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Home My WebLink About0120 GREEN DUNES DRIVE ✓, ara Pt.,- �' ,tf� pq. t y� t44d�� 'Yf':'� f A £ R ti' ,� �',� t y 'fit q,� i. ',,r to � ,.tF tif''«.F�.� �ti'�j,:.� 413 i7 kk +i�}'"e * _�' Fr ,,t '✓' ',y ';:i. " 'w. ,n •. - '!' •�'�:± .� ,., '� "3 �, d ,yY �"." N : "fr`•"k.,�f q .ter,_ . ll ,�" T O 1 }cy'.. ,..Y yS.:kr" 4.. .xi �. .f ) , � '.4:c9,." _ic � r.ivi ,� •� t � n7�...:N n•A= S.�y t��`-' _J... ,+�.. 4. e x s+. •. u R 'a t .,�M Y 4 {a.i.�!..' � !4' a 'if��4 i F� �. t r r f r .a /� Nr y 0 Yr I , a ' , c � a G• Y a , H r, , i k c • 41 �, S ,�'� toy CERTIFIED Hartford Casualty Insurance Company' THE Bond Center ,HARTFORD Bond Department. t "' , 200 Colonial Center Parkway, •5th-Floor 4 ,: Lake Mary, FL 32746 k ti `.-, NOTICE OF CANCELLATION OF BOND f E January 16, 2 013 "li >, _ ` 3 CITY BARNSTABLE - • - ' Building Dept. - 200 Main Street A 4 Hyannis, MA 02601 ,; + ,RE: Steven L. Mellor BOl]dNUmber: ,0(83SBGI9530 WHEREAS; on oI about 09/14/2012 the Hartford Casualty Insurance Company ,,as Surety, executed its EPPcsaflWeight and Other Highway and Street in the-penalty of six Hundred. .' ' Dollars ($600 , on behalf of Steven L. Mellor �- , of West Barnstable, MA 02668, ) as Principal and in favor Of CITY BARNSTABLE *� "as Obligee. WHEREAS, said bond, by its terms,provides that the said Surety Rshalfhave the'right to terminate its w suretyship thereunder by serving notice of.its election so to do upon the said Obligee, and WHEREAS, the Surety'desires to take advantage of the terms of said bond and does hereby ilect*to, , terminate its liability in accordance with the provisions thereof. NOW therefore, e efore be it known that the Hartford Casualty Insurance Company shall, ❑ At the expiration of days afterreceipt of this notice' ` X❑ Effective 02/25/2013 Consider itself released from all 'liability.by. reason of any,default•committed thereafter by the said Principal. i SIGNED and DATED this• 16th day of January, . t..,,; 2013 - By Robin Talbert Attorney-in-Fact - CC: EASTERN INSURANCE GROUP LLC f 233 WEST CENTRAL"ISTREET - NATICK, MA 01760' CC: 'Steven -L. Mellor ; 199 Percival .Drive ' ` West Barnstable,MA 02668 :• a . GEN5502 « Hartford Casua.lty. Insura.nce Company Bond Center . Bond Department 200 Colonial Center Parkway, 5th Floor T , Lake Mary., FL 32746 NOTICE OF CANCELLATION OF BOND August 7, 2014 CITE' BARNSTABLE Building Dept. 200 Main Street Hyannis, MA 02601 Steven L. Mellor Bond'Number: 08BSBGI9530 WHEREAS, on onabout 09/14/2013_ the vHartford_Casualty �Insuran_e company , as Surety, executed its Excess Weigh: and Other Highway and Street in the penalty of six F.lundred. Dollars.($600 B.e=lit`s _.._........__- .._...____.._.._._......._:__�______..____ t' on behalf of Steven. L. Mellor , of West Barnstable MA 02668 as Principal and in favor of CITY BARNSTABLE as Obligee WHEREAS, said.bond,by its terms, provides that the said Surety shall have the right to terminate its suretyship thereunder by serving notice of its election so to do upon the said Obligee, and, WHEREAS,the Surety desires to take advantage of the terms of said bond and does hereby elect to terminate its liability in accordance with the provisions thereof. NOW,therefore, be it known that the Hartford Casualty Insurance Company shall, f ❑ At the expiration of days after receipt of this notice. Q Effective o9/1.4/.201.4 Consider itself released from all liability by reason of any default committed thereafter.by the said Principal. SIGNE nd DATED this 7th day of August ,.2014. � —a -- -- C) Sandi Smith, Attorney-in-Fact �- CC: EASTERN INSURANCE; GROUP LLC t' ,233 WEST CENTRAL STREET NATICK, MA 01760 e sa CC: Steven L. Mellor 3.99 Percival Drive ,West Barnstable,MA 02668 GEN5502 t"Eti Town of Barnstable Building Department - 200 Main Street � * MA 02601 MAC. �, :Hyannis, . 9� (508) 16g9. 862-4038 Certificate of Occupancy . Application. Number: 201205625 CO Number: 20140105 Parcel ID: 245139 CO Issue Date: 08/04/14 Location: 120 GREEN DUNES DRIVE Zoning Classification: RESIDENCE D-1 DISTRICT Proposed Use: DEVELOPABLE LAND Village: CENTERVILLE Gen Contractor: MELLOR, STEVEN L. Permit Type: RC00 h CERTIFICATE OF OCCUPANCY RES Comments: " �Z 1� Building Department Signature Date Signed TOWN OF BARNSTABLE INE 2012525 sAtuvsrnB>.B, Issue Date: 10/OS/12 Pa m i t; MASS. i639• Applicant: Permit Number: B 20122439 ArFD MA'1 A Proposed Use: DEVELOPABLE LAND Expiration Date: 04/04/13 Location 120 GREEN DUNES DRIVE Zoning District RD-1 Permit Type: NEW SINGLE FAMILY HOME Map Parcel :245139 Permit Fee$ 7,395.00 Contractor MELLOR, STEVEN L. Village CENTERVILLE. App Fee$ 100.00 License Num 49879 Est Construction Cost$ 1,450,00.0 4 Remarks I APPROVED PLANS MUST BE RETAINED ON JOB AND CONSTRUCT A NEW 4 BEDROOM 4 1/2 BATH WITH TWO CAR GARAj GETHIS CARD MUST BE KEPT POSTED UNTIL FINAL ATTACHED _ _ _ _� INSPECTION HAS BEEN MADE. WHERE A -- CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: BROWN,DAVID G&ANN MARIE BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 66 PAYSON ROAD INSPECTION HAS BEEN MADE. BELMONT,MA 02478-2718 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS.NO,RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK'0R ANY PART THEREOF;EITHER I- ORARILY R E L ENCROACHMENTS ON PUBLICPROPERTY;NOT - SPECIFICALLY.PERMITT.FD UNDER THE BUILDING CODE,.MUST BE.APPROVED BY THE JURISO TION..,STREET OR ALLEY GRAD' A V WELL AS'DEPTH AND LOCATION OF PUBLIC SEWERSeMAY BE . a . l 1C OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS:-THE ISSUANCE OF THIS PERMI DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS: ,.- MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO 8E CONIPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TftATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. _PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF :DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESSES TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 '�J�Sk 6)�1 l g`l3Ur 2 �/� 2 c� 3 1 Heating Inspection Approvals Engineering Dept Fi a Dep 2.. AI, Board of Health ok #q1( L-/ k�- TOWN OF'BARNSTABLE "'* 20130 -1877 B� I�I,d i n g . 4 - • BARNSTABLE, Issue Date: f 0 /08/13 Pm 9 MAS& f` 1639. A�� Applicant: MELLOR,STEVEN L. y Permit Number: B 20130726 CFO MA't Proposed Use: DEVELOPABLE LAND Expiration Date: 10/06/13 Location 120 GREEN DUNES DRIVE Zoning District RD_1.Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 245139 Permit Fee$ 280.50 Contractor MELLOR,'STEVEN L. Village CENTERVILLE App Fee$ 50.00 License Num 49879 Est Construction Cost$ 55,000 , Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND MAKE CHANGES 2 FOUNDATION&FRAMING TO ALLOW 4 2ND STAIRMANYCARD MUST BE KEPT POSTED UNTIL FINAL TO ROOM OBOVE GARAGE,FINISH ROOM(PLAY ROOM)ADD TO POMWECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: BROWN,DAVID G&ANN MARIE, BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 66 PAYSON ROAD _ INSPECTION HAS BEEN MADE. BELMONT,MA 02478-2718 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS`NO RIGHT TO OCCUPY ANY STREET,ALLEY oR SIDEWALK OR ANY PART THEREOF,EITHER ORARILY Y .ENCR ACHIVIENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER"THE BUILDING CODB MUST BE APPROVEDrBY THE NRISDICTION STREET OR ALLEY GRADES AS L AS DEPTH AND LOCATION OF PUBLICrSEWERS-MAYBE' ti A OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS THE:ISSUANCE OF THIS PERMIT DOES NOT'RELEASE THE APPLICANT FROMTHE CONDITIONS OF ANY APPLICABLE SUBDMSiO?I'- - RESTRICTIONS ° MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. 7.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN.SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). a-0 My;® . ,�, f ®INQ BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 �t-�Sk n 40Q 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Hea/lth ( r x Pok _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICA�O G�o�Dlo2� b Coo��o -TOWN OF �a/moo, aS Map Parcel ` pplication # Health Division Z Z A R 9: 3 Date Issued` 17 , Conservation Division , ;Application Fe lop Planning Dept. C� CT �� Permit Fee a- Date Definitive Plan Approved by Planning Board Historic {•KH 1n. G _Preservation / Hyannis vim.. Project Street:Address Grp e-, rIUk, I Village w�Q i If s, C) b'rt - Owner = .�^`�` �Sv +fh Address.- Telephone 40 L7 w1 00 Permit Request q _amr) RnA Lnts LAM Square feet: 1 st floor: existing proposed, C 2nd floor: existing proposed 1. ,�Total new Zoning District Flood Plain Groundwater Overlay _ Project Valuation Construction Type Lot Size 1� n o 0 ,6 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: M' ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) :)�J Number of Baths: Full: existing new �` Half: existing new kP Number of Bedrooms: existing new 'Total Room Count (not including baths): existing _new First Floor Room Count Heat Type and Fuel: LI/G as ❑Oil ❑ Electric 0 Other Central Air: 2 Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing J(new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # r Current Use Proposed Use OM APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �y ;� � � �� Telephone Number p Address License # "09 7 N Home Improvement Contractor# l�l Cam_ Worker's Compensation #�'UjC :2 �LC (a 0� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOT LA�,j �-- �PJ SIGNATUREMK;—> t DATE A� ti i FOR OFFICIAL USE ONLY - APPLICATION# r y DATE ISSUED MAP/PARCEL NO., r rQ ADDRESS VILLAGE OWNER r DATE OF INSPECTION: € .FOUNDATION 9 Zi 3 /7- FRAME Sty ZAP 113 S�I II * INSULATION 4 4 13 FIREPLACE ` ELECTRICAL: ROUGH _ FINAL Af— PLUMBING: ROUGH FINAL "t GAS: ROUGH -:, - - :. 'FINAL s I FINAL BUILDING f 2 ''7/23' K ,g N b A DATE CLOSED,OUT { ASSOCIATION PLAN NO. F Town of Barnstable Regulatory Services. M+sa Thomas F.Geiler,Director t 0.19. �1 fp Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, CZy/G� ye�d'1 ,as Owner of the subject property 1. . °pertY hereby authorize7��t✓2c.�/(� to act on my behalfy in all'matters relative to work authorized by this building permit 44'e `t (Address of Job) *Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name J J�, Date QTORMS:OWNERPERMISSIONPOOLS I THE Town of Barnstable Regulatory Services t MUMST"LE, : Thomas F.Geiler,Director MASS. py.g. �.�� Building Division Tom Perry,Building Commissioner _ 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village. "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER , Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is; or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use'and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mini num inspection procedures and requirements.and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official ` Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply 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 p ovisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hireto 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 1� when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a lice-used Supervisor. The homeowner acting as Supervisor is ultimately responsible. 1 To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt RIGHT-J SHORT FORM ZONE 3 CLIMATROL HVAC DESIGNS Job:CL75 9-17-20112 PO BOX 35,DU MSPORT,MA02639 For: BROWN/TED FITZGERALD 120 GREEN DUNES DRIVE, WEST HYANNISPORT, MA Htg Clg Infiltration ,,;,; Outside db(OF) 10 88 Method Simplified Inside db(OF) 70 75 Construction quality Average 3 ,r, Design TD (°F) 60 13 Fireplaces 0 Daily range - M Inside humidity(%) - 50 Moisture difference(gr/lb) - 28 HEATING.EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent.cooling 0 Btuh Heating temperature rise 0 OF Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Clg load HtgAVF CIgAVF (ftj (Btuh) (Btuh) (cfm) (cfm) LOFT 625 8496 8482 246 310 BED 2 225 4183 3885 121 142 BATH 2 98 1121 999 32 36 BED 3 225 6235 4509 181 165 BATH 3 98 1121 999 32 36 ZONE 3 n p 1271 21156 18875 613 689 Ventilation air 0 0 Equip. @ 0.93 RSM 17554 Latent cooling 2696 TOTALS 1271 21156 20250 613 689 Printout certified byACCA to meet all requirements of Manual J 7th Ed. .A�—. wrnghtsoft Right-Suite Residentialm5.0.14RSR20780 2012-Sep-1910:1422 C:\MyDocunients\WhghtwftHVAC\FrrZCL75.rsr Page 3 RIGHT-J CALCULATION PROCEDURES A, B, Cl D Entire House CLIMATROL HVAC DESIGNS Job:CL75 9-17-2012 PO BOX 35,DEMJISPORT,MA02639 Procedure A-Winter Infiltration HTM Calculation* 1. Winter infiltration AVF 0.7 ach x 44902 ft3 x 0.0167 = 525 cfm Isolated zones= 0 cfm Total= 525 cfm 2. Winter infiltration load 1.1 x 525 cfm x 60 OF Winter TD = 34644 Btuh 3. Winter infiltration HTM 34644 Btuh / 761 ft2 Total window = 45.5 Btuh/ft2 and door area Procedure B -Summer Infiltration HTM Calculation 1. Summer infiltration AVF 0.4 ach x 44902 ft3 x 0.0167 = 300 cfm Isolated zones= 0 cfm Total= 300 cfm 2. Summer infiltration load 1.1 x 300 cfm x 13 OF Summer TD = 4289 Btuh 3. Summer infiltration HTM 4289 Btuh / 761 ft2 Total window = 5.6 Btuh/ft2 and door area Procedure C -Latent Infiltration Gain 0.68 x28 gr/lb moist.diff. x 300 cfm = 5628 Btuh Procedure D -Equipment Sizing Loads 1. Sensible sizing load Sensible ventilation load 1.1 x 0 cfm vent. x 13 OF Summer TD = 0 Btuh Sensible load for structure(Line 19) + 67505 Btuh Sum of ventilation and structure loads = 67505 Btuh Rating and temperature swing multiplier x 0.93 Equipment sizing load-sensible = 62779 Btuh 2. Latent sizing load Latent ventilation load 0.68 x 0 cfm vent. x 28 gr/lb moist.diff. = 0 Btuh Internal loads = 230 Btuh x 24 people + 5520 Btuh Infiltration load from Procedure C + 5628 Btuh Equipment sizing load-latent = 11148 Btuh "Construction Quality is: A No. of Fireplaces is: 0 Printout certified byACCA to meet all requirements of Manual J 7th Ed. wngHtsoft Right Suite Residential'"'5.0.14 RSR20780 2012-Sep-1910:14:22 ACCA C:ftDocuments\WdghtsoftWACfrrZCL75.rsr Page RIGHT-J CALCULATION PROCEDURES A, B, C, D ZONE 1 CLIMATROL WAC DESIGNS Job:CL75 9-17-2012 PO BOX 35,DEMJISPOW,,MA02839 Procedure A-Winter Infiltration HTM Calculation* 1. Winter infiltration AVF 0.7 ach x 6552 ft3 x 0.0167 = 79 cfm 2. Winter infiltration load 1.1 x79 cfm x 60 °F WinterTD = 5235 Btuh 3. Winter infiltration HTM 5235 Btuh / 115 ft2 Total window = 45.5 Btuh/ft2 and door area Procedure B -Summer Infiltration HTM Calculation 1. Summer infiltration AVF 0.4 ach x 6552 ft3 x 0.0167 = 45 cfm 2. Summer infiltration load 1.1 x45 cfm x 13 °F SummerTD = 648 Btuh 3. Summer infiltration HTM 648 Btuh / 115 ft2 Total window = 5.6 Btuh/ft2 and door area Procedure C -Latent Infiltration Gain 0.68 x28 gr/lb moist.diff. x 45 cfm = 850 Btuh Procedure D-Equipment Sizing Loads 1. Sensible sizing load Sensible ventilation load 1.1 x 0 cfm vent. x 13 °F Summer TD = 0 Btuh Sensible load for structure(Line 19) + 8628 Btuh Sum of ventilation and structure loads = 8628 Btuh Rating and temperature swing multiplier x 0.93 Equipment sizing load-sensible = 8024 Btuh 2. Latent sizing load Latent ventilation load 0.68 x 0 cfm vent. x 28 gr/Ib moist.diff. = 0 Btuh Internal loads = 230 Btuh x 3 people + 690 Btuh Infiltration load from Procedure C + 850 Btuh Equipment sizing load-latent = 1540 Btuh "Construction Quality is: A No. of Fireplaces is: 0 Printout certified byACCA to meet all requirements of Manual J 7th Ed. wnghtsoft Right-Suite ResidenbalTM 5.0.14 RSR20780 2012-Sep0910:14:22 ACCA C:WIy Documents0rightsoft HVACWrrZCU5.rsr Page 2 RIGHT-J CALCULATION PROCEDURES A, B, C, D ZONE 2 CLIMATROL HVAC DESIGNS Job:CL75 9-17-2012 PO BOX 35,DEPWISPORT,MA02639 Procedure A-Winter Infiltration HTM Calculation* 1. Winter infiltration AVF 0.8 ach x 24390 ft3 x 0.0167 = 323 cfm 2. Winter infiltration load 1.1 x 323 cfm x 60 OF Winter TD = 21305 Btuh 3. Winter infiltration HTM 21305 Btuh / 468 ft2 Total window = 45.5 Btuh/ft2 and door area Procedure B -Summer Infiltration HTM Calculation 1. Summer infiltration AVF 0.5 ach x 24390 ft3 x 0.0167 = 184 cfm 2. Summer infiltration load 1.1 x 184 cfm x 13 OF Summer TD .= 2638 Btuh 3. Summer infiltration HTM 2638 Btuh / 468 ft2 Total window = 5.6 .Btuh/ft2 and door area Procedure C -Latent Infiltration Gain / 0.68 x28 gr/lb moist.diff. x 184 cfm = 3461 Btuh Procedure D-Equipment Sizing Loads 1. Sensible sizing load Sensible ventilation load 1.1 x 0 cfm vent. - x_ 13 OF Summer TD = 0 Btuh Sensible load for structure(Line 19) + 48331 Btuh Sum of ventilation and structure loads = 48331 Btuh Rating and temperature swing multiplier x 0.93 Equipment sizing load-sensible = 44948 Btuh 2. Latent sizing load Latent ventilation load 0.68 x 0 cfm vent. x 28 gr/lb moist.diff. = 0 Btuh Internal loads, = 230 Btuh x 15 people + 3450 Btuh Infiltration load from Procedure C + 3461, Btuh Equipment sizing load-latent = 6911. Btuh *Construction Quality is: A No. of Fireplaces is: 0 Printout certified byACCA to meet all requirements of Manual J 7th Ed. W r 14Q htSC3 t Right-Suite Residential'*'S.0.14 RSR20780 2012-Serr1910:1422 ACCA C:\MyDoamentslWrightwftWACWITZCV5.rsr Page f RIGHT-J CALCULATION PROCEDURES A, B, C, D ZONE 3 CLIMATROL HVAC DESIGNS Job:CL75 9-17-2012 PO BOX 35,DENNISPORT,MA02639 Procedure A-Winter Infiltration HTM Calculation* 1. Winter infiltration AVF 0.5 ach x 13960 W x 0.0167 = 123 cfm 2. Winter infiltration load 1.1 x 123 cfm x 60 °F Winter TD = 8103 Btuh 3. Winter infiltration HTM 8103 Btuh 1 178 ft2 Total window = 45.5 Btuh/ft2 and door area Procedure B -Summer Infiltration HTM Calculation 1. Summer infiltration AVF 0.3 ach x 13960 ft3 x 0.0167 = 70 cfm 2. Summer infiltration load 1.1 x 70 cfm x 13 °F Summer TD = 1003 Btuh 3. Summer infiltration HTM 1003 Btuh / 178 ft2 Total window = 5.6 Btuh/ft2 and door area Procedure C -Latent Infiltration Gain 0.68 x28 gr/lb moist.diff. x 70 cfm = 1316 Btuh Procedure D-Equipment Sizing Loads 1. Sensible sizing load Sensible ventilation load 1.1 x 0 cfm vent. x 13 °F Summer TD = 0 Btuh Sensible load for structure(Line 19) + 18875 Btuh Sum of ventilation and structure loads = 18875 Btuh Rating and temperature swing multiplier x 0.93 Equipment sizing load-sensible = 17554 Btuh 2. Latent sizing load Latent ventilation load 0.68 x 0 cfm vent. x 28 gr/lb moist.diff. = 0 Btuh Internal loads = 230 Btuh x 6 people + 1380 Btuh Infiltration load from Procedure C + 1316 Btuh Equipment sizing load-latent = 2696 Btuh "Construction Quality is: A No. of Fireplaces is: 0 Printout certified byACCA to meet all requirements of Manual J 7th Ed. wnghtsoft Right-Suite ResidentialTm 5.0.14 RSR20780 2012-Setr1910:14:22 /lCG\ C.*Wy Documents\Wdghtsoft HVACWrrZCL75.rsr Page 3 f RIGHT-J MULTIZONE A,B,C,D PROCEDURES REPORT CLIMATROL HVAC DESIGNS Job:CL75 9-17-2012 PO BOX 35,DENNISPOK,,MA02639 Procedure A-Winter Infiltration HTM Calculation Air Changes per Hour x Volume x 0.0167=AVF AVF x 1.1 x TD=load Load/Area=HTM ZONE NAME ACH Volume AVF TD Load Area HTM OF) (Cfm) (°F) (BWh) OF) (Bb hM ZONE 1 0.7 6552 0.0167 79 1.1 60 5235 115 45.5 ZONE 3 0.5 13960 0.0167 123 1.1 60 8103 178 45.5 ZONE 2 0.8 24390 0.0167 323 1.1 60 21305 468 45.5 Entire House 1 0.71 44902 0.0167 525 1 1.11 601 34W 1 7611 45.5 Procedure B - Summer Infiltration HTM Calculation Air Changes per Hour x Volume x 0.0167=AVF AVF x 1.1 x TD=Load Load/Area=HTM ZONE NAME ACH Volume AVF TD Load Area HTM OF) (Crm) ("F) (Bwh) OF) (BahM ZONE 1 0.4 6552 0.0167 45 1.1 13 648 115 5.6 ZONE 3 0.3 13960 0.0167 70 1.1 13 1003 178 5.6 ZONE 2 0.5 24390 0.0167 184 1.1 13 2638 468 5.6 Entire House 1 0.41 449021 0.01671 30011 1.11 131 42891 5.6 Procedure C - Latent Infiltration Gain 0.68 x Moisture Difference xAVF=Load ZONE NAME moist.diff. AVF Load (9rAb) (Cfm) (BUh) ZONE 1 0.68 28 45 850 ZONE 3 0.68 28 70 1316 ZONE 2 0.68 28 184 3461 Entire House 0.681 281 300 5628 Procedure D - Equipment Sizing Loads 1. Sensible Sizing Load 1.1 x Ventilation AVF x TD=Mentilation Load+Structure Load=Total Load x RSM=Equipment Load ZONE NAME Vent. Summer Vent. Struct Total RSM Equip. AVF(cim) TD (°F) (BWh) (BWh) (BWh) (Bich) ZONE 1 1.1 0 13 0 8628 8628 0.93 8024 ZONE 3 1.1 0 13 0 18875 18875 0.93 17554 ZONE 2 1.1 0 131 0 483311 483311 0.931 44948 Entire House 1.1 0 13 0 67505 67505 0.93 62779 2. Latent Sizing Load 0.68 x Ventilation AVF x Moisture Difference=Ventilation Load Per Person Load x No.People=People Load Ventilation Load+People Load=Equipment Latent Load ZONE NAME Vent. mst Vent. Pers. No People Infil. Equip. AVF(crm) dif (Binh) (BMh) ppl (Bwh) (BWh) (fth) ZONE 1 0.68 0 28 0 230 3 690 850 1540 ZONE 3 0.68 0 28 0 230 6 1380 1316 2696 ZONE 2 0.68 0 28 0 230 15 3450 3461 6911 Entire House 0.68 0 281 01 230 24 552015628 11148 ,- Wrv0Mt50ft Right-SudeReadermal-5.0.14RSR20780 2012-Sep-1910:1422 ACC?. C.I*Doaammts\wnghwa WACFnZCL75.rsr Page 1 Massachusetts -Department of Public Safety K Board of Building Regulations ulations and Standards. , Construction SupmIsor y License: CS-049879 IN STEVEN L MELLOR :. # 199 PERCIVAL Dit F W BARNSTABLE M.4�026�G8 -Y/ .,i W 0 Expiration Commissioner 05/22/2014 t F 0100 a n m REScheck Software Version 4.4.1 Compliance Certificate Project Title: Brown Residencea_ �-� Energy Code: 2009 IECC Location: Hyannis,Massachusetts , Construction Type: Single Family Glazing Area Percentage: 17% Heating Degree Days: 6137 f , Climate Zone: 5 Construction Site: Owner/Agent: . Designer/Contractor: 120 Green Dunes Drive Northside Design Associates West Hyannis Port,MA 141 Main Street Yarmouthport,MA 02675 77 Compliance:1.4%Better Than Code Maximum UA:648 Your UA:639 The%Better or Worse Than Code index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Ceiling 1:Flat Ceiling or Scissor Truss 3065 38.0 0.0 92 Wall 1:Wood Frame,16"o.c. 4136 19.0 0.0 203 Window 1:Wood Frame:Double Pane with Low-E 496 0.280 139 Door 1:Glass 200 0.280 56 Door 2:Solid 58 0.140 8 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 2995 19.0 •_ 0.0 ' 141 Compliance Statement The proposed building design described here is consistent building plans,specifications,and other calculations submitted with the permit application.The proposed building has b desi ed to meet the 2009 IECC requirements in REScheck Version 4.4.1 and to comply with the mandatory requirements lis in th eck Inspection Checklist. Name-Title J gnature Date x . Project Title: Brown Residence Report date:08/08/11 Data filename:C:\Program Files\Check\REScheck\client reports\BROWN.rck Page 1 of 4 r • REScheck Software Version 4.4.1 ` . Inspection Checklist Ceilings: ❑ Ceiling 1:Flat Ceiling or Scissor Truss,R-38.0 cavity insulation ; Comments: Above-Grade Walls: ❑ Wall 1:Wood Frame,16"o.c.,R-19.0 cavity insulation r' Comments: Windows: a ❑ Window 1:Wood Frame:Double Pane with Low-E,U-factor:0.280 For windows without labeled U-factors,describe features: a #Panes Frame Type Thermal Break? Yes No Comments: Doors: ❑ Door 1:Glass,U-factor:0.280 Comments: ❑ Door 2:Solid,U-factor:0.140 Comments: W `_ Floors: ❑ Floor 1:All-Wood Joist/Truss:Over Unconditioned Space,W19.0 cavity insulation Comments: Floor insulation is installed in permanent contact with the underside of the subfloor,decking. ' Air Leakage: ❑ Joints(including rim joist junctions),attic access openings,penetrations,and all other such openings in the building envelope that are sources of air leakage are sealed with caulk,gasketed,weatherstripped or otherwise sealed with an air barrier material,suitable film or solid material. Cl Air barrier and sealing exists on common walls between dwelling units,on exterior walls behind tubs/showers,and in openings between window/doorjambs and framing. ❑ Recessed lights in the building thermal envelope are 1)type IC rated and ASTM E283 labeled and 2)sealed with a gasket or caulk between the housing and the interior wall or ceiling covering. ' ❑ Access doors separating conditioned from unconditioned space are weather-stripped and insulated(without insulation compression or damage)to at least the level of insulation on the surrounding surfaces.Where loose fill insulation exists,a baffle or retainer is installed , to maintain insulation application. F: ❑ Wood-burning fireplaces have gasketed doors and outdoor combustion air. , Air Sealing and Insulation: ; El Building envelope air tightness and insulation installation complies by either 1)a post rough=in blower door test result of less than 7 ACH at 33.5 psf OR 2)the following items have been satisfied: (a)Air barriers and thermal barrier:Installed on outside of air-permeable insulation and breaks or joints in the air barrier are filled or, repaired. (b)Ceiling/attic:Air barrier in any dropped ceiling/soffit is substantially aligned,with insulation and any gaps are sealed. (c)Above-grade walls:Insulation is installed insubstantial contact and continuous alignment with the building envelope air barrier. (d)Floors:Air barrier is installed at any exposed edge of insulation. ' (e)Plumbing and wiring:Insulation is placed between outside and pipes.Batt insulation is cut to fit around wiring and plumbing,or sprayed/blown insulation extends behind piping and wiring. M Comers,headers,narrow framing cavities,and rim joists are insulated. Project Title: Brown Residence Report date:08/08/11 Data filename:C:\Program Files\Check\REScheck\client reports\BROWN.rck Page 2 of 4 (9)Shower/tub on exterior wall:Insulation exists between showers/tubs and exterior wall. Sunrooms: ❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U-factor of 0.50 and the maximum skylight U-factor of 0.75.New windows and doors separating the sunroom from conditioned space meet the building thermal envelope requirements. Materials Identification and Installation: , Materials and equipment are installed in accordance with the manufacturer's installation instructions. ` ❑ Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R-value. ❑ Materials and equipment are identified so that compliance can be determined. ❑ Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided'. ❑ Insulation R-values and glazing U-factors are clearly marked on the building plans or specifications. `.. Duct Insulation: ❑ Supply ducts in attics are insulated to a minimum of R-8.All other ducts in unconditioned spaces or outside the building'envelope are insulated to at least R-6. Duct Construction and Testing: r a ❑ Building framing cavities are not used as supply ducts. ❑ All joints and seams of air ducts,air handlers,filter boxes,and building cavities used as return ducts are substantially airtight by means l , of tapes,mastics,liquid sealants,gasketing or other approved closure systems.Tapes,mastics,and fasteners are rated UL 181A or UL 181 B and are labeled according to the duct construction.Metal duct connections with equipment and/or fittings are mechanically fastened.Crimp joints for round metal ducts have a contact lap of at least 1 1/2 inches and are fastened with a minimum of three'. , equally spaced sheet-metal screws. Exceptions: , Joint and seams covered with spray'polyurethane foam. Where a partially inaccessible duct connection exists,mechanical fasteners can be equally spaced on the exposed portion of the joint so as to prevent a hinge effect. Continuously welded and locking-type longitudinal joints and seams on ducts operating at less than 2 in.w.g.(500 Pa). Duct tightness test has been performed and meets one of the following test criteria: (1)Postconstruction leakage to outdoors test:Less than or equal to 338.2 cfm(8 cfm per 100 ft2 of conditioned floor area). (2)Postconstruction total leakage test(including air handler enclosure):Less than or equal to 507.2 cfm(12 cfm per 100 ft2 of conditioned floor area)pressure differential of 0.1 inches w.g. (3)Rough-in total leakage test with air handler installed:Less than or equal to 253.6 cfm(6 cfm per 100 ft2 of conditioned floor area) when tested at a pressure differential of 0.1 inches w.g. (4)Rough-in total leakage test without air handler installed:Less than or equal to 169.1 cfm(4 cfm per 100 ft2 of conditioned floor area). Heating and Cooling Equipment Sizing: Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code. ❑ For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2009 IECC Commercial Building Mechanical and/or Service Water Heating(Sections 503 and 504). Circulating Service Hot Water Systems: ❑ Circulating service hot water pipes are insulated to R-2. ; Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the system is not in use. Heating and Cooling Piping Insulation: ❑ HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R-3. Swimming Pools . ❑ Heated swimming pools have an on/off heater switch. O Pool heaters operating on natural gas or LPG have an electronic pilot light. 0 Timer switches on pool heaters and pumps are present: Exceptions: Where public health standards require continuous pump operation. Where pumps operate within solar-and/or waste-heat-recovery systems. ❑ Heated swimming pools have a cover on or at the water surface.For pools heated over 90 degrees F(32 degrees C)the cover has a minimum insulation value of R-12. Project Title: Brown Residence Report date: 08/08/11 * Data filename:C:\Program Files\Check\REScheck\client reports\BROWN.rck Page 3 of 4 Exceptions: Covers are not required when 60%of the heating energy is from site-recovered energy or solar energy source. Lighting Requirements: A minimum of 50 percent of the lamps in permanently installed lighting fixtures can be categorized as one of the following: (a)Compact fluorescent (b)T-8 or smaller diameter linear fluorescent (c)40 lumens per watt for lamp wattage<=15 (d)50 lumens per watt for lamp wattage>15 and<=40 (a)60 lumens per watt for lamp wattage>40 Other Requirements: Snow-and ice-melting systems with energy supplied from the service to a building shall include automatic controls capable of shutting off the system when a)the pavement temperature is above 50 degrees F,b)no precipitation is falling,and c)the outdoor temperature is above 40 degrees F(a manual shutoff control is also permitted to satisfy requirement's'): Certificate: A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R-values;window U-factors;type and efficiency of space-conditioning and water heating equipment.The certificate does not cover or,obstruct the visibility of the circuit directory label,service disconnect label or other required labels. NOTES TO FIELD:(Building Department Use Only) _ y Project Title: Brown Residence Report date: 08/08/11 Data filename:C:\Program Files\Check\REScheck\client reports\BROWN.rck Page 4 of 4 20091ECC Energy Efficiency Certificate' Ceiling/Roof 38.00 F Wall 19.00 Floor/Foundation 19.00 Ductwork(unconditioned spaces): Window 0.28 0.32 Door 0.28 0.32 Heating System: ` • i Cooling System: Water Heater: Name: Date: Comments: ; f 7Ae Commonwealth of Massachusetts Department of.&riustrial (ccidents Office of fnvadgadoirs '600 Washington Street _ Boston,M4 02111 www.mass.gov/dig Workers' Compensation Insurance Affidavit: Ru:ilders/Contractors/Electricians/Plumbers Applicant Information Please Print Le'bly Name{> usiness/Or on h&Vidnaij:_ -Address: City/State/Zip: Are you an employer? Check the appropriate bow I.prI am a em Type of project(r equired) ployer with •4• [] I am a general contractor and I �-,� employees(full and/or part tiune).*. have lured�e sub-contractors 6 [1. ew construct om 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet: 7. ❑Remodeling ship and have no employees These sub-contractors have 8 ❑Demolition working for me ia•any capacity. employees and have workers' [No workers' comp,insurance camp..insurance.#• 9. '0 Building addition required.] 5. 0. We area corporation and its 10.[]Electrical repairs or ad�tions 3•[] I am a homeowner doing i1work officers have exercised their 11.Q Phnobing repairs or additions nfysel£ [No wor]ers' camp: right of exemption per MGL 12.❑Rnafrepairs insurance required.]t c. 152, §1(4),and we have no . employees. [No workers' 13.❑Other comp.insurance reqi�dred j `Any applicant that checks box#1 Est also fill out�e section below showing their workers'compensation policy iuformation.. f^l t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such•,.—onhactors that check this box must attached an additional sheet showing the name of tho sub-coutractors and state whether or not those entities have employees. if am sub-contract m have employees,theyimustprovide their work='camp.policy number. I am air,erxployer that is providing workers'compensation irisra once foe my employees: Below is the policy and job site information. Insurance Company Name: Policy#or S�oIf ins.Lic.# -ration Date : _ s Ex pi 1 �- 7ob Site Address: (*R g MY/State/Zip: .. Attach a copy off the workers' compensation policy declaration page'(shoTP ng the policy number and expir 'on date). 5 Fa:a=.tn,secure coverage as required under Section 25A of MGL c, 152 can lead to flie imposition of cffininal 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 S250.D0 a day against the violator. Be advised that a copy-of this statemmit may be forwarded to the Office of Investi lions of the DIA far insurance covers e verifcatian I do hereby c under the ains•andpenalties ofperjury that the information provided above is true and correct' : Date: I • Phone D cial use only. Do not write ire ffiis area,tb be completed Iry city or town affzcial City or Town: PermitlLicense ,Iss ' Authori mpg ty(cu•cle one): . .�1.Board of Health 2.Building Department.3.City/TO Clerk 4.Electrical Inspector S.Plumbing£nsgectar 6. Other Contact Person: Phone#: i i Insulation Certificat i umber and ptreet City County Subdivision Lot Number Permit Number Description of Installation ROOF \ ProductGAQL© (110Q3 Lot Number Thickness(inches) AD Thermal Resistance(R-Value) CEILING Product C��C Lot Number Thickness (inches) Thermal Resistance (R-Value) 2 EXTERIOR WALL Product QpeC jo (a' IZ22A Lot Number � Thickness (inches) S Thermal Resistance(R-Value) 22 RAISED FLOOR Product a-'4-eNS "w� Lot Number Thickness (inches.)— Thermal Resistance(R-Value) SLAB FLOOR Product Lot Number Thickness (inches) Thermal Resistance(R-Value) - Width(inches) ' FOUNDATION WALL Product Lot Number Thickness (inches) Thermal Resistance(R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards. ZKI General Contractor(Builder) License Number Si ture and T'tle Date e Sub ntract (Insulation fnstaller)t License Number 'Signa itle Date i ' z , PROJEC NAME: ADDRESS: PERMIT# PERMIT DATE: M/P: LARGE ROLLED PLANS ARE IN: BOX 1 ' SLOT �O Data entered in MAPS program on: 3 Dat p gr BY: 2� q/wpfiles/forms/archive i Commonwealth of Massachusetts Sheet Metal Permit d4` Map PareelX-PRESS PERMIT Date: Permit# _ JUL 0.9 2013 ,�. S Estimated Job Cost: $ '?�O, (50 0 Permit Fee:-$ .5 Plans Submitted: YES NO--TOWN OF BAR BLEiewed: YES NO Business License# tA Applicant License# Business Information: Property Owner/Job Location Information: Name: Name.D,44 tt� V WA' Stree - Street: a �__C-' S AJ City/Town: City/Town: Telephone: Telephone: ems, Photo I.D.required/Copy of Photo I.D. attached: ,YES NO Staff Initial J-1 kn)1unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family�� Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional_ Other 2. Square Footage: under 10,000 sq. ft. J over 10,000 sq. ft. Number of Stories. Sheet metal work to be completed: New Work. Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: 5 r . �nJ t NSURANCE COVERAGE: have a current liability insurance policy or its equivalent which melts tf a requirements of M.G.L.Ch. 112 Yes SJ/No ❑ f you have checked Y=, indicate the type of coverage by checking the appropriate box below: k liability insurance policy Other type of indemnity ❑ Bond ❑ )WNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Jlassachusetts General Laws, and that my signature on this permit applicationwaives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent f 3y checking this box❑,I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and iccurate to the best of my kriowledge and that all sheet metal work and installations performed under the permit issued for this application will be n compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments n Type of License: ' 3y ❑ Master ltle ❑ Master-Restricted :ity/Town ❑Journeyperson Signature of Licensee 'ermit# El License Number: 146 4 -ee$ ❑ Check at www.mass.govIdol nspector Signature of Permit Approval eA The Commonwealth of Massachusetts .UfDepartment of Industfial Accidents Office of Investigations '600 Washington Street` _ Boston,MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPEcant li formation Please Print L-e l Name(Business/Organizatim/3ndividuat): . • •Ad�'ess• �� tn City/State/Zip: Phone.#-. Are you an employer? Check the appropriate biz: Ty�Ne3 oject(require:. 1.❑ I a employer with -4. I am a general contractor and I * have hired the sub-contactors. 6. onstruction . loyees (fiuIl and/or part-t®e). , 2.LY I am a sole proprietor orpart aer-: listed on the-attached sheet 7, emodeling These sub-contractors have , ship and have no employees 8. 7 Demolition for me is an c employees and have workers' working y capacity, [No workers' comp.insurance comp.hmm�ce.$ 9: 0 Building addition required_] 5• ❑ We area corporation and its 10_Q Electrcal repairs or additions officers have exercised thee '3.E1 I am a homeowner doing aI1 work 11.[]Plumbing repairs or additions . el£ o workers' comp. right of exemption per MGL 1.,❑,Roof repairs insurance regtmed.]t c. 15 1(4), and we have no ❑ Other employees. [No workers' . comp.irrsrrrar,re required_) f *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 Olen 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 employcrs. If the sub-contractors have employees,they mustpcovide their workers'comp.pobcynumber. I am an employer that is providing-workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.# Exprzation.Date: - lob Site Address: Citv/state/zip: Attach a copy of the workers'.compensation policy:declaration page'(showin.g 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 canal 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 gaiast the violator. Be advised that a copy of this statement maybe forwarded to the Office of Iavesti ons of the• for e coverage verification I do her Ldertakepains-andpenalties of perjury that the information provided above is true and correct. Si�atrue: Date: P9M?� Phone r. Official use only. Do not write in this area, tb be completed by city or town official City or Town: PermitUcense# 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#: Town of Barnstable Regulatory Services MASS Thomas F.Geiler,Director t s6;q. o► ` Building Division Tom Perry,Building Commissioner . 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 {. Property Owner Must " Complete and Sign This Section, ; If Using A.Builder as Owner of the subject p .ro petty hereby authorize to act on my behalf, in all matters teladve to work authorized by this building permit INK < (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are perfo ed and accepted. ignatate of Owner Qign -iLof Applicant �--, Print Name Paint Name Gov Date QTORMS:O WNERPERMISSIONPOOLS Town of Barnstable Regulatory Services t sexivsrnal, , :nr.�as. Thomas F.Geiler,Director 039. �•�� Building Division Tom Perry,Building Commissioner. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: ��— �1� N S F �i� % d�` �` ✓1 number street village "HOMEOWNER"-* � s name home phone.# work phone# CURRENT MAILING ADDRESS:_ Pa xoeya eo4ylil 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. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum' _--procedures and requirements and that he/she will comply with said procedures and req ' Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION: The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15).This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt COMMONWEALTH OF`MASSACHIISETTS �; ST METAL V�IORKERS , AS A= r1ASTER UNRESTRICTED ISSUES THE ABOVE LICENSE TO THFODD,} E H' t ITZGERALD I 43 THOF NBERRY CIRCLE MpSHf'EE,. MA e02G49 5342 06/28/14 2r/275 140 i9 ., Fold,Then Detach Along All Perforations 1 F.r.... SSAC MOWEALTH OF MA HUSETTS VdOR SWEET•METAL KERS , AS q t41 AST ER-UNRESTRICTED i NSE TO ISSUES THE ABOVE LICE H I ITZGERALD i THFODOF E s 43 THot'NBERRY CIRCLE ' - 1 A U2644 MA MaSHPI=E I40a 06/28/1+ 2� / All Perforations Fold,Then Detach Along 1 ra v TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0`7Application # �` Health Division Date Issued 4 Conservation Division Application Planning Dept. Permit Fee (fp,—p 5b Date Definitive Plan Approved by Planning Board K y(Yb3 Historic - OKH _ Preservation / Hyannis Project Street Address 6 Village - Owner Address6c QR t^T ��cr,��S M e, Telephone, L4 Qq) 1 �7 ',Permit Request Y (2 G,.�-,�� c9.rJ�.� Square�b � P1 g�— prop �L� gip p �u v feet: st floor: exis �6 ro osed 2nd floor: existin I pro osed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Typed Lot Size l N Cvcnr k G Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Jr Two Family ❑ '-Multi-Family-(# units) Age of Existing Structure DO D Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: JrFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft),�'3 ob (7 Number of Baths: Full: existing new Half: existing 1 new (, Number of Bedrooms: existing -0 new Total Room Count (not including bath,): existing new First Floor Room Count Heat Type and Fuel: )d Gas ❑ Oil ❑ Electric ❑ Other Central Air: &'Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: Wexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# - Current Use Proposed Use O 'M APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name g �g� Y�polj a� Telephone Number AddressAc�2License#_ QLITk7 � o n \,-i 2,2 f5Q,-�,_p Y)c1N R Home Improvement Contractor# u"7 (_i 13 Worker's Compensation # ►� ��( �1�11b��- . ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO h y. �. SIGNATURE �, DATE AI FOR OFFICIAL USE ONLY .APPLICATION# DATE ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE OWNER Y i DATE OF INSPECTION: y , FOUNDATION W FRAME 3 s INSULATION 44 13 , FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 'a I FINAL BUILDING O DATE CLOSED OUT y 1 i ASSOCIATION PLAN NO. "r �; t The Commomveaifh ofMassachusetis epartmerd offndustrial�[cxdenfs ;; - O,Bice of Iavesirgations - 600 ArashinOyt Street- Bostoii .MA 02111 wMinass gov/dia Workers' Compensation Insurance Affidavit: Bwlders/Contractors/Electricians/Plumbers. Applicant Information Please Print Lealy Name( � �, ��,-�.�. lC Gr A ifiress' City/State/Zip: V,-\q Phone.#: 1-I Are you an employer?Check the appropriate box; Type of project(require:• 1.[] I am a Io with '4..E] I am a general contractor and I . I �P YeT * have hired the sub-contra.ctors 6 ®'�Tew construction . employees(fall and/or part time). . 2.❑ I am a.•sole proprietor or partner- listed on t he 8 ❑ 'atfached sheet' . ]'Re odeling i ship and have no employees These sab-co�ractors have . Demolition for me iri employees and have workers' working any capes $. 9. ❑Building addition [No workeza' comp.insurance camp.insurance. regu,�-] 5. We are a corporafion•and its ID.Q Elechical;epaus or additions •3. I am a homeowner doing all•work offiatns have exercised tiieh 11.❑Phnubing repairs or additions-.- right of exemption per MGL myself [No workers comp. 12.❑Roof repairs ingUlanc-r required.]t c. 152, §1(4),and we have no r employees.[No workers . 13.❑ Ofber comp.insurance required.] *Any applicant that checks box#1 moist also fill out am smfim beiow.shoa mg then work='compcosstion policy infnrmatiaa t HD--who submit this affidavit indicating they an doing all work and thm hire outside contractors must submit a new affidavit indicating such. $contractors that check this box must aflached an additional sheet showing the name of the sub-=tract ors and state whctha•or not those entities have employees. If the sub-contractors have employees,trey must providt their workers'coin.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site information. T Insinance Company Name:Q I hC, Policy.#or Self-ins.Lic,#- f-vftf-C� 2L Expiration Date: Job Site Address: J�)_0 -(-j C1 �� )' GSfy/S`t&WZip:\1V +hes,.�.w.;,-,ra A Attach a copy of the workers' compensation policy declaraflon page•(showing the policy number and eapfrrafion date). Failure_to secure coverage as required Tinder 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 imprisonmmi� as-wall as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against foe violater. Be advised loaf a copy of this staferamn t may be forwarded to the Office of - Iuyestiaations of the DIA for inS Era GC coyera>e verification. I do•hereby ce under thepains•and enables ofperjwy that the informadunprovided above is true and correct Si Daft:: .Phone#- V `7 7 Y 1 Offccid use only. Do not write in this.area,tb be compLeted by city or town offzcw. City or Town: Permiuurense# Issrdng Akuthorlty(dicle one): A,Board of Health 2,.Building.Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Pearson: Phone#: . i ,:,zc; n I ! a x i. �ab r '{� { -.$i ft g9 'i�3i + i m aj'ByV0 TOVPn of Barnstable Regulatory Services WAM Thomas F.Geiler,'Director Build in Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www:town:barnstable-mta.us. Office: 508-862-4038 Fax: 508-700-6230 Property Owner Must Complete and Sign This .Section If Using A Builder as Owner of the subject property hereby authorize to act on ray behalf, in aH matters relative to work authorized by this building permit o G u- ` K�u IV. (Address of job) '**Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted.. tore of Owner Signature of Applicant -,OCWL-� Tnw�\- 6-q, Print Name Print Name = Date Q:F0RMS:0V NERPII2MISSI0NPOOLS 62012 f - l :i r�F}��i - 7 y`ry 4 efx•: >`' ,j t l' l Y"i .'r r'4ry 1{rL�u F 1 c�4i d rp.Y 7 , I c0nof:Barnstiible Rq*fory Ser�ces • s Thomas F.Geffer,Director MASS 1659. . Building Division.. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us . Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION +r Please Print DATE: JOB LOCATION: number - street. village "HOMEOWNER": - name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFWMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the-Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner i Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, 'Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly y, when the homeowner.hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/cer ification for use in your community. Q:forms:homeexempt Office. of Consumer Affairs & Business Regulation - Mass.Gov Page 1 g g of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) A�; Consumer Affairs and Business Regulation Home Consumer Home Improvement Contracting HIC Registration Complaints Registration # 117610 Home Improvement Contractor Registrant Registration Home Page Name STEVEN MELLOR Address 199 PERCIVAL DR City, State Zip W BARNSTABLE, MA 02668 Expiration Date' 10/25/2014 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search y License or registration valid for individul use* ,t d before the expiration date. If found return to* Offiee9C mer AB siness Reg E IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Reg HOM Type' I 10 Park Plaza-Suite 5170 . Registration: 1: 7610 Individual Boston,MA 02116. Expiration: _1 12512012 EN L.MELLOF2-._�� _ ST 1 5 i 4 -3 STEVEN MELLOR: � g Not valid without signature. 199 PERCIVAL DRY Undersecretary W BARNSTABLE,MA 0_2 66: . Massachusetts -Department of Public Safety Board.f Building Regulations and Standards 4Y Construction supervisor ` License: CS-049879 STEVEN L ME199 PERCIVAL DR LD W BARNS ABA Expiration J, 05/22J2014 Commissioner _ --- ,.W%a.uL;a.stato.ma.us/hic/licdetails.aspx?txtSearchLN=I... 3/27/2013 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 62 S Parcel T S Application # aG 13 n 33 7� Health Division Date Issued . , .O Conservation Division Application Fee Planning Dept. Permit Fee �� Date Definitive Plan Approved by Planning Board 17h3 Historic - OKH _ Preservation/ Hyannis Project Street Address f`�. FN Village Owner �� YY) '�� rnnr�. Address � @ Telephone �-10`7! C��t7� P�ermi equ t a V Square feet: 1 st floor: existing",'ILZ)'proposed 2nd floor: existing proposed ' Total new _ Zoning District Flood Plain Groundwater Overlay Project Valuation c� = Construction Type Lot Size�_(�t�SL + r Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes r/❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: �ull ❑ Crawl ❑Walkout Other h 9- Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new 0 Half: existing new _ Number of Bedrooms: AWK 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: [9'Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑_Yes ❑ No Q o Detached garage: bexisting ❑ new size Pool: ❑ existing ❑ new size _ Barn: existing �l neg size_ ;Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other` ` Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# ':0 Ct� rn Current Use Proposed Use � APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S 1n� Jl�� Telephone Number L4 Address %el t^4-An'VJ �� License # ON 9 \AJJf2A 2X Home Improvement Contractor# 117 6 d Worker's Compensation # &j C� ).A � gS 6 d�0�1� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE-------------- FOR OFFICIAL USE ONLY " •- t= 'APPLICATION# DATE ISSUED b ` MAP/PARCEL NO. ADDRESS VILLAGE OWNER r c, DATE OF INSPECTION: -FOUNDATION _ FRAME INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING b/Z/ ` DATE CLOSED OUT ASSOCIATION PLAN NO. Ili - = The Commonwealth of Massachusetts Department of IndustrialAccidents - Office of Investigations 600 Washington Street Boston,M4 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers . Applicant Information Please Print Legibly Name (Business/Organi�m.tionUclividual): J�h c D-( -- n Address: City/State/Zip:-. Phone Are you an employer?Check the appropriate bi x: Type of project(required): 1.OE I am a employer with�_ 4. I am a general contractor.and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.n I am a sole proprietor or partner- listed on the attached sheet 7. EMemodeling ship and have no employees These sub-contractors have 8. 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.❑Electrical.repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.7 Roof repairs instn ante required]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other . comp.insurance required.] *Amy applicant that checks box P must also BE out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then him 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'camp.policy number.. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name: Policy#.or Self-ins.Lic.#: (�0.I _ Expiration Date: _L-�, h 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 violatot. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby.c der the pains and p es of perjury that the information provided ab a is true and correct -S i afore: Date: 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): Y 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5-Plumbing Inspector 6..Other Contact Person: w. Phone-#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. . Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partaership,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( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." . Applicants Please fill out the workers' compensation affidavit completely,by checking-the boxes that apply to your situation'and,if. necessary, supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)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 requiired to obtain a workers' compensation policy,please.call the Department at the number listed below. Self-insuredpom epanis should enterthei.r self-insurance license number on the appropriate lime. 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 perinit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current. policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or, ' town)."A copy of the-affidavit that has.been officially stamped or marked by the city or town may be provided to the' . - applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must-be filled.out each year. Where a home owner or citizen is obtaining a-license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 sRibuld you have any questions; please do not hesitate to give us a call. i The Department's address,telephone and fax number: The Commonwealth of Massachusetts : - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel,#617-727-4900 ext 406 or 1477-W.SSAFE Fax# 617-727-7749 .evised 4-24-Q7 _ . . www.mass.gov/din °FWE . Town of Barnstable ° Regulatory Services a... t R�RNCPLRi�R s nEAss. Thomas F. Geiler,Director 163 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.townbarnstable.ma.us Office; 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property liereby autho.t ze .'V\�.l.�l.,� to act on my behalf, in all matters relative to work authot zed by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Da QFoxMS.-OVMERPERMEsrorPooz�s 6n012 A ITT Town of Barnstable Regulatory Services 'Thomas F. Geiler,Director Ass Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:.508-790-6230 HOMES OwNER LICENSE F.XEll4PTION Please Print DATE: JOB LOCATION: number street village "HOMFA WT�IER": . name home phone# work phone# CURRENT MAIL LNG ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a.license,provided that the owner acts as supervisor. 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 shalt not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION I The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor," Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The bomeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may can t.amend and adopt such a foim/certification.for use in your community. Q:forms:homeexerript t54� The Official VVebsite of the Office of Consumer Affairs 8 Busine�ss�RegulaE10ip°C�ABRa)�� Consumer Affairs and Business Regulatwn'° � 4 41M $A , ......... .......-,.._. vim:�., Home Consumer Home Improvement Contracting " " n HIC Registration Complaints y Registration# " 117610 Home Improvement Contractor Registrant Registration Home Page Name STEVEN'MELLOR Address 199 PERCIVAL DR City, State Zip W BARNSTABLE, MA 02668 Expiration Date' 10/25/2014 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search r� _:__g Only - �tivaa�_ - License or re istration valid for indrvidu use °� gulation before the expiration date. If found returnrtoulation Office of Consumer Affairs&B smess Red IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business ly Reg HOME Type: I 10 Park Plaza-Suite 5170 . Registration: 7610. Individual Boston,MA OZ116 Expiration^ <70/212012 . L.MELLGI-, ST EN '1 STEVEN MELLOR� r•z' �= o �Si, aurot valid withoutn 1 g9 PERCIVAL DR W BARNSTABLE, MA�Q? c`� Undersecretary ; Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor 87 Licenser CS-JD -v,,,, STEVEN L MELL�R W BARNSTABLE �N Expiration 05122/2014 Commissioner . ___ .�",,O:Uca.state.ma.us/hic/licdetails.aspx?txtSearchLN=1... 3/27/2013 TE orZo� CERTIFICATE OF LIABILITY( INSURANCE DA03/2712013YY' a3rz7rzo13 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)_ CN PRODUCER 04331 -001 2 NAME CT Eastern Insurance Group LLC '"' �o No Extl: (800)333-7234 -- _— jQ4c-No.: (608)663.8089 _ 233 West Central Street I EIAAIL ' Natick,MA 01760 ADDREss:_....__ .._.--.......lf.#SOEL?ISI AFF0ROING.E4.VERA.GE. __._.._..__..1_...... _..__.. A LM Mutual Insurance Company ( 33756 INSURED INSURER Steven L Mellor . ....... 199 Percival Drive i West Barnstable, MA 0266E _..._._.._:..____........... _.._.... INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 11.1E 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. ILTR TYPE OF INSURANCE DDL SUER _ POLICY NUMBER POLICr EFF POLICY EXP LIMITS ._.__..{._.. .INSRI WVDi GENERAL LIABILITY ! i ' EACH OCCURRENCE 15 EN`I'ED cor..1f•6°-RGAL'GEI-JE.RALLIARILIT: ?F R 1l$ ,c cwicDcat , , I S , . j CL.Air S-MADE ! OCCUR i ° -----_.-- i MEC•EXP limy one person) I S —_......._.— , PERSGNAL o AL1w INJU^nY c I ! I 'GENERAL A G EGATE S rarL.AGGREGATF LIMIT APPLIES PER i � � i PRODUCTS-COrdP70PAGG S OUCY URD. I LO'_ I 1 T_ I ;COh�BIIJED SINGLE LIB+IVT S — AUTOMOBILE LIABILITY i i `'Ea a::cident BODILY jPe,AWY AUTO _................ r'- ALL O`JvTJED SCHEDULED ! I BODILY Ir,iJ'URY RY(Par�dent;:S i I AUTOS __ AUTOS i — T= .-.._..........__. NON-O IANED I I PROPERTY DAld+�1�.. ��5 —� HIRED AUTOS AUTOS i i ,? �r a-c�deill .�— w i 1 EACH OCCURF !S .a • UMBRELLA LIAB !{T"i=1JR I EXCESS LIAB I CLAIMS MADE I I y AGGREGATE::- — I DEC ?" RETENTION 5....... I --....._...-------------'-----------� - - - - - , I i rnJ K RS COf P� S T NT{.`RY LII1 75! ?_ER_ p{�KEE N qq GG i _ AND Et1PLDYE S CIABI�ITY_ YIN ! i ' I E L.EACH ACCIDEIf•I _ !S - 1 ,600 Ar•Y r Rr7j%r��Er'")RlPA.f�7 I,�r�;;:XECUTIVE----'-'I _—_ ,4 D�FICE�:,MEh1ErcR EX�LI`Ibc�', I N I:N 1 A i AWC7020385012012 12127/2012 121Z712013 �--- rMantlatory In NH) F.L.DISEASE-EA..DT PLOYEE S _ _......a: ,000 F I!lu�descrr!+=under i - ! I ELL.DISEASE..vLl Y LIM!"T S I ,Of30 E Gc�_RIPTIOh1-01:OP ATIOP1S _.-.__._..__._.__._._._.... - DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) I: CERTIFICATE HOLDER CANCELLATION Town of Barnstable 200_Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hyannis,MA 02601 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE' 1988-2010 ACORD CORPORATION.All rights reserved. :ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD 05/22/2013 13:22 6174849301 THE UPS STORE _ PAGE 02/02 May 21,203 Steve Mellor Mellor Building&Remodeling 199 Percival Drive West Barnstable,NIA 02668 RE:Detached Garage IV 120 Careen Dunes Drive Steve, As the owner of the property located at 120 Green Dunes Drive,West Hyannis Port,MA,I hereby confirm to you as my builder the following information with respect to my planned usage and intention for the detached garage being constructed on the parcel,adjacent to the new home and attached garage under construction as well. As an oversized detached garage,this building will NOT be utilized for living space.The building will be used: • To garage one passenger vehicle o Possible garaging of a second passenger vehicle via an installed four column hydraulic car lift • Use of a small wall mounted urinal and an adjacent sink for intermittent use/dean up • Shelves and small storage of tools,car related cleaning materials and other small equipment • Possible heating unit for intermittent use during cold weather periods • No partitions to be constructed;will be open rough-finished space • Again,no utilization as a dwelling or living unit Best Regards, David G.Brown 4� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s 1 --7 Map Parcel Application # Health Division Date Issued IL W Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board plc y18JIT L Historic - OKH _ Preservation / Hyannis Project Street Address I D_ Z .g Village' ^ Owner Address Telephone Permit Request (� c Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 S_�.Construction Type Lot Size 3� fi Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure NQu, Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) �` Basement Unfinished Area (sq.ft) 1 Number of Baths: Full: existing mil' new Half: existing new--� Number of Bedrooms: -!` existing —new Total Room Count (not including bath-;): 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: Arexisting Vnew size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use (-1 o Proposed Use o N APPLICANT INFORMATION Z N O: (BUILDER OR-HOMEOWNER) Name _ �/�V Telephone Number Address License# 0H 9 k?l Yn, r Home Improvement Contractor# I 726112 —Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE tl 1QQ DATE FOR OFFICIAL USE ONLY APPLICATION# r DATE ISSUED - a MAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: I -FOUNDATION FRAMES l . INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH -FINAL GAS: ROUGH 'FINAL I FINAL BUILDING -' DATE CLOSED OUT ASSOCIATION PLAN NO. lU�x+,J OL 4 1 t • 1 The'GTOlKlIIOlLNiB[llfli of�I[ISSILC IlSe1 3�:':t r{' -�'� a ;k'�s f '.f fl Yr i x•d �r r� f�o- ! ,..y _ ,� ! i .� f._ r Depar4nent Of LLdI[rSfl7.QI1�.C[�elltS� Office ofixt►esfiffatfons 600 Washington Street _ Bostoi,HA 02111 - www.massgovldia Workers' Compensation Insurance Affidavit:BmWers/Contractors/Electricians/Plumbers A PPReant Information Please Print Leuffily " Name(Bnsmess/ City/Sia&a. : Phone.# Are you an employer?Check the appropriate box: ro ect'(re4 e • 4. I am a al contactor and I Pa of P 1 1. am a employer with�_* ta have hired fhe sob-cont actors 6. ®'Now construction . employees(full and/or part time).- 2.❑ I am a sole proprietor or partner- listed on$re'atfached sheet': 7. ❑Remodeling ship andhave m employees These sob-contractors have' 8. ❑Demolition �� an es d have workers' . working for me m any�•P�S'• $. -9. ❑Buu>Zding addition [No workers' coin.in>mmic_e comp.insurance. requured] 5. 0 We are a corporatian and its 10.0 Electrical repairs or additions '3.EJ I am a homeowner doing aIl•work offictns have exercised their 11.0 Plnnbing repairs or additions right of exemption per MGL myself [No workers comp. 12.0 Roof repairs insurance required]t c. 152, §1(4),and we have no employees.[No workers' 13 J Other comp.mmrsnce rqqured] *Any applicant that checks boa#1 must also fM out the sc ction bdow.s'how ng floc's workers'compensafion policy information. t Homeowners who submit this affidavit indicating they am doing aU work and thm hire outside contractors must submit anew affidavit indicating such. tcontractms that check this boa must attached an additional sheet showing the name of the sub-contractors and stair whether or not those cotities have employees. If thc sub-conh=ton have employees,they mostprovidt their workers'conV.policy number. •I am art employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insuzance Company Name: p Policy#or Self-ins.Lic,#r` Expiration Date: r- . Job Site Address: Attach a copy of the workers' compensation policy declaration page'(showing the policy number an. expiration date). Failure•to secure coverage as regnaed 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 imprisonmP.,f as-well as civil penalties in the form of a STOP WORK ORDER and a fine of urp to$250.00 a day against thq violator. Be.advised that a copy of this stat mnmit maybe forwarded to the Office of - Iuvestintions of the DIA for insurance coverage verification. 16•hereby certify under the pains•and penalties of perjury that the information provided above is true and correct Sienatrrre��" • • Date: �•/ '� `'��)Z• _ . . Phone# Ojj7c4d 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): .',Board of Health 2,Building Department 3.City/Town Clerk 4.Blectricai Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone# . i 03/27/2013 15:36 FAX 781 261 2097 EASTERN INSURANCE NORWEL Q 001/001 I ,mac®®�z CERTIFICATE OF LIABILITY INSURANCE - F °ATE'M''v°°`{YYY' 03/2712013 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 04331 -001 :CONTACT - iNAME: Eastern Insurance Group LLC � ccNN.E,r,l (600)333.7234 FAX Na (608)663.8089 233 West Central Street EMAIL ._........____ _-_......_._.___._. Natick,MA 01760 ADDRESS: AYLM_Mutual Insurance Company -- 33758 INSURED - INSURER StevenL Mellor ,._.._._—8..:...-. . .........._._._.__.._.._......_....__--...__....--- --...__..._...----------;..._.-..._..................... 199 Percival Drive West Barnstable,MA 02666 7NsuRgS.p_u._..............._..._..._—..............__.......- -...,....,.....- —....................................._....... j INSURERS COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BE'O V 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 VVHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE IADDLISUBRI POLICY NUMBER ! -------_.._.- ----- _ --- POLIC' EFF POLICY EXP , .LTR_j_. ;INSR WVD= n1MIDYYYY 'MM/DOIYYYVI LIMITS ........_......_i_._.._._..----....__..._ �EACH- _.._...- .....---- --------_........ GENERAL LIABILITY ` OCCURRENCE 5 COr:1FAERCIAL5EIJERALUABi'_1 y ----..._..._...__....................., I A. S. i' I CLAiF.!S-PAaGE :OCCUR , I e person} S 'e.1EG FRCP rgny un PERSONAL n ADV INJURY ' I ......... L.-.G.,.REGAE-- -------.......... _. G f=TJC24 %+T i 5 CEN'L AGGrEGATF WAIT APPLES PER PROD DUCTS AGG IS POLICY PET O,, _....------ __- i:C'OM.371•JED SINGLE LIFAVT I S AUTOMOBILE LIABILITY fEa accident) ANY AUTO BODILY INJURY(Per person) 5 —_.._... r......- - -- - DIL ------........._..._..... .�ALL CANNED SCHEDULED I '—AUTO5 � irJTOS i ; BODILY INJURY fPer aadentj _ S HIRER AUTOS -- — All - a=C:denn t►.y I CJ — - -, ._...;:._... —....__.._..... `. •OCC_URF.EI _..... 5S.........W ...._....EACHUABRELLA LIAB i v�CJR ..... e+r i EXCESS LIAB 1 A..5 Fi:AGG € iAGGREGATE OEG RETENTION S .............................._.................................___.{_......._._...._--------------....................----------..`------------------ ... - "ipRKERSCOgP�NS^TIpN X , �"�•RSTI1T_:.. ...,E`1,' FND EtdPLOY�RS 11AVIL7TY 1 ! T v L 1 :_ „_••,< " YIN ! I-.._.:. ....... •:r•1'r i•R:i%RI'eT�R:PF r�T Fj�R;:XEO TIVE'----� I EL E CH,...0 GEI1. S .. „ 1 .000 A _FFI E ; "dE R EX tip % J N NIA AWC7020385012012 ) 12/27/2012 1111712/13 _ --- --(Mandatory in NH •-........ S -µi( ry ) c SE-Eh Erc PLOYEE a 000 °lrK d rt+^under j -�_ ....PO�I�.Y_—ur-ti— - d Rlar:drl ,F o= R.Anor:S tKtcv: DISEASE- .rT s S ,000 r j 0. if I � I I i I s DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space is required( CERTIFICATE HOLDER CANCELLATION Town of Barnstable 200-Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hyannis,PAA 02601 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C: � i 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD f 9 r. L t..k " {{ ��I -.r " t Sryl'ri • t .� r,:. .�tk " *A.r L;ri��'3��r : fj t e �$ t ,$i ty? sd, � & TovPn of.BAtA table ' Re k4 Services ' gui ry �• Thomas F.Geiler,Director - • Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 0260I www:t(;vmbarnstable.ma.us_ Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This .Section If Using A Builder I, e1J d5 , as Owner of the subject property hereby authorize )i��`� ,_l Q to act on mp behal f in all matters relative to work authorized by this building pettait (Address of job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. lg ture of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OVRMWERMISSIONPOOLS 620I2 r Town of Barnstable ' Regulato -�.Services n .. • ra, • Thomas F.Geller,Director ,� �•�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 .Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number - street. • village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/,town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. 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 brie home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the-Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit.' (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner I Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, '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 y Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt ' I JOB ��"� tag• Nod'Z�1--S �0 Lis TAYLOR DESIGN ASSOC., INC. SHEET NO. ( OF 2_ P.O. Box 1313 Forestdale, MA 02 02644 CALCULATED BY- � DATE �•r ��•.�� Tel./Fax: (508) 790-4686 A� ' CHECKED BY DATE 'SCALE ZM OF G111Ei0 .... 7AYL i3lCYN Moot 2... ....: ....... ....... ... /mod ......... NAL .... .... .... L� � Co+ i rVC� .6. . s'e"v.po._Y' - �-� t .. .. ... . Jd�sYs. _� �c. G.. ... t ocss_ .. Z caw'Y• ...... ..........: �.,�. C w ................_..3. S ?.... . 3 �03 - Ssr�T ti 'k t ��, `3P l /_� /�taoc... . ..- ... . ...L .... .. G .... ,, _ ... _.. Tat �P tZs- .. SY� -t'c 5-rv .c_a ovrt... ._C-r. su �zC .. ... .. . . .. L ... V .... . w Z 3 7 5 Pam. t:3 o . __ �., c--aUf V- ... ... .. ... 38'C+ t4� I JOB i "O� tog J TAYLOR DESIGN NC. Q ,! ASSOC.,� SHEET NO. •`"� OF P.O. Box 1313 _ Forestdale, MA 02644 CALCULATED BY cz T DATE Tel./Fax: (508) 790-4686 CHECKED BY DATE ZQ SCALE �.afrsar - �1a•NNtS''PbR."C' .. ....... ... .... .... . . ... l C-rtU 1 e�0 t r�G a.;-�R�1n. S Coves r tt7 0 . ... ... K ._ ��;__..L.�/C.. S ...... t;y.... 1( c� C too --• Zr�s T-c 4o Z S-c• " +� o�,, ... ... .. . . ... ov1.- ... !i `� _.. 7 'SQL l �j v/ Z t4 x It / . c._ S . .... K Z...... ir IcK.L .......... ........... ....................... L .... ........... .L. . .. .... ?s` S0o..G.4 ........_ . ...... r - 04/05/2013 13. 10 FAX 508 655 8853 EASTERN INS COMML IR 002/002 February 7, 2013 I-d,BTFORD CITY BARNSTABLE Building Dept. 200 vain Street Hyannia, MA 02601 REINSTATEMENT NOTICE Re: Bond Number., 09ssBGI9530 Principal: sloven L. Mell r Bond 1 pe: ay and street PerMILS On 1/16113 ,we sent you Nonce of CaucellationlNon-Renewal on the above- bond to be effective days following receipt Please disregard our Notice of Caneellation/Nou-Renewal and consider this bond in full force and elfeet without interruption. We are sorry for any inconvenience this may have caused your office. HareECrd casualty Insurance Covany Jessica Ciccone, Attorney-in-Fact . ,y CC' Steven L. Mellor Q 71 199 Percival Drive t west 8arnstabls,MA 02668 C: BASTVM INSURANCE GROUP LLC N 231 WEST}CENTRAL STREET NATICK, MA 01790 ACT:Please forward a copy of this reinstatement notice to the insured.Thank YOU. a ' PROJECT t . NAME:- �CJw ADDRESS: 10eszo-, Uy�o., PERMIT# St PERMIT DATE: OLf LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered Yn MAPS program on; t'6 �.�. t Z_ Doa=1 r 169 r O79 07-01-2011 3:179 Ctf*=194666 BARNSTABLE LAND COURT REGISTRY QUITCLAIM DEED We, William F. OToole, Trustee of The William F. O'Toole Trust of July 3, 1992, created by written Agreement dated July 3, 1992 as evidenced by a Trust Abstract filed with the Barnstable Registry District of the Land Court as Document No. 1091814 and William F. OToole, William F. O'Toole, Jr. and Michael L. Brown, Trustees of The Dorothy J. Toole Trust of July 3, 1992, created by written Agreement dated July 3, 1992 as evidenced by a Trust Abstract filed with the Barnstable Registry District of the Land Court as Document No. 1091815 , for consideration of SIX HUNDRED SEVENTY ONE THOUSAND AND N0/100` ($671,000.00)DOLLARS paid, grant to David G. Brown and Ann Marie Brown,husband wife as tenants by the entirety, of 66 s Payson Road, Belmont, MA, with QUITCLAIM COVENANTS, A certain parcel of vacant land known as 120 Green Dunes Drive, Barnstable (West Hyannisport), Barnstable County, Massachusetts'described as follows: , LOT 24 LAND COURT PLAN 15694-D(Sheet 2) The Premises are conveyed subject to and with the benefit of all matter set forth or expressly referred in Certificate of Title No. 186189, insofar as they are now in force and of effect. For title see Certificate of Title No. 186189. Grantors hereby certify as follows: 1. That the Trusts are still in existence and that we are the duly appointed and incumbent Trustees of said Trusts; 2. That the Trusts have not been altered or amended; 3. That the Trusts have not been revoked and are currently in full force and effect; 4. All of the beneficiaries of the Trusts are of full age and competent;and 4. That we have been authorized by the beneficiaries of the Trust as follows: to execute, acknowledge as required and deliver any and all documents necessary to effectuate the sale by the Trust of property Known as 120 Green Dunes Drive, West Hyannisport, MA for consideration of$671,000.00. -SIGNATURES ON FOLLOWING PAGE- MASSACHUSETTS STATE EXCISE TAX BARNSTABLE LAND COURT REGISTRY We: 07-01 2011 a 03:09vm Ct1Y: 1100 Docr: 1169079 Fee. $2►294.82 Cons: $671000.00 BARNSTABLE COUNTY EXCISE TAX BARNSTABLE LAND COURT REGISTRY Dotal 07•-01•-2011 D 03:09am 11.00 poet: 1169077Q Fee; $IP311.111 Cons:. $671.t000.00 - Executed under seal this day of ,.,2011. William F. O'Toole, Trustee of The Mllia F. O'Toole,Trustee of The William F. O'Toole Trust of July 3, 1992 Dorothy J. O'Toole Trust of July 3, 1992:a William F. O'Toole, Yr Trustee of The Michael'L. Brow , � stee of The -4 " Dorothy J. O'Toole Trust of July 3, 1992 Dorothy J. O'Toole Trust of July 3, 1992 , 4" COMMONWEALTH OF MASSACHUSETTS County: o-r t - . On this 1 day of r-3 tl `t > 2011, before me, the undersigned notary public, personally appeared William F. O'Toole, Trustee as aforesaid, personally known to me ,. ULU to be the person whose name is signed on the preceding or attached document, and acknowledged to me-that he signed it voluntarily for•its'stated purpose:" otar P co ices: JEFFMR JOHNSON a Notary"go commonweOnh of MQ=htUetis ly Commmon WIres COMMONWEALTH OF MASSACHUS fyovem t0,a017 County: �PK � On this !�T day of `J y �' , 2011,' before me, the undersigned notary public, personally appeared William F,O'Toole, Jr., Trustee as aforesaid, personally known tome or evictence or OEM i to be the person whose name.is signea on the preceding or attached document, and acknowledged to me that he signed it voluntaril for its stated purpose. ota c con is expires: , FFERY J O HNSON ` Notary Puboo Commonwoaith of MGedc&&rifts MY Commuon hoa a November 10,2017 — �. _.. ........... . ......_..... ....... _.... N Law Office of JEFFERY JOIINSON, ESQUIRE 1550 Falmouth Road,Suite 16 Centerville,MA 02632 jeffna jefferyjohnsonesg.coin•• (508) 790-5776 Telephone (508) 775-1945 Facsimile June 17,2011 Thomas Perry Building Commissioner Town of Barnstable 367 Main Street Hyannis,MA 02601 Re: . Buildability of an "Undersized Lot" Locus: Assessors Map 245,Parcel 139 Lot 24 on Land Court Plan 15694-D 120 Green Dunes Drive, West Hyannisport, MA Dear Mr. Perry: Please accept this as my written opinion,that for zoning purposes,the above-referenced lot is a nonconforming lot exempt from the current minimum dimensional/lot size provisions of the Barnstable Zoning Ordinance/Regulations. The title history of lot 24 and the three adjoining properties are attached as exhibits to this letter. The history of the zoning in this section of the Town as it relates to lot 24 is as follows: According to the February 1985 "Zoning By-Laws" of the Town of Barnstable (copies of the relevant pages are attached) lot 24 was in an RD-1 district,which required only 20,000 square feet of area,20 feet of frontage and 125 feet in width. Lot 24 has 170 feet of frontage/width and has an area in excess of 34,500 square feet. On February 28, 1985,by article "One" of the Town Meeting of the Town of Barnstable the minimum Lot size for the subject area was increased to 43,560 square feet. This is the first date on which lot 24 became a so-called "non-conforming/undersized" lot. On the date of this change, lot 24 stood in separate and distinct ownership and control from the 3 adjoining properties and has remained in separate and distinct ownership and control from those 3 adjoining lots ever since that date,i.e.title to the same has never merged with any adjoining lots,nor has "control"been shared by any adjoining lot owners. 1A Page 2. Based on the foregoing it is my opinion that under the single lot protections of the Town of Barnstable Zoning Ordinance(§ 240-91. A attached)and under M.G.L.c. 40A section 6 (copy attached),Lot 24 remains "buildable". Lot 24 was not held in common ownership with any adjoining land at the time of the zoning change which made it non-conforming, and has a minimum of 5,000 square feet of area and 50 feet of frontage and conformed to the existing zoning when legally created(a subdivision plan was approved by the Barnstable Planning Board) and was separately owned at the time of every zoning change which made it non-conforming. It is therefore my opinion that Lot 24 may be built upon for residential purposes under the current zoning ordinance and/or under M.G.L.c. 40A section 6. Very truly yours, e on Enc. 2 TITLE/ZONING. HISTORY LOT 23 DATE CERTIFICATE NO. 8/17/1972 Wendell P. Chamberlain to Wendell P. Chamberlain 55807 and Pauline M. Chamberlain 3/1/1985 Zoning changes 8/5/1998 Wendell P. Chamberlain and Pauline M. 149623 Chamberlain to Wendell P. Chamberlain and Pauline M. Chamberlain, Trustees of the Chamberlain Family Realty Trust TITLE/ZONING _ HISTORY - LOT 25 DATE CERTIFICATE NO. 3/18/1983 Norman R.Meier and Margaret F. Meier.to Margaret 91312 F. Meier 3/1/1985 Zoning changes 9/16/1994 Margaret F. Meier to Norman R. Meier and Margaret F. 135025 Meier `4/25/1997 Norman R. Meier and Margaret F.-Meier to Georgia H. 144249 Welch 9/23/1999 Georgia H. Welch to Robert W. Bashian and Eleanor L. 154876 Bashian 5/21/2009 Robert W. Bashian and Eleanor L. Bashian to 188595 Robert W. Bashian 5/21/2009 Robert W. Bashian to Robert W. Bashian and 188596 Eleanor L. Bashian TITLE/ZONING HISTORY LOT 24 "Locus" DATE CERTIFICATE NO. 10/9/1971 Thomas H. O'Toole, Jr. and Laura H.O' Toole 53376 to William F. O'Toole and Dorothy J. O'Toole 3/1/1985 Zoning changes 6/12/2008 William F.O'Toole and Dorothy J. O'Toole to 186189 The William F. O'Toole Trust and the Dorothy J. O'Toole Trust 5/19/2011 Death Certificate of Dorothy F. O'Toole Affidavit of No Estate Taxes Acceptance of Appointment of Trustee for Dorothy J. O'Toole Trust TITLE/ZONING HISTORY LOTS 16 and 17 DEEDS DATED CERTIFICATE NO. 8/1/1971 Harriet E. Kenney dies, will leaves lots 16 and 17 70023 1/5 each to Elise K. Irving, William Ellwood Kenney, Harriet K. Pinney, Robert L. Kenney, Jr. and John Henry Kenney 3/1/1985 Zoning changes 4/12/1993 Elise K. Irving to,Frank L. Fortunato,Jr. and 130071 - Marie A. Fortunato, 4/14/1993 John Henry Keeney to Frank L. Fortunato, Jr. and 130071 Marie A. Fortunato 4/22/1993 S. Michael Schatz, Raymond A.-Keeney, II and 130071 Robert L. Keeney„III, Co-Executors of the Estate of Robert L. Keeney, Jr. to Frank L. Fortunato, Jr. and Marie A. Fortunato 4/27/1993 Harriet K. Pinney to Frank L. Fortunato, Jr.and 130071 Marie A. Fortunato 4/28/1993 Ellwood Keeney, Jr. and Christine B. Kenney, 130071 Co-Executors of the Estate of William Elwood Keeney to Frank L. Forhmato, Jr. and Marie A. Fortunato ANS '/POQ/NSOM ET AL. yELEM RANOOL PM fL12ABETM S. MAY D E M Cho OP Ito ! /r OD ! iSDOb gyp; IIGI 00 0 •�s'it'a°b'♦ V ce : : ap �, Of 46 / CREENi�` DUNES .�•it a `r of $ Z N� /5000to-flu 0 O ~ o ! e a 4► i A a .s -s_ _,- '__4'_� 6 _ ♦ Y - itO/ ! 16041 S/4 �. -ss6`s° 4t _ ___ -� S T. �•� ' � � r '' � �- �� '� e�/7...� -•# -"�x_; '�?ems p feet Wids, o � ��: �� 23.�7I ^ 4 NR a HALL M 40 O A DArEll�la:oavrYn ACORD,, CERTIFICATE OF LIABILITY INSURANCE ,.1 3-'20 12 PRODUCER r ,^a; THIS CE IFI ATE 15 ISSU D A5 A MATTER OF INFORMAT10N ONLY AND CONFERS NA RI®HT$ UPON THE CERTIFICATE rn _nsu��.n_a �rccp L L C -Ccnrerc_a L= HOLDER, THIS CERTIFICATED D0 D Y AMEND EXPEND OR Ea3te 23{ i+dest Csr,tz sl 5t_eEt ALTER THE COYEF�AGE AFPr ! BY THPS PQ IE 9ELOW. 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P6IleONAL&AD'1 IlylullY E�fERC1AL G B 0 7C7 A mfimAIF lR 1 GENERAL'AGGREGATE s 3 00�__ PRODUCT 6•COMP/OPAli4 9 �li ,�.c -G-E-Ni AGGf1EGAT E LIWT APPUES PER' 1 POLICY I PIT Loc 1 j I I CO SiNEDVNGLELIMIT 10 I Ali1OAlQBILELIAEyUTY �— i ? I A,4 f AUTO I ALL oaEDAUTOG ! ! !ECHEDULEDALITOB I ' r"� 1' 1 ` I BWLYINJIlF1Y i; ozm HiRED AUTOS I -_ i NCN•OWNEDAUTOS , IIPaa PEATY a.Iditt}M1l!GE ri AUTOOPI:Y•EAACCIDENi Is - I flARAOEWABIWTY I EA ACC I I I ANVAUTO I I i AU7(ILYN A4�p— 1 t^ I 1 EACH OCCURRENCE EXCgS&UMBRELLA UAEIWTY !' y AGGREGATE 4 OCCUR J CLAIMB MAW i I 1p i DEDICTI6Sc i RETENTION I A g wowcERatIPEIasATN IOAND IzL:I;.;02C.°.@50120ii i12r'27/2�_i1112/27/202 IE.L.EACH ACCIDE $ _ I EMPLOYERS'LIABILITY ! I UJY PROPRIE113RPARiT�il ,VE I 1 E I El DISEASE EA EMPLOYEE S IOppC[F{rN1py13EAfXCLu ? u �uad pldl'A8E•POLICY MIT A INS I*' OTHER i I i DESCRIPTIONQPCPERRT10Nb/LOCATIONS/VEMICLES/EXCLUSKOMMOADDED8Y ENDCRBEIN�T:'SPECIALPRC 1BOh6 JxkaT3 Corp �Brt111C3:8. LG LU11ov �TGIA CESI:@: CANC T N ^ n CERTI C TE HOLD R S6CULC ANY OF ::m ?BUVE DESCRIBED iC3IC:E8 PE w4aC3LLED EE:ORi TE8 EY£I?�.T:.� DATZ TK-i32ECF, SE IS?UING i:5 JREA Toca. OL Barn9�ahle 54---' ENL'8?1VJR .O :ian 30'ZMS WFITTYN fifO:ICff TO Ta3 3r;7. N_uitl StrL`Pt CLR�IF_CRTE HC:,UER `3IFC TO TEL LF.F_, BUT FF.,LURE i Ya Vain JF .OGEC= BO a(i4IL :.1P0gE vD CSTloAT:CN CR :IFa.,IT: Or A:1X BIND U'Di`' TilE :NSG•RL�, =Y5 .I-GENTS OR FE?P"SEN`"ATI`iES• A;l1'MOR2ED REP P1EiENrATNE /»•aw;,;' `y';..» ' @p/ECORD CORpgRATIQN 1g88 ACORD S6(Z001108) Affidavit of Substantial Financial Interest wj_:- P 1, of , on oath depose and state as follows: 1. 1 am an applicant for a building permit for the property located at Mapti Parcel . The address of the property is nA. � ,�,p CIAAA LV H ,( 2. 1 have V % legal or equitable interest in the real property which is.the V subject of the building permit application which is identified.,in paragraph 1 above. 3. Within in the last twelve months from today's date, which is A I the following individuals or entities have had a 1% or greater legal or equ-itable interest in the real property which is the subject of the building permit application which.is identified in paragraph 1 above: Name Address 4 r 4. Within the1ast twelve months, from today's date, which is I have had a 1% or greater legal or equitable interest in the following properties which have been the subject of a building permit application: Map/Parcel Address 5. Within this calendar year, I have submitted building permit applications-for property in which I have a 1% or greater legal or equitable interest. 6. Within the last ten days, l have submitted building permit applications for Y 9 P PP property in which I have a 1% or greater legal or equitable interest. 7. Within this month I have submitted uildin9 permit applications for property Y in- which I have a 1% legal or equitable interest. 8. Within this month, I have received building permits for property in which I have a 1% legal or equitable interest. Signed under the pains and penalties of pe 'ury, this 0_3day of 200_. 2001-0050/affin 1 0/LOTTERY/AFFIDAVIT N N? 15694 SHE E T `` /• ® �� SUBDIVISION PLAN Or LAND IN BARNSTAkE Bearse & Kellogg, Civil Engineers ) Maroh 29, 1954 1 �` 4Z13.tg69•tr' 1 '•, N I y �a R;;/ '6•. as c � `� - Gt4( y ' v ,,, t ,r gGe to cu ,-i 1-4 LA , - O*.>% ! i I � U "o ( ••wP \ '� N mi N \ \�` I ! t4i 1 - rl r-I i3,OW ON gar+ 1 ! wwa Go t~ H 111 43 141 0 PC ' HALL Cd .a,� a4) , Poo W w N k.OG � p,/pv wo'r� 1 /any/Nc/r..u.•.� M 2 Je L�ryr e�u/der Sspd/a/s c�tt/Its of Isdued FOR L o TS a rmfiu 44, Cow oras,i of p/an B,C,Qf..f ti M� t d ..... s .alw+ni Mason AND ON SNEET 8. (,gyp REG/STRdA•T/ON orf7cf Bj�r/+e COU JULY /./9 4 �� .. . .. Sw/r arthlsp4A/60 W to inalndl/A C.M.ANDfRSON.GfPUTY ENO/NEEA Dac: 1s166s253 05-19-2011 8:46 BARNSTABLE LAND COURT REGISTRY The Dorothy J. O' Toole Trust of July 3, 1992 Acceptance of Appointment as Trustee WHEREAS, The Dorothy J. O'Toole Trust of July 3, 1992 was created by written instrument dated July 3, 1992 and most recently amended by Restatement dated Jun 5, 2008 ("2008 Restatement" ) ; and WHEREAS, Dorothy J. O'Toole was the sole Trustee of the Trust until her death September 4, 2010; and WHEREAS, the Trust provides at Article 12b of the 2008 Restatement that upon the death at when Dorothy J. O'Toole ceases to serve as Trustee her husband William F. O'Toole, her son William F. O'Toole, Jr. and Michael L. Brown are appointed to serve together in her stead; and WHEREAS, William F. O'Toole, William F. O'Toole, Jr. and Michael L. Brown, intend by execution of these presents to accept their appointment as .Trustee; NOW, THEREFORE, William F. O'Toole, William F. O'Toole, Jr. and Michael L. Brown, hereby accept appointment to the office of Trustee, effective forthwith. IN WITNESS WHEREOF, William F. O'Toole, William F. O'Toole, Jr. and Michael Brown,. have hereunto .set their hands and seals _. as of this ay of May, 2011. William F. O' Toole William F. O'Toole, Jr. `" .. Michael L, Foundation Certification in West HZannisport MA . Prepared For : David Brown Address: 120 Green Dunes Drive Assessor's Map: 245 Lot: 139 Baxter Nye Engineering & Surveying Community Panel Number 250001 0008 D Registered Professional F.I.R.M. Map Zones: Zone C Engineers and Land Surveyors Plan Reference: Lot 24, Land Court Plan 15694—D (Sheet 2 Of 2) 78 North Street, 3rd Floor Hyannis, MA . 02601 Certificate of Title: #194,666 Phone — (508) 771-7502 Fax — (508)-771-7622 Date : 11-30-2012 & Owner: David Brown Job Number: 2011-022 Scale 1 = 30 12-17-2612 GARAGE A MAP 245/PARCEL 018 N/F a FOUND DH ROBERT W. & ELEANOR L. BASHIAN rn cp LL. 00 Z N 2 - S �2.44, 4 � W l l 2p8 S?S e _ v '/ J� o / co 00 , of Mo 02. ? (0 >6' 5.9J Q CD 2 w 0 _ o) 4.0 , 0 LL' N !2 0` N' ASSESSOR'S MAP 245 LOT 139 - - / 10.991• LAND COURT LOT 24 � 9oz Mo J"2a' AREA=35,040 S.F.f o m - N / ?5.96, g J �k / Ex/sn C O ^ TO FOU1& aj F�232,t14 W, o 203 72. cf) �� N '2 .44, b r OS W N r N MAP 245/PARCEL 019 N/F h 'WENDELL P. & PAULINE M. CHAMBERLAIN, TRS. CHAMBERLAIN FAMILY REALTY TRUST I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE EXISTING "STRUCTURES SHOWN HEREON IS d IN COMPLIANCE WITH THE APPLICABLE BARNSTABLE ZONING. DISTRICT SIDELINE AND SETBACK ��N OF M REQUIREMENTS, IS LOCATED IN RELATION TO THE MONUMENTS SHOWN AND IS NOT LOCATED WITHIN A SPECIAL FLOOD HA_4ARD AREA. o`er SHANE M. n THIS PLAN IS NOT RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY LINES. 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JOINT DESCRIPTION -T or- Wurmrn or nAn.erAcuw. NDR UTl.RT'STIUIPI tA_470N NAttD BOX NA" STUD _ - ININVOK BILL ROOF FRAMING q1L2A�EIZ TO PLATE GONNEGTION w BLOCKING TO RArTIJs(7p�NAIIID) EACH QII7" - aCALB.N.TA - RM BOAND 7o IfArT'!7�(a►b mr—1 2-Kd a-kd EACH END • . Il V MTALL-:Ft�lAF11NG. I ��; Q �^j Q� TOP-PI.A*m AT (PACE NAILED). 4-IId 6-lid. AT.PINTS •2-wd C : I i ODL TOP PLATE STUD To.sTLID(PACE NAILED) 2-kd 24•a . O:C rl Y�NE*DOS To NEADEN(FACE WALm). kd Idd 20 .ALONG EDGES � � �I � i � - � - �v/Z i vti I 6/S•AWLGIOR not •ai• I I w Q Z FLOM FIUMING- I l7 �z JOIST To GlUv TOE' KATE ON GIImER(TOE HAILED) 4-ad 4-IM I=JOIST � - . � ^�_ - � � _ MIN. 5cV4 PLATE I•IASHER 'r � Q Z a w 000NG TO JOIST(TOE NAILED) - - a-ee 2-1" RAW Erb 7'� eLoc+aWw TO SILL ae TOP ruTe(rx NAILJ9) a-idd 4-Idd tACN et.00K. 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BASHIAN FOUND LON / �/ � z0 / Q N Q �2.44. e � W l o f 208 S2 s E / CO J w 02, 20.ge. 4.>s• 00 1 .s 8.16 n' Q '^ O V a 2 � . /O / _ 9.97. 'to B o A��SES.3Vf J MAP 245 LOT 139 �z _o r 20,• o Io.s9•^ LAND COURT LOT 24 ^. Q / 9'02' ^o 323 AREA=35,040 S.F.f 3 o J2 Cb � 2o.s3. � tq8j, a4 N V / - - Q v - 25.96• � Y 2 O n OVS7� G FDIle U / O of c Na4n . O (GgR4G?t �N M 2p3, e f� N "2.44.0 5- W w 30�0 N t MAP 245/PARCEL 019 N/F a° WENDELL P. & PAULINE M. CHAMBERLAIN, TRS. CHAMBERLAIN FAMILY REALTY TRUST I I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE EXISTING STRUCTURES SHOWN HEREON IS IN COMPLIANCE WITH THE APPLICABLE BARNSTABLE ZONING DISTRICT SIDELINE AND SETBACK ��H OF M REQUIREMENTS, IS LOCATED IN RELATION TO THE MONUMENTS SHOWN AND IS NOT LOCATED WITHIN A SPECIAL FLOOD HAZ RD AREA. o�' �^ SHANE M. THIS PLAN IS NOT RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY LINES. BRENNER ^ No.45917 _ i 2 //Z= ' o�FJs��FGIS S�Q R ISTERED PROFESSIONAL LAND SURVEYOR - BAXTER NYE ENGINEERING & SURVEYING DATE 0:\2011\2011-022\SURVEY\WORKSHEET\2011-022_CPP.dwg, 12/21/2012 10:52:32 AM, 1:1, ACN • �l�3�1Z � �JkSE p niLy� Foundation Certification i n West Hyannisport , MA . Prepared For : David Brown Assessor's Map: 245 Lot: 139 Baxter Nye Engineering & Surveying Community Panel Number 250001 0008 D Registered Professional F.I.R.M. Map Zones: Zone C Engineers and Land Surveyors Plan Reference: Lot 24, Land Court Plan 15694-D (Sheet 2 Of 2) 78 North Street, 3rd Floor Certificate of Title: #194,666 Hyannis, MA 02601 Phone — (508) 771-7502 Fax (508)-771-7622 Owner: David Brown Job Number. 2011-022 Scale : 1" = 30' Date : 11-30-2012 A / nN MAP 245/PARCEL 018 0 ROBERT W. & ELE/.ANOR L. BASHIAN / to N LL O O zN . 'Z .S J l �l �2*44'05• w q 2p$52 £ 00 0 / co / Q 8 >6 ^O 88 /O 9.9>. 0 �� / - �•~ _ N. N _.. LOT 24 ?o - — -AREA=35,040~'S.Fa / �2• °b 3.2g. 3 O ow �Z O O / 10 20.g3. 10 :8q. 8> LhN 4Q / co o N N / 25.98 2p3,72, \ A N 72�44'05b ¢ W iri O - N O ' MAP 245/PARCEL 019 (o N/F h WENDELL P. & PAULINE M. CHAMBERLAIN, TRS. a CHAMBERLAIN'.FAMILY REALTY TRUST n. U N � N O O i N W W 2 Y I CERTIFY THAT TO THE 'BEST OF MY KNOWLEDGE THE EXISTING STRUCTURE SHOWN HEREON IS IN COMPLIANCE WITH THE APPLICABLE BARNSTABLE ZONING DISTRICT SIDELINE AND SETBACK 0 REQUIREMENTS, IS.LOCATED IN RELATION TO THE MONUMENTS SHOWN AND IS NOT LOCATED �� ,. } WITHIN A SPECIAL FLOOD HAZARD AREA. w JOHN THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY LINES. Ln 298,1 o REGISTERED PROF SSIONAL AND SURVEYOR N BAXTER NYE ENGINEERING & SURVEYING DATE N ,-a O N Z ¢ '