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0045 EBEN SMITH ROAD
��;�f� •vr�n�y�.� �•,ri far .. fil+ n�•�'�"� �y�+": '! { k 'fie; iN .:p:, .: -'m^' •.:,� �.'r.� ... r .-.iv i Av .- .... r �,,..'I'h .I � r �i gyp. !, l�J���j��J F+� �aiy,, 7SF y:.�� ��j:r.,� t�'�1 'Mr, ..r4 ,U.. .,.' r . .)�/M�i'.�if �+:I."�. L., J•..! 1.. ,.; .r�).Z. i+1�. ,.. ,. .. n. � � t1 � �C.,i!S .�. 'T� ��f,,. •A ,�an X 1 �. .."r,+!f -'a ,�.�+7 +/t. ,�rk�x ail i idl. Sd` r �y r1'y7'�: ar Y, 1R11W "'�(i° ny, >➢' �7� �f�4 �Arrr !f 117..�� ��.,.w✓.r 4 r,-.:r, d, y .! ,t�.! 1�,�. 'i' ,r � a � �9'j� >.r�� ,t �'. i -.� tYn� .�", ��✓ _�!'�. ,� �as �1 ��:,.....:rl �. ,.k. Xr rh a of .'Ir�t>' ! +.,, P L - a &.�. a :.• 5u. n �. 4 t�,�' �,,9,i' e� G1,, ...,a}!y ��+� r.,�+'� �� '+� ' r fry�{a��JMr�i �"�+ �':, �r •,� `���jy`� �T`� 4. It r� � � F''4A�f' .• ��'6 ;K �!h�.7;�lra� r ' :'� "+ h y y r r w r� ' c t � G P m PHIILBROOK �± � ENGINEERING 107 BEACH STREET DENNIS, MA 02638 CONSTRUCTION TO'�t'�4 OF :ARt ,' , E E1-508-385-8682 ENGINEERING DESIGN • CONSTRUCTION INSPECTIONS • BUILDING, ALTERATIONS & RENOVATIONS 20M AUG. 29 AM 25 August 2014 DIViS�1'`�<I Town of Barnstable Attn: Mr. Jeffrey Lauzon Building Inspector Barnstable, Massachusetts 02601 Reference:. l Family Residence—45 Eben Smith Road, Centerville, MA Framing& Foundation Remodeling& Alteration Checks Dear Jeff: The purpose of this letter is to highlight the design review I performed for Matt Scavarelli's proposed residential work. I was at the site this month to review existing conditions. Based upon the plans I checked work to meet design requirements IAW the 1 & 2 Family Wood Frame Manual for 110 mph in an EXP B windzone and the 81h ed. Building Code. Notes with back-up calculations are attached. Briefly: a. The roofs will be made partial cathedral—the living/den will receive a bearing wall in the attic and a 2°d bearing wall in the basement. Loads will transfer to the slab and redundancy will be maintained with the existing steel tube columns. The bedroom will be reinforced in order that the ceiling and roof remain self-supporting. b. The dining room floor will be beefed-up to carry a lineal load created by the new eyebrow window framing—double joists and a row of solid blocking. c. The existing porch will be properly tied together and will be mechanically attached to the slab-on- grade. The existing slab is only 10"thick and bears slightly below grade. Although it is in very good condition deeper and more robust bell piers will be added to ensure bearing remains in the coarse free-draining soils at this site. These sands are non-frost susceptible and the deeper piers on a compacted gravel base will more properly support the increased construction loads being added. Thank you for your help in this matter. Please look over the design submittals and call me with any questions or comments you might have. My cellphone is still 508-364-1301. Respectfully submitted, ����H ssgy 0 T VARNUM Gs o PHILBROOK MECHANICAL T. VARNUM PHILBROOK, P.E. q N0.30690 SANAL Design Notes & Plan Mark-ups attached ' PHILBROOK ENGINEERING i FIELD REPORTMORKSHEET ! Project �. 107 BEACH URE97 No: I i 1 DENN.M Sheet No: )- of 3 i � GENZRAL DESCRIPTION Stefan Richman 280-5738 8th ed. P14-27 Narrative: 1 Story Extended Ranch w/ 1 Car Garage. New Ceiling BQ4510 ---------- Spaces for Existing Construction on Full Foundation , j Location: BCAVARELLI, 45 Zben Smith Road, Centerville, MA HOFMgSsgyG Construction: 2"x 4" Q 16" O.C. platform Frame w/ Concrete T VARNU M u' ------------- Foundation and Stick-built mood Framed Root & Ceilings U PHILBROOK CONSiDZRATIONB MECHANICAL ; BPZCIAL I 0 9No.306900 Use Group(@) : R-3 (1 Family Residence) ° c! TE Construction Type: V-B (unprotected) see separation below Al EN f Mist or Comments: o site Check, Note & Review Layouts ----------------- o Design Review - Chords, Struts & Braces o MEMO w/ SK Plan Notes & Certification C DZBIGN CONSIDZRATIONB -� Soil Data: - Site Plan or Boring Log available: NO ---------- Direct Observation: NO from CC Atlas - Gravelly Sand, Cobble*, Outwash i Description: I j USCS ® SP ( ) BBC Class ® -6- !� Specifics: Br(allow) ® _2,000 lb/sq ft w/ 10% allowable width & depth increases I Fire Data: Existing Separation between Garage & Residence - no changes ---------- Loads BBC Location N/sq ft ' Dur Note 1st Floor 40 1.0 Tbl. R301.5 o Docks - Stiffer 50 1.0 Tbl. R301.5 Attic - non-Expansion 5 1.0 Tbl. R301.5 i Partitions: 2x4/6 12 1.0 bear/Non-Bear aFCaS lit Fetid y,Chp 9; Prescrintivo D4stiYtvd for BnoN 6-xisul`t>�t� Snow - m 6/12 (26°) 30 1.15 Tbl R301.2(5) (MA) 'Rind - speed - 110 MPH ExP B 1.33 Tbl. R301.2(4) (MA) t Height & Exposure Coef. ® 1.00 Tbl. R301.2(3) t Rof Pre* (Horis) Zone 4 -20 MWftS Tbl. R301.2(2) Ref Pros (Horis) Zone 5 -28 C&C Tbl. R301.2(2) b Roof Pitch > 109 to 300 Mrh 15 ft 1 Story Rat Pros (Vert) Zone 1 - -18 MWFRs Tb1. R301.2(2) Ref Pros (Vert) Zone 3 - -25 C&C Tbl. R301.2(2) 1 Loadings 1*t Floor Attics Roof/Ceiling Decks { ------------- ----------- --------- ---------- ------------------------ t LIVZ LOAD 1 40• 5 30 SO ------ ----------- --------- ---------- ------------------------ DEAD LOADS 1 12 8 9 6 j Mist 12"x 10" Joists, 21'x 6" Ceiling & Rafters Q 16" c/o j DESIGN TOTAL I 55 15 40 60 w/ round i w/ 5• on DL Tbl. lZ NET UPLIFT - (100 to 309) (') - .6(_) - ® lb/sq ft -286 per tail for C&C/UL Uplift (-25) - .6 x (15) - -16 lb/sq ft -277 @ 16"o/c f e i I i a. P82-FRW-7 I PHILBROOK P1�1� 21 ENGINEERING FIELD REPO RT/WORKSHEET Project No: 107 BEACH STREET N 1-5w-35sm ; Sheet No: ?` of k 7 -y GENERAL DESCRIPTION Stefan Richman 290-5738 8th 9si" l — �-_Fl4- ��.�.ZN OF MgSs9 Narrative: 1 Story Extended Ranch w/ 1 Car Garage. New Ceiling i ---------- Spaces for Existing Construction on Full Foundation T VARN UM Gs ! PHILBROOK Location: SCAVARELLI, 45 Eben Smith Road, Centerville, MA MECHANICAL --------- No.30690 DESIGN ANALYSIS: �p ,n� G�STER y�oocl=Fsims Cosi*t: ual'1�2 Dasii�ly - *T 3'Pii,B 0ptiv�b th+�d"iri EXe e Rafters; 2"x 6" Coast Fir ® 1611 c/o (Tbl. 3.26D) 7_3 A V("-uq ! Wul n (30 a 10) lb/sq ft w/ ceiling a insulation Maximum Span - 121011 vs. 12110" from Table OK by Table - ;Rafter/Ridge Tension Ties; 1611 c/o (6+/12 Pitch) (Tbl. 3.6A w/ note 4) 2 so 10d bx x 1.33 a 3 so 10d nails each aids OK by Table ;a f Rafter Lateral a Uplift; 21'x 101, 0 1611 c/o I Plate (Tbl. 3.4 <6 ft to corner) ff a 176 lb a 0 96 lb/nail Nn a 2 nails (16d Box) Minimum nailing - -286 lb a @ 31 lb/toenail Nn - too many nails NQ not enough room. I so add Simpson H4 Clips 1 161, c/o w/ nails OK by Mfg. Table Over Bedroom Ceiling Joist; 21'x 6" 0 161, o/c w/ No StoragO (Tbl. 3.25A) Maximum Span = 1319" vs. 16111" from Table OK by Table 4 Porch Coiling Joist; 21'x 6" O 1611 c/o w/ Limited Storage (Tbl. 3.25B) ` s Maximum Span - 1010 vs. 111611 from Table OK by Table Rafter/Ceiling Joist Lop; a n 6+/12 (Tbl. 3.9A 6 1/3 Raised Positions) j ® 5 as 16d Can x 1.37 (Box/Cmn) 7 ea 16d Box nails ! - 7 ea 15d Box x 1.5 (1/3 point ) - 10 Box Nails OK by Table j riaEngieseerad Design (IAq P#ra. 3t3O1`1.3) fOr JOristsr Readers a SlsppOxtB� . A. Existing 21'x 1011 S-P-F Joists 0 161, c/o - Sister Member, 14 ft span i Wul = 1.33 x (40+10) = 75 lb/lf Pwall = 1.33 x (30+15) x 101/2 + 120 = 460 lb/joist @ 101011 V b req = 883 psi & F'b avail = 980 psi f DEESmax = .6011 (w/ 85%) 6 DEFact — .3311 OK by Design i B. Flush or Dropped Header Beam - Dining/Entry; 2/21'x ®" w/ 1/2" CDX ply New 21'x KD 8RP stook - Simple Span and Bearing Wul - (30+10+10)x 261/2 + 10 - 660 lb/If 1 span; 416" Mmax - 1,671 ft-lb f'b req - 763 psi a F'b avail a 930 psi j ! DEFaax - .191, (w/ 85%) a DEFact - .061, OK by Design I C. Basement Slab-on-Grade Loading, t - 3.511+ minimum thickness Wul a (30+10+10)x 261/2 + 150 + (40+10)x 261/2) - 1,450 lb/lf Area (2"x 6" PT Shoe on Bearing Of 1211+ ground) n 1.0 *q ft/lf 8b.(act) - 1,450 lb/sq ft < Sb(allow) n 2,200 lb/sq ft p OK by Design D. Porch Framed Walls/Pilasters - BEAR Mall Loadings Parallel to House only ROf Pres (Norio) MNFRS - -20 lb/sq ft a Ref Pros (Uplift) MNFRB a -18 lb/aq ft V(roof) a (Mrh - 13' x MNFRS) x (Length)/2 - (13x20)x 12/2 - 1,360 lb A end Lateral Connects; 2 Pairs of Simpson LCE4 Post Cape 9 1,425 The - 2,850 The Up(roof) - (MNFRS) x Width/2 x Length/2 a (-18) x 141/2 x 121/2 a -756 lb uplift Uplift Connect; Simpson LSTA18 Strap Ties ® 1,110 The NOTE - Lateral i Uplift are low numbers and no deduction for Floor Deadload taken Concrete Lateral Anchor* - 1,560 lb/14' - III lb/lf Concrete Uplift Anchors - 756 lb ® Corners l Check Simpson TitOn HD 1/2x6 anchors which provide 2,270 lb uplift a 2,795 lb lateral 8 3-3/8" embed. OK by Design, Mfg. Tables r► 241, o/c Install E. Porch Foundation Bearing; Frost plus Pilaster Point Loads - Total 5 Oa ; NOTE - Poorner - 3,030 lb and Paid-wall - 4,500 lb II Design l for All points I Area req - Pmax/Sb(allow) - 4,300 lb/(2,200 - 125) - 2.2 aq ft Therefore provide 16" deep x 18" square Hell Piers below slab at the 3 locations. Over-dig holes approx. 101, and fill w/ compacted gravel to provide frost a heaving break in the soil OK by Design Inspection P82-FRW-7 f I PHILBROOK , ENGINEERING FIELD REPORTMORKSHEET Project No: j 10?SEAQi STREET I Sheet No: ?2 of of _ GENERAL DESCRIPTION Stefan Richman 280-5736 8th ad. Pia-27 I Narrative, 1 Story Extended Ranch w/ 1 Car Garage. New Ceiling Spaces for Existing Construction on Full Foundation Location: SCAVARELLI, 45 Zben Smith Road, Centerville, MA DESIGN NOTES: 4 of A. Sister existing 2"x 10" 8-P-F Joists 0 16" c/o w/ 2nd 21'x 1.0" joist E. Porch Foundation Bearing; 16" deep x 18" square Bell Piers below slab at the 5 locations. Over-dig holes approx. 12" and fill w/ f compacted gravel f 0'I Install row of solid blocking beneath the new rear dining wall 02 New 21'x 6" load bearing wall beneath existing girt. Provide a single top plate and double bottom plate. Contact plate to be pressure treated. OK to pin w/ powder actuated fasteners 03 Optional openings not to exceed 310" rough - match right end 04 Fasten ledger w/ 2 rows of 3-5/8" True-look screws 0 16" a/c j06 Provide Simpson LSTA straps i LCE cap ties thru to foundation a below. Posts attach w/ Simpson PS series anchors or equivalent 1 6 Of7 S. Flush or Dropped Header Beam; Dining/Entry; 2/2"x 8" w/ 1/2" CDX ply and double jack stud/corner pilaster build-up D. Porch Walls/Pilasters Lateral Connects; Pairs of Simpson LCE4 Post Caps and Uplift Connects; Simpson LSTA18 Strap Ties 0 All Framed Openings 6 Of A. Sister existing 21'x 10" S-P-F Joists 0 16" c/o w/ 2nd 211x 10" joist 11. Flush or Dropped Header Beam - Dining/Entry; 2/2"x 8" w/ 1/2" CDX ply C. Basement Slab-on-Grade Loading; Drill i check t . 3.511+ minimum thickness D. Porch From Anchorage - Simpson Titen HD 1/2x6 anchors 0 24" c/o E. Porch Foundation Bearing; 16" x 18" s� Q deep guars Bell Piers below 1 slab at the 5 locations. Over-dig holes approx. 12" and fill w/ 1 compacted gravel 01 Install row of solid blocking beneath the new rear dining wail ' 02 New 2"x 6" load bearing wall beneath existing girt. Provide a single top plate and double bottom plate. Contact plate to be pressure treated. OK to pin w/ powder actuated fasteners. Brace one face 04 Fasten ledger w/ 2 rows of 3-5/8" True-look screws 0 16" c/o 06 Provide Simpson LBTA straps i LCE cap ties thru to foundation below. Posts attach w/ Simpson PS series anchors or equivalent 06 Uplift Connections; Simpson H4 clips spaced 16" o/c 07 Rafter Ties (tight to ridge); 21'x 4" Rough Spruce 0 16", o/c w/ 4 ea 12d box nails each end 08 Bedroom Ceiling Joist; 2"x 6" 0 16" c/o set at the intersection of the false ceiling. Nail lap joint w/ 7 as box nails EE 4 08 Porch Ceiling Joists (out from existing stock); 2"x 8" 0 16" c/o. Raise 819" above finished floor and nail lap joint w/ 10 as nails EE 010 New 2"x 4" load bearing wall beneath existing rafters. Provide a double top plate and nail bottom of etude to existing top wall plate. Run a single brace on one side mid-height 7 Of 07 Rafter Ties (tight to ridge); 211x 4" Rough Spruce 0 16" c/o w/ 4 ea 12d box nails each end 08 Bedroom Ceiling Joist; 2"x 6" 0 16" c/o not at the intersection of the false ceiling. Nail lap joint w/ 7 ea box nails EE 08 Porch Ceiling Joists (cut from existing stook) , 2"x 8" 0 16" c/o. Raise 819" above finished floor and nail lap joint w/ 10 as nails EE 010 New 21'x 4" load bearing wall beneath existing rafters. Provide a double top plate and nail bottom of studs to existing top wall plate. Run a single brace on one side mid-height i i } k 1 P82-FRW-7 PROJECT NAME: �o C-C,n J4 ADDRESS: PERMIT# PER.AM DATE: .. LARGE.. ROLLED PLANS IN: a Bo .................... SLOT Data entered in 1VIAPS program on BY: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ----------- Map Parcels Application # Q6 NO Health Division Date Issued Conservation Division Application Fee V Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project:Street Addr-essz--- -6� r rH V_illag�G°ex��-w Ut ups 6:Owne�/ 41iozkj9�SLO 5cAu-q2c-Lc.-( Address Z-21 Ana U✓#IY c_-Te-lepho" e 4-cl - 77 6 -- SG 9f PermityReq_ _-ues^� cS`.�-r daTrY.�•���")� S t�-�� ..�.��e��'a•r- 9�e�do�%l /no�� c��-��S �'af�e�i•c� � e e,`�,'...S K�r�v ��� �c�7�� '� f�i�Cfreh /IC2�/ �Y�CI� la 1107�0 Qr,4 ad✓ !Ja ram'.k Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay cP=rojecfVdI taon I '8�c%myo Construction Type 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 ❑ 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 ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NWa e=4f- fft w Scaw i�-r Telep' Done Number�i��" (Addr- ess`O-Y �4wL-j fj — License#- CS 03/c77/ ' Home Improvement Contractor# 13 7,8'04zz, Email I 0? c_0Me-Ae Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /✓1 /Scc� Lrhvi SIGNATURE � FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED Mf:W/PARCEL NO. h ;r ADDRESS VILLAGE I, OWNER f: h!hj DATE OF INSPECTION: 'r FOUNDATION a a lO (� L/ FRAME S `INSULATION l D3 !. `Yl '. FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL FINAL BUILDING 6N Ok 0 DATE CLOSED OUT' ASSOCIATION PLAN NO. i Town of Barnstable :.OFIME T a Regulatory Services �g� o Richard V. Scali, Director 'sTnsi.e Building Division ' BARNSTABLE * anxiv . � B nnu5-zsE-c r[a t •ovrt+rnxxis MASS. � N RS b5 MIS fkIILE*AS(M0.VSfA0t[ 9eb i639. .• Thomas Perry, CBO 1639 2013 Al�D1"0�s Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.liarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 July 25, 2014 Matthew Scavarelli 274 Ames Way Centerville, MA. 02632 z. RE: 45 Eben Smith Rd., Centerville, Map: 171 Parcel: 200 Dear Mr. Scavarelli,. , This letter is in response to application number 201404203 submitted to obtain a building permit for the above referenced address. Unfortunately,the application can not be approved as submitted for the following reasons: 1) The side entry on the proposed construction documents appear to encroach on the required setbacks. 6" STOOL 2) Engineering is required based on design of the construction documents. Please do not hesitate to contact this office with any questions. Respectfully, r au y ocal Inspector jeffre. .lauzon ,town:barnstable.ma:us (508) 862-4034 - o1Z1�y. i The ComwonweaM o,f Vassachuselft D8parftnent of hulustiwi l Accidents - QUice of Investigations 600 W slsingfon Street Boston,HA 02HI wnhv.rnasmgoWdia 'tom❑ricers' CampensatianInsuranceAffiidavit.Bu lders/ContractorslElectricianslPlumbers Aptplirant Information Please Print Legibly +Cty`IStatJZip: ! ©Z(,3 Z Phone .5 48 ---—Are-y-ou.an_employer?Cl erk hr sppxapr __. ...._Ta)e-of project{require')=._--------.--- _--- I.El am a employer with 1r4Y❑ I atn$ sub -c ctos and c�I 6- ❑New oansttuctioa 2- employees{full and/or part-time)* have hired the�b listed on the attached sheet. 7- 5'Remodeling ❑ I am a sole proprietor or partner ship and have no employees These ees a d ac c have g- ❑Demolition w for me in an c ct ,_ e�� .and.have workers' orking y ape. fij e �r$ 9_ ❑Building addition [N�o workers'coup_irmum„re. °mP k+_ _ 5.,❑ We are a corporatiouand its 10-❑Electrical repairs or additions am as homeowner doing all work officers haG'e exercised their 11_❑Plumbing repairs or additions myself,[No workm'comp- right afea(em and MGL 12.❑Roof repairs ur insance required-]1 c.152,§1(4},and t�Te have no employees-[No workers' 13_❑Other comp-msntanm requueid.j *Any aq Rc=t that checks boa#1 uaust also fill out the section below showing their waders'compensation pa u infcrmatk . Htrmeawners who submit this.ng thiey_nre.doing.mfl--Loris mi.dom hats-outside contractors.nmst-submit anew afidscit l such_ � metctts-tltsft-Hxtc-t3is box mast sttarhed as additional-slieefshocrine rite ns�of"5�e�nti=oo�r-.tctoss`and state uhethectxnattI�ns$.ie�ities Tisve�� t?mplgyr?es.. If the suFr-toattactats Bare empTagees,they must provide their workers'tamp.paliu number- lam an emplo}7er tltcd is prmif trg it�orkers- co runtion irmirarice for my emplay-ees. Below is the policy artd}ob site informatiorz Insurance C,ompanyName: Policy 9 or Self-ins-Lic-4 Expiration Date: Job Site Address: City/StatelZip: 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 MUL c, 152 can lead to the imposition of t i i aal penalties of a fine up to S 1,500.00 and/or one-year in4xisonment as well as civil penalties in the foam of a STOP WORK ORDER and a fine of up to S250-00 a day against the violator- Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIAL fir insur-=ce coverage verfficatim I do hereby ce&jy render thepai►ts ae penalties of peduq thattlte in,,{ormation pravided almn c is tare and correct (Sitntatuie--,A `l�ate:'----�-`e—# 1 71 Phone#: 0JR&I mw onty. Da not write in this area,to be completed by dV or fawn officiaL City or Town:. PerraitUcense# Issuing Authority(circle one): _ 1.Board of Health 2.Building Department 3.CityHown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#- 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for arty 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)Nith the insurance requirements of this chapter have been presented to the contracting authority.- Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addresses)and phone number(s)along with their certaficate(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_ Lae advised that this affidavit may be submitted to the Deparment 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 obtaum 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 tinted legibly. The Department. has rovided a ac„at the bottom P PP space the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations III (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture G.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depaxtment of Industial Accidents Office Oflave�tigations 600 Washtngtan StT=t Boston,MA 02111 Tel#617-727-4900 ext 406 or 1-8 MASSAFE Revised 4-24-07 Fax#617-727-7749 WWW-Mass-govldia Town of Barnstable Regulatory Services °Fme'r Richard V.Scali,Director , � y Building Division EARNSTABM « Tom Perry,Building Commissioner hrass. 9Q� 1639 ��� 200 Main Street, Hyannis,MA 02601 RFD MA'I A www.town,ba rnstable,ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / Please Print O LO ,` CATION: '5�5� L=Bc� S ph i rH �G-,.�2n i/a cc number (� street village CHOMEOwNER- 1.1_1Afr7 XVJ JG1qj �7O8' 776- f GS,f SZk- 776^- g6 9Ip home phone# work phone# CURRENT-MAII.ING-ADDRESS�" Z�� c=q 7i.J Cc-wi2�c !/r�[cf AA- C726 3� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall Dot 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. -"Signatuie of Homeowner. Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. . HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 Town of Barnstable Regulatory Services Mpg Richard V.Scali,Director Fo;q.. 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 Se 'on If Usin A Build I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work autho ' ythis building permit application for: ( dress of Job) ""'Pool fences and ala are the responsibility of the licant. Pools are not to be filled or tilized before fence is installed and all final inspections are perf ed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q TORM S:O WNERPERMISSIONPOOLS MATT SCAVARELLI 274 Ames Way Centerville, Ma. 02632 Ce11508-776-9698 To: Barnstable Building Dept June 24, 2014 200 Main St Hyannis, Ma Re: Permit Request I am requesting a remolding permit for 45 Eben Smith Rd, Centerville Ma,the permit is to include all exterior walls to be changed to vinyl siding and Azek trim Non load bearing walls to be moved to allow a walk in closet in master bedroom,wall between baths to be moved master bath to be equal in size to hall bath, den wall moved to allow a laundry and closet/pantry can be on first floor between kitchen and den,the sun room to have windows/slider installed to make it part of the living space,to make a cathedral ceiling from existing dining room to kitchen to den and in sun room and master bedroom removal of wall between dining room and kitchen, install new cabinets in kitchen, install spray foam insulation in all exterior walls and ceilings, Construct a deck in back of house and a covered porch in front and.side of house Install an eyebrow dormer in den IJ List of sub contractors .. Electrician: John Hassay , Plumber: Sean Hanranhan Air Condition: not determined at this time } I MORTGAGE INSPECTION PLAN (THIS PLAN WAS NOT CREATED FROM AN INSTRUMENT SURVEY AND IS FOR MORTGAGE PURPOSES ONLY, MACDOUGALL SURVEY WALL NOT ASSUME LIABILITY FOR ANY OTHER USE). \/v VV SM� PARCEL ID: / A, N 171/201 0 CY -- �C #45 PARCEL ID: 171/202 p O_ ' ^h0 PARCEL ID: 171/199 PARCEL ID: 171/200 700 00 PARCEL ID: 171/204 PARCEL ID: 171/205 1 CERTIFY THAT THIS MORTGAGE INSPECTION PLAN WAS PREPARED IN ACCORDANCE WITH 250 CMR SECTION 6.05 OF THE MASSACHUSETTS RULES & REGULATIONS FOR THE PRACTICE OF LAND SURVEYING. THE BUILDING SHOWN IS NOT AFFECTED BY A SPECIAL FLOOD HAZARD AREA AND DOES _CONFORM TO THE LOCAL ZONING BY—LAWS IN EFFECT AT THE TIME OF CONSTRUCTION WITH RESPECT TO SETBACK REQUIREMENTS OR IS EXEMPT Y-RROM,VIOLATION ENFORCEMENT ACTION UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 40A SECTION 7. REFERENCED DEED SUBJECT TO AND WITH THE BENEFIT OF ALL RIM S,;RCOH;TS OF WI)Y EEASEMENIS. RESERVATIONS AND RESTRICTIONS OF RECORD. IF ANY THERE BE AND INSOFAR AS THE SAME ARE OF LEGAL FORCE AND EFFECT. 414 1 is TOWN: BARNSTABLE (CENTERVILLE) DATE: 06�09�14 APPLICANTS: MATTHEW M. & JUDY M. SCAVARELLI z CERTIFY TO: JOHN W. KENNEY SCALE: 1"=30' �H ofs TITLE REF: 3183/336 MacDougall Surveying PLAN REF: 306/21 & Associates EI)Ua+IRO ti FLOOD ZONE: "C" - P.O. Box 2428 COMMUNITY PANEL: STONF 250001-0015—C Mashpee, Mo. 02649 DATED: 08/19/85 a a.289 " " ph. (508)419-1086 • � �Q CURRENT ZONING: RC fox. (508)419-1087 email: 0comcast Ine{rvey JOB# 11057 Commonwealth of M ssaehusetts. .She mit /� Map Parcel. Date: Permit# c � 5 Estimated Job Oust:S 310oo � PermitTee::$ Plans Submitted'. YES: !� to ►►� Plans Reviewed: YES 1/ NO Business License# Applicant License:# Business Information: Property Owner/Job Location.Information: Name; Name; Street: zLra=E S &Z-101cc Street: CAI SMIV4 f4O City/Town. iLy`i �_r City/Town;; Telephone:.19! 290 M? ,Telephone: ` Photo I:D;required I Copy of Photo I.D. attached: YES NO Staff Initial J 1 ' -1-unrestricted lice e J-21 M 2-restricted o dwellings: r es or less end commercial:lip to 1 V..Q sq.ft./2-stones or less �. Residential: 1-2 family Multi-family Condo]Townhouses: Other j Commercial: Office Retail Industrial Educational Fire'Dept.Approval lastitu4o _ Other Square Footage: under TO,QQO q.11;1 over,l O,QQQ.sq: Niii:M er of Stories: a Sheet work to be edg leted: New Work Renovation HVAC -Metal Watershed Roofing_ Kitchen Exhaust.System j Metal Chimney/Vents Air Balancing. Provide detailed description:of work to be done: l,•L//Tip //f 6)W421 7/7�/� G�•- � 9 i I _INSURANCE COVERAGE: ` I have a current liability.insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes ZNo If you have checked Ygs,indicate the type of coverage by checking the appropriate box,below: A liability insurance policy ❑. Other type of indemnity ❑ Bond ❑ j - OWNER'S INSURANCE WAIVER:I am aware that the licensee hoes not have the insurance covera9e required by Chapter 112 of the Massachusetts General Laws, d that my:signature on this permit application.waives this requirement Check On my Owner Agent ❑ Signature of Owner or Owner's Agent ' By checking this box[],I hereby certify that all of the details and information l 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 forthis,application wfll 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 Progless InsRec ons ; i Date Comments i .Final Inspection Date Comments Type of License: 3y ❑ Master i itle ❑ Master-Restricted ;ity/Town ❑Joumeyperson Signature of Licensee 'ermit# ❑Jouirmeyperson-Restricted License Number: =ee$ Check at www,mass.doyldnl I nspector Signature of Permit Approval • i Commonwealth of Massachusetts ` Sheet Metal Permit Map - Parcel Date: Permit# Estimated Job Cost: $ Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# Business Information: Property Owner/-Job.,Location.Information: Name: Name: Street: Street: City/Town: City/Town: Telephone: Telephone: Photo I.D.required/Copy, of Photo I.D. attached: YES NO Staff Initial J-1/M4I 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 i Commercial Office Retail Industrial Educational Fire Dept. Approval Institutional_ Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: r Town of Barnstable a� Regulatory services �* Tllo"mias F.Geller,plrecEor Building Division Tom Per y,.:BuIlding ammissioner 200 Main S�aet;; yaanis,MA 02b0.1. vvvvtv.town.barnstable,ma.als Office; '508-862-4038 Ymm 508 79M230 Property Owner Must Complete and:Si,11:T. t s`Section.. If Using:� Builder as Owner of t e.subjettproperty . hereby..autho=d t Tl/f 2 to �tion iny.beh in.allmatters.reiative:to:work,,a,4thodze b Ibis:b ern it {Address of Job) "Pool fences and.alarsns am the tesponeibility ofthe.applicatit. Pools: : are-not to be filled before fence is installed and pools ate.not,to be- utilized-until all:final inspections areperfor=ned.audaccepted. 1. d .Signature of Owner Signature;of Applicant Print Nari e: .'Print-Name. Date gYORMS;OWNERM4WSSIONPo0I.S _ - , - -- _ =- _. ----- — e. Fold.Then Detach Along All Pedc,.U., MONWEALTH COM OF MASSACUSET •S • - BOARD SM SHEET MTTEEETRRAL VyORKERS WHIA T r J TYPE Cff R] M1 SERVICE �=RD f . �� BARNS= TABLE MA- 02668 283186 Wl"Fold.Then p • 'g5 etach Along All Perf6ratlons ~ � t ' i i 77te C0mmonwea4 :.ofMassachuseM . Depa, inent ofrnstrten : Office pf Investigations 600 Wash ngtoa Street.: . Boston,MA 02111 ,° . . wwwmasx gov/dial • Workers'Compensation Insurance Affldawit:Runde)rs/ConttactorsfElectricians%Plnmbers ARPH.cantInfonnadon Please Print L i . Name,musincsdorgsairat wvhdividoey, Andress /C� �SC"��CE /2D, ��T �3 W45rX9667 City/State/Zip.- ,Phone:#: Are:you au employer?Check.tlit appropriate:bow a of to act z i 4. I em ti general. ' •Type p j ( equired): I:❑ I am a loyer with (� g contractor and I 6. ❑New c nn.. ogees(hill-and/or part»time).*'. have hired the gbb;contractors listed on the'atiached sheet:; 7. de 2. I am a'sole proprietor or.pattner- ` ship andhave:no employees These su&cont actors have . Ye to 8. Demolition working..for me is any:capacity:: employee@:.and have:workers'' [No.worlcep'comp,insurance, comp eutance.t 9. [].Building addition required;] 5. �"We area corporation and its i0:E1-Moctrical repairs or additions officers have:aXercised their 3: ] Tam a homeowner daing:at[work I1:O Phunbiiig reparsor additions Myself[No workers'comp, right df exemption per MGM. 12.[]Roofrepairs insurance required jt ,c.IA§1(4),and we.have no to C M-IN6 workers' 13..0 Other. �mp,1;,�;,•�^ceregtuired.] - *Any.applicant fiwtcbecka box#I umst also fill out the.secdon below showing dIMr.work='compensation policy hiformatiam. t Hotriaovmers>who submit.this 4davi.01 is aft guy ate doing ail.work and'tlien hire autsida c6ntxactora stsulirnit a new affidavit ind{eating BUCK,;. xCor traotorx that aheckthis box must auscbed an:aMtional sbmg g mwing the.ume of the sub=ftctbm®d ntatawbetber ornot those entities have efgloyeos,.If the 8W3, ttttactm Kays cmplgym,tbry taust pmyidO that wotketa' ,-policy Lum bar,. I:am an.e Tkyer that Isproviding workers'compensation:insurance. or m .ene.lo ease Below is the o ob site lnformadbn. f.• y ..p y p Ug�j: insurance Company Name: Policy#or Self-ins,.Lie.# 'EapiraddnDate: . Job Site Address.- copy of the workers compensation golf declaration a e' aho.. the oif Attach,a co ' cY p g ( wing p cY number and expiration dstej, Failure,to secure coverage as required under Section:25 A of MGL.c. 02.can lead to.the imposition of criminal penalties of a. 'Aim ti to,$I,S60.00-and/orone- p year.imppsanment,as well as civ11 ptBoalties in the:form of a SZ`CP$VO]tI:ORDER::and.afina ofup to:$250.OD a;day against:the violator.Be advised:#hat.a copy.of:this statemeriE maybo foriYarded.to tbe.Office flf byeistigAtions,of the DIA for'insurance coveraze.verification. I.'do:her eby fY:' der pams•and a4ki gf perjury that tlte.infowwUon pr,1vided:above.. ::true an arrect. ;OOF, ' ,�naiure: /v Phone:# .useonly. Do not wrrfe:in.thlsarea,.to:: .ecomp„ y ortpwn.offu1a[ .City or Towns Pertnit2iconse Issuing Authority(clicle ones !.Board ofHealth.,z.Building Department:I City/Town Clerk 4:RlectricaI Inspector S.PlumbinInspector Other g Contact Peron: Phone::#: Town of Barnstable I . �t"Eli,,, Regulatory Services C y Richard V.Scali,Director 9BARNSTABMO Building Division 'OtEp � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# o?O!�� S c�3 3 7 FEE: $35.00 P� SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less Location of shed(address) Village „ Property o 's name Telephone number �a Size of Shed Map/Parcel# r 1 t _ ll ignature Date Hyannis Main Street Waterfront Historic District? / u' Old King's Highway Historic District Commission jurisdiction? lT If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:040914 MORTGAGE INSPECTION PLAN (THIS PLAN WAS NOT CREATED FROM AN INSTRUMENT SURVEY AND IS FOR MORTGAGE PURPOSES ONLY, MACDOUGALL SURVEY WILL NOT ASSUME LIABILITY FOR ANY OTHER USE). PARCEL ID: 171/201 o _ . #45 PARCEL ID: ��- 171/202 p �O PARCEL.ID: cb 171/199 PARCEL ID: 171/200 7OO O� PARCEL ID: 171/204 . PARCEL ID: i71/205 I CERTIFY THAT THIS MORTGAGE INSPECTION PLAN WAS PREPARED IN ACCORDANCE WITH 250 CMR SECTION 6.05 OF THE MASSACHUSETTS RULES ®ULATIONS FOR THE PRACTICE OF LAND SURVEYING.THE BUILDING SHOWN IS NOT AFFECTED BY A SPECIAL FLOOD HAZARD AREA AND DOES _CONFORM TO THE LOCAL ZONING BY-LAWS IN EFFECT AT THE TIME OF CONSTRUCTION WITH RESPECT TO SETBACK REQUIREMENTS OR IS EXEMPT FROI'A-VIOLATION ENFORCEMENT:ACTION UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 40A SECTION 7. REFERENCED DEED SUBJECT TO AND WITH THE BENEFIT OF ALL RIGHTS RIGHTS OF WAY E�SEMEI,ffi RESERVATIONS AND RESTRICTIONS OF RECORD, IF ANY THERE BE AND INSOFAR AS THE SAME ARE OF LEGAL FORCE AND EFFECT ! ` : TOWN BARNSTABLE (CENTERVILLE} DATE: 06/09/14 APPLICANTS: MATTHEW M. & JUDY M. SCAVARELLi inw- CERTIFY TO JOHN W. KENNEY SCALE: 1"=30' _ n TITLE REF: 3183/336 MacDougall Surveying _� k PLAN REF: 306/21 n FLOOD ZONE: 'C" Associates COMMUNITY PANEL: ' F.O. Box 242$ 1-00�5—C 25000 Mashpee, Mo. 02049 3 0 r DATED: 08 19/85 CURRENT ZONING: "RC" ph. (508)419-1086 fax. (508)419-1087_ email: mocdougallsurvey Ocomcas..net y JOBS 1105i # S �t r Town of Barnstable *Permit( "7 6 a 6(a5 'rG Expires 6 months from rssue date • Regulatory Services Fee ,7 seRNsrABu. ; At" & $ Thomas F.Geiler,Director i639 p�0 Z, Building Division a� .L o� Tom Perry,CBO, Building Commissione 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790- EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 17 / ae0co Property Address_hp),e►, 5rn iHj Rer4d,, &,,4CrVI tJe, 1W.4q- 02-( 3 2 ❑Residential Value of Work -7 t500. CD Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address gi Gh a r d A4. 1_am o.r' 45 Fben Sm,*n Road, C,°vl- -v I C-o Il- 4 02-6 3 Z Contractor's Name 1PCtn -T. Q.OVC_e:O. '- Telephone Number774 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) QR 3 a 8' 0 ❑Workman's Compensation Insurance PRESS PER 'SIT Check one: ❑ I am a sole proprietor mAY e 1. 2007 ❑�I am the Homeowner U� l have Worker's Compensation Insurance TOWN OF EARNSTABLE Insurance Company Name Qrn n i-fC S�a S�surd»e� C art-� Workman's Comp.Policy# we 14 W 3 q -I.D fQ Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side (� [Replacement Windows. U-Value -� 1 (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town W'Rs, .e: tstoh.;Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. jme pro a en Contractors License is required. 1111 SIGNATURE: i Q:Forms:expmtrg Revise071405 f STAB Town of Barnstable RAWHAM Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us a Officer 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder q I R arcl kQ fY)QI' as Owner of the subject property hereby authorize SP_Q l'1 RDuc ru T to act on my behalf, in all matters relative to work authorized by this building permit application for: 45 E-hen 6r»i-fh lRWCL, Cen4Cr Vi l/1:!� , MA.} . va63 2- (Address of Job) Signature of bwner Date Cn w Print Name Q:Fomis:expmtrg . Revise071405 s :6 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): bear) J. QUVGroE E Address: (p�6 Eben Smith fcrLC) City/State/Zip: Cen+6'rvc l Ire gyp- 02-63 2 Phone #: 7-7 y - g 3G -66 2 Lj Are you an employer?Check the appropriate box: Type of project(required): 1.ZI am a employer with a °. 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- _ listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof re airs insurance required.] t employees. [No workers' P � / S comp. insurance required.] 13. Other lace p "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:_Gim -k— SYl'suran ce Comp—anU Policy#or Self-ins.Lie.#: WC !J W 3 Qaa(oq Expiration Date: 911 /a200 7 Job Site Address:1{S Ebert 5MMK, pow. City/State/Zip-CfT�_-r 1(,� M4 0263 2-- 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 ce fy un er t pa' n enalties of perjury that the information provided above is true and correct. v Si ature: Dater '( Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector - 6. Other Contact Person: Phone#: 08-06-06 10:04am From-SOUTHEASTERN INSURANCE AGENCY 508-7900557 T-996 P.01/01 F-834 ---- ---tu sr @ a,a ae — % a — va r .a %rvw_w a e eevrve%a-aaevII.- I U5/LI5/LUUb PRODUCER (SU8)997-6061 FAX (508)991-3283 THIS CERTIFICATE 18 ISSUED.AS A MA FrER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPOI I THE CERTIFICATE 662 State Rd. HOLDER.THIS CERTIFICATE DOES NO AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED B THE POLICIES BELOW. P.O. Boa. 79399 1 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC p ►NBuREo Roycro t & Kuehne BuilderS Inc INSURERA. Arbella Protection Insurance 6S Eben Smith Road INsURERB. Merchants Ins Group Centerville, MA 02632 INSURERC: Granite State Ins INSURER 0: INSURER E: COVERA THE POLJGES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD)401CATED.NOTWITHSTANDING ANY REOU.REMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF CATE MAY BE ISSUED OR MAY PERT,-^THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIOA S AND CONDITIONS OF SUCH POLICIES.,%GGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS ZT GENERAL LIABILITY 9S00022739 07/03/2006 07/03/2007 EACH OCCURRE NICE s 2,QQQ 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO REI TED $ S0,000 CLAIMS MADE a OCCUR MEO EKP(Any of 0 parson) S 5,000 A PERGONAL&AD I INJURY S 1,000.000 GENERAL AGGR GATE $ 2.000.000 G&ft AGGREGATE LIMIT APPLIES PER PRODUCTS-CO APIOP AGG S 1 000,000 POLICY JEC M LOC AU•.OMOBILB LIAOILITY COMBINED SING.E LIMIT $ ANY AUTO (Es eccidarn) 1,000,00 X ALLOWNEDAUTOS 7AM0277014095 10/19/2005 10/18/2006 BODILY INJURY $ SCHEDULED AUTOS (Per Person) B HIRED AUTOS BODILY INJURY $ NON•OWN&D AUTOS (Par acdowl) PROPERTY DA GE $ (Per awdenq incl. OAICAGE LIABILITY AUTO ONLY-EA 1CCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY. AGO a Elf(ESISIUMBRELLA LIABILITY EACH OCCURRE ICE $ OCCUR ❑CLAIMS MADE AGGREGATE $ • $ DEDUCTIBLE $ RETENTION $ $ WORKERL CONPEN6ATION AND X WC STATv TH- EMPLOYERS'LIABILITY C Apr PROI RIETOMPARTNERIEXECUTIVE E.L.EACH ACCIO rNT $ 100.000 OFFICERAAEMBER EXCLUDED? WC4W392269 09/01/2006 08/01/2007 E.L.DISEASE-Ei EMPLOYEE 100,000 If yes,deer 6be umfer SPECIAL I ROVISIONS palow El DISEASE-PC LICY LIMIT S 500,000 ' OTHER DESCRIPTION Or:OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS For any and all operations performed during the policy period. CERTIFICAI:E HOLDER CANCELLAIJON a SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B E CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER t OLL ENDEAVOR TO MAIL Tow,T of Barnstable 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Att:.l' Bldg Dept BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE O OBLIGATION OR LIABILITY Mal n•St OF ANY KIND UPON THE INSURER.ITS AGENTS OR RE PRESENTATIVE$. Hyannis, MA 02601 AUTHORIZED REPRESCNYAYrvE 13oan Martin ACORD 26(.2001108) CA CORD CORPORATION 1988 f - Y ♦.f`\ .J lie L/O%N Jllbi2C11!(C(l� OI v/(.IIIJCGCI2CldP.�l.J Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 141225 Expiration: 1/22/2008 Type: Private Corporation ROYCROFT&KUEHNE BUILDERS,INC. Sean Roycroft 65 Eben Smith Roc,. , Centerville,MA 02632 Administrator '+ �"e�R �,���_ ✓ft� 'ZJUY7C.%It(ilCCflC2E�/L. Q���GCZ�i2ClLLC.oE.G'' r Board of Building Regulations and Standards Construction Supervisor License License: CS 83280 4. Expiration: 11/29/2010 Tr# 5313 Restriction: 00 SEAN J ROYCROFT 65 EBEN SMITH RD CENTERVILLE,MA 02632 Commissioner, Engineering Dept. (3rd floor) Map / Parcel Zed _Wpermit# 5?34y, 190 House# to Issued r. Board of Health(3rd floor)(8:15,7.9:30/1:00-4:30)�',Qd k,!�f �G-y3r Fe 25-,00 Conservation Office(4th floor)(8:30- 9.30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) SEPTIC MUST BE Definitive Plan Approved by Planning Board 19 IN37A1 PUANCE ENVIRo TOWN OF EARNSTABLE TowN CCaE AND LATIONS Building Permit Application _ ProjftreetAd&ess 'y� C 6 f ti Village Owner/4?// ,01 /if Z'415 lr Address VS 66Pti :51°//1 Telephone C,!"-Oli Permit Request /fJ ��OSe �(/$7`/�/G' �r �� SCrfeeoy First Floor Zfo 4?� square feet Second Floor © square feet Construction Type VV O 09 ;c 'rj'/#,&le 0 J C/.p /,v c aY/:raS oeoeS Estimated Project Cost $ t Zoning District A c Flood Plain Water Protection Lot Size /d G X /SO Grandfathered ❑Yes ❑No Dwelling Type: Single Family � Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes &J-14 On Old King's Highway ❑Yes Qqlqo Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) O Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing 1, New O Half: Existing New No.of Bedrooms: Existing New d Total Room Count(not including baths): Existing New O First Floor Room Count 6 Heat Type and Fuel: f gas ❑Oil ❑Electric ❑Other Central Ai ❑Yes f�vo Fireplaces: Existing ( New Existing wood/coal stove ❑Yes (<o Gauge: tached(size) Other Detached,Structures: ❑Pool(size) Attached(size) �0,� ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Flo If yes, site plan review# Current Use W 1 van,-, ��pJ(;,[-L I&J 0� Proposed Use S i l j�( �/1 K L� ----ttom� / Builder Information C� �[ Name7ZIbO h 7 "RA t 1)tie� 3- k Telephone Number J d y��� I b r � Address ITO F_Yet(Spt-eA) -,T)R 1 V`e License# 6 00 �S IYANs1596 r-1 k, M4 Home Improvement Contractor# /0 73 y Worker's Compensation# c a-®11%3 2 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r-MgjY__ 6F s blC '_�15 (35k P-eO SIGNATUR DATE 7-7 BUILDIN RMIT DE41FD FOR THE FOLLO ING REASON(S) t FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED . ..E tjjt ♦ �F MAP/PARCEL NO. ADDRESS VILLAGE OWNER ' n DATE OF INSPECTION: ` r _ \ FOUNDATION FRAME `r INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL,' r, GAS: n R �H� FINAL '1 FINAL BUILII ° .., P3 - DATE CLOSE-.,, w !O !` ASSOCIATIONT i! 1 ran •�` S Lam( - � St�D2L�OM. � 6 _ &AtztEsaGE. �t t_�1. ,>`i-o�-'� - t to 4.S� 33o G-Ptl). � f=,.rtc 330.r (SC % • [S._9 6.po. 1> G 2�>t5POS AL P tT - tJStr I o00 GAL— �7 r OC 5UGWALL. A2EA = (50 S•1 Reop ISo SG' ,c 2.S • CIS Q.P.D. � 6.a.� - .�..� AV- CEOEAT S►j=. .Mc 1 . 50 s D. (4t. TcfrAL 'Vt--SI6W = 425 TOT,4 L t'7A.t L'( I=LOw :.PMOCOLaT1O0 CZ/�TE : � 10 2.Mi kf Otz L". raAim- 4 pi r Ae&-J Ul VIP +. A 3'.'AW m sT -�`g�8o ,c�, -gq f -rcbp Vw, s ,LOW lwv. ,. + pe loco IblV ' Sett... 4'po� rw. G,a�. 9G 8 Z r 'box `'IG•� St rtc IC n; t►�v , TANK 1000Hwy, tw. t• LspAcLH 9oL Ra•�/ � G�tav�L PIT WAi►1E'a { Si,:D CE_C'TIFIED PLC) - P_L.A1-J_ uc SGp,Lt Sc.ALC GrQTIt=�( Tt-(AT .T1-1t . U4J��FlL3t.1 Staow�J PLAN TZGP, ZEV.1GE. • ���'C=.bt�1 Gc�ti�PL�lS W t Tf� 't't•1::= 'S I D i=.LI►at;— Aut' LC7 iB A, :TG-W- 4 W tuc. Tl-AIS C7t_A►�4 I-' LlOT L'A;i"L7 U4•J Ak1 4)S'TE.V- IL_t.G v M.LSS%, •,- _... ;LtCr�_'� :i1(=1.1�' .�i:_.i�_..r x -T.�.•. c��c-•ter_-ram, ie-tc.e:Jl� j w The Connnonti•ealtk of!lfassachusetts Department of Industrial Accidents « Imo.t lY :z t. . � 0IJ/ceol/m�est/gat/ons ,•. 600 ►f'ashiniton Street :. `; •= .�" Boston.Muss. (12111 Workers' Compensation Insurance Affidavit w 7.7 aeen,4`l02 ormation �Z A LI)W le k locntion: I [�o V (� lr�P�rt� �l 11✓2 p C� Cit�f ! �S /U S ' t'c�S ly/7 x nhone# r50 (/z) /-2$/ 6/ I am a homeowner performing all work myself. 0 1 am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. cnmp�} city: // ���'S /y��.Ls /�SS nhone#: 5 699 incurince co �if policy# IV e 12 —o 9113 a? I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: m an •name, address: Sit) nhone#• - -- incurnncc co noliev# ..• ...;;t..- - y,e7�!J,:r�,,,'.n�we-a•rrs•r- .eYeKr+nt'>MeLtY"'. "'mt 'TJVf,t73�JR'J° �C2T.#• z2W 91a - �a rim n1•name- address: 1. city nhone#• incur•tnce co Rolla# :Atiach additional'sheei itaecessa �K• ;+'"`-�* '�"' `•'' :" ~ ^+ Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the D1A for coverage verification. I do herchr rtifj•un er th a s mid put t•es of, ' •that the information Provided above is true and coma. Signature Date //r�11,21017 P` name �Le Phone# } official use onh• do not write in this area to be completed by city or town oMcial 4' city or town: permitfilcense# rtBuilding Department �Liceasing Board C3 check if immediate response is required �Selectmea's Office �tlealth Department .s contact person phone#• nOther t Imwised 3M5 PJA) Information and Instructions Massachusetts General Laws chanter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted tom the "law", an enip/oree is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An eynp/ot'er is defined as an individual, partnership, association, corporation or other legal entity, or any two or more the foregoing engaged in a•joint enterprise, and including the le-al 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 dweiIIna 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 hou or on the ,rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that even,state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionaliv. 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 ha been presented to the contracting authority. ...is .. ;t.:�i, ��'�.•'.....�1_v"Y 1 J ic+.r:v:�;�,o. 73 r. S� 1L► i+-:�. �.-..�s'.�, ..�_ Applicants Please `ill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of ,Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Cite or•towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Plea: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned tr the Department by mail or FAX unless other arrangements have been made. The Office of investigations would like to thank you in advance for you cooperation and should you have any questions please do not hesitate to Live us a call. I .ram•— .._.v,.....:•..n.w..`w.,++•.v-�.r.—.+v..zsa-e�-w*..�-+w.. .., _ .-rre..r.��...�n+++r The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 :x.•, r *�cT?-3 "� yv�a:.�• �...•-t�Yr^k���±,.,c wa-.:;r�..e��4 ,e. a c3�i*.� '�*',;J=` �:.�.r^.'� �. �'�a.,;. -` '8���i�-ma.�"!Ce��=is�� 'r.-�s'+�.x�'��.4y�e'r-#�lr,�a�'erm�eta� ram. �.-:` S'. ���•���;��i�iFfE%���TiL�G �ti���(�flCiPififd' ''; � .; ` y P.ry%'�} Al as4G. '- Al - 4�. r,�,c�` r $ ig i _ `'`y. �t,.. "'"'�- t-a. y k.:.p r✓-fi1�`m.q--.'rty 5 ;y-.Fx�q,� e n ;°,x''*bSI—pis{ny - t `+k Y`"'bti�y..7"..p �t� Fu:` w.-. t_. • ry..-2 ;n T• we3!`>v T'� 5+t^Y..s::•11 ,pyi',2Y zs!' yis.-ttT. fft:wa"�y5.,�a: t YY.4.r '�.1 7,'. y:�' A42><a.:'4aN �'�•,9 K �;..y'i.'- ;Eli' Mt. -'IMPROVEMENT CONTRACTORS REGISTRATION A "* " ?, ` oard of yy Building Regulations and Standards *�j' 4 '��' ���� t �,_ >§ $r'�-�• fit•' "?� a. F�k f4t f•,( (. S'� li<M'4't T }fiy `}'S 1 One Ashburton Place Room 1301 . � f a �; p -4 xl•�M� yk� 2:t L'�' �I 2 �.V fib.S`sy .4__.� 3^T'iy�'. -. �. � Y ��.�"`-., �r 4k�2 oston ,'s,.TMassachusetts 02108 @ i�✓. P2 $'...- t i''- �n .�t' �, t,,,*f , < t°-&ro'M,. x,�'��A:yif -%'ir,,ce.Y '�7 � i'r �„ z Fa-3 rt HOME', IMPROVEMENT CONTRACTOR '` --- Registration 109344 �} Expiration 09/10/98 Type .INDIVIDUAL � wZY t . -4 t "HOME IMPROVEMENT CONTRACTOR { I .• �Y n f= .� y�'t l Registration 109344 E3ALDNER FRAMING CO . ? `� ��,'`{ .4 <hy 'yi Type INDIVIDUAL ± N' _ JOHN J: 'BALDNER ,- JR . ��� z� ,h� l LEzplratlon" 09/10/96 •,, 180 EVERGREEN DR y IE � - A MARS70NS MILLS MA 02648 ~ ¢f • ty '" � �,> t 4 BALDNER FRAMING CO X JOHN J: 9ALDNER, JR G� �oVERGREEN DR• t t , <w a r i I2 ADMINISTRATOR R 1 r >MARSTONS MILLS MA 02648 ` - .. .._ - . - --� ;:,; .��. -'�7 •'bra -.,. ✓Jze Varyxryxo�awea _ n� �\ I Restricted To: 00 'Ire,ARTMENT OF PUBLIC SAFETY "PERVISOR LICENSE 00 None Number:` Expires: A - 1 E 2 Family Homes Restricted T0: v0 Ni' sess a Current edition of tiic Massachusetts State 2uiildiog Code JOHN J BRIDNER JR is cause for revocation of this license. 180 EVERGREEN OR �T14I1 L, MA 01"8 �WE to The Town of Barnstable 9� "� �0� Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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. �pr•C j') ° / �oo+s To r X is �'1'w� Type of Work:s 10 l S Est.Cost Address of Work: /�/J Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY ere appi fora permi g nt the owner: / Date ontractor Name Registration No. OR Date Owner's Name Assessor's map and,lot number O/� ' T E �P® 7 �= SEPTIC SYSTEM M i Sewage Permit number ...... .... �................. INSTALLED IN COM WITH TITLE = H9flB9TSDLE, rasa House nu.mber' ........................... .... .... .............:..... t ENVIRONMENTAL CO 9 �0 T SASrGULATI ° TOWN OF BAR' A' NSTAB BUILDING ' JN'SPECT0R APPLICATION'FOR PERMIT TO .....:..... . . y............ ....................................................................................... TYPEOF. CONSTRUCTION ............................................I......................................................:................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: q� Location ....... . . .1. ..................... .................. �4f.11.1..1�.. � !Ji.e' .. '�v ! ProposedUse J-4 .................................................................. ZoningDistrict ....................................Fire District .........;...................................... ...... ........................................................ Name of Owner / ®� ..Address ........... `. . /y �J !.. G............... .. . Name of Builder e Address Name of Architect ..................................................................Address ...................................... ........ Number of Room ................................................Foundation .... .. Exterior ......... :.�..........................................Roofing ...... .... . .. ................................................... Floors .......e�... ...........................................................Interior .... L��l Heating � �� .................................................Plumbin .......�... . .......... ........................................... - y.. � g i Fireplace /.......Cr..."'byy ................:...........................Approximate Cost .....��.. .. . ..................... Definitive Plan Apprning Board -------------------_-----------19____.__. Area ... ..�. ............... Diagram of Lot and Building with Dimensions Fee .......... ..:L...,r..�.. ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH oYv� r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............ Small, Alan No .....22443. Permit for ......one sto .......... .................U. CAW Single famil Y Loce4ion ..........45.1ben..Smith.Road.............. .........................Qmtp=ille................................ Owner ...........Alan..Small........................ Type of Construction .......fram....................... ................................................................................ Plot ............................ Lot ......#167................. Permit Granted ....... .......................19 80 Date of Inspection ..... .........19 Date Completed ....A. ...19 PERMIT REFUSED ........ ......r.'.1.............. ......................... 19 rn > .....Vj........— .................................................... . .... 0 ....... ... ......................................................... . .f" 5. ................................................... ............................. ........... Cum C A i. ....................................pA?bjd ... 19 ............. ...... ....................................................... ................................................................ 69r Avessors, map and lot number ..................... r THE Sewage Permit number ......:,a� !........ ...,....�^................... d�' °� f ZO89HB�3 T LEA i �0 House number ........................... .. ! ........................ r ra 0 Uk"I TOWN OF BARNSTABLE w BUILDING INSPECTOR , ,�° APPLICATIONFOR PERMIT TO ..............::.::. ::.,:.................................................................................................:.. TYPEOF CONSTRUCTION .................................................................................................... ............................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 1'n f = a 7 }'fib A I - t}-1�J i"................6........................ .. ......................... _. ProposedUse ........ .�. ................... ...................... . ..........................I......................... ZoningDistrict .........................................................Fire District ........... 1............... ::.................................................................. Name of Owner .............. ...... .. ..::........................Address .......... F: Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .........................................................6.......................... Number of Rooms '' ...Foundation ......... ." E . ............................................................... .................................................................... s Roofing �s '. Exterior ...........:....:............................................................ ........................::.... ....: .............................................. 1 -- Floors ...................... �- Interior ' f%f Heating ...................r..................... ....................................Plumbing .......F...............' " .:_......:........................................... Fireplace ............:f. :! ..w.. . ...........................................Approximate Cost ......:r:...' ................................................... , , Definitive Plan Approved by Planning Board ________________________________19________. Area :.....�...._......................... Diagram of Lot and Building with Dimensions Fee .. .f {.... ..... .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name -° . :.....:' .. ::. :. ?' ''......................... Small, Alan A=171-200 22443 � one sto No ................. Permit for .......................Y`Y.......... single family dwelling ..:................................. ................... Location .....,45 Eben Smith Road.......:............ ........... ........ Centerville ............................................................................... Alan Small Owner .................................................................. Type of Construction frame .................. ...................... ....................................... ........................................ Plot .......................... . lot ............#167........... August 20 Permit Granted ......... ...........................19 $� Date of Inspection ........ ...........................19 Date Completed ...... ..............................19 P RMIT REFUSED ........................ .................... .............. 19 ....................... . . ................................................ V ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... a v TO` F BARNSTABLE � t ermit s Building ;Inspector r tl�on �` Cash - — ,. OCCUPANCY PERMIT Bond _-7— No building nor structure shall be erectedand.no�land, building orlstrueture shall beti used .for, a new, different, changed, or`..enlarged} use -withonta Building, Permit•therefor'; first having`been.obtained from.the Building;Inspector No.I uilding shall be_occupi'—until a ' certificate:of,occupancy has.,been issued°by.'the.'Biiildmg Inspector " .. issued to. Alan Small ncidress Lot 4167` 4 5 �Eben.- Smith ': as CenterVi lle. 0 Wiring.Inspector y,�`J r � Inspection date ''Plumbing Eas ecto i. j1 Inspection date Gas Inspector `. . 11 j Inspection,date y b Engineering',Department Inspection datef _•THIS:PERMIT' WILL-NOT BE VALID; AND THE-BUILDING SHALL NOT BE OCCUPIED: UNTIL -SIGNED BY THEBUILDING INSPECTOR UPON' SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. as �- � - BuiIdin Inpe sct or g' t, �Is.J/.yl_���Avittr�f - �� �i✓Ut���M, ... - t...:L�' C At�t:.G.� Fes•��4J*.�F..� 97.S 1 00 - 00 ��T�"P'lC TA.o,1�,. = 33a.r (5G r � [l.-�> �.`?t7• - � '/ � Tfr%G ?�15'P�35AL PIT uSE 100o G.o.l_. . pu/4 LL AIZE A = tSG G.P. ,c Bcrn-a.xA llt?EA= =-�C> sr-. k(c1 .o - �o � 1 TOTAL, 4ZS U.1?T::>. 7-OTa L P=L O W ' 33D 6.P 7'N acP I r.4414 4 PIEf2GDL&TtO tJ CZl&T•E-:- l tu ZM 1 u OtZ 1E�95. Prr i4Q�q r u .-(�. / Tap 1-wo =Ioo.o 4- "A, '�Y tuv.* 970 LOW G"Ope o� iuv + tw. Gay• 9G 8 S� tc. 4'pc� atsT: •• ( -Box S�r►c o . tbty. TANK 1000 9G° guy t►N. '. 5�vc� G&L. 9e,Z Ro.� PIT 'Allw ('Iz WASWOC t3 t P2oT=-PLC �aU�Tio� BG IZ tJo • o VdA r �^ PL a►� 1Z�_s= Pz �c CmtZTtF-j TuAT TI- c— t Ooj�ATIOIJ 5llotic/1J { •�• �t--tF.E?E:.ra�,1 G�atilPt_�lS vJ t'�t-•i Tt.l` S t p�.t_t►-tom 1-.G� �� A..ti.1D 5ET'��JaC►G, �'C-Qt.3t�Eticc�TS Dom' TµG— �a I J PA'tG _ y� �... �3A.ACT[CW- 4 4JY'C_ 7? PzcGtS Pc,;ca ""c) l � _ C)b..► �.+�.! - '- U"S T C.t='_�/t l..l..G o r1r��L ti . ��SP '1•' C=f.t i !it%t��/L •Tt�L i3t=tr �i_:T�i it l[,tilLD /LN{a l_t C_A.FJ—r c�,r_ ur.c.1:1 r�, t� 'T C t'_rt.l c�+�` t<n c i_ ►� •� AL4Q