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0160 FOX HILL ROAD
T-7 -op 4 q � 6 iw t r. . v n 'AC:TIVE e o O P a p FINE Town of Barnstable *Permito 0 Expires 6 months from issue date Regulatory Services Fee ILAMSTnBt e 9 "ASS' 039. Richard V.Scali,Director 1� PRO I��u®U�� Building Division WIC I� Il®Il Tom Perry,CBO,Building Commissioner S 2 1 2015 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us T®w[TVF8RptjAj Fax: 508-790-6230 EXP S PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Num her 50 o Y 3 Not Valid without Red X-Press Imprint I / � Property Address / _6 c {'�e g ! l l ''l oA b C 'e o 1 iz u/ l/e ® � [Residential Value of Work$ ��� 01® Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address. °Y 2 A/VA/-e C M Contractor's Name �l�f �' J41ryenj Telephone Number Home Improvement Contractor License#(if applicable) /�lJ� `I" Email: C 4� e- C��'�Z 2� /�c�e. �cBa Construction Supervisor's License#(if applicable) C f ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name A m 6 I!n ja e) I Iw U lz_4/ll L' Z C'` Art rAd 1 Workman's Comp.Policy# -�aj G ��-7 Copy of Insurance Compliance Certificate must accompany each permit. L't 4 114 j A),tee¢ G Permit Req est(check box) / , t V Ul-t d o cJ 4#, CA V?4 7 4 n4y Re-roof(hurricane nailed(stri ping old shingles) All construction debris will be taken to 'Togo ©r YAn Wlo'v`r Al b'l (hurricane nailed)(not stripping. Going over existing layers of roof) r� Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign ope Owner Letter of Permission. of the Home Improve nt ontractors License&Construction Supervisors License is SIGNATURE: C:\Users\Decollik \Local\Microsoft\Windows\Tem rary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 Ofe i(in»anznnruertlf�n���CIJJCrO/rate ffice of Consumer Affairs L:BL9iness Regulation Ukense or registration valid for indivicul use on!y ME IMPROVEMENT CONTRACTOR before the expiration date. i goun.d recur to:' ... Office of Consunier Affairs a;-ad Business Reguladon egis'tration: 100740 Type: J[QD]Pant]Plaza-Suit€5170 T,Expiration: 6/23/2016 Supplement Card Boston,Iy[j A 02116 CAPIZZI HOME IMPROVEMENT,INC. P- ✓ ��`�� ' JOHN STP.UMSKI 1645 Newton Rd. Cotuit, MA 02635 UJnderseeretory ! Not valid without signature Q ro1µth. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS 064817 JOHN T STRUMS$ t 1 r. IS ADBN AVE Batzaards Bay M9 O532 f L Expiration Commissioner 0691 016 1 - I31.12 2014 16:49:00 Guard Insurance Guard Insurance Group III ACo CERTIFICATE OF LIABILITY INSURANCE °ATE'N�D°",�' 12 30 2014 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 DR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policypes)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not confer rights to the certificate holder in lieu of such endorsemenE s. PRODUCER CONTACT NAME ROGERS&GRAY INSURANCE AGENCY,INC. PHONE Eilk Fnlc : 434 Route 134 ADDRESS; INSURER )AFFORDING COVERAGE NAIL I South Dennis MA 02660 INSURER A: AmGUARD Insurance Company INSURED INSURER B: CAPIZZI HOME IMPROVEMENT INC INSURERc: 1645 NEWTOWN ROAD INSURERD: INSURER E: COTUIT MA 02635 INSURERF: 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 REQLAREMENT,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_ VTR TYPE OF INSURANCE P POLICYgUNABERoLIcYEXP mwo EfF PM LOWS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIARILrTY PIU3AlSES eseearr. S CLAIMS-MADE D OCCUR NED EXP(Anyone person) $ PERSON&&ADV INJUPY S GENERAL AGGREGATE 5 GEN'L AGGREGATE W.9T APPLIES PER- PRODUCTS-COMPIOP AGG $ POLICY jECT LOC $ AUTOMOBILE LIABILITY C N DSI I a accident) S ANY AUTO BODILY INJURY tPer person) $ ALL OYJNED SCHEDULED BODILY INJURY(Per awdenl) S AUTOS .AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE S gLMOg eracddeni) $ UMBRELLA L IAB OCCUR EACH OCCURRENCE b EXCESS LIAR HCLARISdNAD-- AGGREGATE $ DEQ I I RETENTION$WORKERS 3 A AN PLOCYOER5EUA>�tLn YIN Y R2WC527200 iz/2S/2Dta 12/25/2J15 x T RVNSATIONTM S._.: OTH ER ANY PROPRIETORIPARTNME XECU IVE NIA EL EACH ACCIDENT S 1,OD0,000 OFF'ICER&AENBER EXCLUDED? (Mandatoryin NH) E.L.DISEASE-EA EMPLOYEE 5 1,000,000 U es,deactiba wR der DE SCRIPTIONOFOPERATIONSkIbw E.L.DISEASE-POLICY LIRI3T S 1-000,000 DESCRIPTION OF OPERATIONS IL.00ATIONS IVEHICLES(Attach ACORD 101.Addidanal Remarks Schedule if more space Is regWred) Thomas Capizzi Jr is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 Main Street THE EXPIRATION DATE THEREOF, NOTICE WIt.L BE DELIVERED IN Hyannis,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATBIE ©1988-2610 ACORD CORPORATION. All rights reserved, ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD s The Commonwealth of Massachusetts = W Department of Industrial Accidents o I Congress Street,,Suite 100 Boston,MA 02114-2017 wwwmass.gov/dia Y Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Indiv--dual):CAPIZZI HOME IMPROVEMENT, INC Address:1645 NEWTOWN ROAD City/State/Zip:COTUIT, MA 02635 Phone#:508-428-9518 Are you an employer?Check the appropriate box: Type Of project(required): 1.®✓ I am a employer with 40 employees(full and/or part-time).* 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in ❑ 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]P umbing repairs or additions 5.®I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.# p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL a 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AmGUARD INSURANCE COMPANY Policy#or Self-ins.Lic.#:R2WC527200 Expiration Date:12/25/2015 Job Site Address: /4 0 `r 0/ Pi 1 j R IJ44 City/State/Zip: C-e14 f-ekydjt I. W4 U44 3 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage venation. 1 ation. I do hereb cent under the pains and penalties o e information provided above is true and correct Si ature: Date: ® � l j / - Phone#:508- 2 -9518 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#: EA Page 7 of 7 Capizzi Home Improvement Inc. Specifications and Estimates STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I/WE, Sy2 aJ414C X- e; 'C/f5 , OWN THE PROPERTY LOCATED AT 146 � I`/� IN '/1" , MASSACHUSETTS. I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING qODE. SIGNATURE OF OWNED: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APPLICANT'S. SIGNATURE: - - APPLICANT'S ADDRESS: 1645 Newtown Rd., Cotuit, MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: - 17) a_ _ o o . ;. opo ly December 29, 2015 a wk1D/NG Town of Barnstable T C 30 ATTENTION: BOLDING DEPARTMENT OWI�OFgq J 200.Main Street R1USTgeC� Hyannis, MA 02601 RE: 160 Fox Hill Road, Centerville Permit No.: 20505976 Our Job No.: JB-0261682 NOTICE OF CANCELLATION This letter is to certify our proposal to install Solar(PV)at the above-referenced property has been moved into a cancellation status. SolarCity Corporation and Suzanne Methelis will not be moving forward with the proposed installation at this time. We would greatly appreciate reimbursement for the permitting fees paid, but understand that the.town will not refund any fees. If you have any questions or concerns, please don't hesitate to contact me. Thank you for your attention to this,matter. Sincerely, CheryCGruenstern Cheryl Gruenstern Permit Coordinator SolarCity Corporation egruenstern@solarcity.com Telephone: (508) 640-5397 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ` r Ma ��1� Parcel 04 xx p Application #_ D�d/� Health Division Date Issued 2-3 1 S Conservation Division -.Application Fee Planning Dept. Permit Fe Date Definitive Plan Approved by Planning Board Historic - OKH 10 _ Preservation / Hyannis /vim Project Street Address a :-FH i I( IUD Village Owner �J tc?�,r,r�c I�lce.��t Address 1 c fA/! _Bo.e( Telephone �Jx �(o �� 0cr7 Lr Lr; (r_ 6 6- 63632- Permit Request . nc ts ana '� of GY-ist 64 PE �t��tr-c�rc,�c� r- ►���`f�n Vrfi ete4C� -4I sty �e w �5a P-_,,e(s Square feet: 1 st floor: existing —' proposed— 2nd floor: existing — proposed _ Total new Zoning District RC Flood Plain Groundwater Overlay Project Valuation d�ak,bbb Construction Type Lot Size Grandfathered: ❑Yes 2(,No If yes, attach supporting documentation. Dwelling Type: Single Family 6, Two Family ❑ Multi-Family(# units) Age of Existing Structure M - Historic House: ❑Yes WNo On Old King's Highway: ❑Yes ANo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Wh Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new t- 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 dA' New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new sizd&Pool: ❑ existing ❑ new size a Barn: ❑ existing ❑ new ._..sizeAl— Attached garage: ❑ existing ❑ new sizkTShed: ❑ existing ❑ new size YtOther: D Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes XNo If yes, site plan review# __7) Current Use Ir n- 6 . Proposed Use rn APPLICANT INFORMATION rr (BUILDER HOMEOWNER) Name �a�� l�v� U1a�l� ��s� Telephone Number J1S$ �Ltb �3`�r) Address License# CIS — 15 `1 I u� r11� �li�' 11aL�6 Home Improvement Contractor# Email CA t-'ucJ)5'" S G�. . c Worker's Compensation # I/UCD�RaDlS'-Do ALL CO TRUCTION DEBRIS RESULTING ROM THIS PROJECT WILL BETAKEN TO,_Q �wn,05 SIGNATURE DATE e D % FOR OFFICIAL USE ONLY APPLICATION# '4 DATE ISSUED MAP/PARCELNO. ri ADDRESS VILLAGE OWNER - DATE OF INSPECTION: F . FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. =; SolarCity. t OWNER AUTHORIZATION Job#: �f3`Oz6l( 2 '00 ` Property Address: (`U)'10 ram' R-P. f Gr- 1. as Owner of the subject. . property hereby authorize SOLARCITY CORPORATION to act on my behalf, in all matters relative to work authorized by this building permit application. .. .. .'`fie . � . .i ` • r .. R ` e Sigwafure of n_er: ,. Dater , [ _ T SOLARCITY.COM AZ HOC 2a377VFiOC2aSR°.Rf�7C217d98,CAUC+688764,COeCBOdt,.CTtttC00ffi7i�Eti'rOtES�OS,OCtT1t0'!48&ECHO¢5E5.HLT•1917U.h4tlii�;�35tTCiiA�it3F3kH,itDkiH'Ct28�[S8, A . ' tit tiAilCR13+hI061B0900r3+EBQ773?7W,OR CB180098�CS82'FB1702 PA tRCi'A.67T3d3,1X'tf0 00B,WA SOLAHtr"9t9Q '9D3?0201d$C.'f:AF,ryOORPORAT".Fli Ft,%JS Ep, ,. _t r -..aCUe`z �r � pFIKE r Town of Barnstable *Permit# Expires 6 monthsfrom issue date ~' Regulatory Services Fee XJPr i639 a1� Thomas F.Geiler,Director d k 6110/l n Building Division sARNS-f�BL Tom Perry,CBO, Building Commissioner -�O\NN O 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79076230 EXPRESS PERMIT APPLICATION T-RESIDENTIAL ONLY f Not Valid without Red X-Press Imprint Map/parcel Number `� y d Property Address r I � (� Q 2�'� e✓ 11 r ' '1 Z� Residential Value'of Work �' Minimum fee of$25.00 for work under$6000:00 Owner's Name&Address d C'J .;1 (J 2--C, Y) d F F ( V-1 D263 9 Contractor's Name nj 117,i�,'�FS i) �. . Telephone Number 0 't 2S— 57 0 Home Improvement Contractor License#(if applicable) ! V / T Construction Supervisor's License#(if applicable) D orkman's Compensation Insurance f Check one: ❑ I am a sole proprietor a I am the Homeowner have Worker's Compensation Insurance l Insurance Company Name. C—ru�Yl cj ,s t� �� h If'_ 1 ,� .:• Workman's Comp.Policy# . 0--L" J 3 Z g' Copy of Insurance Complian a Certificate must 4ccompany each permit. ' Permit Request(check.box) e-roof(stripping old shingles) All'construction debris will be taken to (A m, t�. .J 5 2 0 ❑Re-roof(not stripping. 'Going over existing layers of roof).: ❑ Re-side #of doors ❑. Replacement Windows/doors/sliders.U-Value (maximum.44)4 of windows *Where required:Issuance of this.pernut does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pr perty Own must sign'Property Owner Letter of Permission. opy.of me Improvement'Contractors License&Construction Supervisors License is re uire SIGNATURE: Q MPFILES\FORMS\building penmi oraLTIZESS.doc Revised 090809 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' a 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): . C,t 7—Z ,/91 CL Address: e-0.4 tad/I ' 6 C, City/State/Zip: v Phone.#:_ Are you an employer? Check the appropriate box: Type of project(required):. 1.1�0 I am a employer with 6+ 4. I am a general contractor and I employees(full and/or part-time). have hired.the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have $. ❑Demolition working for me in any capacity. employees,and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. We are a corporation and its' 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work : officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4), and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing:their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers compensation insurance for my employees. Below is the policy andjob site information. � Insurance Company Name: /� f / A Policy#or Self-ins. Lic.#: W Ltl U/1 T s-e'C 3 Zd k Expiration Date: Job Site Address: 1 �.0 City/State/Zip: Ceqf�i l�l 1r4 d 2-4 3 2— Attach a copy of the workers' compensation policy declaration page(showing the policy number and x. P Y P g ( g p y a 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 imprisonmentt 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 h ains-and-pe alties-o perjury-that-the,information-provided-abov ' true-and-co rrect Si tore: Date: ` 20 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#• Client#:47298 CAPIHOM ACORU, CERTIFICATE OF" LIABILITY INSURANCE DTE(MM2010 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 NAME:CONTACT Karen A Walther, CISR Rogers 8r Gray Ins. -So. Dennis PHONE FAX 434 Route 134 A/c No 508-760-4630 Ext: (A/C,No): 508-258-2230 E-MAIL AD walthka ro com P.O. Box 1601 oDRESS: er � g g v ers ra CER South Dennis, MA 02660-1601 CUSTOMER ID M ' INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:National Grange Insurance Co. Capizzi Home Improvement, Inc. INSURER B:ACE Property&Casualty Ins.Co Capizzi Enterprises, Inc. 1645 Newtown Road INSURER C: Cotuit, MA 02635 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBRJ POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS q GENERAL LIABILITY MPB1075-H 06/08/2010 06/08/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTE PREMISES Ea occurrence) $500,000 CLAIMS-MADE F x1 OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO LOC $ A AUTOMOBILE LIABILITY M1 M28O44 06/08/2010 06/08/2011 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) 500.000 BODILY INJURY(Per person) $ ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY(Per accident) $ , PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON OWNED AUTOS Uninsured $250600/500000 Underinsured $2500001500000 A X UMBRELLA LIAB X o'CUR CUB1076H 06/08/2010 06/08/2011 EACH OCCURRENCE $5 OOO OOO EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DEDUCTIBLE $ X RETENTION $ 10000 $ B WORKERS COMPENSATION NWCC45843208 12/25/2009 12/25/201 'X WC STATU- 5TH- AND EMPLOYERS'LIABILITY Y/N OFFICER/MEMBER ER ANY EXCLUDED PROPRIETOR/PARTNERIEXECUTIVE� N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 T_ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required). Carpentry CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Of Plymouth ACCORDANCE WITH THE POLICY PROVISIONS. 11 Lincoln Street Plymouth,MA 02360 AUTHORIZED REPRESENTATIVE 0 198 -2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S52547/M52541 KW III • ✓�ie (Qom.�ruYal o ✓v[aae�u : . Board of T3u:ld:ng Regulations and Sfandards License or registratioq valid for individ.ul.use only b HOME IMPROVEMENT CONTRACTOR before the expiration date. Iffoupd-return-to. �f Board of Budding Regulations and Standards Regist t_ 100740 . One Ashburton Pfice Rm 1361. 17I=t 23/20.10 Boston,ma 0210$ e _ 4p(ement Cant. CAPfZZi HOME1T1� bARY GUSTAFSO� �,+ � . 1645 Newton Rd Cotuit MA 02635 Administrator No vali itho f nature ia4�sc Itws :ttti llz ►irk ti xii Eat uf33ic S x!'c t� .: -- _ -- -: Biaarii r3f 8crdcl�sa=„ic�ii{dt3l9ti. tna St�ndarcis Xv cons#rt3c#it3A Supervisor Lrcpi�se Fteatricted o 00 GARY GU9TAFSOt�t 8 SHORT VItAY � ' SANDWICH, MA 02563 {� Er,3:tatszf..-11(2912010 Page 7 of 7 CAPIZZI HOME MIPROVEMENT INC. SPECIFICATIONS AND ESTIMATES STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT I, 9 b�' 1(' �cJ 2- OWN THE PROPERTY LOCATED AT I Q )C .' I a- IN C`�� � �— ,MASSACHUSETTS: I HAVE AUTHORIZED CAPIZZI HOME IMPROVEMENT TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR,THE MASSACHUSETTS STATE BUILDING CODE. I GIVE MY PERMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN CO STATE BUILDING CODE. CE WITH 780 CMR,THE MASSACHUSETTS jC� SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: APPLICANT'S ADDRESS: 1645 Newtown Rd.,Cotuit,MA 02635 APPLICANT'S TELEPHONE: 508-428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: �F ��Ds PL(�rv►►3T-�� , RQ lw ryLe�cf f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map lqo Parcel � � Permit# '?a5g Lf y, C P V' 0 F E3� y" TABLE Date issued' 7''to�0'{ Health Division 04—3 0-9 IiD may' Conservation Division R �.L11 . ,- 1��' �r;° f' AM Application Fee 6 . Tax Collector-' Permit Fee0 X Treasurer:. 4. F C SYSTEM MUST BE Planning Dept. _ INSTALLED IN COMPLIANCE ' Date Definitive Plan Approved by Planning Board WITH TITLE 5 ENVIRONMENTAL CODE AND - Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address 160 Village 11�L Owner fA '�e�c S - Address S _ Telephone T71— ;7C P Permit Request Square feet: 1st floor: existing) proposed 2nd floor: existing _ proposed SC " Total new �� Zoning District Flood Plain Groundwater Overlay Project Valuationq70,OY0 Construction Type GJ00 (� Lot Size Grandfathered: [ Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two FamilL ❑ Multi-Family #units t b Age of Existing Structure I �b_L� - • Historic House: Cl Yes to On Old King's Highway: ❑.Yes ❑No Basement Type: �Uull �Wrawl r O Walkout ❑Other {�. Basement Finished Area(sq.ft.) e__ Basement Unfinished Area(sq.ft) f? da Number of Baths: Full: existing new - Half:existing _ new Number of Bedrooms: existing3_ new _. Total Room Count(not including baths): existing new First Floor.Room Count Heat Type and Fuel: SGas 0 Oil O Electric ❑Other Central Air: ❑Yes qNo Fireplaces: Existing New Existing wood/coal stove: ®Yes No Detached garage:0 existing ®new, size_ Pool:0 existing ❑new size Barn:0 existing ®new size ' Attached garage:keexisting ❑new size �. Shed:0 existing ❑new size Other: Zoning Board,of Appeals Authorization ® Appeal# Recorded Commercial 0 Yes ❑No if yes, site plan review# Current Use Proposed Use ` BUILDER INFORMATION / A Name ` . w� � K afn5 Telephone Number Address D� f 6b f License# ®l( a Home Improvement Contractor# z c � Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE a, —p DATE v 4 -+ I ' FOR OFFICIAL USE ONLY PERMIT NO. - i DATE ISSUED _ e MAP/PARCEL NO. , ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ,q FIREPLACE ELECTRICAL: ROUGH FINAL m PLUMBING: ROUGt,In A FINAL y 0O GAS: ROUGIfi S FINAL t FINAL BUILDING Imo- m 0 0 DATE CLOSED OUT co J7 ASSOCIATION PLAN NO. by i a- Town of Barnstable a3 �� Regulatory Services .� Thomas F.Geiler,Director S& sAsat�$ BLIildug Misl on , �IFDy� Tom1'erry,Building Commissioner 200 Main Street, Hyannis,MA 02601 , Fax: 508-790-6230 Off ce: 508-862-4038 permit no. NTPACTOR AFFIDAVIT NMNT CO SUpp XMNT TO pFFly=APPLICATION . GL a 142A requires that the`lTecanstruction,alterations,renovation,repair,modernization,conversion, M re-existing ow�,er-occupied improvement,removal,demolition,or construction of an additionto any p bti}lding containing at Least one but not more than four dwelling units or to structures which Sre o��nt to such residence or building be done by registered contractors,with certain exceptions,along with requirements. [Y Rstims,ted CostE Type of Work, Address of Work Owner's Nye; •• ' lication:- Date of App� r I hereby certify that: Registration is not required for the following reason(s); [Work excluded by law ' C]76b UndeY$1,000 ; []Building not owner-occupied Downer pulling own permit . Notice is hereby given that: TEALING GISTERED 0 WMRS PULL3NG THEE OWN PERMN EaROVEMINT WORKDO NOT EkV3 CONTACTORS FOR p,ppL7CABLE$0 OR GUARANTY FM UNDER MGL c.142A. ACCESS TO TSE ARBITRATION PROGRAM SIGNED UNDER?BNALTIES OF PERJURY Thereby applyfor apermit as the agept of the owner; --- 1"�- Contractor Name RegistzationNo. Date OR Owner's Name ' r °pYHETpk, Town of Barnstable Regulatory Services `s $ Thomas F.Geller,Director = � Building Division - TfD µP{ Tom Perry, Builcliag Commissioner 200 Main street, Hyannis,MA 02601 office: 508-862-4038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using A Budder � �� •5--_ vnet.of the.subjectpopetty - - - . hereby authorize �- -- t- 5 ' to:act on tny..behalf,. sn all matters relative to work authoiize •by.this binding permit application for: (Addtess of Job) , l D S� y�of Omet ate Print Name j C � y�� ✓RC T0,69J7/IILO�ZI.IIP�G(IL O��G6C�LUJr.Q4 �I BOARD OF BUILDING REGULATIONS k6 License: CONSTRUCTION SUPERVISOR { wN t`ti 0 6J Numbe.,tC��, 16981 �` Bi�t}Id;�>i��Og/07l_1�947 0 607/20Q6 Tr.no: 18047 { s I - V ''`i I , Restr cedti�QFO JJ I DOUGLA$L WILLI`�MSz,,SR PO BOX 1069 CENTERVILLE, MA 02632"'' Acting C i*Isner . _ t I 9/400s and standards Board of Bailding & CONTRACTOR HOME IMPROVEMENT CONTRA RegisttltopJ 102227 ,pp i I ,r M j DOUGLAS L.W I�LIA�11 O�BUILDING Douglas William t t Doug s BOX 1069 CENTERVILLE,MA 02632 Administrator « i tend in BARNSTABLE Bobnping to The Shirtey Family TrLm Oaad to Baer Page toad Court cwwosb",I isma. M Book in Bsr+nabtile itepistry Dtesried Reoor od Wan UwW Goutt Pten%h**w n4ft k OW *h Cediflilcaft Numbw TM W Dab o1 Phn De weber IM In Sarrmteble Registry Dbt►iat Book 292 No. 26 FMW Plan No. MORTGAGE INSPECTION:PLAN Robert W. Pa ady.A m*y at Law Loan No. Robed J.Methellb and C.Me*Aft ISO Fox Hill Road,Centerville a _ o l-ot 16 .a.... _r 1 W' ~. o C 51MY WOa7 aE NaMo H't t J� casd Ox H ILL. ' ROAD may 1,z�. A 09025 scale: 1.`=So.' THIS PAN IS FOR MORTGAGE PURPOSES ONLY .' i•The Comznani�edth of jVlassachuseits Department of K&strialAccidents' - o16d ImmApff 600•Washington Street _ Boston,mass. .02111 ., 'PF'orkers'.C m ensaifon.usurance Affidavit-General Businesses OF q.A (lam+o t7"d 1 j+• ess: ` • stater'/ s �� Establishment . work sitel ocatiasi fu11 addres Re•�[]RestawantBar/EatYng 7 ata.a sole proprietor and have no one 131411. ss e: a Office Sales('including REal 13sta e,Antos etc.)' achy. yrorking in any Cap. [] am an em 10 er wth •'0 % %/%/%%%%////y%%//�////%%%%%/�%//%%/%////////� ' 'ob. , compensation for my employees worl6ng cn this 9 r { � z Providing y�Orkers' t• •' 'tf r'''`.. t'�i..:',.,r.,;:t ' ' •t' .: 0� aZnane�n�lQy� t S ,..r.. yf '•�` t1. t.s�t :,Y`d',R:'•'.iti7t'r''lit '''.af tr.te��, `I %8A^'n>i'met':' , •' J .: .•i' t•It'"�•a..•Frc.� t}:;{+*i:nt!-t:�::'.1:!.,it'r,'•:'•'t' ••• •j'r••,i�',•`S:,•''; v.S:P'•�+tl•t:'I•�y+•:• Y%�t•t ttip , ,t��...'f• C0111 5', ..+.' 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' :r fr�.3.t.$=j,.::�;: yr'.,7•i5.� .' 1. ,, 5 O11C •5r.•SSSu '. ��h ' �iusui at�ce.cb:,r::: ,:..t 7•�t••�v•••''=s;;, .:..,f orlCets' a followin lv I am a sole proprietor and'have hired 11e independent contractors listed below v>rho}lave:th g �p sensation polices: ;• {•,s; ":' t,i.tip}',j{ ' �.;'.:M1''1` y. :; ' 'f' •y.. ''.i R''l' 1,•r• .•la':ir':}i. f�,5•.• ,1.e' i•': i 11'• '•.. r r....r •'; r::' •Cis. ,•sit. •' ,• t.y. •s;s,t};,..,, .:.�.;�, +r. .. r. •„ 't ':.,•,+:•..:P.w�iAi•:'' °•.,,{''•'i.l•t�ti. •• ' ''''''8II �aII'g'e'`,;• .e. r j �� r: •a�.,rnr;t.,,�Ir ... ::: t' s',i'c{f:';� .: t,ty:ll�:�a..•:• to CUln .,Y pftl':•It,'c�'1.[:<•. 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'•.•I f�t; .•J�•t,.'n• •d' �} :+,' i w+,.r •l'• �i:.t011�•if .....ra.v�.•I,,T��ttt�,-t:.:�.,'.• ::1'.;,;1+.+;'f i1 tir•'�,t��±•mot .i,� ':,; ''• '' .yr ry +.t4, •'� 6,P••n'i','' tt' \ t t'':t:yl••7• ,r: t i ,,, CI %. .i 5}b., :r�•1•+' :....a:r '•;•, G: r e f •I t ,yf' f. r•°t. t , .t a ,y� L. , y. .lil .�,,�`�,'• • .t•,�{ ., +'.1'•' ,• t r�^ t .a,i';; �" S 14.5".tu../.4 O11CI':ft>: •f n':•' • '``�''••1 �'• ••/,_• f'�i75: 'j�•r' ;4y:.:•'rtr;.,t:,.y: .•., r''., I '• 1 fnsiii$n "- penalties of a fine up to$1,500.00 sin or Fallnr'to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal rvomnent as viell as etvilpenaltles to the fdYm of.STOP WORK OPDBR and a fin'of S100'00 a'day against me, I understand that} one years imp be farpvai ded to the Office of Invesflgations of the DTAfor coverage verification. ; . copy o f this statement may • , • under the ins and penalties gperjury that the inform ation provided above is frue an r!i I do hereby certify Date Si�aature �`',` phone# Print name official use only do not write in this area to be completed by city or town official permitlitcense# []Building Department ❑Licensing Board city or town: ❑Selectmen's Office [�cheolcif immediate response is required ❑iiealthDepartment []Other phone#; contact person: (revised Sept 20 3) { ,......R-.ram.-u.,..nn-ar,t� 'r�'a�a"xcrraSy�Y- InformiaH6 and Instructions. al Laws'c ter 152 section 25 xequires all employers to providb•workers° eompensatidn for their•. Massachusetts Lefler •• L';` quoted-fromthe °lsw',, an employee is.defined as every person' the service oi`another under any contract empllgye%_' .As elu of hire, express or irr�dd; oral or writtm individual,part�.ersht , association,corporation or other legal entity, or any two or mare of An employer is defined the foregoing�gag ed.in a:joint enterprise,and including the legal irepresentatives of a deeeased,employer, or the-receiver or partnership,association or other legal entity, employing employees. 'Howevei.the owner of a trustee of an individual,P . Px dw g house��g:not'fnom than thrce apartments and who resides therein, or the... the dwelling house bf peI. - to•domai-atenance, constrection or repair work on such dwelIng fious"6r on the grounds or another who. Pl°�'s "cause f s ent.be deemed to be ari l er ` t buiq g pp enact thereto sha71 not b'e ,o uch.e•mploym employ din ', •:, . ; :' _' IylGL chapter 152 section 25 also'states fhat'every state or legal licensing agendy shall withhold the fssuane0 or renewal of a license or p et xuit to operate a business or to construct buildings in the.cbmmonwealth for any applicant who has xiot.procluced acceptable•eyideziceof compliance wIth the ha11 enter into any c�.tracgfar the performance of public work unto coix���'ealthnor•any,of-its political subdivisions Y e of compliaflce with tie insurance rbquu•ernents of this chapter have been presented:to the contra acceptable evidenc cting•. authority: . •�-,ij�^!o/yp�����ri/yi.��',%�j// li„%GILL% �k' Applicants Please f tlic workers''compensation affidavit completely,by checking the box that applies to your situation.•Please supply company n, me, address and phone numbers along with a certificate of insurance as all affidavits maybe submitted to the Dep ent of Industrial Adeidents•for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The fit-0 t should be returned to the city or town that the application for the permit er licens a is being requested, not the pepartment 6# dustrial Accidents. Should you have any questions regarding the'"Iaty"or if you are obtain a worker9!.compensationpQIi please call theDepart=t:at•the niwmber liste�lbelo�sr. required to, ME City or Towns Please b e sure that the affidavit is complete andprinted legibly. The Department has provided a space at tad 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 suze to fi11in the perinit/liccme,m amber'which wM be usecl as a referencb number. The.affidavits maybe returned tp 1�AX unless other'arrangements have been rna.dq. -"' the DepartinentbY. °T, • '. . .. .:. , The Office of Investigations would like to thank y'ou in advance for you cooperation and kould you have any questions, mot-hesitate to give us a•ball. ' please do moth _ The Depaent's address,telephone and:fax number: . ' The Commonwealth Of Massachusetts Department.of Industrial Acdcdents MN of ft�esligstlens 600 Washington Street Boston,M2, 02111 fax#: (617)7Z7-7749' ALN NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I(we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY 11 NORTH AVENUE, P.O. BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY VWC 6005003012004 001 01/25/2004 - 01/25/2005 POLICY NUMBER EFFECTIVE DATES O'Briens Centerville Insurance PO Box 610 Agency Inc Centerville, MA 02632 (508) 775-0005 NAME OF INSURANCE AGENT ADDRESS PHONE Doug Williams dba Doug Williams Custom Building 222 Pine Street Centerville, MA 02632 EMPLOYER ADDRESS 01/16/2004 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0_ Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 7-23-2004 DATE OF PLANS: 7-04 TITLE: Kitchen expansion M PROJECT INFORMATION: Methelis 160 fox Hill Rd ' centerville COMPANY INFORMATION: Doug Williams Custom Building Co 1069 Centerville Mass COMPLIANCE: PASSES Required UA = 72 s Your Home = 71 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value .U-Value UA ------------------------------- ------ ---------------------------------------- CEILINGS: Raised Truss 280 38 . 0 0 . 0 7 WALLS: Wood Frame, 1611 O.C.. 352 13 . 0 3 . 0 25 GLAZING: Windows or Doors 69 0 .400 28 FLOORS: Over Unconditioned 'Sp ace 240 19. 0 ---------------------------------=-----------------------------------------1--- COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The =HVAC equipment selected to heat or cool the building shall be no greater than 1250 of the design load as specified in sections. 780CMR 1310 and J4.4 . te Builder/Designer C Da - and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR. 1310 and J4 .4 . MISC REQUIREMENTS: [ ] Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only) ------------------`------ MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 Kitchen expansion DATE: 7-23-2004 Bldg. Dept . Use CEILINGS: [ ] 1 . Raised Truss, R-38 Comments/Location Insulation must achieve full height over the exterior wall. WALLS: [ ] 1 . Wood Frame, 16" O.C. , R-13 + R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1 . U-value: 0 .40 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 .5" clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and, equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building, plans or specifications . DUCT INSULATION: [ ] Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the -building must be insulated to R-8'. 0 . = DUCT CONSTRUCTION: , {y ] All ducts must be sealed with mastic and fibrous backing tape.- Pressure-sensitive tape may be used for fibrous ducts . The HVAC . system must provide a means for balancing air and water systems . . f TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or .shut off the heating RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE Al square feet x$96/sq.foot= a-a' � x.0041= r73. 1 9 plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf - 50.00 >750 sf- 1000 sf. 75.00 >1000 sf= 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041 STAND ALONE PERMITS Suc� j9perrPorch _�x$30.00= 0 h D (number) Deck.._. x$30.60= (number) Fireplace/Chimney . x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Feed .� Projcost Rev:063004 f The Town of Barnstable BARN Department of Health Safety and ErMronmental Services - - M�� Building Division 367 Main Street,Hyannis,MA 02601 ce: 508.862-4038 508.790.6230 PLAN REVIEW Owner: � `e1 1 3 MaP 1Parcel: Project Address: (® Eby- H-i I Builder: k i 1 i OL W`g The following items were noted on reviewing: o```er, w1 uaNG S1i Reviewed by: Date: TOWN OF BARNSTABLE- BUILDING PERMIT ` PARCEL ID 190 043 CEOBASE ID 11209 ADDRESS 160 FOX: HILL ROAD PHONE CENTERVILLE ZIP - LOT .. 16 BLOCK LOT SIZE IDBA DEVELOPMENT . DISTRICT CO PERMIT 56005 .DESCRIPTION 92 .SQ. FT. BA/BR ADD TO REAR PERMIT TYPE BADDI TITLE BUILDING PERMIT ADDITION I CONTRACTORS; WILLIAMS$- DOUGLAS L. Department of Health, Safety .,ARCHITECTS: ' and Environmental Services li TOTAL FEES: $77.38 TIC CONSTRUCTION COSTS $8;832.00 434 RESID ADD/ALT/CONY I IVATE P', r • BARNSTABLF, + MASS. g I BUIL G IV SION BY j J. DATE ISSU19D _ 09/24/*01 XPIRATION, DATE THIS PERMIT CONVEYS NO'RIGHT-TO-OCCUPY ANY STREET, ALLEY ORSIDEWALK;OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE.OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION'RESTRICTIONS. j MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK; APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT POSTED UNTIL FINAL INSPECTION WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU I' (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- II 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4..FINAL INSPECTION BEFORE OCCUPANCY.. r so I' BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS t 2 I` t� . 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I2 BOARD OF HEALTH' OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APP ROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF'DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED.ABOVE. TION. DD H (3 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map d © Parcel OW d Permit# ®O Health Division 1 r-/� Date Issued2-4 ° Conservation Division `P 6 FeecomplaNc f 2�8c Tax Collect �(� I C�1 'p' �� UIRT la in Treasur INSTALLE Planning Dept. • ENVI ONM I�NTAL CODE ANP Date Definitive Plan Approved by Planning Board yOWN IREGULATIONS Historic-OKH eservation/Hyannis 40Y Project Street Add ess L_L_ r) m Village Owner M4d,11 Address 15&1?16L l7►'' �1�t7���L �• , Telephone3a 75 9 B7�yS Permit Request f cLC�rt"tdY1 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new _' . Estimated Project Cost D Zoning District • Flood Plain Groundwater Overlay Construction Type Z Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family lJ Two Family ❑ Multi-Family(#units) Age of Existing Structure 3�' Historic House: ❑Yes W1ko On Old King's Highway: ❑Yes ,diklo 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 ALII) Total Room Count(not including baths):existing new First Floor Room Count 11 Heat Type and Fuel: as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New W 6 lExiig wood/coal stove: ❑Yes ❑No Detached garage: existing ❑new size I Pool:❑existing ❑new sizearn:❑existin ❑new size Attached garage: existing Elnew size ( Shed:❑existing ❑new sizeOther: /�/J� Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 'No If yes,site plan review# Current Use Proposed Use 1�% BUILDER INFORMATION Name 1 otrG Lot u- _-_� Telephone Number 31K Address [a q License# es 0/6 Q V M Home Improvement Contractor# Worker's Compensation# • ��� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1=4C 6 SIGNATURE 1 DATE 17 _ FOR OFFICIAL USE ONLY 6� PERMIT NO. DATE ISSUED ° MAP/PARCEL NO. ' ADDRESS r °: ' ." VILLAGE OWNER ^. .. DA F INSPECTION:; foe- ' ,r FOU ON t • FRAME INSULATION FIREPLACE ' ' ELECTRICAL: ROUGH FINAL . } PLUMBING: ROUGH FINAL j` r GAS: ROUGH 'FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN.NO: t TOWN OF. BARNSTABLE BUILDING PERMIT PARCEL ID 190 043 GEOBASE- ID 11209 ADDRESS 160 FOX HILL ROAD PHONE CENTERVILLE ZIP -- LOT 16. BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 56005 DESCRIPTION 92 SQ. FT. BA/BR ADD TO REAR PERMIT TYPE . BADDI TITLE BUILDING PERMIT ADDITION CONTRACTORS: WILLIAMS, DOUGLAS L. Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $77.38 THE CONSTRUCTION COSTS $8,832.00 434 RESID ADD/ALT/CONV 1 PRIVATE P'�* E�` ; * BARNgrABM • MASS. 1639. A�O� ED M1�►1 BUILDING/DIVUSION BY � DATE ISSUED 09/24/2001 EXPIRATION DATE THE FOLLOWING , IS/ARE THE BEST IMAGES 4FROM POOR ' QUALITY ORIGINALS) IMfi DAT A TOWN OF BARNSTABL I BUILDING PERMIT PARCEL ID 19C, 043 GEOBASE ID 11209 ADDRFSa F0 ' 1?iLL ROAD ' �ENTEitV I LLE LOT 160 16 BLOCI{ I� DEA DEVELOPMENT PERMIT 56005 DESCRIPTION 92 S FT. FERilI'i TYPE BADDTJ TITLE BUILDING PE CONT:�ACTORS: WILLIAMS , D) GLAS L. ARCHITECIS: 'OTA1 FEES: $77.38 BUND $.00 CONSTRUCTION COST:' $8,832.00 4%24 RESID _%DD/AI,T/CONV 1 PRIVATE P # r s + RARNSTABL F, • MASK. BUIL NG VIS ON" \ DATE ISSUED C9/24/2001 EXPIRATION DATE BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND M FOR (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. CH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. l i 0 BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. `ro 0410 b s •���Ga nrM�r O ' et�e4110�Ofe�d���b ,� _ • �0 8�A0 + BARNSTABU& • BACV s659. ♦0 RFD MA'f A Town of Barnstable Department of Public Works 367 Main Street, Hyannis MA 02601 Office: 508-790-6300 Thomas J. Mullen Fax: 508-790-6400 Superintendent SUBJECT: Numbering of Buildings Map No. /go Parcel No. 0443 'Y Date•A/ov. -7� 1997 Dear Property Owner, Notice is hereby given in accordance with the General Ordinances of the Town of Barnstable, Chapter III, Article V, Numbering of Buildings, adopted March 3,1931, revised July 21,1994, public convenience and necessity re wires the assignment of number /60 for your property located on fox N/!_� AU C�.yT�rLyrLLc STREET NAME VILLAGE This number should be affixed to your building so that it is visible from the street as outlined in Exhibit"E", Town of Barnstable Rules and Regulations for Numbering of Buildings. Please contact the Engineering Division at(508) 790-6317 to verify E-911 records when the change is made. Robert A. Burgmann, P.E. 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', p t11�t��1c140GTUVN"tA" *` 1 MAScheck COMPLIANCE REPORT y" 'Massachusetts Energy Code I Permit # MAScheck Software Version 2.01 Release 3 I I: Checked'.-by/Date I I I TITLE: Bedroom/ Bath Addition CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family,, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 4-11-2001 DATE OF PLANS: 4/11%01 PROJECT INFORMATION: Robert and Suzanne Methelis 160 Fox Hill Road Centerville, MA COMPANY INFORMATION: Kenneth Sadler Associates P.O. Box 1149 Hyannis, MA 02601 508.790.3922 COMPLIANCE: Passes Maximum UA 39 Your Home = 33 Area or Cavity Cont. ' Glazing/Door Perimeter R-Value R-Value U-Value UA CEILINGS 117 30.0 0.0 4 WALLS: Wood Frame, 16" O_C. 216 15.0 .0.0. 17 GLAZING:. Windows or Doors 24 0.310 7 FLOORS: Over Unconditioned Space 117 19.0 0.0 5 COMPLIANCE STATEMENT:,. -The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating.load for this building, and the cooling load- if appropriate,': : has been determined using the applicable Standard Design Conditions found . in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 78OCMR 1310 and J4.4. y j 3 Builder/Designe Date (( E TITLE: Bedroom/ Bath-Addition. MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 Release .3 DATE: 4-11-2001 Bldg. I Dept. I Use I i CEILINGS: [ ] I. 1. R-30 Comments/Location WALLS: [ ] I 1. Wood Frame, 16" O.C. , R-15 Comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.31 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? [ ] ,Yes [ ] No I Comments/Location I FLOORS: [ ] I 1. Over Unconditioned Space, R-19 Comments/Location 1 _ AIR LEAKAGE: [ l i Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC-rated, manufactured with no penetrations between -the I inside of the recessed fixture and ceiling cavity and sealed orb I gasketed to prevent air leakage into the unconditioned space. I 2. Type IC rated, in accordance with.Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement. from the the I conditioned space to the ceiling cavity. The lighting fixture I _ shall have been tested at 75 PA or 1.57 lbs/ft2.pressure I difference and shall be labeled. I VAPOR RETARDER: [ ] I Required on the warm=in-winter side of all non-vented framed I ceilings, walls, and floors. r I MATERIALS IDENTIFICATION: Materials and equipment must be identified so that`complience can, be determined. Manufacturer manuals for all installed heating j " and cooling equipment and service water heating equipment must be I ' provided. ,Insulation R=values and glazing U-values must be clearly marked on the building plans or.specifications. . I DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I . I DUCT CONSTRUCTION: - [ ] I. All accessible joints, .seams, and connections of supply and return I ductwork located outside conditioned space,. including stud bays or I joist cavities/spaces used to. transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. , Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing air and water systems.. I 1 TEMPERATURE CONTROLS: [ l I Thermostats are required for each separate HVAC system. A manual . I or automatic means to partially restrict or shut off the heating and/or cooling input to each. zone or floor shall be provided. I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling .system is I not greater than 125% of the design load as specified I in Sections 78.0CMR 1310 and J4.4. I I SWIMMING POOLS: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless -over 20% of the heating energy is from 1 non-depletable sources. Pool pumps require a time clock. HVAC PIPING INSULATION: [ ] i HVAC piping conveying fluids above 120 F or .chilled fluids i I below 55 F must be insulated to the following levels (in.) : i PIPE SIZES (in. ) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1..0 1.5 1.5 2.0 I Low 'temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: ' Chilled water or. . 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I CIRCULATING HOT WATER SYSTEMS: [ ] I Insulate circulating hot water pipes to the following levels (in.): I - PIPE SIZES (in.) NON=CIRCULATING I CIRCULATING MAINS & RUNOUTS 1, HEATED WATER TEMP (F) : RUNOUTS 0-1". I „ 0-1.25" 1.5-2.0" 2.0+" 1 170-180 0.5 I 1.0 1.5 2.0 140-160 0.5 I 0.5 1.0 1.5 100-130 0.5 I 0.5 0.5 .1.0. ci2'+Zl The Commonwealth of Massachusetts •=j Department of Industrial Accidents alike aloyesti$adons • 600 Washington Street " ... Boston,Mass. 02111 Workers' Com ensation Insurance davit / / name: v 91`CS L location: 1 A city C� °� �/� Vt-" phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one worlari in anv capacity /AI/%//AWIMAIM41 M ME 4//%//////////%%%/%//////%%//////i din workers' compensation for my employees working.on this job.::: :; ;:;:;;;::::;::;::::>:;: Qum an employer prwig:.:.:.;:'<' COS : «<. .. '.:::::::::..: .': ::.>;;.>;.......;.....;: ;:.: com anv name: a ddress. cites { � shone M. insurance co: ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have ' compensation polices: the following w ..................mP . .::...:..:. :P .:::.:::.::.},::;: , .:::;::::.:.:>..:.::;:.}:.:.. ::'.::.:.}:}::.;'.;:;;;.:.;:..:::.;.:::. .:.;.;.:;'.;':::.;:.; ate. c<'::....> :::>.....:>::.::.........:}::<;.:;'::.:>:<;; com pan :;::_:::.:... ;;:<:;:::;.>:>:;;;:.:::}:::;;:::.::....: :.:. ::::.........: .......... ::.:..;.:::.:,::.:::.. ... :.:,�... e .... ...... :.:: .:... ......:...... �hon .�::: :::.iY:}i:!iSi?i•}i}Y:}::::::i:::::::•:.�::::,:.�::v:�.:vi:�:i}::•:•::•ii:• : .......:}.....h}.:::. ..............:..... ........... rv:::-:::•'-v::.:••v::v:•:••:•L:i4::{•}::•}:::.}}}:iaY iiti^}i}}:4:•i:_iti•:?}}i:•iY.G}w:._::::::::::................. r.::v.�:::::::::::::::::::::.:�:.. ................................. .......... ..................................... ......... ..... ................................................ OiIC4 insurance ///%%% c anv name: ;:•:.}•;.:.::..:.,::;.;•.::.. :,,::::::::::<>::<•::<>::>;::;;; :.. bw :. address: ......:... ..:::::...:. ne T ...................... :::::: :; :::':::::::::: .....;;::::;::.:;;.:;.;;;::..:.:..::.::.:.:.:....::. n i in�aranceFEMININE:!:MENOMONEE co Fafinre to secure coverage as regdred mmder section M of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or all Years,imprisonment ecoverages well u civil penalties in the form of a STOP WORK ORDER and a tine of 3100.00 a day against me. I understand that a one may be forwarded to the Office of investigations of the DIA for coverage verification- copy of this statement 1 do hereby certify under the pains and penalties of perjury that the information provided above is m1p a ed Date . Signature Print name f ! t— 1, l(.LM2Phone# - official use only do not write in this area to be completed by city or town official permit/license# ❑ ceding Department city or town: LII,icensing Board is aired ❑selectmen's Office ❑checkif immediate response required ❑Health Department Other contact person: p hone #; - ❑ (towed 9/95 PIA) $QARD OF,BUtLOINt3 LA iO S t»ticsnse; 'COhiS FFtE CYitl1N SOPER1llSbl x dumber,CS -01C98i " Birtitdete 133l0?Y19A7 . xps: 33tOT7 �? try no. :t86Q3. Restri�Ged To. W C?11G4AS L W1.LlU�iu15 Pa soX toog tNtViLi>* MA` J? drrtlrfas{satOt f °p 7HE T The Town of Barnstable r � + BARNSrABL& 9�A MASS. � Department of Health Safety and Environmental Services 1659. rEc N,pt A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. 56oD Date 01 1 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. nn Type of Work: �F r` (N\ Estimated Cost Address of Work: Owner's Name: t&LAL S Date of Application: Z— O I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav Land in BARNSTABLE Belonging to The Shirley Family Trust Deed in Book Page Land Court Certifcate No. 118660 in Book Page In Barnstable Registry. District Recorded Plan Land Court Plan Number 33466-A,filed with Certificate Number 37136 Date of Plan December 1965 in Barnstable Registry District Book 292 No. 26 Filed Plan No. MORTGAGE INSPECTION PLAN Robert W. Parady,Attorney at Law Loan No. Robert J.Methelis and Suzanne C.Methelis 160 Fox Hill Road,Centerville II. COAd, C 121,89) ' Q , O L16 X 60' O ONE 5fOkY WOOt7 ONE CAP No•I60 y GAGE ll't � � r ;N (94,94) , C•D,fnd; .. FOX. . HILL ROAD May 1,2000 �JN 69025 ��, ✓Jam• - `` �' £Nsr`'�,,,�c�� I I • set , - <ze _1•Jario�a�e .c �L h kl•Y--1e gCb�L I , ) , 1 ��(aa•� \ C( I1.410 -ter I •Sjva� `�- ALzf�j !v•a�• CMTr�h 7`oac`•ouC�J - Ic ---=_= — — — — - — — — — --•-- -- --�P•�,.�a 9x ��Ixt Po5' • � .� a • iLa`" I � II p mess C�-1t e�Ce��• $ �� C P nG Ile � �� �I/PT I�Inie 'Can1C^I"iui_ c�c4' '� i `Ofd� - a I: At1 - - W�C•5i t'�-� `{ - �" 1 ^� la"Scrl� IMPORTANT ly �> ANY .CONSTRUCTION THAT INCREASES LIVING SPACE wz IIS � C-Flbr,n� BEYOND 1200 SQ. FT. PER LEVEL MAY REQUIRE THE INSTALLATION OF ADDITIONAL SMOKE DETECTORS. NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL I PERMIT DOS SATISFY THIS REQUIREMENT. �- n 2L.� — —4— — 1 1 Ib /�t1J+L 92dt o•..,' Pp5 ' L�ctf�Gli2� �O ri l020�_/ I I - . v �}j ��• lz Or.hal�ers y.sdL• k�zpk Zw �T RZ,t. s ,,� 1�1 r�-Mvs tR�6er� l Ine�I \ 5 /•�Ha�� vY �o�rsewLE APPROVHD BYE - DRAWN DY � �b��4f /Iluf£_ .,�y IJ` �Cd•t3s1 Is C� CG2� �a ��� s�• - -- �1�1i►�n `' �c6a�Srtn DRAMA NO NUMBER