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N Co N A r nlQ C0 CO op c 3B30BUTT GAS RANG°;a BDREPI 1 52TF 4 N WR3912 °: Np J CV N .30030BUTT W3012 W30306WTT • m,y ,. 1 1 30'±- 3011 30 30 35 315 . 30 148" CUSTOMER MEASURE. LOWE'S IS NOT RESPONSIBLE FOR, ACCURACY.OF MEASUREMENTS All dimensions size designations given are This is an original design and must not be Designed: 5/1 1/2009 subject to verification on job site and released or copied unless applicable fee Printed: 5/11/2009 adjustment to tit job conditions. has been paid or job order placed: 49- Levine, Bob,verslllB.kit All Drawing#: „1 J 188 8,. 60„ 50 4,� 77 .. M _ Y/ .. - 16 N ........ ...._ CO 00 00 .........., : a ......... ........... .... ....... ....... ..._ ...... 00 Poll N 148" All dimensions size designations given are This is an original design and must not be Designed: 5/6/2009 subject to verification on job site and released or copied unless applicable fee PrmteTdYS/6/2009 ;, adjustment to tit job conditions. has been paid or job order placed: 4 49- Levine, Bob,versIllB.kit Architecture Drawing#: 1 K --Tt- r CA y. : • N : . _ --- ' ) - - b© o 3 - � J c. ✓ref.--'�S �'�`��`�k`" � �I x��� r (10`! � a - 3G - M Vil ALP W.A �� SCAL _. .. . u . W �,. .._ , ti - �� _ soY . _ au µ N I{ . _ as TL ____ t► r a - - L boot 14 fi v 0 o❑ LL- (ID ® ® (ID I Note: This drawing is an artistic Designed: 5/11/2009 interpretation of the general appearance of Printed: 5/11/2009 the design. It is not meant to be an exact rendition. 49- Levine, Bob,versIIlB.kit All Drawing#: l I : i Note: This drawing is an artistic Designed: 5/11/2009 interpretation of the general appearance of Printed: 5/1 1/2009 the design. It is riot meant to be an exact rendition. 49 Levine, Bob,verslIIB.kit All Drawing#: 1 1 . LLI LLJI r - o 0 0 Fffff oao� . : 1100 Note: This drawing is an artistic Designed: 5/1 1/2009 interpretation of the general appearance of Printed: 5/1 1/2009 the design. It is not meant to be an exact rendition. 49- Levine, Bob,versillB.kit All Drawing#: 1 i Note: This drawing is an artistic Designed: 5/l 1/2009 interpretation of the general appearance of Printed: 5/1 1/2009 the design. It is not meant to be an exact rendition. - 49- Levine, Bob,verslllB.kit All Drawing#: 1 z.. � - a v^ ,,.E �a„ y'' •.fi ' MUM p •" *1 4t a k i x y "^ ¢' .arAll �y - S M C. a � an n Note: This drawing is an artistic Designed: 5/11/2009 llikhl interpretation of the general appearance of Printed: 5/1 1/2009 the design. It is not meant to be an exact rendition. 49- Levine, Bob,verslllB.kit All Drawing#: I t L Note: This drawing is an artistic Designed: 3/25/2009 interpretation of the general appearance of Printed: 3/25/2009 the design. It is not meant to be an exact rendition. 49- Levine, Bob,,ersIllB.kit �„ 68 8,. 33 86 1., PLAN B .� 3,; ., 3 , t 24 36 50 4 30 --47 g I 60's 50 4 ;77.8.", 36" 36" 47811 g .m_%�. r>u�ro"::. F' �+w4, 3 °uk: Y't•�`54jt3. .A ,�, .H .V .. M J r°y W3630 r - - - -� W3030 �I N W B 69 24 DtSHVU SB36 Cle) EZR36R �� p ........................ .. ......:.. .... fit::. 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Lj49-:Leine, Bob,verslIIB.kit n ii .' c i o , CO) ❑o i ❑o �00 I ® � � (ID (9) ------------------ i Note: This drawing is an artistic" interpretation of the general a Designed: 3/25/2009 g appearance of Printed: 3/25/2009 the design. It is not meant to be an exact rendition.. 49- Levine, Bob,vers]IIB.kit .. ..... . . . ......... .. ..... . . . .... .... . .... . . . ....... .. ... . . . .. ..... .. ..... . . ......... .. . ... . . . .. ...... . ..... . . ......... .. ..... . . . ......... .. .... . . . ......... .. ..... . . . . ....... .. ..... . . . ......... .. ..... . . . ......... .. ..... . . . ..... . r ka r� i a ... . ... . Note:This drawing is an artistic _... . Designed:.3/15/2009 interpretation of the general: Printed:3/15/2009: appearance of the design It is notmeant to be an exact rendition.. .....� _..... 3150e2bb.kit p ll Drawing#: 1 ......... ..... ......... ... ......... ... ... .. .. ..... ......... .... ......... ..... ....... y Note:This drawing is an artistic Designed:.3/15/2009 interpretation of the general. Printed:3/15/2009 appearance ofthe design.:It:is not meant to be an exact rendition. 3150e2bb.kit Drawing#i a ..... _ _ . .... . . , P f t �rf' f ° r Note:This drawin is an artistic $�. Designed;3/15/2009 interpretation of the general Printed:3/15/2009 appearance ofthe design.It is not meant to be an exact rendition. 3150e2bb.kit All Drawing#: 111 i . 141" ... 24„ 24 1.2" 51" i 30,E 57" 278,E 3 ,s8 2 35Z _. W2430BUTW1230R.. 1N3030BU:TT M d' r N r r. N _. .. o Q . .M B9L 24 DISHW EZR36R > >: ' 1, F- . . ...... M 16 ' 2 a J.. _ t>D M �- !A C."_ W N 00 -- OD r�,C `x CD .. . f f ` 30 RAN'GE1 � :3 B30BUTT . , BPPS30 152484E r 30. WR3912 W3030..BUTT W30.12 W3030BU.TT fs 30„ 3 30'� 31 15" _ _.. . z 4 66". 3 " 30" 30" „ 39" 16 2. 14.8 All dimensions_size designations This is an original design and must Designed:3/15/2009 given are subject.to:verification on not be released or copied unless: Printed:3/15/2009 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed.. 3150e2bb.kit .All Drawing#i 1 141 " 24" 24" 2 51 3 0" n:i:n P� O. WA2430R 2430BUTVV12.30 3030BU lu d'CON : :� �❑0 , ,ems - EZR36L 19L 24.DISHW SB36BUTT . EZR36R 3 5 1n . _ 7n 1 �� __ . 5 3 8 � 8n 2 . All dimensions_size designations This is an original design and must Designed:.3/15/2009 Fill nil. given are subject to verification on not be released or copied unless Printed:3/15/2009 LIJ ILJ [L job site and adjustment to fit job applicable fee has been paid or job conditions. order placed... 3150e2bb.kit Ell Drawmg#'. I . ........ _. 148" 6 39" 30" 2 T. MIS MIS r.. Y-1 .. NR3912. . ..... 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E14 ; Drawing#: 1 . ......... r Town of Barnstable *Permit# Sc Expires 6 mo from issue date : .Building Department Services i� t Brian Florence,CBO ndass #'03 R Building Commissioner � \ 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.uso�^u Off-tee: 508-862-4038 EXPRESS PERN uT APPLICATION RESIDENTIAL 1Ui I IuI aP parcel Number/ C� v �,,� No'valid wuhout lied X-Pw$,rft pr1n1 TOWN Oa 8A H IV`t7!ABLE �t a� Property Address [Residential Value of Work$4060. 00 Minimum fee of$35.00 for work udder$6000.00 Owner's Name&Address Uv\'F"t'V R Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email• Construction Supervisor's License#(if applicable) []Workman's Compensation Insurance Check one: ® t am a sole proprietor am the Homeowner have Worker's Compensation Insurance Insurance Company Name j Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Ret(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to U Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side [� Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: •Where required. Issuance ofthis permit does not exempt compliance_with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. IGNAT RJEL Q:1WPHLESWOEiibFS'lbuilding permit formslEXPRESS.doc wwAA�t V" .. ?Tie ComrrioHivealth of141assachusetts Deparh mit o,f lndush ial Accidents - Office o,f Imwstigations 600 Washbigton,S'treet Boston,-41A 01111 fi ymnntrrss_gov/dire Markers' Campensatian Insurance Affidavit:B•gilder/ContractorslElectricians/Plumbers AvPHcant11nfQrmatiGu 1 Please Print 'bl Name(BusimsstOFganizationll &ddaaw- ' Address: 'f pity/Statelzip:: ��.���v Phone O'�:-'.76 T /O Are you an employer?Check the appropriate box: ` Type of project(required)-1-El I am a employer with 4_ ❑I am a general contactor and I 6. [:]New construction - employees(full andlor part-time).*. have hired the sub-contractors 2..❑ I am a sole proprietor orpartner- listed on the attached sheet; ?. ❑Remodeling ship and have ao.employees. These sub-contractors have g_-❑Demolition wodring far me in any capacity: employees and have workers' 9. ❑Building addition [No worloem'Camp.insurance comp_insuranmi required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3 I am a homeommer doing all woriG ofEcers have exercised their 11_❑Plumbing repairs or additions myself [No watken'camp- rim of exemption per MGL 12.❑Roofrepairs +nsura++ceretluited.]F c.152,§1(4X and we have no employees.[No workers' 13.❑Other- comp.insurance required-] •Any appHcautihatchecksbox is1 mug also faloattlee sectionbeaawshmring&ekworkeW compensationpolicyin5rinsaon- . #Homeowners who submit this affid2va md5 rating they an doing all wank and then}nine outside cant maors mast submit anew affidavit indicating sucli =Coatractots that ebwl This box must,atudhed as addilinnal sheet showing the nee of the sub-cantructm and state whether ar not those entities have emplwjees.Ifthe sub-contrectats bate emplayw%they mnstpmuide t'he'u workers'damp.policy number- 1 am an empioper thatisprmadireg workers'caerrperisatia!!hmirancefor my*amplaj ees Below is die psrticy aad job xrle i►formaliolz Insurance Company Name: Policy;9 or Self-ins..Lic.,4: Rkpigation Date: i Job Site Address: CitylStawzl p: Attach a copy of the work-ers'.compensat ionp.olicy declaration page(showing the policy number and expiration date). Failure to secum coverage as required.under Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,50a.00 andfor one-yearimprisonatent,as we11 as cix l penalties.in the fonts of a STOP WORK ORDER and a RM of up to$250.00 a day against the violator. Be advised that a copy of this statement may,be forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby cetfify Tinder theeppizins an rlahFles~-afpet' that the informationprot ided abmv is bus and.correct S' Ci Date: Phone at+ F Official use.only. Do not write in this area,to be campt`eted by city or town official City or To*n: Permit/License# ' Inning Authority(circle one): 1.Board of$ealtlu 2.Budding Department 3.City1To wn Clerk d.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: ' Phone#: Information and Instructions ; s Massachusettrs G&neral Laws chapter 152 requires all employers to provide workers'compensation for their employees. pmrsuantto this she,an employee is defined as.",-every person in the service of another Tinder any contract of hire, express or implied,oral or wuftem" An ernpkyer is defined as"an mdividnal,partnership,association,corporation or other legal entity,or any two or more of the foregoing engag-d in a Joint entrprise,and including the legal representatives of a deceased employer,or the receiver or trastee 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 occapant of the - dweT�house of another who employs pemons 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 airy of its political subdivisions shall enter intD any contract for the pM fom,an ce ofpnbho work until acceptable evidence of compliance with the insaran ce-_ recIL n=ts of this chapter have Been presented to the contracting mif aor ityf Applicants , Please fill out the worriers'compensation affidavit completely,by checking flit boxes that apply to your sitnation and,if necessary,supply sob-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of ins=c,e. Limited Liability Companies(TLC)or Limited LiabslityPart aer hips(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. B e advised that this affidavit may be submitted to the Department of Industrial Accidents for confamaiioa of=' r ance coverage. A ho be sure to sign and date the affidavit= The affidavit should be retzaned to the city or town that the application fur the permit or license is being mgaested,not the DePartmeeat of Ladush•iai Accidents. Should you have any questions regarding the law or ifyou are regoaed to obtain a workers' . compensation policy,please call the Department at the number listed below. Self-msnred companies should enter their self-ir s*rance license number on the appropriate line. City or Town Officials t Please be sure that the affidavit is complete and printed.legtly. The Department has provided a space of the bottom u the Iicant c t o re of the affidavit for you to fill out in the event the Office of Tnvestigafions has to oniac y regarding aPe Pleas e be sure to fill in the permitllicense numberz7l which w be used as a reference number. In addition,an aPelicant that must submit multiple pennWhcense applications in any given year,need only submit one affidavit indicating current p olicy bafbrruation(if necessary)and under"Job Site Address"$e applicant should Write"all locations in (citY or town)--A copy of the affidavit that has been officially stamped or marked by tht city or town may be provided to the - applicantPs on as •roof that a valid affidavit i file for f tore 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 (Le. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would at 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_ Tht�Gn3MnWeajth of Massaclhnszc-,tts ' •1 Department caf 1iAu t ia1 ACCWent9 ' ice ref bvegtigatio.= (504 wasbhoml S`tc t Borg M&02111 T(,-1. 617-727-49QO cot406 ar 1-M-Ma AFE Fax#617-`27-7M Revised 4-24-0 7 €.IngQWdia V i Brian.Florence,CBO Building ComnnissiOner $ fit 200 Main St: c� Hyannis,MA 02601 area www town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 q ] HOMOwNM IJCEM EJETION DATE ` ` ` PleurPrint JOB I=AnOx• u, t c ` -'LC.tc��.\0 r wamber village name home phone# work phone# C URREMMARMADDUM: It CQ Shama . zip code The current exemption for"homeowners"was extended to include owner-nMxed dwellings of six units or less and to allow homeowners to engage an individual for hie who does not possess a license,provided that the owner acts as supervisor. DEMMON OFHOM A)V#WM Person(s)who owns a parcel of lead on which he/she resides or intends to reside,an which there is,or is intended to,be,a one or two- i$mily dwellm&attached or detached structures accessory to such use and/or farm structures. A'pecson who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Buildmg Official on a form acceptable to the Bn7ding Official,that he/she shall be responsible for all such work RgfgMd under the bnildingpermit (Section 1.09.1.1) . The undersigned"homeowner"assmnes 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 thathe/she w01 ly with said procedures and requirements. ofIiomepwn� S Approval of Building O&cW Notm Three-family dwellings containing 35,000 cubic feet or larger will be inquired to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.L1-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 Constriction 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 this issue is a form currently used by several towns. You may can to amend and adopt such a form/certification for use in your community. Q:1WPFHXSMRMStuildmgp itSarmstl:R1'RE.Mdw 08n6/17 e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION U Map Parcel ' Application # r � � Health Division i 000 3 410 "Date Issued Ct' O Conservation Division ` ��Appication Fee Planning Dept. =`Permit Fee 5 • C.� Date Definitive.Plan Approved by Planning Board 7�910� Historic - OKH Preservation/H annis v Y P oject Street Addres/s� Village .Owner ,r�1APA r (5� p.ull�1� Address N'1 C-Telephone - � — r-�P.ermit-Request_ 1 C`J ` H,( e Al t wiwol /dtty 6'r,x-b - (AA O® Square feet: 1 st floor: existing proposed 2nd floor: existing_proposed_Total new Zoning District. Flood Plain Groundwater Overlay Pect=Valuati_. o Construction Type f 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.) BasementUnfinished 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: ❑existi� g ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 63 Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use °P f w v, w, APPLICANT INFORMATION 01 �f (BUILDER OR HOMEOWNER) Name L f—Tie-lephone 6mbe1��O�r_ lam•-n''-'_ Address A.A.5 License # V I a �,, ,-�°,� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CIC�Q ZdGtC7r' r C� SIGNATURE. ,:, A E ' ' (v A 4� r: FOR OFFICIAL USE ONLY APPLICATION# QATE ISSUED MAP/PARCELNO. r ^ ADDRESS VILLAGE OWNER s DATE OF INSPECTION: —FOUNDATION .FRAME O) YkA9 INSULATION o ��lv Liz— FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING x f - t - DATE CLOSED OUT ' ASSOCIATION PLAN NO. _ s i; F f r The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations' ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia (� Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers `�A-``li'cant Information Please Print LeLribIV Name(Business/Organization/Individual): �J� , ! • I City/Sta e/Zip:-• e= G �1/4 Phone.#: 5" ?7 2 � Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. -I am a general contractor and I * have hired the sub-contractors 6: ❑New construction employees(full and/or part-time). t 7,:- --&emodelin 2.❑ I am a'sole proprietor or'partner-' listed on the•attached sheet g ship and have no employees These sub=contractors have g_'❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY- # 9. ❑Building addition [NNo workers'-co n -insurance comp.insurance. ��re tured._ 5. We are a corporation and its 10.�Electrical repairs or additions - q 1 officers have exercised their 3. Lam-a-homeowner-doin all works 1 L Plumbing repairs or additions � �< g right of exemption per MGL � • myself.,[Nomorkers comp. P p 12.0 Roof repairs insurance-required]`t , c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. IContractors 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: City/State/Zip: _ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the'imposition of crimirial penalties of a fine iip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day.against the violator. Be advised that a copy of this statement maybe forwarded to the'Oflice of Investigations of the DIA for insurance coverage verification. I do hereby e i ,and r t e p 'ns and penalties of perjury that the information provided above is true and correct Si attar o ,Dates �0 Pho e#: 1-501 Jed (? Official use only. Do not write in this area,to be completed by city or town offtclal .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#: r Information and Instructions Massachusetts General Laws chapter IS2 requires all employers to provide workers'compensation-for their employees. y 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 an contract for-the performance of public work until acceptable evidence of compliance with the insurance Y 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-cont=actor(s)name(s),-address(es)andphone 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 of permit to bum leaves etc.)said person is NOT required to complete this,affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The C6mmonwea.lth of Massachusetts Department of Industd-11 Accidents Office of Investigatlons- 600 Washington Street Boston,MA 02111 TeI. #617-727-4900 ext 406 ar 1-877-MASSAFE Fax# 6.17-727=7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable Regulatory Services • � � t Thomas F.Geiler,Director MAM 1639. ��� Building Division jDlFn Tom Perry,Building Commissioner 200 Mairi.Street;--Hyannis.MA 02601.. www.to wn.b arnstable.ma.us Office: 508-862-4038 Fax: S08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print „ : ,_ LocA�- 96 -y�ere�� MAWv'c number street village "HOMEDWN'ER� ejkaA-fS—, k pVM l SDI??S �Ov� l-i D qq'?"0"9 name rr home phone# work phone# CURRENT MAILING ADDRESS: � C city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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 Budding 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 Budding Code and other applicable codes,bylaws,rules and regulations. 'Fke undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department um' ection procedures and requirements and that he/she will comply with said procedures and ` r em is Ci `_;_ `_ S f Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code stairs that "Any bonreowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section l 09.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a parson(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 bDMC0wner 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 hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community, Q:fonns:homocxcmpt sry Town of Barnstable Regulatory Services. BARNnABLFMusa. Thomas Thomas F.Geiler,Director iOrEn 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this binding permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on therevers:esde�� Q:FORMS:O WNERPERM ISS ION YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you, must do by M.G.L.-it sloes not give you permission to operate.) You must first obtain the necessary signatures on this form'at 200 Main St., Hyannis, ' Take the completed form to the Town Clerk's Offioe' st FI'., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Fill in please ,,,�• � � APPLICANT'S YOUR NAME%S: d&i BU NES Y R ONE E5 • .� ' .:. Qri . . TELEPHONE # Home Telephone Number N ME OF CORPORATIO NAME.OF NEW 13USINE5S .. PE..OFBUSIIVESS: , : S,OCC P. ON Y • •'• H U . �. ssessiri .: - CEL.IVlJMi3ER :PAFI A ODRESS,OF;Bl•�SINES5::, ` " - - When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you.may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to-make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO ER'S OFFI This individ of h e n inform o e per it r quirements that pertain to this type of business: . MUST' COMPLY WITH HOME CQCCUF'ATIQN Au horized na t7r-e* RULES AND REGULATIONS. .FAILU.RE.TQ. MENT t r11-.11), l-�! MAY RESULT IN FINES '0 n,�4) J I 2. BOARD OF HEALT This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature**, , COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements.'that pertain to this type of business. . Authorized Signature** r • COMMENTS: Town of Barnstable THE r Regulatory Services xr, �p'� '►�� Richard V. Scali,Director • BARNSfABLE, Building Division Mass. ��' Tom Perry,Building Commissioner, i639. �'OIFn 't°i 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Pe rmit#• C9-©/SD�C HOME OCCUPATION REGISTRATION T Date: Name: Phone# ' '; l Address:CA \{J► ' Village:l�L!1 1 � Jll1 ,Name of Business: � _ Type of Business:� Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity' shall not be discernible from outside the dwelling: there shall be no increase in noise or.odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes,- and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use`does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or'hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. " • There are no commercial vehicles related to the.Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • r No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be, included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. ` I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: a . Ho meoc.doc Rev.1 13 A ' oFT°wti Town of Barnstable *Permit Expires 6�olhs �issuedate Regulatory Services Fee rt BAMSTABLE + prMA 039. s Thomas F.Geiler,Director, ED MAC Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address :6 �r lmeffl Residential Value of Work t Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ` l✓tS� . Contractor's Name ��� ( (tC Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) A4' ❑Workman's Compensation Insurance ; Check one: ❑ I am a sole proprietor IMPRESS PERMIT 04 I am the Homeowner •. ❑ 1 have Worker's Compensation Insurance JUL 2 2 20,10 Insurance Company Name r r VVN OF BARNSTABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping:. Going over` existing layers of roof)' Re-side #of doors_ C Replacement Windows/doors/sliders. U-Value , fo _(maximum .35)#of windows �Z,— *Where required:,Issuance of this permit does not exempt compliance with other town department,regulations,i.e. Historic,Conservation,etc. , ***Note: `-Property Owner must sign Property Owner Letter of Permission. L ,A copy of the Home Improvement Contractors License& Construction Supervisors License is re u' ed. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revised 072110 ?"Iae Coninronstwalth of Massachusetts Department of Industrial Accidents Ogg e of Investiga¢t ons , 600 Washington Street Boston,MA 02111 rt tw.ntass�gov/dia Workers' Compensation Insurance,Affidavit: Builder:s/C'ontractor�JE-le.cttic ns/ lumbers Applicant Information Please Print I.,e�;ibl� Name,alusineswOrgau aat au vidual)= - :— k�, � dd�Z. c Address:— � �S� City/StatelZ,p �44ViAV Phone# Are you an employer?Check the appropriate box: Type of project(required): ; 1.❑ I am a employer with .4. I am a general contractor and I : employees(full and/or part-time).* have hired the sub-contractors6. I�eu construction 2.0 I am a sole proprietor or partaier listed on the attached sheet E]Remodeliug ship and have no employees .These sub-contractors have 8.-E] Demolition urorking for me in a c ac employees and have workers' any aP `- 1 9. ❑Building addition [No workers' comp.insurance comp.insurance.. required.] 5. We are a corporation.and its 10.❑Electrical repairs or additions 3. 1 am a homeoumer doing all.work.- officers have exercised their 11. Plumbing repairs or additions self. o workers' right of exemption per MGL ffiy � cep- 12.0 Roof repairs insurance required.]I c. 152, §1(4),and we have no 3 employees.[No workers' 13 0 Other . comp.insurance required.] •Any appikmir that.checks box#1 must also fal out the section below showing their workers:cormpeimbon policy infortsation Homeowners who submit this affidavit indicating they are doing Al wait and thin hire outside contractors must submit a.new affidavit indicating suck ICmntracwrs that check this boas must attached an additional sheet showing the name of the sub-comtractnrs and state whether or not those entities hate employees. If the sub-contractors have employees,theymust:provide their workers'comp-policy number. .1 aria an employer that is providing workers'cougmtisa on.iitsuranc-e for uty employees. Below is the policy acid job site irtforaration : Insurance Company Dame: Policy#or Self-ins.Lic.4: Expiration Date: Job Site Address: CityiStateiZip: Attach a copy of the workers'c:ompensalion policy declaration page(shoving the policy number and expiration date). Failure to secure coverage as required udder 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-y+ear 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 fomrarded to the Office of ;. Investigations of the DIA for insurance coverage verification. " I do hereby cart rid tie s and ,es of pedury that the inforination proilhietd aboire is liar aced correct: Si Date: _ Phone Oj6ff dfal also on Do not sprite in this area,to be completed by city or tottril of ciaC City or Town: PirmitUcense Issuing Authority(circle one) L Board of Health 3.Building Department 3.City/I'ommi Clerk 4.Electrical lnspector 'S.Plumbing Inspector b.Other Contact Person: Phone 9- Town of Barnstable Regulatory Services BAI#sTAst.e, (ASS. Thomas Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnsta ble.ma.us Office: 98-862-4038 Fax:' 508-790-6230 HOMEOWNER LICENSE EXEMPTION /f Please Print DATE: JOB LOCATIO numb f — street village /9..HOMEOWNER": f�l /���, S/�� S®T���(® name ��cc !" home phone# work phone# CURRENT MAILNG ADDRESS: W0 Uo-&Lo lff l_f /� K city/town -- State ` zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall 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. T un ersigne "h eowner'certifies that he/she understands the Town of Barnstable Building Department minimum inspection pr c res n it rtent nd that he/she will comply with said procedures and requirements. Sign re of om owner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION. The Code states that: "Any homeowner performing work for which abuilding 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 ofthis issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. r Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 r of t"e rqy, i s * BARNSCABLE. MASS. 1639. Town of Barnstable `��' �ArFD MPr A Regulatory Services Thomas F.Geiler, Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form-'o*n the reverse side. QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 ''i' ✓t SEC ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICAJ N Map Parcel ` Apr)10c. on # Health Division Date Iss ed 4 Conservation Division Application F .. { Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 96 b/'f A Village C eA4 (// / Owner /1 C Address 35 tAkE U l tl e Q�• �U�fle i1 , Telephone Permit Request E' UL P /x - Square feet: 1 st floor: existing _Y p"rc�posed� i1 2nd floor: existing proposed Mr� Total new j;-AAk5 Zoning District Flood Plain /V+ Groundwater Overlay . Project Valuation Construction Type r Lot Size Grandfathered: YYes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure qO 11r5'tHistoric House: ❑Yes J No On Old King's Highway: ❑Yes N'No Basement Type: YFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) M/VE Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new 0 Half: existing D new Number of Bedrooms: existing 0-new ~ Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: %,Gas ❑ Oil ❑ Electric ❑ Other Central Air: NLYes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 14 No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: Vexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes NoNo If yes, site plan review# .__.Current Use XA4141f 5 C �Proposed Use- APPLICANT INFORMATION (BUILDER O EO —N-E Name r� hfLV Telephone Number ro T_ Lt Z —0 AddressdS /,CLkL k)P(4, License # IV4 1 n I^V l`'L Home Improvement Contractor# /✓4' (2A JooZ Worker's Compensation # AA ALL CONSTRUCTION DEBRIS SULTING FROM THIS PROJECT WILL BE TAKEN TO AIA- 6 uJRi olt7'44w, v SIGNATURE DATE c� h FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION • FRAME c- ��L9 13 R INSULATION FIREPLACE d - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH QQ FINAL FINAL BUILDING �C►l�1�13 DATE CLOSED OUT ASSOCIATION PLAN NO. 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 LeLribly 'Na_B siness/Organizadon/Individual): A �j Ad-dress Wit{6 �`� di5 t--City/State/Zip:.e hUE �l�im co Phone#: `Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with c4--� I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors' - 6. ❑New.construction• 2.El am a sole proprietor or partner- listed on the attached sheet. 7. EI Remodeling shipand have no employees These sub-contractors have 8. n Demolition . working for mein any capacity. employees and have workers' [No workers' com p.insurance comp. insurance.$ 9. ❑Building addition required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions � 9 I am a homeowner doing all work officers have exercised their 11 ❑Plumbing repairs or additions myself [No workers' comp.. right of exemption per MGL 12.❑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. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self--ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I I do hereby c u th ains a d penalties ofperjury that the information provided above is true and correct D Si ature t ate----,.. %.r - - Phone#: 57 oy,— �✓ : ® .;�_V =L 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#: Me °4 Regulatory Services f f F AIANLT<� * Tomas F.Geller,Director ice. pp �0� Building Division Tom Perry,BuBding Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us e. 508- 62 _8 -4 03 8 Fax: 508-790-6230 HOMEOWNER LICENSE EIUF IPTION Please Print DAM. 'I'Lo/ JOB LOCATIGN: �6 . ��eu,�-��s� ,� ���2�%►�i��f /�j� D�6,� ber / sit 72 q0 village "HOMEOWNER•'• l�Pe, 11VII name home phone# work phone# CURRENT MAIIING ADDRESS: S Ce4 city/town ' state zip node . The current exemption for"homeowners"was extended to include owner-occu led dwell' to allow homeowners to engage an individual for hire who does not possess a license, _m .of six units or less and supervisor. ,provided that the owner acts as DEFINITION OF HOMEOWNER PersoII(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,attach detached structures accessory to.such-u"a and/or .farm structures. =A .._ personrwho constructs more than one home in a two-year-prnod'shaU not be"conside'red a`homeowner. Such 4 "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she e shall be a r re onsiI -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 ofBainstable Building Department cc' procedures and requirenxnts e and that he/she will coutply with said procedures and ature of Homeowner Approval of BuildingOfficial Note: Three-family dwellings-containing 35,000 cubic feet or larger will be required to comply with the State Building Code Seciion.127.0 Construction Control HOMVIEO.WNER'S EXEMPTION The Code states that Any homeownerpecfnrnring Work for 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 persons)for hire iD do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they sor(sr ar'assumingthe Rules&Regulations for Licensing Construction.Supervisors,Section 2.15) This lack of warene sooftenlrresults in serious problems, arti 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 ofhis(herrespond lilies,many communities require,as part of the permit application, that homeowner certify that he/she understands the responsibilities of a Supervisor, On the'last several t rwns. You may can t amend and adopt such a fnrm/certi5cation for use in P of this issue is a form currently.used by your community. 2-formsdrom0exempt TME' __Town.ofBarnstable ------------ f Regulatory Semees KARS Thomas F.Geiler,Director Building Division . Tom Perry,Btnadjng Commissioner 200 Mein Street,Hyamis,MA 02601 vvww.town.barnstable.maus Office:. 508-862-4038 Fax 508-790-6230 Property Ovmer Must . Complete and Sign This Section . If Usirng A.wilder as et of the subject property hereby authorize to act on rap behalf, in all matters relative to watk authorized by this b Permit (Address of ob) . Pool fences and alarms the responsibility of the a licant. Pools pP .. are not to be filled before f 'ce is installed and pools are'not to be utilized until all final ins coons are performed and accepted. Signature of Owner. Signature of Applicant Print Name Print Name Date Q:FORMS:0WNERPERMISSIOXT0DLS ` TN E TOWN OF BARNSTAELE CF t0 • .l 8A"ST11HLE, T ,639. , DUI,l.DING INSPECTOR l pp z63q. 9� y s APPLICATION FOR PERMIT TO �b.%.f?-...... Q ..................................................................................... TYPE OF CONSTRUCTION ....00..k.&... F .......... ......................................................:.................................... �e ................. re.&b.e TO THE INSPECTOR OF BUILDINGS: The undersigned hereby_applies for—atepermit �according to the following information: Location . `?..... G'fl f.... f1/Z 1....IT.4!9 :..C�.�N.f.l y / ..9, .......................................... ................................... ProposedUsela. l.Llx .................................................................................................... ............................................. Zoning District ........................................................................Fire DistricterJfe/?Yl.�� ' Qf�eizeri��� . ........ ........... .............................. Name of Owner t........................Address IV... ...... ......... fi l Nameof Builder .:...........w...............................Address .. AN........................................................................ Name of Architect .\. Ji....................................................Address :...SA!nr:...................................................................... 11 Number of Rooms l Foundation .RJKEA4..... Q??�R�f�........................................ ..... ........................................................... Exterior foif. x.......Yh/' ..9J..ey..........................................Roofing b-S.P.k!9.�L..O;.jAs.......................................... Floors .... .1�.�.................... R...................................................Interior Dq.......W.t g,".Z/......../................................................ ................................Plumbing ....1.1o... .................................................. Fireplace .fiA......................................................................Approximate Cost yr..A.D.A.................................. ....... ......... Definitive Plan Approved by Planning Board ________________________________19________. A 6 Diagram of Lot and Building with Dimensions �� e, /aLr7 SUBJECT TO APPROVAL OF BOARD OF HEALTH ul 7SLj co LU J O Q � cn iJ Ul) z �= d LL t, w 2'\o O LL O� a>J. Ld o Ld °_ w _U — tr- o wS Q c_n� cn cn. zz www� �� . 0 < oQ a- U _ Ljj � a _ z Q � + ~ < z N I� . f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. L 0�a�- Name ........ .�° .- .............. Fawcett, Lester L. • a 15625. Permit for one stony single family dwelling ............................................................................... i Location . ( ... Great Marsh Road Centerville .............................................. 1 " Owner Lester L. Fawcett ........... { ...................................................... Type of Construction ..............frame............................ ................................................................................ Plot ............................ Lot .....f........................ j October 26 72 Permit Granted 19 L Date of Inspection �0 t 7�' � 9 i .. Date Completed ...Z .. ,� 3 �'►�,9�u �i PERMIT REFUSED o ................................................................ 19 ................................................................................ ............ . ................................................................ r ........................................... ............................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... —� COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY ^ acrcv�rt t S OF ONE ASHBOnTON PLACE i :g��hyc.ct-' �MRund' " ' f MASSACHUSETTS BOSTON,MA 02108 OYPia'i*t EXPIRATION DATE U ` C()Fi i T R. U P E R V 1 5 0 R CAUTION rr �� FOR PROTECTION AGAINST ` TJ�/27/1 996 Et"FECTIVEDATE LIC-N0. RESTRICTIONS IIIEFF, pur niG1-IT THUMB No NE _ {j G/ 1 I)/ 1 9 9 3 Q U 5 9 7`i PRIN F IN APPROPRIATE BOX ON LICENSE. r rA11hfFF C I_AFFnt2IERF t1 t)x FL 7 z RL AS 11�« 11 OPF(A 101�S ss a 032-5 $-6719 +: FAI_roUTI1 PA 1'11536 , �mbs i jOt'1huoE I-10 tt ). F r„�nc',�nf,-,`eiirr;i�rnr�rii•��' FE=: 1 UQ. Cr1) �) .1 rn,rvnlnI47ui It.si,rnnn,inrtr=ir .vmrniiciniry IIEIGFIT`, mrn.nn.s.o;rrnrrnirronn' .anea^.vur[n J DOB: 950 nut:(xrr:uI.i PIT MU;r nF' uIFIAI " rr!u nnovc SICINATME unr cnnNFnoN IITr rFn':.oN!11 % sroFIA11111For ltcF.Nsu 111E nOLOFn Wrr F.N Ftr omens-ntnm lt,,vrmtrt (:nf;[DI NTW':o000rnri(IN t it nur,vr�ir:ntr,rtrr A41*19a"a INSURANCE BINDER ISSUE DATE(MMIDD/YY) 2/8/94 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERS E PR COMPANY Merchants & Business BINDER NO. Men' s Ins.. Co. ' EFFECTIVE EXPIRATION DATE TIME DATE TIME X AM 2/7/94 1.2 :01. PM 3 7 94 12:01AM :a � � NOON 0 THIS CODE T S BINDER IS IS SUED SUED TO EXTEND TE-495 SUB-CODE COMPANY PER EXPIRING POLICY NO: PenOVERAGE IN THE AB=OVE NAMED DESCRIPTION OF OPERATIONSNEHICLES/PRO ERTY�(IInnczudngLocation)zance INSURED On RusineS's Personal Property andd DeCoste Remodeling & Des-ign Center Liability usual tO sunroom sales DRA: Four Seasons Sunrooms 4380 Falmouth Road Cotuit, MA. 02635 COVERAGES __.. _. _�_... _.....__.•.__ . _ ..___.. _ TYPE OF INSURANCE COVERAGE/FORMS PROPERTY CAUSES OF LOSS AMOUNT DEDUCTIBLE COINSUR. BASIC BROAD X SPEC. Comm' l Package Policy -_._ . ._......_.._..._____- GENERAL X COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE PRODUCTS—COMP/OP AGG. $12,000,000 CLAIMS MADE X OCCUR CGL OWNER'S&CONTRACTOR'S PROT. PERSONAL&ADV.INJURY $ 2/000,oQ0 EACH OCCURRENCE 11000,00011000,000 FIRE DAMAGE(Any one fire) $ . ._._RETRO DATE FOR CLAIMS MADE:. 50,000 AUTOMOBILE LIABILITY _ MED.EXPENSE(Any one person) $ f- ANY AUTO COMBINED SINGLE LIMIT $ �. j ALL OWNED AUTOS BODILY INJURY(Per person) $ 1 St SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS MEDICAL PAYMENTS $ GARAGE LIABILITY PERSONAL INJURY PROT. $ UNINSURED MOTORIST $ AUTO PHYSICAL DAMAGE CEDUCTIBLE ALL VEHICLES SCHEDULED� _VEHICLES� -' "' """"'-'^^�^-•--•-----•- $ ''"""" "-' "'"-'_-•-- COLLISION: ACTUAL CASH VALUE OTHER THAN COL: STATED AMOUNT $ j EXCESS LIABILITY "' '�'- �'- �� _ OTHER UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: AGGREGATE $ SELF-INSURED RETEN110N $ WORKER'S COMPENSATION -Y STATUTORY LIMITS AND - EACH ACCIDENT EMPLOYER'S LIABILITY $ DISEASE-POLICY LIMIT $ SPECIAL CONDITIONS/OTHER COVERAGES DISEASE-EACH EMPLOYEE $ $1 ,000. Property Damage Deductible as respects Prodt,cts and Completed Operations coverages NAME&ADDRESS _...,_.-. .. _ _._...,.._......_.._..._... Four Seasons Sunrooms MORTGAGEE X ADDITIONAL INSURED 5005 Veterans Memorial Hwy. LOSS PAYEE Holbrook, Ny. 11741 LOAN# AUTHORII.EDREPRESENTATIVE _._...._.. "__...----,_w_.-,...,..._ CORD 75-S (7/90) nACORD CORPORATION 1,990 • • E Q9 INFORMATION FACE-AR 5T WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY CS WZ HARTFORD FIRE INSURANCE COMPANY 13269 HARTFORD PL_AZAv HARTFORD CONNECTICUT 06115 POLICY .NO: 77 WZ CS5799 01 RENEWAL -------------- 1 . NAMED INSURED AND DECOSTE REMODELING DESIGN CENTER MAILING ADDRESS: LTD y 4380 FALMOU'TH RD THE NAMED INSURED I S: C:OTU I T v MA. 02635 CORPORATION FEIN NO. : 042997293 OTHER WORKPLACES NOT SHOWN ABf.)Y E: 4380 FALMOUTH RD9 COTUITv. MA 2. POL16Y PERIOD: FROM TO i('D--16-941 i2'-:01 A.M. STANDARD TINE AT THE INSUREDS MAILING ADDRESS PRODUCER'S CODE: 083475 PRODUCER'S NAME: MASS.WORKER,a COMB' REINS POOL ALMS I DA & Clq'�LSON I NS 92 TUPPER RI..IAD SANDW I CH s MA. v ,025r, PREVIOUS POLICY N0 w -r7' 4 WZ CS5790 POLICY PROVISIONS FORM N0; " WC s,1 t3 00 + 0 (MA+ M I, NM, T X ONLY) s WC 00 00 00 A RUSINESS�CF NAMED INSURED SELLS 'GREENHOUSES AUDIT PERIOD: ANNUAL 3 TOTAL ESTIMATED ANNUAL PREMIUM ------------------------------------------------------------------------------------ POLICY MINIMUM PREMIUM $60o tlA WIN COUNTERSIGNED BY ----------------- AUTHOR I ZE:�AG ORM WC 00 00 01 T (PRINTED IN U.S.A.) CONTINUED ON NEXT PAGE 10-06-93 77 WZ CS57 9 t 10•-16--94) X C Assessor's office(1st Floor): ;3 Assessor's map and lot number /U �� ��_ SEPTIC SY � � O��`THE?0`` Conservation(4th Floor): \f� �, `) INSTALLED IN C® PLIAN� Board of Health(3rd floor): a .. WITH TITLE 5INARISTAX • Sewage Permit number g ENVIRONMENTAL CODE AN yoo rb o• ,� Engineering Department(3rd floor):" House number t;. ' TOW REGU"TI0NS FOR Definitive Plan;Approved by Planning Board 19 4. APPLICATIONS PROCESSED 8:30-9:36 A.M.and 1':00-2:00 P.M.only f - TOWN j OF BARNSTABLE ;BUILDING INSPECTOR APPLICATION FOR,PERMIT TO I TYPE OF CONSTRUCTION _ l�-$S nl- / 3 -7,2 y 19 _ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 44, 4 '92E -T kliq kS h- Proposed Use ��\E�5—_N Hoy3 Zoning District 2(2 Fire District Name of Owner �o/ 91VCl S Address es C7_11?AE4:T A14 RS 1-{ /2,0, Q wtOdle Name of Builder. Le C�S�e �d�// 4 4 Address Rap p Name of Architect _ Address Number of Rooms Foundation D G Exterior <f2'1_ A S Roofing 5;_Z z S3 Floors G2 �YZ,O_ Interior 6_7 Ga S S Heating IYAO Plumbing Fireplace Approximate Cost o, 4,6 Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Siipervisor's License f�spa� T ` Sweeney, Florence No 3tsyr Permit For BUILD GREENHOUSE f Location . 46 Great Marsh Rd. Centerville . � Owner• Florence' Sweeney Type of Construction Plot . J Lot Permit Granted _` July 14, 19' 94 " L Date.of Inspection: , _ 1 a' Frame 19, Insulation 19, ; Fireplace 19 + - Date,Completed �'�D-� 19 eZ �1r w''Yf*s t f I e • r , `7 •1 ,. t . ��,��-_ , I�_� ,. � I I I I � I I i I � . , - 11 11 I � I .,�, .1 I :. �.1 I - I I - -- I ., �. I.,. I , I 'I I I 1 1 1 I I �� .i� 11 �z _4 - t i....." . 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