF: REVISION NUMBER: COVERAGES CERTIFICATE 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. CERTIFICATE MAYBENDING ANY REUIREMENT,TERM OR CONDITION OF ANY GONTRACT ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIESRDE.SCRIB D HEREIN IS OTHER DOCUMENT SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUBR PfM/D EFF M�IAJM LICY EXP LIMITS i('SR�� POLICY NUMBER - _ LTR I TYPE OF INSURANCE INSR ww — ' i' •' EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE TO RENTED iCOMMERCIAL GENERAL LIABILITY i�I ❑ PREMISES(Eaoccunerae) CLAIMS OCCUR rT_MADE u PERSONAL GENERALAGGREGA. is GEN1 AGGREGATE LIMIT APPLIES PER:I I I PRODUCTS-COMP/OP AGG'is c^LICY ;PROJECT !LO¢ _1 r COMBINED SINGLE LIMIT A(rf6MOBILE LIABILITY is — ANY AUTO ,I0 i "i ]BODILYINJURY Per ' $ � -- ;ALL OWNED AUTOS i f ;BODILY INJURY(Peracodent i$ SCHEDULED AUTOS j IPROPERTYDAMAGE j$ HIRED AUTOS I I _— I NON-OWNED AUTOS $ - - CH OCCURRENCE f !UMBRELLALIABi OCCUR i i f AGGREGATE 1$ EXCESS UAB CLAIMS- - — i I MADE ❑ a i -'—-- — — I 1$ is 1 DEDUCTIBLE RETENTION $ - '7 �_ i ATU- Y/ORKERS COMPENSATION jAND EMPLOYERS'LIABILRY y/N E.L EACH ACCIDENT I$ 590,000 i ANY PROPRIETORIPARTNERI i 4 EXECUTIVE OFFX%EWMEMBER �7.j i N!A U 6-84 2 3 9 6-01-O 1 p8�02�201118/02/2032 -- T `EXCLUDED? GJ 4E.L DISEASE-EAEMPLOVEE is 500,000 R (Mandatory In NH) i tt yyes.describe under II E.L DISEASE-POLICY L MFT $ I SPECIALPROVISIONSbelow ❑ 0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,it more space Is required] l CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF+ll 'ABOVE DESCRIBED POLICIES BE CANCELLED BE-FORE-THE E.A. Bar83ess & �• EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH I THE POLICY PROJNS. 54 Angus Way I. centerviUe, NA 02632-1802 AUTHORIZED REPRESENTATIVE00 010, I 1783118 Attn: Project Manager ACORD 25(2009/09) The ACORD name and logo are registered marks of ACtZTl,11 91 2M ACORD CORPORATION.All rights reserved. k Eric Barsness<eric@eabarsness.com># Outdoor shower October 1,2011 11:57 PM Hymie, I spoke to Bill regarding the plumbing. We propose as follows for the outdoor shower: -Redo the drain line in the basement(done as a"repair"without permit): $450 -Outdoor shower with permit,shower pan,drain to ground without vent(Bill thinks inspector will be ok with this):$900(pan allowance is $250-included in$900) -A basic stockade enclosure will probably run less than$500 depending on what ends up being your preference. Also,please print the attachment you see with this message. Please sign as owner. I will need this as part of the permit application. Please call me anytime to discuss any questions you may have regarding the outdoor shower/8x8deck section decision. Thank you, Eric www.eabarsness.com Statement of Confidentiality This email is intended solely for the person or entity to which it is addressed and may contain confidential information.If you are not the addressee,note that any disclosure,photocopying,distribution or use of the contents of this e-mail is prohibited.If you have received this e-mail in error,please contact the sender immediately and delete the material from any computer. l i. t aAaNBrhaV.t _ Town of.Barnstable i}1}, Regulatory Services - # Thonms F.Geller,Director . Building 17ivisi6n Thomas Perry,GBO Building Commissioner 200 Main Street,Hyannis,MtA.02601 MyW.town.ba ruslahle.m u.us Office:508•862 A038.. Fax:SOV190.6230 Property Owner Must Complete and Sign This Section If Using Builder 4 ' t . s i_ /941 �{inl� r as'Ownerofthesubject prop" hcrebyauthnn J ze /�.�Y .�kI.S'94- to nct on my behalf, Writ rs m es3 in all matters relative to work:authorixed by this building permit,applicadan,for, r�a�v�eu1 G;.r .JP (Address(1(Jg4 £, ) Signature of Qw r Date !LJim,A ��1�r Print Na e If Property OVA Is appl}Mgior pertnitt please complete the.6lomeonners.License F remptton Form on the, reverse side./V� (..�iUstre'kceellilAAPPDwtU.oniMlienwvfliW'indasv(Tem�.vnry IWemei FileslCaniem.thiilaatiUDV87AAZ16'l'PREti$.doe Resised072110 i �4�'Sh�ct (D�� ttr�t`tt 'ttl'Itts #x fit erase GAS 79883� g ERl ps, SNES " �s HE.4`ANC3J EN �+ c. _ xcrataon" 8/27/2a13 ' _ s Office of Consumer Affairs and usiness Regulation t 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration: 141078 Type: Private Corporation -" Expiration: 1/6/2012 Tr# 294424 E.A. BARSNESS & CO., INC. ERIC BARSNESS 54 ANGUS WAY CENTERVILLE, MA 02632 Update Address and return card.Mark reason for change. Jl Address ] Renewal j i Employment F Lost Card DPS-CAI 0 5OM-04/04-GlOI_216p ✓'CG V/L✓.rt/IJt4'Iu!/C�ll/L 4�✓G'(.R40CJ.CitCldP.�6 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only f= g HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ij Office of Consumer Affairs and Business Regulation Registration..,_.141078 10 Park Plaza-Suite 5170 Expiration ;-1/6l2(3 2 Tr# 294424 Boston,MA 02116 Type:-. Private;Coiporation E.A. BARSNESS4 G_Q WCi: ERIC BARSNESS., `' w >< 54 ANGUS WAY \ CENTERVILLE, MA 6A32- Undersecretary Not valid without signature .fib$ 771- 75-6P it Foundation, Certification in Centerville - i�a I Prepared For : Hymie & Angela Rimer Assessor's Map : MAP: 252 Parcel 51.016 BOXfef', Nye & Holmgren, Inc. � Community Panel Number 250001 0005 C Registered Professional F.I.R.M. Map Zone: C Enginewu and Land Surveyors i Plan Reference Book. 505 Page: 78 812 Main Stmet Owner : Hymie & Angela Rimer CWervMlle, MA 02655 2002- 018 Scole 1" = 40' Date : March 18, 2002 i a CRESTVIEW CIRCLE �� 091 LOT 49 0. I 50 G' p 'S 6 oQO� . 93 �Q J 14,687 sq.ft c00y �a2�` 0.34 cc. Q ��,� N8 f 39 `� 18 71' t,t LOT 51 op w Li fL see, 6 Q OPEN SPACE g�OJ• s i I CERTIFY THAT TO THE $EST OF MY KNOWLEDGE THE FOUNQATrON° i SHOWN HEREON IS IN CO MPUANCE WITH THE APPLtCA9LE' tIARNSTABLE• ZONING DISTRICT SIDEUNE AND SETBACK REQUIREAII:NTS, IS ; LOCATED 1N RELATION TO THE MONUMNrNTS SHOWN, AND IS NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA. THIS PLAN IS NOT TO BE RECORDED NOR IS Cr TO SE GSED TO ESTABLISH PROPERTY-LINES. Y REGISTERED PROFESSIONAL LAND SURVEYOR gAE �e •d wd ze: 9e zeez-si-z�jdw "? . NIP 1 687 sq,ft, 0.34 At OPEN SPACE •t3,�. I CERTIFY THAT TO THE BEST OF MY KNOWLEDOE THE FOUNVA77ON SHOWN HEREON IS IN COMPUMCE WITH THE APPLICABLE tKRNSTA8jF ZONING DISTRICT SIDEIVNE AND SMACK REQUIREUE1 TS, IS LOCATED IN RELATION TO THE UONUMNrNTS- SHOWN. ANO 15 NOT LOCATED WffHIN A SPECIAL FLOOD HAZARD ARU is NOT TO BF RECORDED NOR IS IT M BE USED TO ESWUSH RROP0 V PROFFUSIONAL LAND SURVEYOR DATE I C-p- tN OF MASS � ,,� �s z Cljt)%LO 0 � -4 AAA 2 ri) 0 No.34714 q# tr - - VttjC-rURAL ST Imp LJA L Rmi jq 0,V"f 55 W (LE) O�- ;LX b4l �vg rJ. W�Z 1460 ----------- I � tN OF Mgss 7 CI' ,r$Tvf��J cf- (.� �� lAICHELEicy 1\Iz O , z CUDILO CfLUt o No.34774 STRUCTURAL , TON P i' `i a xlv DSL� fr� �O/5T I Mj ; i Pl Ports Anci 5Mg!-3 To E5e- (YI 'n f / I I I OFMass ICHELE t7r a� P �JJ f� f I CUDiL �� i. `'}��I� No.34774 cn 8 � „ O f ��O ✓ 4TRUCTURAL gFGISTS L-7 a q n/oc ti Tc) gP R-p/ cee� 0 _ �� 3)�X,►� MAN, ��1�� b��.-° \sty �U�\.• , ,.�11./ // JAY 4� (07 Cre SOU ew C_p- Exi4io f 'irr- L2bnl- 70 Le.� 1 I Pr , 30 Ye— .Roo--\ Sh,,-,7 C s —� -�. axe C�rin4 v bIS/ p --- -- � � i � l/� 4 E f i SS "5� •vvt F ��f qAb MecN T� ��f7 �. ' v. �O ;l� �•�. rl✓((��/7GC'�{'T'f`��'Pe�+�'+'�M�--L• �#s. � ! � e `5C:Sw d. n # 'Xa � - i c i i 06 �77 CZ f of kJ f I f N,7zzl ® a x�v vSL��►r� Bois i "� -.____ �--._ r0�. J. 1' f P!1 Pos-o r-,id &Ac-5 7-0 ge j Co li \ jrol c'c Nnal r I i c ST\J E V,/ G mac. r f 4q �°A` S 4-1 I4,6ST7 161.a3 it..-.. •:41. - A-jdP 25Z RCL 510614 .. zo,iE CE,�T/.�•/ED .SLOT P�l�c/ T/-/AT TNT vtil1�A7�osJ L C,4 T/O.�/ t!'t,(177�V�(1 /iS�y�A(lit�J f j /OWit/f�E,2E0.C/C0A-1,z-L YS k//Thy SCA L T,�/�,S•/OE,C/.c/� A�/o SETBA C/c .�Eq l//.2E�-1E.t/TS O.� 7".�/�' Tow�t/aF •��,4�(! .eE�"�.�c E�t/C� A,vo is Na?' ,l q N l300� SDS 79 ,COCA 7 e > WiTy/,t/ 7 Z, --Z, 7- ,CZ /&, LAV6 �vv�r i�c1�.� �?6.16% D,4 Tom: i0 .�0 9P f/ G BA xTE.0 E.VyE /it/C Tip//S G.C�1�t//S iC/aT BASE"O Gig/.4it/ ,2EG/STE.2F�7 L.4��O SU.el�6Y�t� /NST,eU�/�it/T $U.2YEY Tye 0, L5"E'7 5 r17 14/4 > 141l07- 4g U.SEL� TO OET�"P_ii1/.t/� !-UT L./ICES_ 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map s a Parcel 51, J0 Permit# Health Division Date Issued ` 3S Conservation Division c Fee Tax Collector Treasurer INSTALLED IN COMI LIANCE Planning ' - 9 Dept.P WITH'6""'I'fLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE'ND _ � /o -- Syl S'' ` TOWN REGULATIONS Historic-OKH Preservation/Hyannis ' Project Street Address 6 9 OAr57 Ulm G) CleCLE (D ei ✓ .4-0 7 Sa) -Village LCX176 ML 8' - Owner 611YS/dg 90/42) /N9 Address, 66 Jc CE.617F_�' Telephone ? -71_ 6416 Permit Request TO C 0 Al5TR VCT /49 Square feet: 1 st floor: existing proposed /3 F4 2nd floor: existing proposed 7/4 Total new o? D�O Estimated Project Cost /X,9S0 Zoning District RO`1 Flood Plain C. Groundwater Overlay W IA Construction Type w007 f MAE Lot Size /q, 6 27 9 Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Oho On Old King's Highway: ❑Yes Ca<O Basement Type: 2full ❑Crawl ❑Walkout • 0 Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) /3�Q Number of Baths: Full: existing new c Half:existing new Number of Bedrooms: existing new. Total Room Count(not including baths):existing new First Floor Room Count 1" Heat Type and Fuel: MGas ❑Oil ❑ Electric ❑Other. Central Airs ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes BIN o Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size tVQ3 Shed:'O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes EKNo If yes,site plan review# Current Use VACIIA J 1-0 T Proposed Use BUILDER INFORMATION Name_ /��s/� ?GA6' /.r�'e Telephone Number 77/— /0 1/U Address /3� x q S License# �� CF-417F4 V I L�(—E Home Improvement Contractor# Worker's Compensation# -TCQ NY ©W /0 w 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 R �' � " V- DATE OF INSPECTION FOUNDATION ' y' FRAME' INSULATION' '� ''r• - FIREPLACE ELECTRICAL: ROUGH I FINAL - 1 ` PLUMBING: ROUGH "" i FINAL F = •' GAS: ' ROUGH FINAL FINAL BUILDING., DATE CLOSED OUT r ASSOCIATION PLAN NO. i _ MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 10-15-1998 DATE OF PLANS: 10/14/98 TITLE: LOT 50 CRESTVIEW CIRCLE, CENTERVILLE__ PROJECT INFORMATION: LAKE ISLE WOODS COMPANY INFORMATION: BAYSIDE BUILDING COMPLIANCE: PASSES Required UA = 397 Your Home = 317 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA -------------------------------------------------------------------------------- CEILINGS 1132 30 . 0 0 . 0 40 WALLS: Wood Frame, 24" O.C. 2151 19 . 0 3 . 0 113 GLAZING: Windows or Doors 294 0 . 350 103 DOORS 21 0 . 350 7 FLOORS: Over Unconditioned Space 1132 19. 0 54 -------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . Builder/Designer Date MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 LOT 50 CRESTVIEW CIRCLE, CENTERVILLE DATE: 10-15-1998 Bldg. Dept . Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 24" O.C. , R-19 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0 . 35 For windows without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location DOORS: [ ] 1. U-value: 0 . 35 Comments/Location FLOORS: [ ) 1. Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications . DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems . I� TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in sections 780CMR 1310 and J4 .4 . MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only) ------------------------ .51 klG Ls, F4M IL-( '3EDRcnlA z E PL.A.tit oN BA4Y- 40zt l�o Ga¢r3q�� Gcz�r<.t�� VAa L� FW k!'= X 110 = �'? t"'" LCJT `7 O SQ11G TANL • 3,io x?oo a} USF- 15d0 GAL.• I 4 A.'PvC PIPiG- U5e 3 CULT6C ZecW :330G4lAwlwpS/4 STWE —- - - --- -- - -- n 4TTU !::A-MCW A E-A EGO'D, pIST. 17� 3�S• GPD 4 v•74 5F =44to SF PP T1oN . 51 t;,=-wncL AtZr--4 x'�x2=�� .• ,w . PLO VIE=w — LFAC41W—,- 'fPAMBEe5 $oTTOM AMA = 27� 12 ='ioU IMAL, AMA s Ll s� Fi wsN G eaves PE2LOL-AT U34 aTE 4— S Mild/I iN- ii .. i.�. �i�+ ter• S011_ (aA Z' 3 MAX �7 I /jH OF"9gSsAat Sg /z r E a ' STEPHFN �:,;p a�� 0 r CUL7r-G y j` .� ALL N �\,y ✓ 9 � 3TtF1E w 3' t s r� D,c GISTEQ FSSIGNALEN�� CZO%--SGcMDN OF C'PAM�>~Z— Lo A-t, ri ri JC `r I� •^ 55 3 LW,44 cNgn�s� cz5f4- y e 54TA W- z c -�L�t,`�. �L=`jam c� .�•K GGSG' Sau9 C-•zA�.� � � tJo �atioa- • ►z �z-- a CE"RGD PLOT PLAt j IJ n tt,.Ta z — 1 nGAT lo►�l Ce>Ji�2u�I L- � P I Lf=ZTI Fy TEAT Ti4 E Fo v PF 10►J SNoyvN FLAW QMFEy--IJG�- 4ECEO J Cw1 R-y 5 w I IIA -T-F4E SI D=-L%W E Al m LZbArNyr4p-,L,4, A► t► is krF LOCA7VD wIr4IN A MAP 'e C— AL FL•tbD HAZ.Ntb 7-OHE. BAX -r-2- A Nys ING L �dIG I N • . � OSTB2�/ILLi'o Md'S�i.. S AS Mom BUIL.DIO&6 49aXr' NOT' 13'66 QPPLaG4NT, uStD Ttb PWOPE=Ty L►Offl. 04 J + 71 /6z�, 1 F-w 6, / 5$ SCP LE ; 1 -ZOO ./ g�, _ ,;• , of ti+q .. r y d • •try. rya r .,r ;� S-,i lai4- �j8 fY �'7/ _ 1 � ( I I I I TT II � II I i it = , e II illll . Il II I c II I .I I Il; ! I I I I i I!1, � i F--j E=_1 i 0 r V I _ � L F---3_►= N i i Jul- �Dl II 1I Ii II Ali i llili ---- - - IL Lt I I - - f � I i 1 I I i I j III ,I 'i Ilj I it I' illl III 41/ / f' �x , 22•-o• 19'•G' lo'-o' ��""" 0 1 = y0 0p� _I iP I PTO - 1.0 1 w � i L� 10 • - cto p662 OEM I (' • T o � I I I II Jan t I rn y :J C 'Ir. 15" a- a i� J � 29t4 :.. A•'1" L a� �—':4- 1=a � �`-------- to Y I P PTO 29<7 IT • III ,A 0 PTO 2553-2 I 56 i `r I la .I it �O- I 0 I P PTO,2953-2_ I gN aio �i� ,I .P N pIIO yIJ i Ir!u viN W � u�W f LT, cm mar:_'3-rirsXe$ I I i� I .,,,d •oydvtoJ I I 2vv OVCD I I VL I I 1 S'11�T-'v 7.NC- r%-Jr Mm _ .LM;4vF �745- Tilil� N w ((, L'IlIF o 7j� „ i� L -j I I o 0 i I I u ,j j Ll ..o-s ..o•.mot � + b W _ i M 5 � l II i ri LV NO A 40'ry L Non C a v pr 61 c r � yz [ P S w h R"� ;w • I ' `��e �n»rrrrorrrnen�/� r/•.•�fr�.rrrr�n�r(/r DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number: Expires: Restricted To: 11 BRIAN T DACEY 62 FERNBROOK tH CENTERM LE, MR 62632 10`�0 Restricted To: 11 I 11 - 35,611 c'f enclosed space I (M6t C.111 S.61t) IA - Masonry only 16 - 1 6 1 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. 'I V�ww- COMMO TH OF NLASSACHUSETTSDEPARTMEN1T OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET ames ca=:)ee BOSTON, MASSACHUSEM 02111 �crnm:ssicne' WORKERS' COMPENSATION INSURANCE AFFIDAVIT nicenscc/perminec) with a principal place of business/residence ar �). l30 rajs C'_CIJrEA9- ✓lie 0--� 63-2- (City/SuteMp) do hereby terrify, under the pains and penalries of perjury, char. [q/1 am an employer providing the following workcrs' compens<rion coverage for my emplovecs working on this job. IIWIzV(Atilb C, ►50J Ty Tc r 00 2 lq1 16V I Insurance Company Policy Number [ � I am a sole propricror and have no one working for me [ ) I am a sole propricror, general contractor or homeowner (circ?c one) and havc'hired the contractors listed bc:ex• who have the tollowing workers' compensarion insurance polic= Name of Contractor In u nee Company/Policy Number Name of Contractor Immnnee Company/Policy Number Name of Contractor Insurncc Company/Policy Number Q 1 am a homeowner performing all the work myself. ?VOTE: Please be aware that while homeowners who employpersoes to do maintenance,construction or repair work on dwciling of not more than three uniu in which the homeowner also resides or on the grounds appurunant thereto are not gener:Jy considered to be employers under the Workers' Compensation Act(GL C 152,sect..1(5)), application by a homeowner for a lice=sc or permit mry evidence the Icg-A suns of an employt:r under the Workers'Compensation Aet- u dc.st:.-id that a copy of this statement wifl be forwarded to the Depart/c:-:of Industrial Accidents'Office of lnsurancc for cove.a.: vcr.Tacs:ion and th:: failure to secure coverage as required uncle Sccdon 25A a.-.MGL 152 un lead to the imposition of ciminal per.L: s consisting of a fine of up to S1500.00 and/or imprisonment of up to one yG:sad civil penalties in the form of a Stop Work Orde. fin c of W0.00 a d:v a€sins: me. Si£;Icd this day of . 19 Lic��sc:'Pcrmirtcr Licc:isor/Pcrmitror I SUBCONTRACTOR'S INSURANCE ENGINEEER: BAXTER & NYE ENG: (L) FIREMENS FUND - S30MXX80564866 (W) LIBERTY MUTUAL - WC1312595563023 WELLER & ASSOC: (L) NAT'L GRANGE MUT.- MSP45246 EXCAVATION & SEPTIC: ROBERT J. OUR (L) U S F & G - 1MP30109550901 (W) U S F & G - 771521695 DECO CONSTRUCTION (L) TRAVELERS - 660364IC8342 (W) LIBERTY MUTUAL - 312446298044 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 - 006CO023972416C MICHAEL DUFFLEY: (L) COMMERCIAL UNION - NBF821356 (W) LIBERTY MUTUAL , - WC1312492127024 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 STCURITY: (L) FIRST FINANCIAL - FF0131 G400831 (W) COMMERCIAL UNION - CB0743379 CENTRAL ,VAC,: VACUUM 1101JSE MERRIMACK MUTUAL - SBP1608045 r INSULATION: MAP INSULATION: (L) AMERICAN STATES - 02CC326435-3 (W) U S F & G - 7711099932 SHEETROCK: MEL REED: (L) WORCESTER INS - CB817530 (W)� COMMERCIAL UNION - CBH557387 INTERIOR TRIM: DAVID'S REMODELING: (L) COMMERCIAL UNION - NB F821442 M & R CARPENTRY (L) MARYLAND .INS. GRP- SCP30235965 (W) CIGNA PROP & CAS .- C80049997 OAK INSTALLER: ROBERT BUDDEN: (L) NORTHERN ASSUR. - NBF528652 PAINTING: CAMPBELL PAINTING: (L) TRAVELERS - 1680251K4083COF (W) AMERICAN POLICY - WCC 186604 GARAGE DOORS: ALL, CAPE GARAGE DOOR: (L) U S F & G - BSC14667590301 (W) COMMERCIAL UNION - CB11573757 STORMS & GUTTERS: ALTJMINUM PRODUCTS: (L) AETNA - MP0021014146 (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 TILE INSTALLER: TONY AVERINOS: (L) ASSURRANCE CO. - CFP26528977 (W) HARTFORD FIRE - 77WZCY2409 WIRE SHELVING: CAPE COD CLOSETS: (L) U S F & G - BSC146983441 APPLIANCES: KITCHEN APPL 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 A I I I I I � I ----i,- -. r!- —, I - ;— .�. -- -i . ..— ——..; -.- f. . ; , I . � . : . : ! i I t I : : . � 7... ...........;----4 -- - !...--.--...........V,--�....: I............i............... 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