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0194 DONEGAL CIRCLE
._ �n� � „. . . -:; ;i ,: :. ,�; ., h,- F .. :' " S ,. � ., - t ,. n .. O .. s �. - .. o A LT-E R A::I V E. W.,EATKER,IZ:AT:I,O.N ' Date: � � O .D • r• ` ':'cis.. ''.' . Town-of Barnstable.. ;izwy;-: •^r 200 plain St ,.>::::,° K�;••••5.^p,;f..d:0.�c55.j "p�tiri:1', M'"e` <'rr:��:�1� . H .annis,MA 02601 /p��"e� • r" " fy}` I•�y"Ai�•ie'F�fr•!"�4�!^t���yu^r'''�1'�• ���b'-'•'j�'%�'�''.S�L T'' � . , ,a::X.$.•at,+!6•H:�..'N'li:P M1.�h:.1r"rY!`F!::., '�� ' , /�. y..,i,TV rvrr4, •' 'L:µi: ,r I'. A.F ' / :P Re ermit# r S,� , $7 3 a:w.:>su:,r. Villa e':!::. g :'" :':...�l 'iN :a°.,._:Jn�j„+;o;�;g• '#.�A::x ,,:5"}1�.y3��y��9-^rr,�n.bN�/ ::Ai.�Z.r•1 ''.,..�,.i.k,.:s,�et,p ', , •t,. av x Vic?r,:A;::' �,apifr•J..�s�r r'.•.J'`r.•. . .,��};...Mfs •• r! ,�s'"'•� is:'s�;•••.:r,�5••.:. :w y'�,�i'y.,::.XOiai•J•,• '"y'f'(,Ji��1�ed�� Y!!�>J�h:'� •.jJ$+1'! .i.:l. :•4,�N�.�i:�9:�•. nra"<.4 ^,�•'FA'fc"4'•`;r2.''� :,F •(,q�c,.2•, " `J ^:'xy`' ;;nr::,,r;'.:'•• .. 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'r.•v��P5�7%•"crd:�r. •i hw: `ia �tE..,,!`'• �r.n}.Y y c...Z'•, •' w:;r 4r,.,a^.,:yL`e� `f�' Yp'r ,�.,• a r. :; - .. car:�4.,4e':$1Qiy>d..;;u��,,4�i•P. _ Timothy.Cabral, President PL-105454 ; 58;DICKINSON STREET. �' ;FALL,RIPER . ..,A 02721 ,I (508).567:4240 I ';ALTI='RN.AT1'W.I wfoiTHERiTATIOId C1v1Al4:CQNl Application numb a _ ... Date Issued u�� MAN Buildin InsP ectors Initials �w.. aPI M arced 1 TOWN OF BARNSTABLE ° r EXREDI E =PERNIIT-APRLICATION: .Y . . . ; ROOF/SIDING/WIN.DOWS/DOORS/TENTS/STOVES/WEATHERIZATION ,,k PROPERTY�NF'ORMATION Address of Project. NUMBBR , � S T .. . w VII LAGE Owner's Name:. Ida'L� ,���5 Phone Number ? cPOZ 7 Y Email Address: Cell:Phone Number �. 3K Project cost$ 17 O. Check one.; Residential Commercial r: `. O R S AUTHORIZATION ... .. , As owner of the property I hereby authorize w to make application for a building permit in accordance with 78 1V1R Jac Owner Signature: Q, G�G - Date: TYPE OF WORK ' t Q Siding Windows(no headerx change):'# Insulation/Weatherization Cl' Doors.(no header change)# Commercial Doors requareaan anspector's review 0 Roof(not applying more than 1 layer of shingles) Construction Debns will be going to w CONTRACTORS INFORIVIATION , . 01 Contractor's name : Th ( / B6 Homeddmrovement Contractors Registration(if" #' / �f'O !7 (attach copy) `'' .-;..� MTh Construction Spervisor s License# / , (attach copy) Email-ofContractor umber ALL PROPERTIES THAT,`HAVE;STRUCTURE. OVER 75 YEARS OLD.OR;IF THE SUBfECT PROPERTY/SIN s A HISTORICVSTRICT, YOU MUST OBTAIN HISTORICAPPROVAL BEFORE PERMIT CAN:BE ISSUED. . APPLICATION NUMBER..................................................F......... *For Tents Only* r ti Date Tent(�s) wi' be erected Removed on number of tents total Does the..tent have sides? Yes No (If yes please attach floor plan with exits marked) t� J Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNERS LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APP IC T'S SIGNATURE Signature (/ Date 16 � All permit applications are subject to a building official's approval prior to issuance. it . - F �a Town of Ba StAble BuildingDepartmtnt Services a • NAM Brian Florence,'CB® Building Commissioner. 200 Main Street,Hyannis,MA 02601 wW.towa.barnstable.mmca.ns Office: 508-862-4038 Fax 508-790-6230 Property Owner Must . Complete and Sign This Section f'U s i der t as Owner of the ro subject l property hereby authozize4&0q �+. to.act on my b eh24 ; in all matters relatire towork authorized by this building pe=ait application for, 1�y -Doh9 h7z-nu�il/ :44 © Z- 63 z (Andress 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 peogs are performed and accepted. S ture of Owner � S• fire of Applicant Print Name Pant Name' �:rC R�:S:Oe,.xa a S?C tic ;if j �J The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC.' Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in g. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 1[]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.M I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole I LF]Electrical repairs Or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6. We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other INSULATION 152,§1(4),and we have no employees.[No workers'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:LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lie.#:XW058867158 Expiration Date:06/07/2020 fJ , Job Site Address:! / �� Tyr City/State/Zip: i k Attach a copy of the workers' co ensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up.to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under e s and alti s of e ury that the information provided above is true a correct. Signature: Date: G Phone#:508-567-4240 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I ;�►C"R" CERTIFICATE OF LIABILITY INSURANCE DATE(1AM DD/YYW) i .` 65/24/19 THIS CERTIFICATE IS ISSiJED 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 have ADDITIONAL INSURED provisions or 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: Anthony F.Cordeiro Insurance Agency PAICONN Ext: 508-677-0407 FAX No): 508-677-0409 Fall Pleasant Street E-MAIL HSouza Cordeirolnsurance.com Fall River,MA 02721 INSURER(S)AFFORDING COVERAGE '-NAIC# INSURER A: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURER C: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 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 PIUUL 5UtSK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Q OCCUR PREMISES fE@ occurrence) $ 300,000 MED EXP(Any oneperson) $ 15,000 A Y Y BKS58867158 06/07/19 06/07/20 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑ PRO- JECT LOC PRODUCTS-COMPlOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea acciden? ANY AUTO BODILY INJURY(Per person) $ B A OES ONLY X AUTOSULED Y BAS58867158 06/07/19 06107/20 BODILY INJURY(Per accident) S X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY IPer accident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE 'Y Y US058867158 06107119 06/07/20 AGGREGATE $ 1,000,000 DED I I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y 7 N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,0()0 C OFFICER/MEMBER EXCLUDED? n❑ N/A XW058867158 06/07/19 06/07/20 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA,its direct and indirect parents,subsidiaries and affiliatesshall be named as Additional Insured on commercial General Liability and Automobile Liability polcies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT q x, fr f ©198#-2015 ACORD CORPORATION. All rights reserved.il ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r ' Commonwealth of Massachusetts a�t Division'of Professional Licensure. Board of Building Regulations and Standards Construetii 'Supervisor CS-105454 4p l res: 05/08/2021 TIMOTHY CABRAL�x4 rr- , t 58.DICKINSdN STREET PALL:RIVER MA 0 r�n "' � Commissioner ;;6�,z /•; I .. pJ /['(mil /�CJ�//�,/�V cL/a•��,- .(�C/Vl�'/(/ (f`-L,C' �W✓J(iV'4'/, L'�"e��� .. Office of Consumer:Affairs and:Business Regulation 1.000 Washirigton Street.- Suite 710 Boston; Massachusetts 02118. ... Houle lmprovement Contractor Registratiori Type: .,orpora�Ion ALTERNATIVE:WEATHERIZAT!ON ING: trGficn; 175683 Regis Expel a.ibn: 05i28/2021 2 L,4RK S T EAU :R!V'Z. MA 0272.i::.:::: iw :Update Address and Return Card. SCA 1 :0 WA-05/17 ,�� '�nriirisniiri�n/r�/�!�•.Y�i/ii:ii�i/•i(I�• . Office of Consumer.Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR: Registration valid for individual use only TYPE:Ccrporatton before:the expiration date. If found return to: Registration Expiration'. Office of Consumer Affairs and BusinessRegulation 1.75683': 05l28/202 i. 'f000 Washington;Stregt.-.Suite 710 ALTERNAT I E WEAT HERIZ TION.INC. Boston.MA 02118"f i I� 1/!_ j TIMOTHY C'SRAL ry' t `1;,. . FALL RIVER.MA 02721 ; /. �ot valt d WithoAsignature Undersecretary �a I Town of Barnstable Building Post 'his Card So That rt�s V�s�ble,FromFthe Street-Approved,Plans"Must be Retained on Job and�this Card Must be Kept * BARNl3tXlSLde. .s " ,"�". `•. .*x re x. �' � '•' „r '.. .: "° , r;^�� z t Posted Until;Final Inspectio`nHas Been Made � � mm " x " ��".'' shall�Not?be.Occu ieantil a'Final I`ns ection has'been made, e�llll L Where a C�ertficate�of Permit No. B-19-1871 Applicant Name: PAUL G. MUZYKA -Approvals Date Issued: 06/07/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 12/07/2019 Foundation: Location: 194 DONEGAL CIRCLE,CENTERVILLE Map/Lot 169-037 Zoning District: RC'2 Sheathing: Owner on Record: HOBBS,DAVID B&JANET K N y ContractorName PAUL G. MUZYKA, 1 Framing: 1 Address: PO BOX 494 - Contractor"Licens�e- 176448 2 VA CENTERVILLE, MA 02632 Est Prdjbct Cost: $35,000.00 _ Chimney: - Y Description: remodel existing kitchen-new cabinets. new;hardwood floors/trim Perm§Fee: $228.50 Insulation: interior baseboard&trim.add 4 new skylights t�Fee Paid $228.50 I Project Review Req: � Date 6/7/2019 Final: f Plumbing/Gas Rough Plumbing: m y. y ui m icia Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized`b this permit is commenced'within si months aff issuan . All work authorized by this permit shall conform to the approved application and the;approved construction documents wh fo ich�this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zonin& y,2 laws and codes. ' Rough Gas: This permit shall be displayed in a location clearly visible from access street or,road and shall be maintained open for public nspection for the entire duration of the work until the completion of the same. Final Gas: n The Certificate of Occupancy will not be issued until all applicable signatures by",the Building and,Fire Officials arefprovided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work:' a ' 1.Foundation or Footing , Service: 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue;lmmgis^installed ,_ f g 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: EXISTING EXISTING . 7-e" a p-Bx NOTE .____ 1 Ps-traela io wily ded : 0- J eaaNg aNmnsbns i rerov ' mComtrCe3an KITCHEN 4 1 J a I� FSM02 NOTE FSA102 I . C 30 VIBTd30• VH�TISLA � 30 I/IB"X30• 1 Ure dzo I MOR TO SVI 11 SHAIT 110-------- udi dco C ry- Co CO v�V" Xedredbg coma _= L'013/4ae- .0 -_ OO /bnarr 2900 OF 5U ¢ C7) Bock mw to - 4X6 Ind bdow Sbr mOd 0 C7J W-Y to Smal E 1 boom blow � Bunstable LIVING - — —- - C- )O 7) I CD �,. 1"_' _ROOM A 7 N CLOSET , } FSMOB; I FSMOB _ 30 V67453/9" 0 VBT(953/4 �. VENT thdi aa. - 3 am LOCATION ai r-ax' ExlsTd4G - Q Existing/Proposed co w FIRST FLOOR PLAN � J A Scale:l/4"=r-0' O > - i7 S FikWig 2aB.ie' / _":'"�"'•_. io remain W HMOs _:= _ 2�• _ ML 2X8 o R0. OLL z FSMO2 TBLOCK OLA dU 13/— V7 O PLATE L0 Lij Z \ U TO PLATE 01V..3/4.20 / BELOW 28000E BELOW b a O co W 4•-S IV S•-33• I 4'-71i• III -10 3'-4h' 7 Q Q LIVING ? KITCHEN ROOM 1I I 0LLJ U cc Q o � LLJ z PATE O ` I Coidrmla to.oily at edd dbtimmmn. FULL BASEMENT Q • �C.IE+9l,PVPVV'Xf✓�• I 3 APfA.2018 VN�/J SECTION- A ocePyieh tebr /��f'w at U✓ / Scale I/4"=1"-0" ZIBRArRM.CART 1 u, aCiJ�+' (/ ff B II NOTE This drawing le protebted as an 1 -ArcNtealurd work-under eeellon 102 of the Copyright ect(title 17)and mey not o 4 e is be reproduced,copied a used without ..press permledon of il9 author. I s f'} 14 0" 11" 37 G' 21" 33 21a"— ' i 3" 7n_ ,n ," z ,n 26 a 34,8 79 76,8 34 4 2 S8,-s" 16;8' 16',-e' 20 B" 113;e' 26 36" 221" 3 222" 83 24" x. I W 1130 L a13 2130- A M N FER - $ HOOD30 3 � C wLL 2DB36 4 B �'� 3tDO . _ .. _.. ._. .._ ......... ._..... - ..... .. _...._.........._F. _.__..._ ._ ..I. F to � A I I ci te33 r- ". c� ( m --- 3I " OD 0) ( w w w 1OOz' W e. alp �_ Q N n � 'I I ___ _�.i_-.._._..-_-_--.__.. �� --- 39 - M �: - 64 BRC18 1/G3019BK1 DISHW24,;;i BD 253424 -55;a A 1 r- I i , C ., i BDE-R S72308ESRS DE-L _ �i3f� n Im K) 00 w 0 W ml� alw - - - ----- -•-- ----------- -- — t" -- —'— —— ---- _ j M .x I MU co I- —.. 18" 3 „ 2 V 25 Z„ „ OD I CO U 34' 282" 378" „ I 102 8„ All dimensions-size designations Sarah Whittaker This is an original design and must Designed: 1/28/2019 given are subject to verification on Botello Lumber not be released or copied unless Printed: 3/19/2019 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Fridge Near Hall 1.28.19 FINAL All Drawing#: 1' No Scale. DIAIG JUA DFPT. ofTMe rq� j O 0 7?019 Application Number......... �.�-..! .71................... BARNSTO r�'�'�'� wN OF gARNSTA Pit Fee......... �O ..`� ....Other Fee........................ BCE TotalFee Paid............. ................................................. TOWN OF BARNSTABLE Permit Approval by...... on..G.�?.�t.t......... BUILDING PERMIT. `` /f tMap........16.�.................. v. 2.................... APPLICATION Section 1 — Owner's Information and Project Location - Ij Project Address Ig� �o.�JFLCs.4z ,�«r Village C4,j Owners Name �//�,�,f T l�A✓ro A s 5 s Owners Legal Address / 9`� /�`✓�s c—� 2�%� City �✓ +�<<-�—r State Zip Owners Cell# S"o° — 3 3 - a o E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 —Type of Permit ' ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ' ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm wt `r Rebuild ❑ Deck Apartment El Sprinkler System 41 ❑ Addition ❑ Retaining wall ❑ . Solar Renovation ❑ Pool ❑ Insulation Other—Specify. Section 4 Work Description AIP .) s4�+-Otc000 Ft�c�e.n S �/Ll�^t /n/'TK�trcr,� d-45/F T ♦/raa� R k Application Number. ...:.......................................... . Section 5—Detail � 1 Cost of Proposed Construction 3 ova o Square Footage of Project �Do Age of Structure Dig Safe Number 4 #Of Bedrooms Existing 3" Total#Of Bedrooms (proposed) -3 110 MPH Wind Zone Compliance Method ❑.MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public k. ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: 4 I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No T act i rlatp+ 11 it cnm 2 y Application Number............................................ Section 9- Construction Supervisor L Name 14, lqj Lti Telephone Number �,f- 2__�5 o Zz33 Address' �o s-, 5 r. City Yo A;e ,r" State 11A Zip 11 z(14- License Number e5-IDYL916 License Type Expiration Date 0812-2-12-a Contractors Email_ 14�. M I��t K+ a M A-) Cell # 9 -7-f--Z-2 I understand my responsibilities under,the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date IZ.-,3r Section 10—Home Improvement Contractor ` Name //9 r 4!�< Telephone Number 2-ep q�� S� k Address City _ � 2.tc� ✓-z-! State R4- ' Zip 02-Le,7L Registration Number 176 LE` W Expiration Date 66 /42-lZ.0 15' I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 f CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date 3�A07 1- Section 11 —Home Owners License Exemption G Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date i a APPLICANT SIGNATURE Signature� � Date 3Aw Print Name G. /tz')?.y14".- Telephone Number 91 -Z�o 3 E-mail permit to: Ra z y XA- &,Li A)L , �- Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ + Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ ' For commercial work,please take your plans directly to the f re department for approvab Section 13— Owner's Authorization I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: . i (Address of job) Signature of Owner date Print Name l .. Wowl,nowf"eaAl o��?/Gl���.,��.. "Je/lr' .License or registration valid for individul use only - fiice of Consumer Affairs&Business Regulation before the expiration date. If found return to: ( TOME IMPROVEMENT CONTRACTORpe ' Office of Consumer Affairs and Business Regulation egistration N448 10 Park Plaza-Suite 5170 Expiration' 8/2312 Individual i Boston,MA 02116 PAUL G.MUZYKA � `. ' PAUL MUZYKA 45 CROSBY ST >Ar.1 ,..s ., .._ _- . Undersecretary ' 0t valid without signature - r , SOUTH YARMOUTH,MA 0261i4 i Massachusetts Department of Public Safety Board of Building Regulations and Standards ' License: CS-109298 i Construction Supervisor ' \PAUL MUZYKA , '- 46 CROSBY STREET.,tT 'r,, SOUTH YARMOUTH MA 02664` Expiration: Commissioner 08/2212019 \ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR' Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: �Aegcstration Execration Office of Consumer Affairs and Business Regulation fiMA-4 08/22/2019 10 Park Plaza-Suite 5170 PAUL G.MUZYK Boston,MA 02116 'PAUL MUZYKA 45 CROSBY ST `z ; S ISrA o2ssa Not valid without signature SOUTH YARMOUTH, Undersecretan: 9 , Information.and Instructions• Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." - MGL chapter 152,§25C(6)also states that"every state or local licensing agency shad withhold the issuance or renewal of a license or permit to operate a business or to constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone nu rnber(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 sire 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 perm/license number which will be used as a reference number. In addition,an applicant that must submit multiple pemut/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 markedby the city or town may be provided to the applicant as proof that a valid affidavit is on file for firtare permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hlce to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: 'The Gommmweelth of Massachusetts Department of Industrial Accidents fie ofbVestigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 424-07 Fax#617-727-7749 www:mass.gov/dia The Commonwealth of Massachuseft Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Plumbers Apulicant Information Please Print LegiibIv Name(Business/Organiationandividual): 4,+5rm -✓- Address: City/State/Zip: +4-4AZOV-1 at'fi Phone#: } `2-7>z -Lz'>3 Are you an employer?Check the ippropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El 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' [No workers'comp.insurance comp.insurance.: El addition requirrd-] 5. 0 We are a corporation and its 10.E Electrical repairs or additions 3.❑ I am a homeowner doing all work, officers have exercised their I I-❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repair insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance 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 work and then hue 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. r lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Dater Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is t_ rtrue and correct. Si % Date: s / /LviV Phone#: Qjrklal 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.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i ®Boise Cascade I Triple 1-3/4" x 9-1/2" VERSA-LAM®2.0 2800 DF PASSED FB01 (Floor Beam) BC CALCO Member Report Dry 11 span I No cant. April 1,2019 13:16:28 Build 7133 Job name: File name: Address: Description: City,State,Zip: Specifier: Customer: Designer: �u Code reports: ESR-1040 Company: 0 16-02-00 B2 } 81 Total Horizontal Product Length=16.02-00 Reaction Summary (Down/ Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live B 1,3-1/2" 2182/0 119510 B2,3-1/2" 2182/0 1195/0 Load Summary Live Dead Snow Wind Roof Tributary Live Tag Description Load Type Ref. Start End Loc. 100% 90% 115% 160% 125% 0 Self-Weight Unf. Lin.(lb/ft) L 00-00-00 16-02-00 Top 13 00-00-00 1 Unf.Area(lb/ft2) L 00-00-00 16-02-00 Top 20 10 13-06-00 Controls Summary Value %Allowable Duration Case Location Pos. Moment 12887 ft-lbs 68.1% 100% 1 08-01-00 End Shear 2925 Ibs 30.9% 100% 1 01-01-00 Total Load Deflection U247(0.763") 97.1% n\a 1 '08-01-00 Live Load Deflection U382(0.493") 94.2% n\a 2 08-01-00 Max Defl. 0.763" 76.3% n\a 1 08-01-00 Span/Depth 19.8 %Allow %Allow Bearing Supports Dim.(LxW) Value Support Member Material B1 Wall/Plate 3-1/2"x 5-1/4" 3377 lbs n\a 24.5% Unspecified B2 Wall/Plate 3-1/2"x 5-1/4" 3377 Ibs n\a 24.5% Unspecified Notes Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum(L1360)Live load deflection criteria. Design meets arbitrary(1")Maximum Total load deflection criteria. Calculations assume member is fully braced. BC CALC®analysis is based on IBC 2009. Design based on Dry Service Condition. Bolts are assumed to be Grade A307 or Grade 2 or higher. Member has no side loads. Connection Diagram: Full Length of Member b _d a c Page 1 of 2 �r Coastal Services Group, LLC Builder—Renovations-Property Management Mary.3-1,2019 Janet and David Hobbs 194 Donegal Circle Centerville, MA 02632 508-333-8007 Scope of Work: Renovate main living area by removing and installing new kitchen cabinets, increase openings to sun room, remove and raise carrying.beam,.new hard wood floors added, finish and trim. Described more detailed as follows: General Condition: • Provide necessary labor, materials and equipment in order to perform the work contemplated more specifically noted below. • Provide on site supervisiori of all clean up, remediation_and construction-activities. • Provide dumpster and remove to local landfill. • Clean all areas daily and provide safe workplace environment. • Provide life time.warranty on all workmanship for the life of the product(s)-at no-labor cost if failure due.to-poor workmanship-or installation. • Provide protective materials and maintenance of all existing floors, doors and railings during renovations. • Special.Consideration whereas all renovation projects have conditions that are not apparent. Although every effort is made to understand the entire scope of work, unforeseen conditions can and will affect cost and the schedule. Any alterations or deviation from the specifications noted below involving extra costs will be executed only upon written orders. 45 Crosby Street Ext. Office: .508-760-1106 Cell: 978-230-2033 Bass River,MA 02664 paul.muzyka@gmail.com k 3 t _ Coastal Services Group, LLC Builder—Renovations—Property Management Schedule: • Estimated time to complete 60 days after building permit has been issued • The contractor agrees to use his best efforts, work continuously and in' harmony will all owners reps, associates, insurance, designers and specialty contractors in order to deliver project within specified timeline outlined above. Terms: t- Total Labor and Materials $329400.00 • $10,000.00 Deposit • Billed on the 151 and 31It until completed based on progress billing submitted by Contractor; due uporrreeeipt,. Thank you for the opportunity to quote this project, l Paul G Muzyka, owner Owners Signature Coastal Services Group 1 Print Name l � Date 45 Crosby Street Ext.' Office: 508-760-1106 Cell: 978-230-2033 Bass River,.MA.02664 paul.muzyU*gmail.com Town of Barnstable _ Building rwBN rn =Post This Card So That it.is Visible;From the Street.-Approved Plans Must be.Retained on Job and=this -CardMust be Kept Posted Until Final Inspection Has Been Made. �� �� "Where a Certificate of Occupancy;is Required,such Building shall"Noltbe Occupied-until a Final Inspection has been made., Permit No. B-19-1871 Applicant Name: PAUL G. MUZYKA Approvals Date Issued: 06/07/2019 Current Use: Structure Permit Type: Building-Addition/Alteration- Residential Expiration Date: 12/07/2019 Foundation: Location: 194 DONEGAL CIRCLE,,CENTERVILLE Map/Lot: 169-037 Zoning District: RC Sheathing: Owner on Record: HOBBS, DAVID B&JANET K Contractor Name: • PAUL G. MUZYKA Framing: 1 D o 19 Address: PO BOX 494 Contractor License: 176448 2 CENTERVILLE, MA 02632 `� R u - Est. Project Cost: $35,000.00 Chimney : Description: remodel existing kitchen- new cabinets newhardwood floors/trim Permit Fee: $ 228.50 interior baseboard &trim. add 4 new skylights Insulation: Fee Paid:' $ 228.50 Project Review Req: '" Date 1 6/7/2019 Final: Plumbing/Gas Rough Plumbing: IldThis permit shall be deemed abandoned and invalid unless the work authorized by this-permit is commenced within six months after issuan icia Final Plumbing: All work authorized by this permit shall conform to the approved application and the,epproved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoping by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. y. _ } Final Gas: a The Certificate of Occupancy will not be issued until all applicable signatures by the Building and=Fire Officials are:provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or,Footing ` Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throatlevel before firest flue.lining is installed ,,. Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final' Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: r Y �IVKE Town of Barnstable . *Permit# (0 �a ' Expires 6 months from issue date Regulatory Services Fee Richard V. Scali,Director Building`Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-403 8 'Fax: 5087790-6230 ra EXPRESS PERAUT APPLICATION - RESIDENTIAL ONLY n Not VaUd without Red X-Press Imprint . Map/parcel Number 1 to Property Address g �,v,�(rg� L lit ��l„��' 1''�cc. 'E ,�( OL-&3 2- Residential Value of Work$ 63; ° Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address. D4vod gS �� �d� �.4` tns,u�,� L.�.�-rc ✓ic�{ `r I'7� O Zle 3 2� Contractor's Name 4- � �Asr f1 yce4 Telephone Number �-3fl 174, Home Improvement Contractor License#(if applicable) Email: e pc 7,4 42 q.4.g_,4«, L.0,1 Construction Supervisor's License#(if applicable) LDS'—/d I Zq$ RWorkman's Compensation Insurance <� Check one: I am a sole proprietor . ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# K. „� Copy of Insurance Compliance:Certificate must accompany each permit. 14J v V r Owe W Permit Request(check box) 1 ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof.(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: El Smoke/Carbon Monoxide detectorsA 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 zu ired. SIGNATURE; Q:\WPFILES\FORMS\buil permit fonns\EXP}tESS.doc „ Revised 040215 R - y � " .. ° .,•'M° . .. a .... .. .` .... ry ' ?Ile Coasraomtueah*of Massadia setts DeFarbnerzt gflndz bid Acct'derLts 4r fwe Of Li gatrans _ 600 Washrbrtgton Skreet .Bvstorr,,AJA 02.I2 from-maxmgovldia Worlmrs' Compensatian Insurance Affidavit: Blildexs�ntractarsJEIecbricianrdP'umbers Applimit 1nfarm au (/ Please Print �I .1`1275`If.',($noires antrati�y �v 1�� .. `�`���%�1 J :4VCCA4 Address: (�et,4,4g Cif,/Statel CO. VA, di�G ph,Qne� �,��2-:3 a -i�o 3 3 Are you an eragloyerY Che the appropriate bay = of project r Type p J ( eiuired)- I.❑ I our a employer z�ith. � ❑I am a general conixsctor aad I� 6 New oonaft�iotx emgloyrees(firli.andlor pat#time)* have hired the sub-contactors ❑ 2�am a sole pzopsietra orpartnw- Tisted on the afta6ed sheet y. ❑Remodeling slop and have no employ These sab-confractars have . S. ❑Demolafiart Wod ngr forme is any capacity. employees andlmre workers' f INC wor>oers,eoatp.fimna,re camp.Msuranrn# 9..❑Rtacrmg addifica required-] 5_ ❑ Wt a are a-corporation and ifs 1-0--❑Electrical repairs or adcRiom 3.❑ I am a homeovmes doing alt Mork officers have eseraised their 1L❑Plumbingrepairs or'ad&tions myself[No workers' right of es a npfim per MGL 1?❑Roof repairs im==ereS,u=d-]0 c.152,§1(4),andwehaveno employees.Wo workers' 13.�dther S--,a 7 co=p.insurance reriva A] 'Any wKcant&at cheda box#1 mnst slsa Moutthe secHmbeTawsbardag theErumaere caipenmriaapervyinfiomnsaaL E=wwnerswbo submit shis sffid=in g they ma&=Z RU wa&sa46ea bae outside C==ctatsamrt submit a new affida=iodic sacb_ fCantcscinrs that chedr ibis bmc mast attached sa additional sheet shot�g the name of the sv ,and Mute Vrb2fhet ornot tbnse ezifitin ham MPIUYees.If thesoh-cant actmhave empjoyees,they=Mrpxatidetheu Wadm&comp.poli y numbez I am art sucp rr alatis prauiaw workers'compensdian bmurattra for in eaupIay,em Seloev is Yltepalicg arzd jab site information. Ias=ace CompanyName: Pfllicy 44 or Self--ins.Lie_ p EkpiratroaDate. Jab Site Addle CitylState/Zip: Attach a copy of the w•orkesre compeasationpolicy declaration page(shoving the poFicy,rut tuber and respiration date). nn Faie fo secum coverage as regxziteduader Se-etiem 25A o€MGL c-15-7 can lead to the imposition of criminal pen ald. s of a fine up#a$UOD OU sadlor m e Ye wm4t ismrment,as well as cif penahies,im the form of a STOP WORK ORDERand a fine of up to$250_00 a day against the violator_ Be adidsed that a copy of this statement may be forwarded fn the Of of InvesfFgations of the DIES for insurame coverage- verification. rJa Hereby certify under the pains andpsrtafties afpedk7 thatthe in,formcdimtprm d abmv is bars and cvrrect Simature: Bf/ri/l�L- Date: f� //�4 ' Pine� 2-3 d y O WaI use only. Do itat t rite in dig urea,to be compteteri by t*y ar tol n offi*£ City or Ta wn: Permitll icen' se 9 Issuing Authority(tdrde one) I.Board of Heil& 1 BTffing Department 3.Ci.tytrosru Clerk 4.Dectrical Inspector S.Plumbing Inspector b.Other contact Person: Phone#: Information and Instructions Mas�etts General Laws chapira 152 requires all=91CTMES'D PUVICI--wow'oompensa[ion far tbZ=employees.' pmsaantto this stye,an.eNProyne is defined as."-V=ypmsonm the sm-vi-ce of another under any canf-act ofhire, express or implied,oral or wry" An�rrrployer is defined as"an mdtPidnal,pmtac ship,asso�on,cozporafionentity, or other legal or any two or more of the foregoing in a joint e�eaprlse,and mclnding the legalaesenfafives of a deceased employer,air the reiver or trustee of an mdiVidaal,partn�ip,association or otherlegal entity,emploY�emP1OYe- However the ec owner of a dwelling house having not more than three apartmeots and who resides therein,or the occogaat of the - em=t0 do make,c�ctmcfiion or repair K•work on such dwelling house dweIImg house of ano9ier who employs p " or on the grounds or bm7dmg aj jr ro na tlharefn shallnotbemwe of such employmentbe deemedtr be an employe 25 also st±s that"everysta�or local licensing agency sliaII witlzTioId$ire issuance or MGL ter 152,§ C(� chapter a Ticense or permit to operate a b�mess or to construct b�diags in the commDnwealth for any renewal P applicant who has no p " t produced accep f.able-evidence of cumpTtance wn the insarance.coverage required Additionally,MCrL chapter 152, §25CC7)states"Ne fiber the c=nmwean nor jay ofits political subdivisions shall enter into any contract for the perfvtmance ofpublic wuuc unE acceptable evidence of campIiance with the� .. regzm e�e�s of this chaplra have Iieen presemtesd in the�nntr��,a a�.ozhy_" . Please fill ovf the wod='compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sob-contractor(s)nan?e(s), add=s(e s)and ph one xuanber(s) along with then cmt[ficate(s) of insurance. Limited Liability Companies(TLC)or Limited LiabMty-Partnerships(LIP)with no employees other than the members or partners,are not requaed to carry workers compensation insurance. If an LLC or LIP does have employees,a.policy is required. Be advised that this affidavit may be sabmitied to the Department of Indvgtial Accidents for comfrrmation of fi=mce coverage. Also be sure to sigh and date the afudaviE. The affidavit should be ru.tnmed to-Le city or town that the application for the permit or license is being regaested,not the Department of L-nd a. a A=d=tS hOACI you have any guest cns regmdmg iiie law or if you.are regan-(-,d to obtam a workers' compensation policy,please call the Departmen±at the nnmbea hsird belovr pelf-msir<ed c=3panies should mtra their self-insm7an-ce license number on the appropriate line. City or Town Officials . Please be suie that the affidavit is complete and prtrtted legibly. The Departmenthas provided a space of the bD-ff r of the affidavit affidit for you to 01 out in the event the Office of Inver o�has to contact you regarding the applicant- Please be sure to fill.iathe pen:tl ccme runnber which will be used as a reference number. In addition,an applicant eed o submit one affidavit mdicatimg that must subn�mul4lo pemlitMcense applications in any given year,n my policy inl�unation(if necessary)and under-job 5`ite 1�_ddress"the applicant shoLtd route"sII locations in ( Y or p town):'A copy of the-affidavit that has been officially s m aped.or maimed the city or town maybe provided to the applicant as proof that a valid affidavit is on fle fur futare ermits or licenses A new affidavitmirch be filled out each year.Where a home owner or cites is obtaaining a license or permit not related to any business or commercial vent lm (i.e. a dog license or peffiit to bwn leaves etc.)said person is RIOT to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any,qaf slions. please do not hesitate to give us a call- The Department's address,telephone and fzx number_• Th COMMOn tbE of - Dega dmm±of Iz�al A=dentt Qffi=ofXuvesti&ELo= ��4Qn t -z �Qs�nsl�4 E�11F Fax 617-727-7M lZevised4-24--07 w W -mas,- a RARNSMELF. • 19. Town of Barnstable Regulatory Services Richard V.Scali,Director o . Building Division Thomas Perry,CBO ' Building Commissioner 200 Main Street, Hyannis,MA 026011 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230' Property Owner Must ' Complete and Sign This Section A. If,Using A Builder - I, _f,onl�i o�g 5 , as Owner of the subject property, hereby,authorize_ l"/ �/7y iC.4 �4%i�yi-� `��c4 to act on my,behal f in all matters relative to work authorized by this building permit application for: (Address of Job) 6 Signature of Owner Date . Print Name " If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. AWP=S�F ORMS1bnil ' permit Q dmgp formslEXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services k �drIKE r ti Richard V.Scali,Director b o* Building DIVLSIOII t t �arrsresra, • Tom Perry,Building Commissioner MASS s6,1 � 200 Main Street, Hyannis,MA 02601 QED www.town.barnstable.ma.ns Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number sheet village y "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. DEFINPIION 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•farni 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 reMonsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval ofBurlding Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often. results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot i proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner actin, g as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C Q:\WPFILES\FORMS\bmlding permit forms\EXPRESS.doc Revised 040215 Town of Barnstable i t, R6e uiato _vservnces r� Rifihar4 v.Scal ,-bireetar ' ' Building Division Thaaias Perry,CBO Building Coaiinisaioner 200 Main Strut, T ini;MA 02601• w"Aowm bamstable.m a I fffce: 508-862-4038 Fax: 508-790M6230 fl r MushPro e )wte Complete athd. Sign This Section. F If Using A Builder tikes I e S 3 S , as 0d0n4 of ttd'suhj ect proper _i �~1 ,� / ,�fJ L"ts�sny� >f c%c�P lT�co�� to act on mp behai hereby autloxize / �at/Kd � ` in all matters relative to wozk authorized by th s,boding pexxait application fox: ; (Addre s of Job) 14, 2c( /ej s . Date 5 e,of fez i Frop6rt pwetoris applying for germi.4 please complete the Homeowners,License Exemption Form on the r rive sfdd e r. ev r , , K_ �din rgPcrmik bCiL15 1 .E 1G ,. Q. . . Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-109298 Construction Supervisor PAUL MUZYKA " 45 CROSBY STREET SOUTH YARMOUTH MA 02664 Expiration: Commissioner 08/22/2019 ��e �poarui�zo�racae�cl�n�C�/�,ccaaac�iu�eCt� � Mee of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 176448 Type: Office of Consumer Affairs and Business Regulation Expiration:===;81237-2017 Individual 10 Park Plaza-Suite 5170 =x Boston,MA 02116 PAUL G.MUZYKA PAUL MUZYKA `cj" 45 CROSBY ST SOUTH YARMOUTH,MA 02664 Undersecretary of valid without signature Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: VAVW.MASS.GOV/DPS � �/��'04/7/172IYJLLl1P.CL�o�6�Joac�eClq ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: j 76448 Type: Office of Consumer Affairs and Business Regulation Expiration;.-- ;8L23%2017 Individual 10 Park Plaza-Suite 5170 ! � Boston, VIA 02116 PAUL G.MUZYKA 1 , ji PAUL MUZYKA ..- 45 CROSBY ST -; SOUTH YARMOUTH,MA 02664 Undersecretary of valid without signature