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HomeMy WebLinkAbout0038 EVELYN CIRCLE x a _ , .� v 1 .. - _ � � �� �� :, �� .. - � � _ a A _ o _ ., ,_ ,. � _.: �..� N. �. t Application number ila.��o DateIssued................................................................. MAM s �� 1. 1,11 ding Inspectors Initials....................................... Ok AUG 1 4 201 Map/Parcel. !1. �.�V. .. .�.® ......... IMDLt- TOWN OF BARNSTABLE � - O EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WIND O W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE Owner's Name: V ��, Phone Number (,® , '" 6" `\ Email Address: 11we, 1,(,JS�Il��Cell Phone Number Project cost $ s J�� Check one Residential V Commercial OWNER'S AUTHORIZATION Q As owner of the above roperty I hereby authorize ��p to make application fol buil ' e in accordance with 7 MR Owner Signature: Date: TYA OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization. ❑ Poors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to C .L, f CA0 CONTRACTOR'S INFORMATION Contractor's name o x Home Improvement Contractors Registration(if.applicable) 10 (attach copy) Construction Supervisor's License# c-5 ®(0 1 (attach copy) r Email of Contractor � � I 110JA"W"hone number 314 '° " 1709 ALL PROPERTIES THAT HAVE STRUCTURES CYVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER........................................................r.... , . , r � a *For Tents Only* 1 Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No r (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent ff 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 Y right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number • Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature 4 A 4 oens Date Lill t All permit applicati s are subject to a building official's approval prior to issuance. r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly, Name (Business/Organization/Individual): 1 I Q P Address: City/State/Zip: \yV�•J D Phone#: Are you an employer?Check th�&,a�pp opriate box: Type of project(required): 1.LYE 1 am a employer with L � 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y p n'• $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10.❑Electrical repairs or additions required.] 5. We are a corporation and its P officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P myself. [No workers'comp. right of exemption per MGL 12.EKoof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *My 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: W G Expiration Date: Job Site Address: VN �+ .v City/State/Zip:aV\+0, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expira te). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' and p ns and penalties of perjury that the information provided abo a is tr a and correct. Si afore: Date: i Phone#: V, ''r 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#: P r r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons"to'do maintenance;construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152'§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license'or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please.be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Tndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MA.SSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.govldia Office of Consumer Affairs and Business Regulation One Ashburton.Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration 1y, 4 f Type: Corporation Registration: 176959 LONGFELLOW DESIGN BUILD Expiration: 10/17/2019 866 MAIN STREET f r ; `i OSTERVILLE, MA 02655 Update"Address and Return Card. 41 0 20M-05/17 ✓/°e Uar�zinri�ircu-��a�/lr[��riJ¢r��l�JfJ , Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:'Gorporation before the expiration date. If found return to: Regisfration_--_- Expiration Office of Consumer Affairs and Business Regulation 17695'9 -- ." •10/17/2019 10 Park Plaza-Suite 5170 LONGFELLOW DESIGN BUILD" Boston A 02116 MARK BOGOSIAN? �``C CGC� 866 MAIN STREET ~' `� c� E OSTERVILLE,MA 02655 v Undersecretary Not valid withe t signature i Commonwealth of Massachusetts +, Division of Professional Licensure Board of Building Regulations and Standards I f,\--=.. Cons'uuct�ib i rS+ape.rvisor I CS-106114 E�xpires: 10/18/2019 i c Y MARK R BOGOSIAN ` * 33 WATERSIDE AVENUE FALMOUTH MAi02540 Commissioner j i I i I j - Ago CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD"YYY) 08/07/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE-COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must 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 endorsements PRODUCER NAME:CONTACT Charlie Downey Downey Insurance Agency,Inc. PHON o (508)485-0130 (FAX No): (508)485-6463 190 East Main St. AD EA AI charlie� owneY d insurance.com E INSURERS AFFORDING COVERAGE NAIC# Marlborough MA 01752 INSURER A: APPALACHIAN INSURED INSURER 6: COMMERCE INS CO 34754 Longfellow Design Build Inc. INSURER c: STAR INSURANCE COMPANY 866 Main St INSURER D: APPALACHIAN UNDERWRITERS,INC. INSURER E: Ostervllle MA 02655 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. INICY EFF POLICY EXP TR TYPE OF INSURANCE ADDL Swyn UER POLICY NUMBER MMLDDfYYYY MM`DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ .5,000 A IG06AO12713 07/27/2018 07/27/2019 PERSONAL&ADV INJURY $ 1,000,000 �GEEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- JECT LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ 20,000 B OWNED X SCHEDULED RWL621 08/19/2017 08/19/2018 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY /� AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE �RH Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 C OFFICER/MEMBER EXCLUDED? N N/A WC0869275 09/26/2017 09/26/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 Commercial Inland Marine D 70474G180EQF 06/14/2018 06/14/2019 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Bamstable AUTHORIZED REPRESENTATIVE 367 Main Street Hyannis MA 02601 }—�— ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0 Parcel 0 6), ®O G Application # i — a c� Health Division Date Issued Z 3 —1 7 1900 Conservation Division Application Fee Planning Dept. Permit Fee 1 (7 . 3._o Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis I Project Street Address Eve-NY) c�-c e 1�+L Village Ca"ilkN i l Owner PA. CSA SN-C,'� i�` Address �� \`e\MVA C.i(�C�-e Telephone s01 - Permit Request -�-� ��' I k i- S�®� '� n1 c, � L �� �`r f`+ . �(-W Illy a K. P s viT. Square feet: 1 st floor: existing propose 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati Construction Type& 0YV) Lot Size . lv Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family & Two Family ❑ Multi-Family(# units) Age of Existing Structure 3Nez,75 Historic House: ❑Yes Ca Ko On Old King's Highway: ❑Yes 6/No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) ry` Basement Unfinished Area (sq.ft) 1 QL Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing ikew Total Room Count (not including baths): existing new F' st I or Room Count -' - �U�LD Heat Type and Fuel: C1LUas ❑Oil ❑ Electric ❑ Other iNG DEPT Central Air: rl<es ❑ No Fireplaces: Existing New ExisMAN2W stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: Ed existing ❑ new sizf0N " eL0 new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes &19-o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name A'1 � ►�� Telephone Number _�� � ' d S Address �;V7 M C1 ►✓1 License # C S — 1 0 Home Improvement Contractor# Email IM 0A1 fe 0 Worker's Compensation # w C 0 E- / 7r ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I e-4 S4. west- f,) ' w m4 C L.. Nam o� -7 SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # .DATE ISSUED MAP/ PARCEL NO. ADfRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION _ FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Massachusetts Department of Public Safety Board of Building Regulations and Standards license: CS-106114 —onstruction Si3Gs:i MARK R BOGOSIAN 33 WATERSIDE AV ' FALMOUTH MA 02544 R cxpiraUon: Commissioner 10/18/2017 Office of Consumer Affairs and Business Regulation x = . 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176959 Type: Corporation Expiration: 10/18/2017 Tr# 270307 LONGFELLOW DESIGN BUILD MARK BOGOSIAN -------- ------ -- 33 WATERSIDE DRIVE -- -- --- FALMOUTH, MA 02540 Update Address and return card.Mark reason for change.` scF; 0 Address Renewal _ Employment Lost Card ::;N• Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ;;HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 176959 Type: Office of Consumer Affairs and Business Regulation Expiration! 1 0/1 812 0 1 7 Corporation 10 Park Plaza-Suite 5170 Boston.MA Qal16 LONGFELLOW DESIGN BUILD 1; MARK BOGOSIAN f 33 WATERSIDE DRIVE FALMOUTH,MA 02540 - —�--- -- - Undersecretary Not valid without signature ACC>O® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD"Y,") 12/12/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A.CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT pIC Drew Kna Downey Insurance Agency (A/PHONE o Ext, (508)485-0130 ac No: (508)485 6463 190 East Main St. E-MAIL Drew@downeyinsurance.com ADDRESS: @downs insurance.com INSURER(S)AFFORDING COVERAGE NAIC# Marlborough MA 01752 INSURERA: APPALACHIAN UNDERWRITERS INC INSURED INSURERB: COMMERCE 34754 Longfellow Design Build INSURERC: STAR INSURANCE COMPANY 367 Main Street INSURERD: INSURER E: ' Falmouth MA`02540 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEINSD WVDPOLICY NUMBER MOLIC YYYY FOLIC EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE /� OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 A IG06AO12713 07/21/2016 07/21/2017 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO- JECT LOC [PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED AUTOS X AUTOS RWL621 08/19/2016 08/19/2017 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EH AND EMPLOYERS'LIABILITY Y I N R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 C OFFICER/MEMBER EXCLUDED? N❑ NIA _ wc0869275 09/26/2016 09/26/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s,500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN. The Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TownW Barnstable -Regulatory Services ` RA1°'�''� ` Richard V.Scali,Director lkffASEL �� ��• Building Division Paul Roma,Building commissioner ti 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �' ,as Owner of the subject property hereby authorize 0�'1 to act on my beha r' V i � lf;" f in all matters relative to work authorized by this building permit application for. o Po 3�, (Ad&ess of Job) ". **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or-utilized before fence is installed an&all final inspections are erformed and acUed.e of Oavner f A .cant - Print Name Print Naive Date Q:FORMS:OWNERPERMISSIONPOOLS A Town of Barnstable w Regulatory Services of Richard V.Scab, Director Building Division Paul Roma,Building Commissioner KASIL M. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us _Office: 3 8--508-862-40 . . _ � . . . Fax: 508-790-6230 HOMEOWNER LICENSE E2ITON Please Print — DATE: -'-- — ------------ -- --------- -------------- JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: crtyhown 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. ,-%,f ,� DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be-considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws;rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply wifli the State Building Code Section 127.0 Construction Control. -' HOMEOVAUXIS EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required . shall be exempt from the.-provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." . Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. The Co,w= eakh ajf arJrrrset&r Deparfterff Ff r' &uhiatAcdd , Ogre Of- d&aas Boston,MA 02HI ffidavr AppHcamt Infarmafinu Please PrIxd �? Ac�;►� cty{sue fa I m oj ilk. ph. I� Arer>r an ecngIoger?.Checkthe apprapriafe bay Type of project{regTm- * oat a employer urn _ 4 ❑I am a general conimctar 7Md I yew P * hielixedmthe sub-caskacfom 6- ❑Neva • fall a��ifof act-lime 2.❑ I am a sale ptopaetor orpartaer- fisted omthe attached Sheet. 7- 6-!�emodeliag ship and have no,employees These sub-comftactors have Q Demnl¢ioa 1r, ` VQd-in g f k�Md is any capacity ayef___andhave wolkere [No wadmd 1 P MMMM5 5. ❑ We are a cmpomfion and its 1 ❑Ele i ml regaim or addsous 3_ I am a 11 no officers have�s�ised their . ❑ doing allworif 11_❑Fiambragrepairs ar adahfiaas my-self[No 'camp- ugu of per MGL n-❑itoor rqmim inom=e reed-j i a M,§i{4�andwe5avena- emplaymm[Na wodoe& a0other • co>�insarartre required_] . Ann spgF Beat cbed�s'Soz it Est alsa fM autthe�oubdaw dekwoaae mmpP,•mfi,••Pnycgi�a� #1�ameovrarrst�a saba�dads�daea`i g$ley���P aIF armic sa�6�l�attlsieFee samct submit a neTv�d:¢rt mdi�ti¢�SMd rCaat<adn68vut cbecY�¢5 has mast attadm3 MadrIM sired shaming the-of fm sdib-c =d 5tofe.vh2dwr araatft3I!e2fiffes]sz emp�lo3ees Ifthe haveemgIoiea;&egmust�� v the' '. - - lam all eriipfopai fltatis prwffi�-.tvv)kers'canTenwzi an!7.=traz=fOr my euT&ycez $doly is fl[a pUZ14 and jab sits iffformcrtiort. Is�ceC-DMPMplfEaffie WV�i �0 C, 'PoRq44,orSelf-in&lic.4 n�l%1 13 MThmiunD _ al 1 Job Sib--Mdse= J b jE ✓1 C i` T � city/sl er : C ►�1�-Zr�/ e l o o 6 3 ' Atach a oW of fie workewe compensatienpoRcg d edaratian page(shooing the policy number and ezgs:dion Mate). Failnm to seeum coverage as regairednuder Section 25A of Mtn c.15.i:aa lead to the imposition of comical pembi of a fine up to SL50}OG aadlar ofle-gewiMPM D--* as w&as civR peuslfigs m the faux of a SHIP WORK 4RDERand a frae of up to$250D4 a dap wtast ffie violator. Be advised Mat a copy-of this sfatemed maybe ihz, sided to thre.Office a. IzvesEgadom ofthe DIA for fi2smwce coverage ve aoo_ Fdokff* t6.atM irfbrww fimpro F ffe da is f n arLdcorrect Phr8 irr y �` I l o OjTki I am anly. Do not wrke in dib area,€a be con7kta+d by city ortoiFn gjol rar My or Tawm Pc T&erm# Lssleg Aal arity{carde rune): L Soarfl of r.I rg Depw tmsut I CHyffown clerk 4-Dectriod rkspectnr S.PFinabing b=F=fDr Cantact Person: FhrraE _ 1 I 11 , 2 i t 1 1 1 l 11 ►/ `.: _•irl.�•1F - ■ .•:.I ii• �■in�.. I i5f.11 •'i1R It .1 • I- ••.fa 1i'R I■1.■n.1• .I■•]■ ltl [■ ■ .I.■11 • � •• ■.ion�r :1. - •�F.. n n - • .It I■■ rn.i• .Ir ►alnt r • ni 'Il ■..al ■■ It l Yn■iN .n %r u r �.�ai -1. • INNER .I ■If: .1 •'■Ellif■ ' . 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"• • ■tG TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division p - Date Issued. —/ Conservation Division . Application Fee Planning Dept. r dp, �X_ Permit Fee cxl�/• �o Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 39 ZIE �(�( Village 4P.AMUMe Ak Owner OUXA A, MX A I -Address *tVE LY9 GQ1r-_ Telephone _SVg -77h 44 9'9 Permit Request Pu tl pWm i0c- t Van A Sxts+l;..�„ 1J 4 �CRIN�etQ 1 b >C'ae V yyle p [o�ok IN W1 u- RA= A& DeJa QN '5'20��'-tom 76"Vk YARD ►a'x�c�' ee % Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation QW-0' Construction Type D M!,SoApdPX 06A54-0J5 SLQ.A 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 �AoqlL aIJcQ. Pea&A Proposed Use SA M APPLICANT INFORMATION - - (BUILDER OR HOMEOWNER) Name Telephone Number .019 _V* QB.3 Address .mop I License# CSFH`b !B+ AQS�1►� (At t1_s IRA Home Improvement Contractor# 1sa01,'3 Email !!50W by;JptzA a eamwl-.AJ Worker's Compensation # Raw af ALL CONSTRUCTION DEBW RESULTING FR M THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE .r FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. e ;•c t T i r ADDRESS VILLAGE " OWNER '4 DATE OF INSPECTION: Y •' FOUNDATION t FRAME ` INSULATION = FIREPLACE ` ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL ti GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I T7se Comnzo7rtvealth ofMassachusetts Depart ruent of rndastrial Accidents - -- Offwe of Investigations 600 Washington Street _ Boston,M4 02111 } r Fmv l9=mgovfdia Workers' Campensatian Insurance Affidavit:BuilderslContractursJEIectr clans/Plumbers Applicant Infarmailon / Please Print I&dblX Name UtttssiIIeessforganim ionflud"rvidual}_. Q.CX ?414ea eve, Addr Po . box 57m c><yf ter _ ;i M . 48 Phone Aa8 -Re + A,ree an employer?Check k the appropriate box: ' Type of project(required). I.L7 I am a employer-.vrth A, 4. ❑ I am a general contractor and I 6. ❑New construction . employees(full andl`or par#time).* have ltired the sub-contractors 2.❑ I am a sole proprietor orpartner- listed on the attached sheet. 7. .❑Remodeling These sub-contractors have ship and have no employees. $.,❑Detnolitiort . working fix me in any capacity. employees and wosicers' q. .❑Building addition [No w.mi ets' comp.insurance comp-msuranv-- required-] 5. ❑ We are a corporation and its 10_❑Electrical repairs cr additions 3.❑ I am a homeoumer doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself-[No workers'comp- right of exemption per MGL 12.❑Roofrepairs insurance required.]T c,1,52,§1(41 and we have.no employees.[No workers' 13.❑Other comp.insurance required.] "`Any s"Kcml&at checla box Pl—st also fill out the:section below shoo ing their waders'caaapensatiaa policy iufbnnadozL i homeowners who submit ties affidatqf indicating they axe doing RU woo}and them bae outside contractors moms*sabmit anew affidavit indicating satcb- =Coauactors 11Mt check ibis boat must attached as additional sheet sbawing the natae of the sub-cemtractm and state whether or not those entities ham employees.Ifthesub-caatmctmhave employees,�te}n=pm-ide their workers'comp.policy atimlser. Tani au elnpLaywr that,is prov ding workers'a otrgpmsaian hmiraace for my*employees B'eIow is Fite policy arrrl job site informaibn insurance Company Name_ Policy 4t or Self-ins.Lic--4 h 000.2 /4 ZSCA13+ R pir:ation Date_ 614 Job ate Address_ CLVE—L [ C k4ie- Gity/Statel2 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$150D 00 ani -year'mprx as well as civil penalties.in the form of a STOP WORK ORDERand a fine of up to$25(f.00n a da galast the yiolatar. a advised that a copy of this statement maybe forwarded to the Office of . . Investigations of a D1A for insurance ge verification. 3 I d10 hereby finder the d psrtatFies ofpedury that the informadoii pmided abm a is hw-arid correct Si Date- A /b Phone ` Official use only. Do star write in furs are ,to be campleted by city arton�n official_ City or Town: PermitUcense# Issuing Authority(cane one): 1.Board of Health 2.Building Department 3.City{Town Clerk 4.Electrical Inspector S.Phimbing Inspector 6.Other Contact Person: Phone#: Information and Instructions, Mkssachuset s Ge=al Laws chaPtEr 152 requires all employers tD provide workers'compensation for their employees. prasurant-to this stye,anenzplvyee is defined as.".every person in the service of another under any contract ofIiire, express or implied,oral or wat en-" An employer is defined as"an individnal,pa:i{nershi;p,association,corporation or other legal enttl ,or any two or more of the foregoing engaged in a joint enterprise,and inchuding the legal representatives of a deceased employer,or the receiver or trustee of an individual,part amsbip,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 mainfe ance,construction or repair work on such dwelling house or on the grounds or building appurte thereto shaIl not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also sites that"every state-or local Rceasing agency shall withlrnId the issuance or renewal of a license or permit to operate a business or to,construct`bwZdin.&In the commonwealth for any applicantwho has notproduced acceptable evidence of compliance with the insurance-coverage requir-ed." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any ofits political subdivisions shall enter into any contract•for theperfozmance of publicwDikunta amepiable evidence of complimcevvith f e.ms�=. requirements of this chapter have been presented to the confracti ag'aLiiho ty ' t` APplicanfs Please fill out the woikers'compensation affidavit completely,by checking the boxes mat apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and,phonenumbers) along with their cent fiGstt(s) of innzra„ce. Limited Liability Companies(LLC)or Limited?lability ParinPxships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation iasrrmce. If an LLC or UP does have employees,a policy is required. Be advised that this affidavit maybe submit to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date+he affidavit The affidavit should be retrzmed to the city or town that the application for the permit or license is being requested,not the Department of „ , 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 s elf-m s*raace license number on the appropriate line. City or Town Officials f _ Please be sure that the affidavit is complete and priced.legibly. The Department has provided a space at the bottom of the affidavit for you to fill.out in the event the Office of Investig-tions has to confact you regarding the applicant Please be sure to HUM' the perm�crose number which will be used as a reference number._In.addition,an applicant that must submit multiple pennitlIicense applications in ai3y'avea year,need only submit one affidavit indicating cuirent policy baf6rnation(if necessary)and under"Job Sit-Address"the applicant should W= -"aII lacaticns in (city or town)_"A copy of the;affidavk that bas been officially stamped or ima e;d.by the'city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit be filled oiit each year.Where a home owner.or citizen is obtaining a license-or permit not related to.any business or commercial venture (i-e_ a dog license or permit to bum leaves etc.)said person is NOT Tegahtd 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 hesifafe to give us a call The Department's address,telephone and fax number: T`hL-C:o;mmmwm11h-of I&1asa-chusetl s ,, .', •Deg�ent cif Iad`€>�ial Ac�.i�..ents. - Gmce 4f f veg6katio.a'Ei _ - f��4 Stan � •, - : . .. , .. Bwto MA GI I II Tf,-L 4 617727-49W Q�- 4-06 or I­V7-MASSAFE Fax 4 617-727-7749 Revised 4-24 07 zavfdia AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts-Checklist for Compliance(7s0 CIKR 5301.2.1.1)t Loadbearing Wail Connections Lateral no.of endnalled 16d common nails)..._........{T ( able 7j..........................„............................. Non-Loadbearing Wall Connections Lateral(no.of endnailed 16d common nails).._„.........(Table 8)................„................ ....................... Load Bearing Wall Openings(record largest opening but check off openings for compliance to Table 9) HeaderSpans ........................................................(Table 9).............I.................a.._ft,_in.511' SillPlate Spans ...................................................(Table 9)...._........„................._ft_in.511' Full Height Studs (no.of studs)............................._..(Table 9)............................................_. ..... Non-Load Bearing Wail Openings(record largest opening-but check all openings for compliance to Table 9) HeaderSpans.............................................................(fable 9)................................._ft_in.s 12' Sill Plate Spans............................... .............„............. able 9 ......... ft_in.512' Full Height Studs(no.of studs)....................................(fable 9)...._............................... ............... Exterior Wall Sheathing,to Resist Uplift and Shear Simultaneously, Minimum Building Dimension,W Nominal Height of Tallest Opening2 ........................ SheathingType................„............................(note 4)...........„......................................... Edge Nail Spacing....................................._. (Table 10 or note 4 if less)........................ in. Field Nail Spacing..........................................(Table 10)...................................... in. Shear Connection(no.,of 16d common nails)(Table 10).................„..................................... Percent Full-Height Sheathing.................-....(Table 10)„................„....... 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts).............. Maximum Building Dimension,L Nominal Heigh of Tallest Opening2......................................................................... 5 618" Sheathing Type.................... ............_......._..(note 4)...................................................... .... Edge Nall Spacing................. . _......._.........(Table 11 or note 4 If less).................... in. Feld Nall Spacing..........................................(Table 11)............................................ in. Shear Connection(no.of 16d common nails)(Table 11).................................................. 9 g....................... able 11 �% • Percent Full-Het ht Sheathing (7 ).................„......._...„.................... 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)...........„. Wall Cladding Ratedfor Wind Speed?.............._............................................... .................... ........................................ 5.1 ROOFS Roof framing member spans checked?..................... For Rafters use AWC Roof Overhang ...................................................�( Span Tool,see BBRS Websfte) (Figure 19).............. ft s smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)............................................U-_ p IfLateral............................................(fable 12).............................................L _ plf Shear........................„.......... ...........(Table 12)_.................................. ......S= pif Ridge Strap Connections,If collar ties not used per page 21.....(Table 13) = pi _— Gable Rake Outiooker.......................... (Figure 20)............ _ft s smaller of 2'or L/2 ........ ...... .. Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift...............................................(Table 14)............................................U= lb. Lateral(no.of 16d common nails)...(Table 14)................................ ......L= lb. _ Roof Sheathing Type.......................:...........................(per 780 CMR Chapters 58 and 59).................. RoofSheathing Thickness................................_..........................................„..........._in.a 7/16'WSP — Notes: Roof Sheathing Fastening.........................„................(Table 2)......................................... ..._......... 1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 53012-1.1 Item 1.If the checklist Is met in its entirety then the failowing metal straps and hold-downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 C. Uplift Straps per Figure 14 d. All Straps per Figure 1 T e. Comer Stud Hold Downs per Figure 18a 2. Exception:Opening heights of up to 8 It.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate In exterior walls shall be a minimum 2.in.nominal thickness.pressure treated#2-grade. a A WC Guide to Wood Construction in High end Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(7s0CMR530t.2,1.1)' 4. a. From Table 10 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing requirements b. Wood Structural Panels shall be minimum thickness of 7/1 V and be installed as follows: 1. Panels shall be installed with strength axis parallel to studs. 11. All horizontal joints shall occur over and be nailed to framing. " iff. On single story construction,panels shall be attached to bottom plates and top member of the double, top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel,Upper attachment of dower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing, v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row"of 8d -staggered at 3 inches on center per the Figure, Vertical and Hotizontal Naffing for Panel Attachment i t J , . AWC Guide to Wood Construction in High Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.].1)1 -1+Y1 ails EDGE RESTS ON l madwAs • -'� -^ :-=ram—===rr-== -- II 11 Y 94 11 1f 1 11 {1 1 Y r 11 jl 8 ft Fit •i. I t� 1 Q I ;{ O i Ci ' Ed Iit 1f I a°g rICL [7 I u Q t f I fu I� U U /{ 11 II E — y See D&Wl on Next Page Vertical and Horizontal Nailing for Panel attachment CORO® DATE(MMIDDNYYY) A 40 CERTIFICATE OF LIABILITY INSURANCE 8/8/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT KathySilvia NAME: The Fair Insurance Agency Inc. PHCN c (508)775-3131 FAX,AIC No:(508)790-1677 619 Main Street AIL ADDRESS:kathy@thefairagency.com Suite 1 INSURER(S)AFFORDING COVERAGE NAIC# Centerville MA 02632 INSURERAEsseR Insurance Co ` INSURED INSURERB:Safety Insurance Co. 39454 The Waquoit Group LLC, DBA: GCI Builders DBA Paul INSURERC:Savers Property ri Cas.-ARWC 11771 PO BOX 509 INSURER D: INSURER E: Marstons Mills MA 02648 1 INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MMIDDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000i —UA—MAGETO RENTED A CLAIMS-MADE lil OCCUR PREMISES(Ea occurrence) $ 500,000 2CW6103 5/28/2016 5/28/2017 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Individual Risk Mod Prem $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X AUTOS SCHEDULED AUTOS 5052134 6/3/2016 6/3/2017 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Medical payments $ 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ �4EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? ❑ N I A C (Mandatory in NH) WC0002374 5/28/2016 5/28/2017 E.L.DISEASE-EA EMPLOYE $ 100,000 U yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Oliver Marti THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 38 Evelyn Circle ACCORDANCE WITH THE POLICY PROVISIONS. Centerville, MA 02632 AUTHORIZED REPRESENTATIVE Jackie Stewart/FAIMT1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD INS025(goi4m) r - j Tow» of� rltiStabe regulatory Servi.ces ` UkWSTADLe ' Richard V..$cali,Director esnss. - OIfnM"' wilding]Division Tom Perry,:Banding 6immiisiober 200'Nlain Street,Hya�s;NIA 02601 a www.town.barnstablema us:.. Office: 508-862-4038 s " I ax 508-790 6230 1 I'r®perty ®vUner Dust complete and Sign'Phis Section , f�Js wilder a of the subaect property " hereby authorize C�C tr�i S to act on ny behalf, in all matters relative to work authwized by this building pernut appltca don- 2 MA for f Addzess of Job) . Pool fences and ala�sns are'the responsibility of the applicant are not to be'fsllcd of u zed'before fence is%irista .ed°.and all final inspections are performed anal accepted n a Signature F Signature of ilpplacant i 7 1 - 4 Print Name Prnt Naive 4 v Dat 1 Massachusetts-Department of Public Safety f Board of Building Regulations and Standards �.U//1t1 I�t,L1U11�UCI V.nIIT� �]L.:L.F-8itifl� --J , License: CSFA-W7934 F_ PAIIL J MAZZOL .. s PO BOX 509 =� Marstoni MtDs MR Expiration Commissioner •06/19/2017 #r '� �". v/ze�i4mvnrancaea�C�t� c .�, •; - Off ce of Copsumer AffaSrs&Business RegutaUon , . ,z y k 1VIE IMPROVEhIIENT CONTRACTORaidrv�}� : - _ egistration �052253 TYPe - ' f :. xpiration: 8/- rd ndo6te Corporation GCPBUILDERS INC'!w 4 -•1. d PAUL MAZZOLAJ � 644 RIVER:ROA •. f`i _G��� z �MARSTONS MILLS Go48 J . cr_tary t r 1 Restricted'-:One_and two-family dwellings or any accessory building thereto;uTespeehve of s>zb; x s Failure to possess a current edition of the Massachusetts State Building.Code is cause for revocation of this license. For DPS Licensing information visit www.Mass.Gov/DPS °Ltcens> or regI" kitton vand for indtvidul use oul`y before the ez iration date. If found return-to: *` # "`Office of Consumer Affaiis and Btisiness Regulation' t .Boston;MA 02116 -" ` °Not vat without signature `�,,;I yN. a ' • I�4�= __... _ ax E lo FL%ora Boat to RawF V7 o'tx8 �� -oc 2®� N 6 �� Sltae wMt �o� ,r-ir P CuvA��1'tor�� it 1 Nx4v P44Ho64Nr l�stka ug TyP �S�DQa�ac axg Ifo" of a ,A & aT 6w bell" wAu . de e-49MIU, AA � t � OM Fie1D £XtSTiNg 0-0&,+ � 'OMf Ql9l E(Ot15L° i rA7) No. s c lj 1, !x4 O"mv bet ki s le po st- - �oyc 1r1 . Solo f 7 y o . d Co¢aDO- TYP s a _o o 5ee 1� S-C41� X Mil&A&Y - a�2X4 off$ V."o ¢ axtz. Co�1ZT rj4 c`3t�tfl ��t�S .a NEW W6 C ADt, a'k%sr(plcr �5T149 ,� � 3dTeU xls1ju a 8 See D"ALT Ib"oc TYf 77 semi% w%vyvftA.Misr .00 "fYP New ao�+cps o r ADD a xia'' toIR r 8ot+c0 ExIsTt� New a'k8''zolgr P.T GIRT Pos a CROSS 'a0.9csjw(d -ry p o7X6 :3b+sT ,�„ .o` Pr ?osi -Yn ai4o c fCo55 �s $TiOf �1,�1�5 41r�k11 Co4tdr • Qx4 • 5fic� �1�.� a G -O E Ica 0%, axa w,�e� w��nws F,i�sTiWC, 8�c�c YARD Pooh �lovsc No N ehT 91 No Plvm61Ns TYP Etec�q�csC. , e•sX4=�� - l.�sHts D/H - Pt�gs Qc1-i4t ,-�S Reboi)a Ext4T1►jS beck his-hug R�eTi.►v�wg - - - - - - - - - - - - - - - - - - - - - wwit. S01.+o2 TUBES �t?.oPos�� deck k!.e�1.,,,��.Q.��'e�►-�h OF 36 1 x4 M,A1io �Ctc��t 4x4 Posr -P.r 7 4x* Pa r • .Z7t1e "3'E•ST g a ` Its Sor..o2 —toe J . 3 Loz- 4 . r Y 3 71 l2 t ��.. I.. � M _ • �� /� - YT_.�_: W q t-� . P _lFo Zg EingtiffiAS _ f '. C9 Fib G10AFiD. .8 TER '' 1 flC'2aU48-_ � . � r CERTIFIED PLOT PLAN LOCATION C& 1 TG'R.V t L G- L-q.ERTI F.Y THAT THE Foul .SHOWN -. HEREON COMPLYS WITH SCALE 1 '�-4o DATE 3 `;1`�-8� �} E_`SIDELINE AND SETBACK PLAN REFERENCE ' Elp.QUIREMENTS OF THE TOWN :OF. E�1Z[Jsr�.►_.�al l✓ ..AND -IS.:.h9T_-- .LOCATED. WITHIN THE FL00DPLAIN. PZ 13� 3g4 Pam. 3 BAXTER NYE, INC. m THtS PLAN IS NOT BASED ON AN : . REGISTERED LAND SURVEYORS �.114STRUMENT SURVEY AND OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINE _ APPLICANT TAcV.- 'C�ELA�EY �' I �.r y f I 12 + , 57'* LdT. S ...._� - p - g.f:rt • 9 , I , ARD I ^{ CERTIFI ED PLOT IPLAN - - -E`- LO C AT I ON .--,-,--- C6--1 TG?ZV i LL . La ERTIF,Y THAT THE Fp� l �Tiol� . SHOWN : f�EREON COMPLYS WITH r SCALE DATE THEl__,SI-DE-LINE AND SETBACK; RE;Q.UIREMENTS OF THE TOWN ,OF; ^ , : I PLAN REFERENCE' ;LOCATED =WITHIN THE FLOO'DPLAIN. . . Pl... aK. . 394 PG. 3I J. DATE : -1 _ I BAXTER NYE, INC. ;THIS-'PLAN IS NOT BASED: OR AN REGISTERED LAND SURVEYORS _ANSTRUMENT. .SURVEY__AND* THE ____.__.. __, . .OSTERVILLE^- MASS. `.OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES', APPLICANT TACtL TDC(.AK3ey THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) M A k�; -L 7 �C&l DATA 7777 = i =� PINK-DEPT. FILE CO' ". .`.PY/ YELLOW APPLICANT COPY BUILDING .' �` I n fa. TOWN OF BAR' t ,.';SSACHUSETTS PERMIT VALIDATION ' .. A-187-62-6 march 31, I.9 S6 PERMIT NO. ,�,q1 DATE oute Imo, Marstons Itilf . 4E009961' APPLICANT ]OII.I J. i1^}7_;'!�'Y ADDRESS lNO.I (STREET) ^(CONTR'S LICENSE)' NUMBER OF PERMIT TOIIi) _I I S ? 1 STORY S�I1�'18 Family DWP_llill}! DWELLING UNITS NO. .(PROPOSED USE) ZONING RD r t. _�_ I1 1-c.:l.ft Centerville DISTRICT. .61 AT (LOCATION) _. -- 51REET) f BETWEEN ____-- EE 11 AND (CROSS STREET) . LOT. , SUBDIVISIO __— _.---..------- LOT BLOCK ' SIZE L'E 6!_ FT. LONG BY • BUILDING IS TO 'F _.- FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION, TO TYPE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REJARKS7 Bond AREA OR ! ` " I- . 125,000. PERMIT_$ 126.00 VOLUME ESTIMATED COST' L/57UAf=E rEETI . OWNER y BUILDING DEPT.. k ADDRESS BY MINIMUM 0-- INS - -- y PEL Ii _ i V� :`7 PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ALL Co:,:,. , Af D IC..-f'I POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR { I. FOU'." i ELECTRICAL, PLUMBING AND j INA - _RE A CERTIFICATE' OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. MEMB. =-:LIQUIRED,SUCH BUILDING SHALLNOTBE OCCUPIED UNTIL MEMBER.,i:a L::� ',• 3. FINAL INS— ec� I FINAL INSPECTION HAS BEEN MADE. :j OCCUPt-.i:, !. --A S® IT IS VISIBLE FROM! STREET BUI IG!;�_: ;.. —r-.�5 J PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS eZ I �1� 2 l P I 1 3 'NSPECTING APPROVALS R - VALS i) I OTHEF OF )HEALI y WLRK�/ -ECOM E.NULL AND VOID EP CONSTRUCTION INSPECTIONS INDICATED' NDICATE ON THIS CARD ARTED wIT! � SIX MONTHS OF DATE THE' a?AGE_ _ CAN BE ARRANGED FOR By TELEPHONE . ED AS NOTEr' OVE. OR WRITTEN NOTIFICATION. tssessar's map and lot number ... /�7 ......................................... Q�Of THE To�I �Q I� Se�wgge .Permit number ........:....................................... .... SEPTIC SYSTEM MUST r INSTALLED IN COMPLIA ABa E. House number .......... .. .. .. L ............................. WITH TITLE 5 0, i639• ENVIRONMENT CODE A �MAY�' 0 V E D TOWN OF BARNSIPAMB , -TIONS Barnstr. t of "rlr^mi Sion �,F 4 F Date -BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... ONSTRUCT,` •NEW. HOUSE v............................................................. ..�,. .......................... TYPE_OF CONSTRUCTION ...........W.O.Pa...FFIAMR. .......:...............................................:.................................... .....March 4 .....19..Sb.. TO THE INSPECTOR OF BUILDINGS: j The undersigned hereby applies for a permit according to the following information: Location ....Lot.... ... .V.P.I,YT1..cir.Q.Le...... A.....................................................:. Proposed Use .....S,,0.J.1,Q...k:aIri1 ly....pHTs✓.]..1 in.g.............................................................................................................. Zoning District .....RD. Fire District ... Name of Owner John J. .. Marjorie„ ... Address ....1,�. Name of Builder ....John..,J....Delaney.........................Address Z3.Q...RQut.e...,.4.9. Maxzt.OA.S...Ma.11s.... ... 'l' Name of Architect .None ..........................Address.. ............................ .................................................................................... Number of Rooms 6..............................................................Foundation ...1.0.."...Po.uz:e.d...c.aacrat.e.......................... Exterior Wood...C1.c3PY?.Q?rd...i�...Ire.dar...;5.11i7.1gle....Roo,fing ...As.phalt.............................................................. Floors ...Hardwood ..................................................Interior °....She.etr.Qck.......................................................... ..... Heating .F ...Y2Y...Qa.�i............................. g Z........................................................................ Fireplace ....2............................................................................Approximate Cost ... ............ ................... Definitive Plan Approved by Planning Board ----De-aenher____4_,19__84_. Area -17.�_'...`'�_. n` Diagram of Lot and Building with Dimensions Feed ..................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 2 Story Building 0� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town B rnstable a ing the above construction. Name ... .......... ............ .... ... ............ Con uction Supervisor's License ..0 0,9 961 ............. ,,,,,,, ,, , ByEL'ANEY, JOHN J & MAIRJORIE D. No Z9113 0 Story.............................. Permit for ....Two Single ..................... Location �-,.q..... ......................Qpat�6.j:gl Ile Owner ....... Type of Construction 6. P............................ ........... .................................. Plot ............................ Lot .... ............................ Permit Gran+ed ....March 31. .........19 86 ......................... Date of Inspection ....................................19 Date gom leted ....I... ...?:-:7. ....19 all zc M M tr m Assessor's map and lot.number .....:.................................`..... YNe �pF Sevcoge -Permit number ................................................ Z 33ARNST/1DLE. i House. number ............. 3.. ..� .Jk:�......................... mane °p 1639. e0 �E0 M a\ i ' TOWN OF BARNSTABLE a BUILDING INSPECTOR APPLICATION FOR PERMIT TO CONSTRUCT NEW„HOUSE 2 5' I�D�! ........................ ............... ............................ ..... TYPE OF CONSTRUCTION ...........WOOD FRAME .................................................................................. ............................. March 4 .......................19-8A. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... ot...6. EvelYn...Qir.Q. e.....Ceat.rvl..�..l.e. MA......... p...... »................ ....................... ................................... ProposedUse ..... in.91P....�:=11.Y....Dwe..U.--t g.............................................................................................................. Zoning District ..... ..............................................................Fire District .. ......M. ..11S Name of Owner John...J.-...& Marjorie D. Dela.Address ...11. ... WM.3_ �?.c�d,....?`�s�.x.S.#c?I�.�...!�!Lj.�.�s............... .................. Name of Builder ....John...J.r....D �$84':.'.........................Address ... ...R.Q)at_.Q...aA Max Name of Architect ..None................................................................Address Number of Rooms 6 ..................................................................Foundation .......D.t?.Ll]:Pd...mD.G:C:f'.._t mn.cret.e......................... _ ._.. Exierior`;1h1t?OCI...Clapboard...&...Qe.dar....Sb.i.ngle....Roofing ...Asp ha-1t.......................................................... Floors q4pdWpqd...............................................................Interior ti."...13b.eetmor-k............................... ..... Heatin ................. Q.�........................ g FWA bY.... S ............:.................:..Plumbing .................:.......................................................... Fireplace .....?2...................................................................... Cost ... .................................... p Definitive Plan Approved by Planning Board ----D -ae-mhPr---4_,19. 4--. Area !l.' F.t............ I'& Diagram o Fee f Lot and Building with Dimensions '' �. ...................... coo .......12 } SUBJECT TO APPROVAL OF BOARD OF HEALTH t S Story,Building - i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town o Barnstable re �ing the above construction. Name ...... ............ ............. .% Con uction Supervisor's License ..0096.1................... D DELANEY, JOHN J. & -Marjorie D. A=1187-62-6 E Al No0 -Z9............. PerrN ...t for Two Story ..................... .............. Sin le Famil Dwellin .................... . . ............ V.... Location .... Circle ...................... Centerville ............................................................................... Owner John J. & Marjorie..... jorie D. Delan ............................. ............................. Type of Construction ..F.r.ame............................. ..........................I...................................................... Plot ............................ Lot ................................ Permit Granted ........ .......19 86 Date of Inspection ....................................19 Date Completed ......................................19 �... ...f'�-<..JL".... i�fiwr.. '.,. "`+-,..y -r-.,4,�r.�:.+<.-; ' .att :Ati^ -.-.._%-,`31 �..+`.1�41;y,•+:. .. .t1°4,1.Y,e:`C.r�..n.. 'i",yi:,<a_x., � . '<x .�. .:x: a.r+.-..o,r_i'y-iy} _4` oFtx�so• TOWN OF BARNSTABLE 2 .13- Permit No. ................ ......... BUILDING DEPARTMENT KASLl e"81A I TOWN OFFICE BUILDING Cash °�tcrir HYANNIS,MASS.02601 Bond ............. CERTIFICATE OF USE AND OCCUPANCY Issued,to -John J. & Marjorie D. Delaney Address lot -6 38 Evelyn Circle, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. September 9 86 Building Inspector P - TOWN OF BARNSTABLE BUILDING DEPARTMENT = aid°T ' TOWN OFFICE BUILDING � rua HYANNIS, MASS. 02601 �OIU�Y M. I MEMO TO: Town Clerk FROM: Building Department DATE: —qv— An Occupancy Permit has been issuedfor the building authorized by BuildingPermit $k.. .....I» I�J. ...... ._.... ........................... ...................... . ..................._......... ... _ ......._ . ...»»__. issued to ... � f!. /X . »��YI.1(1�...J/..... U /.. _..»._» ... ». ......»..»» U Please release the performance bond. Assessor's offioe_(1st floor) s t � r/ , �ssessor' m `and lot number '..r......� — �GG,� E2' 1C y Fr►+Eto�` Board o ealt (3rd floor): / �C���• ® N � Sewhg Permit number' ...::.�� �N� �� :...y✓U�L' Y� Yj �9S&DLE, if l �f Engineering Department (3rd floor) ®1 E����r House Anumber ....::...........�� ..... T� �� �,° rasa A�'LICATIONS PROCESSED ;8:30 9:30'A.M. .and 1:00 2:00••P.M. only r. A P P;R 0 ,T E.D h ' $� t ?�le ConservAtioai N OF B A R N S T A`B L E ' -LDING INS+,P.EC�T®SUOd APPLICATION ,FOR :PERMIT TO ..t j TYPE' OF+ CONSTRUCTION r...................... ................................................. Zll 19�.......................... :f TO THE INSPECTOR OF BUILDINGS: The undersigned hereby,applies for a permit according 'to.the following information. az f Location ......... .... .......... .................................. ........ l� , .� � � 'Proposed Use ....... .. �. .? � ....... ... . ,,,,. .... �� Zoning District °. ..............:....... ...................Fire District ,.. ..... ..... ......... .. ...... .......... .... .... nt owk Name of,Owner ... ... ess ... ...:.............................................. .......... . ..... .. . Name,,of;Builder !6. .6 �f-�///� �*�Xress �G '.`. f '!✓!r��4.................. Namefof Architect .......:............. ................ g.. Address ................:.......,:,...........:`............................................. . _ Number of Rooms ......................:.....................:.................Foundation •Exie ior ...........:.............................................: .........................Roofing' Floors .........................................................:.............Interior Heating':. ....... y,•itJ-.(....� ...................Plumbing - ...... ..... ... .......... ..... ..... , Fireplace ...........:...........I......6 �1..:.. Approximate, Cost ¢:/ ........ .... ..czz r Definitive Plan Approved by Plahn' ing Board ____ ___(_'___-_. _____19 __ z Area `... X.. � ............ Diagram' of Lot and Building with Dimensions Fee .. �.................... .... SUBJECT TO .APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' I hereby agree to conform'to all the Rules and Regulations of the To n of nstable regar 'n the above 77 construction. , ' Name ....... .... ... ...... ....... .......�. ' s. * Construction Supervisor's License .... ... �.... ....... ....... DELANEY, JOHN & NiAJORIE No 296 �• Permit f r .. r ld Swimming.. ?001 r =' Accessor.X' o D eling ` f 38A" Eves A Location I'.r�, Cir le . .. • ...... ^ . .s ... ..... ........,F .... _ I .0 by • 4't r�' _ - .. - _ Centerville .. , A ,�. r � t � Yam• - - s. - r . s «r John & 'Ra rie Delane } Own %- . Type of Construction , . ...F 1e.. :.................. f y "` l..............................' Plot'.: ...... Lot 41) Permit Granted . July..14....... .... .19 86 = Date of Inspection ......................................19 a t Date `Completed Y.......................... .,l .r19P rrn � � g y p S� y � mJ� y'?'f. •,... F �✓_t)' f.�* r�'r .. � � .• - ' � Q - y `., � t r ..F �� � . i r� .y �. a�.�}• jl.. � .. - _°_ ., F r Assessor's offioe Ost floor): Assessor's map and lot number ......... "...�....0� ..".G�:6 THE o�♦ T , Board of Health (3rd floor): S,Tage Permit number ....................��,v,•��av+/¢° .. ........ho Engineering Department (3rd floor): j ro rasa t639- 9� 4Hbuse number ........................................ s� rE0 YPy a� APPLICATIONS PROCESSED 8:30-9:30 .A.M, and 1:00-2:00 P.M. only. TOWN OF BARNSTABLE 7//�,9BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....... .%I`' 1 v"".'�/LJ/`19...'. 1✓C�t.., .............. TYPE OF CONSTRUCTION / � /!..w� --............ .. . ..... .............. ........................................................................................... .....................7. ....-.-.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the......... `following iinformation: / 4 ............................... Location .........St �. ... � v�w G/ L / �... Proposed Use ......................................................... .................. � ..�....... ....................... ....... ............................................ Zoning District ...... �� .....Fire District +........................................................ .................................:..........,........................c j iX/� 3 Nameof Owner ......................................................................' ress ................................. .A...................................I........... Name of Builder Lr ��( Address !" � . `. ..... .............................. Name �.- of Architect ...........................:......................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ................................................................ Exteior ...........................................:.......................................Roofing .................................................................................... Floors ............................/ '1....--.....................................Interior .................................................................................... Heating .............................................Plumbing ................................................. ..................................... ................................. Fireplace ............................{ -�- ...............n..........Approximate Cost rd ,, > Definitive Plan Approved by Planning Board ____ ___._-_______19_ Area .. . ? Fi ................. CP Diagram of Lot and Building with Dimensions Fee ....... .. .............. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding above construction. Name ... ............... ......... ......... ......... Construction Supervisor's License .. . /,,,.,, DELANEY, JOHN & MAJORIE A=187-062-006 No 29649.... Permit for ...Build.. ..Swimm.i.nZ..Pool .......... . . wi g ...Accessory..to....Dell .............A Location .....38...E.ve.1yA..qir.c.1.e........................ ......................Qpate-Kvllle................................. Owner ........J.q..h...n.....&... ........... Type of Construction .......FKAMP......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .........................July 14,...... ;........19 86 Date of Inspection ....................................19 Date Completed ......................................19 Town of Barnstable � Rk*100F �HAS& 200 Main Street, Hyannis MA .02601 508-862-4038 Application for Building Permit Application No: TB-16-2264 Date Recieved: 8/8/2016 Job Location: 38 EVELYN CIRCLE,CENTERVILLE Permit For: Building-Shed-Residential-200 sf and over Contractor's Name: GCI BUILDERS INC State Lic. No: 152253 Address: PO BOX 509, MARSTONS MILLS, MA Applicant Phone: 02648 (Home)Owner's Name: MARTI,OLIVER A Phone: (Home)Owner's Address: 16 KNOBLOCH LANE, STAMFORD,CT 06903 Work Description: existing non-permitted 16x20 unheated pool building.Rebuild deck on front to back yard 12x16 Total Value Of Work To Be Performed: $4,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is,true and accurate to the best of my knowledge and belief. F All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. / Signed: GCI BUILDERS INC 8/8/2016 Applicant Date Telephone No. - Estimated Construction Costs/Permit Fees + Total Project Cost : $4,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: . $85.00 8/8/2016 $85 00 4045 Check ......:. 1........................ ..._............... Total Permit Fee Paid: $85.00 W . ' 52„ �' 1 60 $„ I 38" ,}�14" / 31 2 �/ 30" r$'i 25 2 / 257 it ' I 318VISNEIV8 J0 NMOI rj!d, )p ^ 77, "'�h,a .. Y.. :�d3® Jill �' �, � _--- 1 � � aline 4� � M Master Bath 00 _IN BATH.ALC.60 L - ' I ¢¢¢ ! ............. ms 00 00 1'61 31i ` a T 14 8 O Hall Bath L Nw _ RL Mµ N v s ma 2 / 50 �'' �--51 „ / 3 11 4 7n / 3�� / 3it 5n / r� 1011,11 616 1 1 5 8 / 22 n �i / 1 11 28 8 / 35 /716'f 4,� -----35 , 50 4 / 91 " / 5�1 / 71 i16 All dimensions _size designations This is an original design and must Designed: 2/1/2017 given are subject to verification on not be released or copied unless - Printed: 2/1/2017 job site and adjustment to fit job O applicable fee has been paid or job conditions. DESIGN BUILD order placed. Kiely Master _Hal Existing s All Drawing #: 1 No Scale. i 67" _7 1° 318d1SN8Ve A®NM®1 a 2 562" ,�-- 47121 , 1d30 Maine i I % IT J I; 4 �_ Ln {I 13ATH.ALC.60=L. 0) <: O _ x ♦V Yl : k OD ! 1 W 00 w 0 £ P I'. x s I m) 04, J M Q j' �� t 'a I ` _ Ti 77, w t ) V I a t >a 6 70 , 51 3g 4, Master Bath Hallath_22o / 28 8 -35 24 11 $ �` 3x 35 50 4 4 / 88" I/ 91" % All dimensions _size designations This is an original design and must Designed: 2/1/2017 given are subject to verification on ! not be released or copied unless Printed: 2/1/2017 job site and adjustment to fit job O o applicable fee has been paid or job conditions. DESIGN BUILD order placed. { Kiely Master _Fall 1 .31.17 All Drawing #: 1 No Scale. - I LoT 8 -0 1 t I I •� I ! i • i I 1 I � I � r, �✓ � ... I I V I I •1 I I I • I r h I 1 1 41 1 , OT , I I I I I _ , �► 1 , A, r I 6'il I ro I 1 I t Ar 4;i Fl F D c 1 I I I I I I 1 1 u I I ' ti I I I t ...�� .. , I, •�'M 1 , I , , , , 1 I ' PIOT 1 ♦, 1 � I I I LOCATION CGKJT uc� c--A I ART I F Y THAT THE Pqo4C ►ATiapti,) WI S.....0 �L_._E... D AT E 1 $HPWN ' EREON COMPlYS • I` ��.... N , ,SID.ELINE AND $ ETOACK, , 1 REQUIREMENTS OF THE TOXIN OF I PLAN REFERENCE AND I $ , ts)j� *-r, L CATED WITHIN TVie FLOO DPLAIN . ► 39 41P Gr -� QATE . (,� x BARTER N Y E , INC. JH � P 'IKAN I �► NpT rdAS► Ep QN► AN . R ,EGISTk �REQ LAND SURVEYOR $ ' I . : . lN TRUMENT SURVEY AND THE ' I 03TERVILLEr--II-0 MASS . OFFSETS SHOWN SHOULD NOT BE ARP L- I _Q.ANT � cA �..� . 1� U S E �.. Q g T.E R M 1 N �1 , . .�..�.. --