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0204 GREEN DUNES DRIVE
�� .�� _ .. . „ .. ;� . u. �4. - � u �, .. �. ,. � .©, o _,. ,. -. .. ,� ., o _ _ ., _ - i - e .. �. .. a _ a _ _ ., .. a .: ,. .. _ I s�. - .: � - �� : .. ti � � - �� ,. .� a - � ., ' � � - ? � s� � - _ - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map Parcel d `� Application # Health Division, 9; {�r Date Issued Conservation Division Application F Planning Dept. - Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis 7 Project Street Address ��_ i.�. , a Cc�D Village Owner Address '1_falwl� Telephone Permit Request422ie�� Square feet: 1 st floor: existing �y proposed 2nd floor: existing proposed Total new _ Zoning District Flood Plain Groundwater Overlay Project Valuation 3� ��. Construction Type_ Lot Size �� 3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �( Two Family ❑ Multi-Family(# units) Age of Existing Structure f , Historic House: ❑Yes X No On Old King's Highway: ❑Yes �61\lo Basement Type: Xt Full ❑Craw`ll ❑Walkout ❑Other Basement Finished Area (sq.ft.) Sv Basement Unfinished Area(sq.ft) L 2-00 Number of Baths: Full: existing `� new Half: existing I new_ Number of Bedrooms: existing 0new Total Room Count (not including baths): existing r new First Floor Room Count 7 Heat Type and Fuel: X Gas ❑Oil ❑ Electric ❑Other Central Air: ;A Yes ❑ No Fireplaces: Existing 3 New Existing wood/coal stove: ❑Yes )d No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:)9 existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ,'d No . If yes, site plan review# y Current Use d iZu� Proposed Use APPLICANT INFORMATION - - - (BUILDER OR HOMEOWNER) "Name Telephone Number Address G J OL,c.cJ-�»�y License# C J - O 'S 0 34 O Home Improvement Contractor# l I ? Oqg Email S bc-GOA.ipleGta01 6)GOr'j'1C,O!; Rohe, Worker's Compensation # Wa,s,00 50/l o0 72-017 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �Z6�� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME hr I INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �;j w A, e DATE CLOSED OUT ASSOCIATION PLAN NO. ' 27ze Comuzorrivealtlt ujf Vassad iusetfs D aratte7zt a rndastrial AccideTds . f3}fzce oflFnr.TSfigatitnu 600 Was ingtorl Street Basforx,?VITA 02111 r itnou,masmgvv1dia "riarkere Campensatimt Insu-mce Affidavit BmlderJCunfractarsMect icians/P u nbers Apphicant Infarmafrnn Please Print LegiblyName(Busj�miizafimadMduady- fz"Ik2� A,,, �if�l 4atef ig PhOnO 4, �50 9'. 7 Areyou an employer?Checktheapprepriatebom ' Type of project r 4 I am a general contractor.andI YID P J { �'= • I.�I art a empla�r veith�_ � ❑ employees(full an&or part--lime * have hired the sub-contractors-fors 6. New consiiuctxon 2. I am a sole proprietor arpartner- risted on.the attached sheet. 7. ,�Remodeling slip and have no employees 'These sub-contractors have 9.,,®Demolition working far l a in any capacity. employees and.ham a worke-re 9. Building addition [No updzere comp.insu nce comp-insurance I . retlaired] 5. We are a corporafioa and its 10_M Electrical repairs or additions 3.❑ F am a homeowner doing all work officers have exercised their 11-[ Plumbingrepairs or additions.. myself-[No wokkers'gip_ of exemption per MGL 12-❑Roofrepaim insurance retEnired]i c.152,§1{4k and we have na employees-[No workers' 13.❑Other cone.insurance required.] 'Any W fcwt&st cbedcsbox ffl I also Montt the section below shuming t6eirwoikers:'compensatiaapeliicyiaformsdmL #FFomeoovneis who submit s3tis.af$davu indicating thry am doing addwadc and thenhoe autsiderontractorsumct SSIltlftit a newaf&daest Indleatlao sacFi fCbntraciars,d=checYthis bout must attached=sdditinnal sheet showing the nnw of the suVcoat<rwb-zsand state whether or not those entities have emplayeas.Ifthe sub-cantcu tmsbave empdoymes,tbeymustpm-!de their workers'-rump.policy n mmber. I am all erltplo1wr tlerrt is pralzding,workers cougm-nsa an insurauce f'or rtry enrp&&,zes $eIoty is the policy rind job sae information. Insurance CompanyName: Poky#or Self--ins.I.ic., G)G 5O®�5O/L O.Z Z O/7 F—Viration Date: Job Site Address L�`y o iZ�P/�t��'/ ,Ldi �/I.1/11�� CtfylStatel.tp:' Attach a copy of the workers'compensationpolicy declaration page(showing the policy number au respiration date.). Failure to secure coverage as required under Section 25A of MGI.c 1572 can lead to the imposition of criminal penalties of a fine up to$L500.00 andfor one-yearimpfisonmeag,as will as trail peaatties.in the form of a STOP WORK ORDERand afrne of up to$250-00 a day against the violator. Be adtdsed that a copy of this statement_may.be forwarded to.the Office of L esk gaticns of the DIA.for imsi mmce coverage'smriff-catiom. I do hereby certr�T rairder tl-te pawls a7trl haloes o pedury dutttlte ucJorma€iau prm d a bot'e.is tsars and r-orrect " sizature_ Date: PhGnBikO / O dal use anTy.. Da not write in thb area,to be.completed by city artowl ffflciat. City or Town: PermitUcense# Imuing--tuthority(cirdee one): 1.Board of Health 2.Building Department 3.City1rown Clerk 4.Electrical Inspector 5.Plumbing Fnspector 6.Other Contact Person: Phone#: - 4aformation and las ct-ions Massachusetts Gf-nmal Laws chapter 152 raga res all employers to provide wormers'compensation for their employee's. pmmaantto this ,as m47rayee is defined as."_.everyperson.in.the service of anoihez under any cortract ofhire, express or implied,.oral or writ." An.employer is defined as"an indiyi dual,pm nersbrp,association,corporation or other legal e�y,or a�two or mare of the foregoing engaged in a Joint cnfrzpase,and including the legal represenfa&rs of a deceased employer,or the receiver or tmstee of m individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having-not more than three apartments andwho resides therein,or the occupant of the- dwellin g house of another who employs persons to do maim mmw,cons m-t;on or repair woIk on such dwelling house or on the grounds or building appurtenmt thereto shall not because of such employment be dcamed to be an employe r-" MGL chapter 152,§25C 6)also sLrEc that"every state or local licensing agency shall withhold the issuance ar renewal of a Ticerhse or permit to operate a Tiuskess or to construct buildings in the commonwealth for any g applicant who has not produced acceptable evidence of compHanm with the insurance coverage r-equi re&" Additionally,MGL chapptr-r 152,§25C(7)states Neither the commaawealth nor a'ny ofifs political subdivisions shall enter iatD any co.ntmd for the performance ofpubIic work uaihl acceptable evidence of mmpliancewith the;ncr,Ta„cCt>. regzm-emerrts of ibis chapter have been presented is the contracting ar�ho�" Applicants Phase 5lI oil the workers'compensation affidavit completely,by checI a boxes that apply to your sitnatian and,if necessary,supply soh-contractors)name(s), addresses)and phone numbers) alongwiththtit certfcate(s)of are not rbq� wry Dance. LimitedLiabiility Companies(LLC)or Lioaited.iabMtyPa-fnerships(LLP)withno employees other than the memb ers orartaers,I worke& en compsation i as c:e. Tic an LLC or LLP does have P be submi�d to the D a-finent of Industrial � employees,apolicyisrequireri Beadvrsedthattusa$dayrEmay eF Accidents for confirmation of insurance coverage Also be sure to sign and date+she affidavit The affidavit should be-retnmed to the city or town thA the application for the pe mat or license is being requested,not the Departmeaf of n Accidents. Should you have aay questions regar-fg the law or if you are requiied to obtain a workers' compensation policy,please call the Department nt at the m=bea listed below. Self-insured companies should enter their s elf_i errran ce license number on the appropriate line. City or Town QfdaJs t . Please be seo-e that the affidavit is complete andprhtedlegh - The Deparimemthas provided a space at the bottom of the affidavit for you to fll out in the event the Office of Investi gatinns has to conf-act you regarding the applicant Please:be sure to fill in the p mitllicense mzaber which w7I be used as a reference number. In addition,an applicant that must submit multiple pe nnitllicense applications in any given y rtrn-ent Teat need only submit one affidavit indicating . policy fi fo atiom(if necessary)and under`Job Site Address"the applicant should T r{ "all Ior tiuns town)-"A co of the-affidavit that has been officially stamped or marked by the city or tnvm may be provided in the PY _ each applicant as proofthat a valid affidavit is on frle for fuf= 'perarits or H enses- Anew of l davitmust be filled out year.Where a home owner or citizen is obtaining a license or permit not related � to any business or commercial v (i_e_a dog license or permit to bum leaves etc.)said person is NOT rviaked to complete this affidavit The Office of Invesbgkions would at to thank you in advance for your cooperation and should You have any questrans, j please do not hesitate to give us a gall. The Departmenfs address,telephone and fax nunher. ' Tha CG.MMMW I*of Massa chmatG • Dep�#mtnt cif Ind �oci�e�.ts .. =Cj_-Qf vestigatio---W S T(-,L 4 617- 74 i�-xt 4-06 or 1- 77 MA SAFR Fax#617` 27'74-9 Revised 4-24-07 W W 7 n., g04dia. I ' AWC Guide to Wood Construction in High Wind Areas:110 infih`Wind Zone Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)` Check Compliance 1.1 SCOPE Wind Speed (3-sec.gust) .............. ............................................. ................................................... 110 mph . ..... WindExposure Category....................................................................................................:..........................B 1..2..APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories 5 2 stories RoofPitch ..........................................................................(Fig 2)........................................... 512:12 Mean Roof Height ...................................................:..........(Fig 2). ............................................. ft 5 33' . Building Width W (Fig 3)......................... ' BuildingLength,L ................................:.............................(Fig 3)................................................ —ft _<80' Building Aspect Ratio(LNV) ...............................................(Fig 4). ....... .....:................. ... 5 3:1 Nominal Height of Tallest Opening2 .(Fig 4). ..................... .................. <_6'8" 1.3 FRAMING CONNECTIONS General compliance with framing connections..............:.....(Table 2):........... ................... 2A FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete..................................:............................................. ............................................. ConcreteMasonry................................................................... ........ ........................................................ 2.2 ANCHORAGE TO FOUNDATION1•3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors an alternative in concrete only Bolt Spacing—general ........(Table 4) in. Bolt Spacing from endfjoint of plate ................ ..(Fig 5). ................. in._<6"—12" ..... . ... . .. ...... ..Bolt Embedment—concrete..................................... .(Fig 5) ................................................_in.>_7" Bolt Embedment—masonry......................................... Fig ............................................. in.>_15" PlateWasher...................................................:...........( )............................................. 3"x 3"x'/." 3.1 FLOORS Floor framing member spans checked ............................. er 78 CMR Chapter 55)................................... Maximum Floor Opening Dimension.............................:.... (Fig 6)..... ..:................................:........ : ft 512' Full Height Wall Studs at Floor Openings less than 2'fro Exterior I(Fig 6)........................................ Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall.:....... .....(Fig 7).....,...... ...................................... ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall...... .........(Fig 8)................. .................................. ft 5 d Floor Bracing at Endwalls........................................ ...........(Fig 9)................... ..............................— ................ Floor Sheathing Type ....................:.:................................(per 780 CMR Cha er 55)..................: ........... er 780 CMR Cha t r 55 in. Floor Sheathing Thickness ..:...........::. (p p ). Floor Sheathing Fastening................................. ................(Table 2)..._d nails t in edge/ in field 4.1 WALLS F Wall Height Loadbearing walls........................... ........................(Fig 10 and Table 5). ........... ....... —ft 5.10, Non-Loadbearing walls. .................. ...... .... j..........................(Fig 10 and Table 5). ...... '............. . ft s 20' Wall Stud Spacing .......................... .....................I.....(Fig 10 and Table 5)..................._in.5 24"o.c. Wall Story Offsets. . ................................. ....................(Figs 7&8) ........................................ —ft 5 d 4.2 :EXTERIOR WALLS3 Wood Studs Loadbearing walls.......................................................... ... ......................... ................:(fable 5). ................ .......2x -_ft_in. Non-Loadbearing walls................................................(Table 5)..............................2x=--ft_in., Gable End Wall Bracing Full Height Endwall Studs............................................(Fig 10)..........................:....................................... WSP Attic Floor Length...............................................(Fig 11). ......... '............................... ft?W/3 Gypsum Ceiling Length(if WSP not used) .................(Fig 11)..............:............................ —ft>_0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. ..(Fig 11).............................. ..........I.................... or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length ........................................................(Fig 13 and Table 6)......................................—ft Splice Connection(no.of 16d common nails).............(Table 6)......................................................... AWC Guide to Wood Construction in High WindAreas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.211)1 Loadbearing Wall Connections Lateral(no.of 16d common nails)..............:...........:....(Tables 7)............................:......................... Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)............................... able 8 Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(Table 9).................................._ft_in.!' SillPlate Spans ........................................................(Table 9).................................._ft_in.511' Full Height Studs (no.of studs)...................................(Table 9)...................................................... Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(Table 9). ............................... _ft_in.512' Sill Plate Spans........................................................... able 9 " Full Height Studs(no.of studs)....................................(Table 9)..........,............................................. Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W Nominal Height of Tallest Opening2 ............................................................................. _5 6'8" SheathingType.............................................(note 4)...................................................... Edge Nail Spacing.................................:.......(Table 10 or note 4 if less)....................... in. FieldNail Spacing ........................................(fable 10). ........................................... in. Shear Connection(no.of 16d common nails)(Table 10)...................................................... _ Percent Full-Height Sheathing. .....................(Table 10). .. .......................................... —1/0. . ...... .. 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)..................... Maximum Building Dimension,L Nominal Height of Tallest eningZ ........ ...........�.......................................... SheathingType........ . ...... ....................(note, : .................................................. Edge Nail Spacing. .................(Table 11 or note 4 if less)....................... in. Field Nail Spacing ..... .............(Table 11). ............................................. in. I Shear Connection(no.of 16d corn n nails able 11)...................................................... Percent Full-Height Sheathing.............. .....(Table 11)....................................................._% 5%Additional Sheathing for a with Opening>6'8"(Design Concepts)..................... Wall Cladding Ratedfor Wind Speed?.................... ......................... .................................................................... 5.1 ROOFS Roof framing member spans c cked?.......................(For Raft e use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19 ............_ft 5 smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift.:..............................................(Table 12).............................................U= plf Lateral.............................................(Table 12).............................................L= plf Shear..............................................(Table 12)..............................................S= pif Ridge Strap Connections,if collar ties not used per page 21... (Table 13) ..............................T= pif Gable Rake Outlooker.......�...............................(Figure 20)............._ft s smaller of 2'or U2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................... ........(Table 14)............................................ . ..... U= lb. Lateral(no.of 16d common nails)...(Table 14)................. - Roof Sheathing Type....................................................(per 780 CMR Chapters 58 and 59) ........... Roof Sheathing Thickness....................................................................................... _in.z 7/16"WSP RoofSheathing Fastening...........................................(fable 2).......................................................... Notes: 1. This checklist shall be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e: Comer Stud Hold Downs per Figure 18a and Figure 18b 2. 'Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. AWC Guide to Wood Constructio►z in High Wind Arens:110 mph Wind Zone Massachusetts Checklist for Compliance(7s0 CnIR 5301.2.1.1)t 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio,determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical an Horizontal Nailing for.Panel Attachment _VMEN EDGE all ON, 1 ElSEEd NAtS 11 11 • ' 11 11 If � Y 1 iI 11 I 1 ' 11 11 1 I 11 11 1 1 11 1 G r 11 Il cc N O M Il m II II 4a Ei It p it 11� 1 I 1 W F Ir ii 11 p 1 .y ' II 11 Ir 4t 1 II 11 11 W 1 it � ii fi 31 i r II 11 11 1 rl -1I DO MA1LSP'ACN3 Y l I Phf3Et_ � j* v See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment f AWC Guide to Wood Construction in High Wind Areas:11 D mph Wind Zorze Massachusetts Checklist for Compliance(7so Cmn 5301.21:1)1 i i w �l ; ati r t: r ' ; rpmING MEMBERS r 1 EDGE NI ERMEDWE ' � I � � . sre• , � :Tz r - GE - 4 STAGRED 3'MK HAJL PATTERN PANEL PANV-L EDGE UBIE NAIL EDGE SPACING DETAL etail ertical and izontal Nailing for Panel A ment 4 AWC Guide to Wood Construction in High Wind Areas: 110 inph Wind Zone Massachusetts Checklist for Compliance(78o CAIR 5301.2.1.1)1 FAQ*: WFCM Checklist Question: I understand if a new home is built in a town in a 110 mph wind zone then the American Forest and Paper Association (AF&PA) Wood Frame Construction Manual can be used to prescriptively design it. I also understand that in some cases the home can be framed per the WFCM too mph Guide, if it meets certain requirements including but not limited to aspect ratio, roof height, number of stories, and exposure category(B). I have heard that Massachusetts has a "modified" checklist that can be used instead of the checklist at the end of the Guide. Is this true and what can you tell me about this"modified" checklist? Answer: You are correct on the items that you have noted. MA has modified the checklist in several important ways. The MA version allows a roof with a pitch up to and including 8 in 12 to not be "counted" as a story. Further it does not require steel hold downs and straps in many locations if full height sheathing is used as defined in the MA checklist. Further, if the building will have furring strips - installed m the ceiling abutting the gable wall then 2 x 4s installed on top of the , ceiling joists are not required. There are other changes-as well that were not noted here. The MA version of the checklist was formulated in recognition of the highly regarded framing methods used in MA for many years and wood framing that has been used in North Carolina over the past 10 to 15 years which has performed well in severe hurricane weather in that state. Answers to FAQs are opinions of the BBRS Staff and do not reflect official positions or code interpretations of the BBRS. • 1 • k r t �THE?gr, Town of Barnstable Regulatory Services B vAB ri s& Richard V.Scali,Director i639• `�� ''reo►rU►'��' Building Division Paul Roma,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 L—A"LOR&L as Owner of the subject property ` hereby authorize - to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of job) **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. ° Signatua of Owner Signature of App t �Z.Z- Print Name Print Name Z/ Date Q:FORMS:OWNERPEMSSIONPOOLS Town of Barnstable Regulatory Services , ,THE Richard V.Scali, Director Building Division ruvsres . « Paul Roma,Building Commissioner Mess. 1639. .� 200 Main Street, Hyannis,MA 02601 i 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 uermit. (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 The Code states that: "Any homeowner performing work for which a building'permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor.. The homeowner acting as•Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many.communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. _ .. ]aiyo office of Consumer Affairs&Business RHOME IMPROVEMENT CONTRATYPE:LLC rationExpiration 02/18/2019� m= i -'SCHULZE BUILWILLIAM SCH``_ZMNW65 Sawmill Rd Marstons Mills,MA�02&318 Underse r d Massachusetts Department of Public Safety s Board of Building Regulations and Standards License: CS-056340 Construction Supervisor - WILLIAM L SCHULZE 66 SAWMILL ROAD MARSTONS MILLS MA 02648 Expiration: 1`Commissioner 1012912018 Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid withouOlinature Construction.Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. .. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. AS$.GOVIDPS DPS Licensing information visit: WWW.M r t 'w -------------------------------------------- -J DECO - ED C (-od ,II MATCHING WOOD A ITOP JJi.. n____..______.____________________________________I CHVAIAN`E- .1 BDTTOM TOE r. �I fpiENCi oSHED t END Pnt 1 19 I TUB II ITD(3"HIGH) _ I6 HIGH ROLL DUT VANITY Ww ' ror AREA TO; REVISED l I I I I � ;0 -. RDDMING 1 _ ORGMNRER I P LOV 121, PANEL TO COUNTER R E SE M BI N 4\I/ I O 2111 ARCH SH O.WEP DE NCEI N:tE j, a IBENCN - Ic, 8 I �ili-I I SE EKL I I E� 'PAN EL TO COUNTER ___________________________________________________.___________________________________________________1 All dimensions-size designations This is an original design and must Designed:5/23/2017 given are subject to verification on not be released or copied unless Printed:5/2 312 0 1 7 job site and adjustment to fit job 0%ke AtL applicable fee has been paid or job conditions. 4ftmFporder placed. DellaRussoSinkVanityFinalOrder5.23.17 All Drawing#:1 Scale:0 3/8"=1' r 3n 3rr f-324"----f-—26r•_ 33..--- y ih 18'- M { � o i+> aVSB3E37.5 DB2 VSB3 .5 M TUB v -33 2'—41 26" k 334" All dimensions_size designations This is an original design and must Designed: 5/23/2017 given are subject to verification on ME not be released or copied unless Printed: 5/23/2017 - job site and adjustment to fit job (Zrief applicable fee has been paid or job conditions. , 1 )I order placed. DellaRussoSinkVanityFinalOrder5.23.17 El 2 Drawing#: 1 Scale : 0 1/2" = 1' r —36" f . 90 Z" nF1 O -W36x48x18-BD O O C-DB36x34.5x1 93 - M All dimensions_size designations This is an original design and must Designed: 5/23/2617 given are subject to verification on PIE not be released or copied unless Printed: 5/23/2017 job site and adjustment to fit job ar ( e l applicable fee has been paid or job conditions. i order placed. DellaRussoSinkVanityFinalOrder5.23.17 El 3 Drawing#: 1 Scale . 0 1/2" = 1' i A6oZ CERTIFICATE OF LIA51LITY INSURANCE DATE(MMroDl 5/30/201717 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Aft 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(les)must be endorsed. tf SUBROGATION IS WAIVED, subject to ...the.terms and_condiii.ons of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER NEErACT , Michael Edwards Lawrence Carlin Insurance Agency PHONE , (SOB)540-7100 IAIC FAX N ;(SOB)5�0-8426 230 Jones Road DOZE ,Michael@lawroncecarlin.com •INSURERS AFFORDING COVERAGE NAIC f Falmouth MA 02540 INSURER A'Abella Protection 141360 INSURED INSURER B:Associated Employers Ins Co Schulze Building Company, LLC INSURERC: 65 Sawmill Road INSURER0: INSURER E: Marstons Mills MA 02648 INSURERF: COVERAGES CERTIFICATE NUMBERCL1753001161 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NBR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP TR LIMITS i X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PR ISE E S 100,000 _,.. .._..__....,_.._...._........ ........ 9520036828 3/5/2017 3/5/2018 MED EXP(Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $- -2,000;"0 X POLICY JET 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 ^ OTHER: $ AUTOMOBILE LIABILITY COMBINED INGL LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED I PROPERTY DAMAGE HIRED AUTOS I AUTOS r a n $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S ~ DIED I RETENTION S WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TATUT R ANY PROPRIETORMARTNER/EXECUTIVE Y� N I A E.L.EACH ACCIDENT S 500,000 B OFFICER/MEMBER EXCLUDED? NCC50050110072017 5/li/201T S/11/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S 500,000 Ir yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,AddlUonal Remarks Schedule,may be attached U mart apace Is required) CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ` David Lawrence/CAROL m 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD _.------- ^_ IN$025nniirin ' v TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. �; Parcel Application # d 1 q t Health Division Date Issued r4 l Conservation Division— Application Fe ' Planning Dept. Permit Fee h C� Date Definitive Plan Approved by Planning Board Historic- OKH _ Preservation/ Hyannis 14 Project Street Address Village - AC�C_V' lit— Owner ,_ �R(A55-t Address Telephone Permit Request AD io 0h MCI so;n 4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 24 K Construction Type )�&S-or r Lot Size Grandfathered:. ❑Yes 7❑ No If yes, attach fsTilpporting`c0ntation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) u tj C Age of Existing Structure Historic House: ❑Yes ❑ No On Old King',?.F,ighway:�•0 Ye�❑ No Basement Type: mull ❑ Crawl ❑Walkout ❑Other v Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) t t 6 Number of Baths: Full: existing new Half: existing newts" Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name LA 1 a hl 5(��v, k1c . Telephone Number 5VL-�' '73�7- 47 Address 6 S ww,d l 920 � License# G <-,;, — y56 3 ZI0 iv�� 42� S Home Improvement Contractor# Email S GG k2=e�'Gad 0 c Ow,c 6 s ra�' Worker's Compensation # W CC Soo&r0/i w'7 2,o 13 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ►��c1 h a IJGl r 4+ SIGNATURE DATE G Z �� 1 f r FOR OFFICIAL USE ONLY k APPLICATION# DATE ISSUED MAP/PARCEL NO. }ti ADDRESS VILLAGE OWNER w i t DATE OF INSPECTION: I FOUNDATION �- 412, 1-1 AJ/ZS)IIJ FRAME cam;I INSULATION 7 FIREPLACE 7I+ttbW ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 5 i GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT t ' ASSOCIATION PLAN NO. The Commonwealth of Massachuseas Department of Industrial Accidents Office of InveWgations ' 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers 'Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: � �i&x'1'A tr� City/State/Zip: Go Phone Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with�_ 4. 0 I am a general contractor and I 6. ❑New cons truction employees(full and/or part-time).*'. - have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling' ship and have no employees These sub-contractors have g• Demolition workingfor me in an capacity. employees and have workers'.� Y � t3'• comp.incrrrance.# 9. ❑Building addition [No workers 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any.applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: f4Z, gv e J)o Y1 Policy'#or Self-ins.Lic.#: CiJGC, 5o/I e,-v7 Zo/3 Expiration Date: rj / /I/L/ Job Site Address: L��/ �-?/`��h �/U h� S /GdJ City/StateMix. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th ains and penalties of perjury that the information provided above is true and correct Si afore: Date: / / Phone#: Of use only. Do not write in this area,to be completed by city or town official City or Town: Permit/L.icense# Issuing Authority(circle one): - 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: 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,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line.' City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submif 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 (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Westigations 600 Washington Street. Boston,MA 02111 Tel.#f 17-727-4900 ext 406 or 1-877-MASSAFE Revised 424-07 Fax#617-727-7749. www.mass.gov/dia I AC RO EP DATE(Mwoor"M CERTIFICATE OF LIABILITY INSURANCE 5/8/2013 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 ISSIANG 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. It 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 endorsemen s PRODUCER nary Ellen Ross Lawrence Carlin Insurance Agency PHA (508)540-7100 iA>< (50e)540-e426 230 Jones Road -MAJL e�.maryellen@lawrncecarlin.com AFFORDING COVERAGE NAIC f Falmouth MA 02540. INSURERA: rbella. Protection 41360 wsURfO INSUUER a Associated Employers Ins Co Schulze Building Company, LLC LNSURERC: PO Box 288 INSURER0: c .., INSURER E: Centerville MA 02632 RERF: COVERAGES CERTIFICATE NUMBER-CL135800142 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSION AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE r M POLICY EFF POLICY E][P LIMrtS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAGE To RENIED X COMMERCIAL GENERAL LIABILITY s 100,000 A CLAIMS-MADE ❑X OCCUR 500050134 /5/2013 /5/2014 NED EXP IAny one paw ) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COUP)OP AGG S 2,000,000 X POLICY PRO- S JFCT LOC COMBIAUTOMOBILE LIABILITYt btlT ANY AUTO BODILY INJURY(Per persm) S ALL OWxED SCHEDULED BODILY INJURY(Per acctdeM) S AUTOS AUTOS NON4)WNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS S UMBRELLALJAB OCCUR EACH OCCURRENCE $ �EXCESS UAB CLAIMS-MADE AGGREGATE S IDEO RETENTION S B WORKERS COMPENSATION WC IATIY MI 7 AND EMPLOYERS'LIABIUTY ANY PROPRIETORIPARTNER,EXECUTIVE YIN 1 E�EACH ACCIDENT 'S SOO OOO OFF LE1[BEREXCLUDED? El MCC50050110072013 /11/2013 /12/2014(Manda—Y In NH) E L DISEASE.EA EMI'PLOYEE S 500,000 a yyeess -,,e Unger DESf:ritPT10N OF OPERATIONS below E L.OISEASE.POLICY LI11T S 500,000 . r DESCR1PT"OF OPERATIONS I LOCATIONS I VEWA.ES(Attach ACORD 101,AdMoonat Remarks Schod,de,d more sPaco Is mgWmd) r CERTIFICATE HOLDER CANCELLATION abcpapecod@comr-ast.net SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AAUTHORUED REPRESENTATIVE Ellen Rose ACORD 25(2010105) ®1988.2010 ACORD CORPORATION. All rights reserved. INS025(201005)01. The ACORD name and logo are registered marks of ACORD --------------- oFTHE,a Town of Barnstable Regulatory Services �a �$ Thomas F.Geiler,Director .Building nivision Tom Perry,Building.Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnsfable.ma.us office: 508-862-403 8 Fax: .508-790-623 0 Property Owner Must 'Complete and Sign This Section •If Using;A Builder I, J G as Ownet of the subject ptoperty hereby authorize //y/ • �ry� i� �7•�' to act on m behalf, y in all matters relative to wotk.authorized by this building pem3it La (Address of Job) Pool fences and alarms ate 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. �l S e of Owner Signatiate of Appli x tint N ame .. - - Print Name. Date WORMS:OWNERPERMISSIONPOOLS 6012 �tHe r Town of Barnstable .- •., �= t Regulatory Services seaivsTART_lt Thomas F.Geiler,Director - ��A 9. Building Division- Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 ww mtown.b arnstable.ma'.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE=112PTION Please Print DATE: 10B LOCATION: number street village "HOMEOWNER name home phone# work phone# CURRENT MAMING 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 Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the 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 -- L Approval of Building Official r 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 perfom-ung 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&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 poison 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 r rquir•e,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:fomu:homeexerrpt Vl VI CU :� ,_, a L :fl •O p cal 92 _ . 0 ' 3 bdv� 00 cNa d Z W m ar o Cl) U o Qj N U to W W G O rn °a_c L 'C3 0 u N O m I � C O g- m LL Department of Public Safety ". StandardsIV . Massachusetts - ulations and Board of Building Fteg U�ae ipor��n�aacuvea,�/o�C%ouc�oac�ccaeG� I., t;��ntitruction SuPer-isor Business Regulation Office of Consumer Affairs& License: CS-056340 ME IMPROVEMENT CONTRACTOR \* Weigistration: 112049 Type' LZE r% piration 2/19/2015 S LLC WILLIAMI'S TER�8 IE- BUILDINGCOp0 A LLC; -` 1 % 4 CEN • ; Expiration F WILLIAM SCHULZE\ �`w � r _ 1 = 10129I2014 65 SAWMILL RD jT1r"issioner ! MARSTONS,MA 02648 k Undersecretary Co I ': e oo Qj N f cave�l • I, 'Xll ll •! , SEAT/C C.VL a /3 _ An 0 M A' 'va Al / v e. ev N6I�i...62FGa.✓4wL_ a / .. Z. STzr- 00 jJ J. FD - J. /a*�..Fr "41AY G2ass ^> TN.� f�cis rr,✓G. _._. ,_..._......._ �w�.c.,..i� -_. �XAGT-•-v71�+1��5 D1r' ?XES c ,tilC frG.2 E. was A� �ro �� A�•m�,✓�v �� , /ZS !A//l .7, _ / cER'roFoE® PLOT. .CTZ PLAN ;. �I✓ 77•G�./Q� Y�2 mop �� /'�5 ,�•�G7 9'/-Ca /wSu�G�= ��� ✓Gr/d� i✓a, 25�/-off-f4 IN oq CA E GE' GI ING c .! ® �� I CERTIFY';'THAT THE �zu�/�„` CLI�� E®IS"1'ERE® LE �'��� � SHOWN ®N 'PHIS 'PLAT AkE LOCATEDd®s ®. -� 1 OR� THE GR®U9o�®:AS l�dDICATEI� ADDCIVIL. N® CONFORK,l T® THE ZONIN LAWS ENGINEER ELO o®Ye .mil.`/: ®F OArz�Y,ST;.q�L � 712 MAIN STREET CKByeHYANRIS, M AS S. SHEEN—/O � A E REG. LAND .SUMVFYn0 : •' h � A f ��, 9 cOJ AJN US TOWN'OF BARN TABI 201q, AMR RAvi - P _ • r t °4 Town of Barnstable *Permit# hobo eos(00 �. Expires 6 months from issue date Regulatory Services Fee swEwsznst.e, t Thomas F.Geiler,Director �� Building Division �TF p s Tom Perry,CBO, Building Commissioner NOF 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office. 5• 08-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Imprint Not Valid without Red X--Press Im p Map/parcel Number Z Z j Property Address ❑ Residential - Value of Work -7;5,C_k_)0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address O P Uz) LA 5 5 U Contractor's Name b, 1 Telephone Number 7 Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ` PERMIT El am the Homeowner �p I have Worker's Compensation Insurance_ JAN N- TABLE Insurance Company Name �//�"�� � � - .k ��-P �1��I>>'� ���••� ntanl� -Workman's Comp. Policy# 6 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof.(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over existing layers of roof) Re-sideW ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *"Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors Licen uireltqZ f `� SIGNATURE: Q:Forms:bu i ld ingperm its/express Revisel 12807 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' +� v d 600 Washington Street " Boston, MA 02111 i� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): (' o Address: Cs C9, � `77 City/State/Zip: h�-e ru 1 �� Phone.#: ( . � 7 71 " &0 Are you an employer? Check the appropriate box: `'• Type of project(required): 1.-0 I am a employer with Z .4. ❑ I am a general contractor and I t. employees(full and/or part-time).*. have hired the sub-contractors 6. ❑New construction .2.❑ Lam a sole proprietor or:partner- listed on the attached sheet. 7...❑Remodeling ship and have no employees These sub-contractors have g•'❑ Demolition workingfor me in an capacity. employees and have workers' y p n' $ 9. ❑Building addition [No workers'-comp.;insurance comp.insurance. required.] 5: ❑ We area corporation and its 10:❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] . "Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Y 14 / �s 5 tiiyt e-�— Policy#or Self-ins. Lic #: �eC/ C 7� 1 7j `� y Expiration Date: Job Site Address: _Z 04n-le _1� City/State/Zip: )4c,13.L r Attach a copy of the workers',compensation policy declaration page(showing the'policy number and expiration ate). 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 civilpenalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ains and penalties ofperjury that the information provided above is true and correct Signature:. Date: Phone#: 7 1 r� Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1:Board of Health 2.Building Department 3,City/Town Clerk` 4.Electrical Inspector 5.Plumbing Inspectory 6.Other Contact Person: Phone#: �a Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in,the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in -_(city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person,is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. I The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations f 60.0 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-7274749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable , ~ Regulatory Services NA S& 'E Thomas F.Geiler,Director �pr 1639. � E r v Building Divisi n MA 0 Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 K Fax: 508-790-6230 Property Owner Must a Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work.authorized by this building permit application for , t (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete thet Homeowners License ExemptionForm on the,reverse side. _. k Q:FORMS:O WNERPERMISSION 1 Town of Barnstable �pF THE fp�� Regulatory Services + sARNSTABI.E, Thomas F.Geiler�Director• 9 MASM q,A i639. p.0 Building Division rED � 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 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 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:for ms:homeexempt f COMPANY OF THE STATE OF PENNSYLVANIA 75190-0000 WC - 683-89730 . ------------------013-8 2-0 5 0 7-o o-- •..�. , PENNSYLVAN I A • •. . . • aw , SCHULZE BUILDING COMPANY LLC P O ' BOX 288 �� Member Companies of f '.CENTERVI LLE, MA 02632-0000 American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D.` •. 11• PMC INS' AGENCY INC WORKERS COMPENSATION AND EMPLOYERS 50 CABOT STREET LIABILITY POLICY INFORMATION PAGE PO BOX .920179 NEEDHAM A 024 2-0002 INSURED IS PREVIOUS POLICY NUMBER LIMITED ,LIABILITY COMPANY RENEWAL 008 40 48 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE — WC 0610 )ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the Insured's mailing address FROM 05/1 1/07 TO - 05/1 1/08 11EM3 A. Workers;Compensation Insurance:.Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed In Item 3.A. The limits of our liability under Part.Two are: Bodily-injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other-States Insurance: Part Three of the policy applies to the states,'if any, listed herq: AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI ITEM4 The premium for this policy will':':be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below Isesubject to verification and change by audit. Estimated Total Rate Per Estimated Remuneration Premium Classifications Code Number mlunerat on a Annual'❑3 Year X Annual El 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $562 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) _$284 MA MINIMUM PREMIUM $500 'MA TOTAL ESTIMATED PREMIUM $1 3,823 If indicated below; interim adjustments of premium shall be made: Semi-Annually Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE WC990612 03/24/07 PARSIPPANY . 82 Issue Date Issuing Office Authorized Representialve.. WC 00 00 01 39907 INSURED'S COPY. Town of.Barnstable Re atory Services v buss ,* Thomas F. Getler,Director � 0 ��1. BW1ding Division Tom Perry;'Building Commissioner ; 200 Main Street, 1Jyannis,.MA 02601 �ww-town.barustable;ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder �Lt,� w , as Owner of the subject property uthorize ►�:' ( l► , h-. c h ��- to act on mybehlf :hereb a Y in all matters relative to work authorized bythis bunding permit application for: Z� rah n r►v(Z_, LA), D (Address of Job) r gnature of Owner Date- Print Name License or registration valid for individul use only date. If found return to: e before the expiration Board of Building Regulations and Standards One Ashburton PlaceRm 1301 I Boston;Ma.02108 I s ` t Not alid.without sign re '. Board ofBuildin g Regulations and Standards HOME IMPROVEMENT C Registrati ONTRACTOR Expoiration 112049 2/19j2009 Tr# I , f Type s;DBq:� 1272591 If SCHULZE 8UILDING`:CO WILLIAM SCHU PO BOX 288/65 CROCKER ST ' f CENTERVILLE, Mq 02632 i.. -- Administrator. I , P TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2- L4 5' Parcel c7 Z�i Application Health Division Conservation Division Permit# Tax Collector Date Issued 41 1_� 01 Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ot< `J17107d111:1_ Historic-OKH Preservation/Hyannis Project Street Address 2 Oq Gtn-e S ��— Village Owner r�d P_f,46 , ram5�--o Address Telephone Permit Request ,-¢_ -�f�Gy► �t .,�a+..-1 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio UC3U Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new 2 Number of Bedrooms: existing new Total Room Count(not including baths):existing new_ First Floor Room Count ' (2 �70 Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other - Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal'stove: U Yes J�b No —, Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# . Y Current Use o -Proposed Use BUILDER INFORMATION Name ��l//L�l� ��h ti� — Telephone Number 509 7-7 — L� Address 6� CI ,�C.e�' �� License# Ig 6 3yy 104 Z Home Improvement Contractor# ��ZOLI4 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �1'`" DATE H- w, FOR OFFICIAL USE ONLY 4. PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VIELAGE OWNER- ,- ` t , DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION t. FIREPLACE ` ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL ; y GAS: ROUGH FINAL FINAL BUILDING j . DATE CLOSED OUT ASSOCIATION PLAN NO. l 1 s The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations . 600 Washington Street Boston,AM 02111 KL. '^ ,y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information // Please Print Legibly Name(Business/Organization/Individual): E.4, Address:_/5 Gf2,@G,ir�r Sf r-e� City/State/Zip: Phone:#: GM 77 1 '9-9eY Are you an employer? Check the appropriate box: Type of project(required):. 1.V I am a employer with 4. ❑ I am a general contractor and I mployees(full and/or part-time).* have hired the sub-contractors 6, New construction . 2. 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 in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp,insurance:$ ] re q uired. 5• ❑ We are a corporation and its 10.❑Electrical repairs or additions � 3.❑ I am a homeowner doing.all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs §1,152 4 ,and we have no insurance required.]t c. O • . employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees: If the sub-contractors have employees,they must provide their workers'comp.policynumber. I am an employer that is providing workers'compensation insurance for my employees. Below is-the policy and job site information. Insurance Company Name: � y Policy#or Self ins.Lic.#: Expiration Date: Job Site Address:__ 20�. �i-ee_J� QLt/M5 A City/State/Zip: U� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify under the pains and penalties of perjury that the information'provid(e�d above is true and correct. Signature: Date: Phone#: 25 0�r -7 Official use only. Do not write in this area, tb be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions - Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a-deceased employer, or the receiver or trustee of an individual�partnersbip,association or other legal entity, employing employees. However the owner of a dwelling-house having not more than three apartments'and`wlio resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance'constrtictionor repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for:the performance of public work until-acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-confractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pemut or.license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must;submit multiple permit/license applications in ariy given year;need only submit one affidavitindicating 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 fo 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 should you have any questions.,--- please do not hesitate to give us a call. The Department's address,telephone-and fax number: e Commonwealth of Massachusetts Department of Industrial Aecidelnts Office of Investigation$ 600 WashingtQri Street Boston, MA 02111 Tel. ##617-727-490.0 ex-406 or 1-977-MASSAFE Fax 4 617-727-7749 Revised 11-22-06 www.mass.govldia / E •-Lv TT AA v1 J-scLaA&Pa 4$-1av Regulatory S&viees uxrisT sE.$ Thomas T,Geiler,Director 9 sbs9 Building Division Tom.Perry,Building Commissioner .200 Main Street, Hymmis,MA 02601 wymtown,b arnstabl e,ma.us ice: 508-862-4038 Fax: 508-790-6230 permit no. Date AFFMANU HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATIDN MGL a 142Arequires that the"reconstruction, alterations,renovation,repair,inodexnization, conversion, ovpment,removal, demolition,or construction of an addition'to any pre-existing owner-occupied - �building containing at least one but not more than four dwelling units.or to Structures which'are adjacent to \ such residence or b 0ding be done by registered contractors,with cerkzo uxceptions,sl=g with o}1�er requirements. �•�,/�� Type of Work'/___� � O. Estimated Cost v Address of Work: 2 y`f �j /C-ee) 014 n-e 5. �r o-ymer's Name: Date of Application: I hereby certify that: ' Registration is not required for the following reason(s): []Work excluded by law MJob Under$1,000 QBuilding not owner-occupied []Owner pulling own permit Notice is hereby given that: OymRs ruLL3NG THEIR OWN PERNUT OR DEALIlYG WITH UNREGISTERED CONTRACTORS FOR,APPLICABLE HOME MROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTYFUND UNDERMGL c.142A. SIGNED UNDER PENALTIES OF PBRMRY I hereby apply for a permit as the agent of the owner: , 2) -v 1�ZOZf Date Contr etor Signature. RegistrationNo, OR Date Owner's Signature Q;�uPfi]es.f4rms:homeafiidav ' Rev: ObObOb RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 ' Alterations/Renovations $50.00 BuildingPe=mitAmendment $25.00 FEE VALUE WO•RKSHEET NEW LIV qG SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTER.ATIONSIRENOVATIONS.OF EXISTING SPACE 2.� square feet x$64/.sq,foot= x.0041= U plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq,ft. ACCESSORY STRUCTURE>120 sq, >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet $96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= ' (number) Fireplace/Chimney x$25.00=' (number) Inground Swimming Pool $60.00 ' Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Prajcost Permit Fee Z. Rev;063004 Town of Barnstable. °; Regulatory Services snxwsrnBr�, t asass. Thomas F.Geiler,Director r T i639. ,0� Buildin Division �p fD MP b g Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I le, 4C7VIA 1 5, 0 ,as Owner of the subject property hereby authorize W1.LC.! A wl � I?_.2_ to act on my behalf, in all matters relative to.work authorized by this building permit application for: 20 � � ti -9, Ahm) so Address of Job) I Si e o r rDate i� � 16,a D LA Se, 0' Print Name Q TORMS:OWNERPERMIS SION DEL;-28-2F ac 10:42 LRWREI CE CRRL I N INS ' ��N GEK 111-1(;A 1 t Ut- LIAWLO INZW ^CANt-or— iz�2s�2oc6 ENZ$�fFytp'��0 i�j5' ' i MI CV 1 I—c - s J A9 A MATTER OF INF RMATIO Laurence Cnr i r ;nsurarce Agency Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,f:MND OR ! 230 Jones Road ALTER THE COVERAW AFFORDED BY THE POLICIES BELOW. Falmouth, KA 02540 ---r Toni Davies INSURERS AFFORDING COVERAGE NAiC 0 fIIIi�4�6'Sc�r� ze' uT g on ny, Ll�— INsuREN k rdnite tate�nsurance o I —PO BOX 288 INSURER B: i- Centerville, 1lA 02632 IN;VRFRC: --� — INSURFR J 11 INSURER t! COVERAGES_ _ THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED 0 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD f ICATEO.NolmITHSTPNO ING ANY REOUIRElaENT,TERM OP.CONDMON OF ANY GOUVRACT OR OTHER DOCUMENT WITH RESPECT TO YMICH THIS C£RTIR!CATE MAY OE ISSUED OR WAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITION$OF$UCH POUCIFS.AGGREGATE LIMITS SHOWN MAY HAVE SEEN 4EDUCED BY PAID CWIAS. 1 031 WSRO TTPE OF INSURANCE T-'---POLICY NVIIV;: D TC Z 1T�1f LIMITS DATY.(kN�DOM'1 OAi�4"s. i 0ENERAL LIANILIry I — JACH OCCURRENCE S 1 0 11 4ERCIAL QENEIQl LIABLIV _ J CLAP JS MADE LJ oCCUR MW EV(Any orw pff"n) S i PriRbONA;,A ADV,NJUKY S I I —• GEh1ERAlAGGREWTY .S 1 I DEN.AGGRCGATIE.IM1T APPLIES PER:i i PRODUCTS•COMP;OF A� POLICY n�ECT 177 lx I AUTOMOOiLE LIAMUTY COIASINeD SINGLE UM1T 1 I S f�ANY AUTO Ea w=kle t) L ALL OWNED Al n'VS SOORY INJURY I (Yrr P�na+j � I ;CMFUULEOAI�Dx NIREDAXOS SODILYDIJURY S I NON-OWi4VAVTOd (Pw'kcdd��t; PROPERTY DAMAGE Y ,(PN�cddint; I OARAOE LAWLITY AUTO ONLY-EA ACCIDENT S IANAUTO OTHER THAN S — I p--� -- AUTO DNIr. AGO;s EYI:kS--WMbAELLA LUIPIUTY ^' y EACH OCCURRENCE S OCCUR CLIMStAAOE AGGV.EGAT[ Ii 3 I �TENTION __S -- _ wOR+CEA4 COtdPEW4ArQN AND WC723BS53 I c, 6 I 65/ /2J YNPLOYYRS'UABLIY E.L.EACHACCIDENT 3 SO�,000 q ANY PR,,,,RIeTOwPARTNF1tfELECVnY6 -- `O►fICEIVAEM9ERUCCLUD`.D7 E.l DISWSF• FMlOY s 50J,000 h m,os+ah+u av 3P_CIALi"AOV)61ONSwL*- C.LOIOCARE•PCl)CY:wn 500,000 1 _ _ OC CRIMIONOFOPERATIUhS;IDCAIIOIrblVflilCL Ol II+WNSA�OL�9Ywu—, MrmSPECIALPRUVLWONS CERTIFICATE HOLDER CANCELLAT10N SNCWLD ANY OVNI AZOVE OESCIMID POLI MS iE CANCELLCO DMAS TXe LX►IkATtON DATE THiRLOF•TM8ISSUNG INSURER MALL ENDeAVOR TO IUJL 30 DAYS wR)TT•EN NOTICE TU Tul emir-ATE KOLDE.R NAMED Tr;THE IXPT• Eli T FA14URa TD MA)L SUCH NOTICE OHALL IMI04E NO OOLWATION OR UAiILPPY Tow, of Barn Aabl a OF AN•I KIND UPON_ E IN9U ITS AGENTS ON Iq?mLuNTA-nvw- 803clinq Depart �— AL► EDRfPhE�EI+T>I E ACGRI2 26(2001108) —_— �� ?JACORD CORPORATION 148E _ u p. and Stulatandards tons go✓ard 0jBu%jdiv'% eN►sar license Construction gu'p 5 - ,� Gg 63AG ' �ah -. 1200a CHI+ A- niter LIAM L 11�+ ' = Cumm:�ss► . t PO BOX2S$ L�E, CEN-TERVI MA Tv Board of Bu�udduu i2egeulate and ` ' y, DOME IlyiM.`'OVEMjEWT C01�1 TRACTOR .L Re istrarYdt'0 12049 2007 SCHULZE.BULL f MLLIAM SCHU BOX 288/66 C CE1*1TERVN_LE,MA 02882 S -:,. , ,r Akd�aimisErailor - " ;t MATERIALS INFO CABINET MPG: PLAIN t FANCY CUSTOM CABINETRY BOX CON5TR.: TOPS,BOTTOMS,SHELVES=45 LB.FURNITURE BD The Dello Russo Residence SIDES= 1/2 N PLYWOOD INTERIORS: MAPLE MELAMINE FRAME TYPE.: BEADED IN5ET WOOD SPECIES: MAPLE FINISH: °LATTE'GLAZE DOORSTYLE: 'VINTAGE' SHALLOW DRW5.: RAISED GENERAL NOTES: DEEP DRW5.: "VINTAGE" DOOR HINGING: CONCEALED HINGE PREP-WORK: CROWN: ENKEBOLL MOLDING FASCIA: ML2 ALL CONSTRUCTION AND REMODELLING MUST BE COMPLETED PRIOR TO THE COMMENCEMENT OF LIGHT RAIL: MLG CABINET INSTALLATION. FURNITURE BASE: MFE2 THI5 INCLUDES,AND 15 NOT LIMITED TO:. DUCTWORK,DRYWALL AND/OR PLASTERING,ELECTRICAL GLA55: PREP*PLUMBING PREP-WORK: ° INSTALLATION OF APPLIANCES: HARDWARE: THE.INSTALLATION OF THE APPLIANCES 15 THE RESPONSIBILITY OF THE CLIENT. THI5 INCLUDES AND 15 NOT LIMITED TO:THE REMOVAL OF EX15TING'APPLIANCES,THE DELIVERY AND COUNTERS BY:T.B.D. FINAL HOOK-UP OF NEW APPLIANCES. PERIMETER ETE T THE INSTALLATION LA TOPS: L TON OF APPLIANCE PANELS I F APPLICABLE IS THE.RESPONSIBILITY OF THE CABINET INSTALLER. BAc KSPLASH: ISLAND TOPS: ROOM DIMENSIONS:. FINAL CABINET ORDER'WILL NOT BE PLACED UNTIL COMPLETE AND FINAL FIELD MEASUREMENTS HAVE BEEN TAKEN. ... APPLIANCE INFO ACCURATE INSTALLATION OF ALL CABINETS SHOWN ON THE FOLLOWING DRAWINGS ARE WHOLLY DEPENDENT ON THE DIMENSIONS AS SHOWN HEREIN, "THE CABINETRY'IS NOT RE5PON5113L E FOR OVERALL ROOM DIMENSIONS WHICH DO NOT CORRESPOND APPLIANCES BY: TO THESE DRAWINGS. REFRIGERATOR:SUB-ZERO COOKTOP: GE PROFILE#JGP9405EK BLOWER HOOD: WALL OVENS:GE PROFILE JT9525K55 .` DISHWASHER: B05CH r MICROWAVE:. WINE REF.: NA. _ SINK: FAUCET: THE °`°°°v Scale °'°a"� John and Kathy Dello Russo Residence R REVISIONS Drew ALL DIMENSIONS AN0517E DESIGNATIONS GIVEN ARE SUBJECT TO I L...L ' by VERIFICATION ON JOaSITE AND ADJUSTMENTS TO FIT J08 Jean Hayes e5 '- On inalES CONWTIONS: `../ 1. ay West.Hyannisport,MA - DESIGNTING THEEROJECTD LISTEDE THNTHIUSE SCONTRACT.TIN' 'I0° ' Project Info Sheet DESIGN LAMS EPROJECTED OR THE THIS CONTRACT. �J D°le°(Dre �j - UDESIGN SEDOPLAND REMAIN THE PROPERNOF THIS FlRM ANDCANNOTSE ,��,H2 T WWW.THEGSµINEETTRE NIET Erika Stern Marcn 6,2007 PPROVEDDY:. ,� J y.� v r - USEDORREPROWCEDWITHWTPERMISSION.. ENKEBOLL - 9'5PUX PULL-OU(5 TO COUNTER . 'CFI IPI I CLM FP2/CLM FP2. _ a/ENIUOUL ONGVx 9D x 429E - - CPL IP2/CLM FP3ICLM PP3 . BO%COWMN (' . - - - - 83 W 831 WD14549.75 _- ` BVAIµNSCOT. (AP,CTI MUWONS) - (DECOR (DECOR MUWUON5) 6C MANIEI HOOD MUWON5) W4231 . IIFARE — —(UECORATIVETOF --1 siD6) sI0E51 I (ROLLOUI5) _ BI53C✓i7 / - . U RP VunNCE) 0 0 0 0 0 nSiE e1 wIPM1EL— L—— B3DI8 . I I ——— 30'COOKTOF —— - - BEP . KALE WAINSCOT BID30 w'OPFN SHELF BELOW CPL IPI/CLMMF2I CLM PP2— (ESL - WA PANEL - 1 DECORATIVE PP TOE VALANCE (DECORATIVE TOE BF528 - ENKEBOl1 _ YP VAIANLq (FOA 25' . CPf IPI/C1M FP2/CIM PP2 FARM 5INK) ON rV x 9D x 42'H .. BOY COLUMN WAINSCOT ENKEBOU. ENKEBIXL . PANEL CORBELS - CPL IP1/CLM.FP21-112— W5R 6i7 ' v ' .. C&-TN264) - - END - —J �P TALL WAINSCOT T2185.5 T3085.5-25D (DUB.DN.1 BL536 DOWN END PANEL 48'5UD-2ERO (TALL PANTRY (WALL OVEN .BREAD DRW.) - �r vd PANELS 1w ROLL-0Uf5) 4OPEN 5HEtP ABOVO W18.53I W18.531 118.531 FAMILY ROOM c. - WI7 Jill WI931 @UND CORNER)(DECOR PULL le 83D30 CUE.ONJ FILM" W153 OW(ARUti 'L———— (BU W3031- RXMCL - - (ay RNE OUnEr irD MULLION PANEL) I IPULL (MCR0) FOR MICRD. CPL IPI/CLM FP2/CLM PF2 REP ARCHED - - VALANCE (REDUCE I(DECORATVE TO - OVERSINK OPENING) I 'PP VALANCE) 36'5UB-2ERO DINING ROOM ENKEBOIL .. '. .. CFL IPI I CLM FP2/CLM PP2 -. B15 - RWA57 I - W183I BIN) .. MULLION .512 I TALL WAINSCOT - - - - END PANG .. - CL05ff I(DECOR. . wPC2431 - WId31 15M) ' Oad�r. Stele: PmledN—: REVISIONS ALLM NSIGNS AND SIZE DESIGNATIONSGIVE„ARE SUBJECTTO //'!J/I THE/ - The DELLO RUSSO Residence VERIFICATION ON JOBSITE ANDADJUSTMENTS TO FIT JOB / �//mil%/AP Jean Hayes _ Rev9 Date Dtevm by CONFICATIO - /vICC//fA/l. ��ze=��-�t� Ori final 2/6/07 ES G/ West Hyannisport,MA Rev.� 2/16/07 Es �_1 DESIGN BANS ARE PROVIDED FOR THE FAIR USE BYTNE CLIENT N ib. Kitchen/Pant Floor Plan - Rev. z 2R2/07 ES COMPLETING THE PROJECT ASUSTEDWITHW THISCONTRACT. �� Design Aemdsia: Dd dl)..vg. 962 WASHINGTON STREETNANOVER,MA a PPROVEDB y^�y _ - DESIGN PLAN S REMAIN THE PROPERTY OF THIS FIRM AND CANNOT BE Erika Stern .March 6,2007 _;^'�.,.V ," j"�_...--�.�.-L, 7 / /� USED CR REPRODUCED WITHOUT PERMISSION. - 7(I1.B29.9123 WWW.THECA&NEIRYNET J (of r ' TILE BACKSPLA5H CATHEDRAL _ 93 3/4' . CEILING 18' GG' 1& 42' ML2/ ENKEBOLL#MLD-NCG DECOR SIDE n I m \ CM-IP2 \ / 7-CUV-PP3 PULL-OUT ENKE13OLL CORBEL \ / b SPICE RACKS DOUBLE LIGHT RAIL(MLG) END CAP CBL-TN2. DECOR WA5TE BINS SIDES (Wl FALSE WAINSCOT PANEL GAS COOKTOP DEEP DRWS.) . v WAINSCOT B OPEN SHELF DW LAZY\\ SUSAN PANEL ROLL- �J�PANEI;� PP VALANCE YF VALANCE 9° 6' 24, 45 18' 1v 30' 18' 24' 3G" 314' 144 3l4' 80118, 37 112' 149' THE D,e9�a ScNe: Pro,°cLNmm: The DELI.O RUSSO Residence REVISIONS ALL I MENSION5 AND SIZE DESIGNATIONS GIVEN ARE SUBJECT TO /J R-9 owl Drawn by VERIFICKnONONJOBSITEANDADJUSTMENTSTOFff JOB Jean Hayes ��2n—fir-�� Ori final 2I6/07 ES CONDITIONS. vICCC///(.w'/ y - - WestHyannisport,MA' A_2 DESIGN PLANS ARE.PROVIDED FOR THE FAIR USE SYTHE CLIENT IN - T"eof D-,w,F RBV.#1 2116/07 ES COMPLETING THE PROJECT AS LISTED WITHIN THIS CONTRACT. �� Oeagn A�"uNa: Dale of Drawvq: Kitchen Elevation Rev.92 2122107 ES OESIG"_ IM WASHINGTON STREEFNANOVER•M4 PPROVED BY: U_._REPROW WDWnHWTEPERMISSONS FIRMAND LANNOTBE 781.829.9127 WWINSHECABPIETRYNET MaFCI 16�2007 h, j� ;'(A«,q J3)1 Erika Stern 113 1/16' 18I/2' 181/2' 151/2" MI-2/ ENKEBOLL AMLD-NC6 :a aDuZIJ _ I / OPEN SHELF ro WAIN5COT SIDE PANEL O LIGHT PAL(MLG) 48.5UB-ZERO WI DECOR PANELS CPL-IPI CPL-IP1 / CLM+P2 CLM-FP2 CUf.DIV. CLM-PP2 CLM-PP2 ° bKMU DRW. /5z ROLL- 25' — 0 OUTS APRON 51NK LAZY i LAZY LAZY \ 5U5AN SUSAN 5U5AN \ Tr VALANCE l� 3/4' 3T 28' 36' � 36' 21° 30° 21' 48' 6 1/16' 6' 156 3/4' 16O 3/4' I THE DB99�• gee: PryadName: The.DELLO RUSSO Residence Re.M REVISIONS � � ALLDIMENSIONSAND SIZE DESIGNATIONS GIVEN ARE SUBJECTTO // _ CVERONDITIONS.ON JOBSITE AND ADJUSTMENTSTO FIT JOB Jean Hayes _CONDITIONS. + (///'/(iY� G GJ 1/2"—��-0" - Original 2/6/07 ES p y West Rev.#1 2116107 ES A_3 DESIGN PLANSARE PROVIDED FORTHE FAJRUSE BYTHE CDENTIN Neo Drewmg Kitchen Elevation Rev. 2/22/07 ES COMPLETING THE PROJECT AS LISTED WITHIN THIS CONTRACT. �� Dade^0.¢meele: Oef•ol Orawvq. DESIGN PLANS REMAIN THE PROPERTY OF THIS FIRM AND CANNOT BE 9MWASHINGTONSTREETIIANOVER,N.4 PPROVEDBY: USED OR REPRODUCED N7THOUTPERMISSION. 781.829.9127 WWW.THECABINETRYNE Erika Stern - March s,2007 + 4 i� ,y,>� ���—�� , r DECOR 510E:-, CPL-IPI ;:.. CPL-4Pi CLM-PP2 CLM PP2 CLM-PP2 CLM-PP2 ENKEBOLL. CORBEL5 PP VALANCE CBL-TN2(2) WAINSCOT WAIN5COT BACK PANEL BACK PANEL PORN. m . BA5E 5 'G5' 65 y 1 _ """° The DELLO RUSSO Residence REVISIONS Ray.p ALL DIMENSONS AND SIZE DESIGNATIONS GIVEN ARE SUBJECT TO - Dat.e. DnwnW VERIFICATION ON JOBSITE AND ADJUSTMENTS TO FIT JOB ]��,,�ef Jean..Ha es 1�2°-1�-0° C0Nan0N5 �I �/ Y West Hyannisport,MA Original 2/6/07 ES DESIGN PLANS ARE PROVIDED FOR THE FAIR USE BY THE CLIENT BI ea D—o4 Rev'.M 2122/07 ES 4 COWLETWG THE PROJECT AS LISTED"THIN THIS CONTRACT. Daa9aA��a: } r �°aL°�•�. - Peninsula Elevations RBY.�rz 2I22/07 Es CESIGNPLANSREIMINTHEPROPERTYOF THIS FIRM AND CANNOT BE 9B2WASHINGTGNSTREETNANGVER,MA APPECIka Slel n March 6,2007 ROVEDBY� USE D OR REPRODUCED WITHOUT PERMISSION. 781.829.9123 WWW.THECABINETRYNETr / I • r I8' 24' 24' 18' 4G' 15, 17' MI-2/ EMBOLL 9MLD-NCG 5 _ DECOR: / SIDES / I DECOR — LIGHT RAIL(MLG) SIDES Q CPL-IPI CPL-IPI CLM-PP2 CLM-PP2 �z J w CLJM-PP2 CLM-PP2 - 10 0 za 0 �I BLIND BLIND I 1 I �' CORNER i { DW CORNER EU fl] PP VALANCE 24° 18, 12' I5° 3G' 24' 15' 42 123 7/8' 43 3/8' ALL DIMENSIONS AND SIZE DESIGNATIONS GIVEN ARE SUBJECT TO //��THE 7�/ Deaeeer: Stele: Projed Name - TIIG DELLO RUSSO RI,SIVenCe - gev.tl REVISIONSOrewn by VERIFICATION ON JOBSITE ANO ADJUSTMENTSTOFIT JOB _ .Jean Hayes .' 1/2"_1r-�° - On lnal 2/6107 ES DESIGN ORS. y West Hyannisport,MA /� —5 DESIGN PLANSARE PROVIDEDFCR THE FAIRUSE BY THE CUENTW Tie° a Rev.#1 2116107 E9 H COMPLETING THE PROJECT AS LISTEDVATHIN THIS CONTRACT. \� � Design Ass°dele: Dele otDmrvq: Pantry Elevations Rev.#2 2122/07 E$ DESIGN PLANS REMAIN THE PROPERTY OF THIS FIRM AND CANNOTSE MWASHINGTONSTREETHANOVER,MA PPROVEDB USEDORREPRODIJCEDWDHOUTPERMISSION:. 781.829.9423 WWW.THECABINETRYNET Erika Stern - March 6�2��7 .� 1 7)!/Jv, 19° 35' 12112' 30' 37112' NKEBOLL#MLD CG ` G' E N N - "F'.._ .:'.� ,�3-vn"52'•�i::.rV�:v 4..<£�:c`.Ri3 -r„x�: C::a`+::a�:: — . ESL WAIN5CCT i FULL i 51DE PANEL MICRO 5UB-ZERO DECOR UGHT RAIL(MLG) UGFiT RAIL(MLG) REF. N � (V 51DE5 _ y CUT.DIV. I ESR - PULL RUNE L \ I � BLIND CAB. 2° i CORNER I - .. 30 11/2' 24' 42' 3I4° 36 314° I L 20 29 581/4' 54 1/2' 17 7/8' 123 718' ALL DIMENSIONS AND Siff- e".a Due DESIGNATIONS GIVEN ARE SUBJECT TO TILE D"a9"er. Scab: Pr"IM Hems: REVISIONS /� I -.,L/ - � The DELLO RUSSO Residence, R Drexn by VERIFICATION ON JOBSITE AND ADJUSTMENTS TO FIT JOB �� '^�/ 1/2e_1r_0" CONDITIONS IjGf/ Jean Hayes L - Ori inal. 2/6107 ES �/ y West Hyannispolt,MA Rev.#1 2/16/07 ES �_{� OESIGNPIANSAREROJECT OFORTHE FAJRUS IS CONT CLIENT P! - Ne" �"�: Pant Elevations - rseV.#� :2/22I07 ES v COMPLET@1G THE PROJECT AS IISTEO WITHPI THIS CONTRACT. - - Des9"A—d*: _ Dale el0mw°p DESIGN PIANSREMAIN iHEPROPE0.TY OF THIS FIRMANDCANNOT BE 962WASHINGTON STREETHANOVER,MA �/ r - PPROVED BY: 781.829.9123 MINTHECASINETRYNET. Erika Stern March 6,2007 p/ f�; �� _ _.1.-'r_7. USEDCRREPRODUCEDVIRHOUT PERMISSION. ! l .y.,.-+•7J J Assessor's office (1st floor): Assessor's map and lot number �`�.. of "E To Board of Health (3rd floor): 41 Sewage Permit number ... c � _ 9T4DLE, Engineering Department (3rd floor): $. , SEPTIC TEM Mll O � ae House number �.....�..................... INSTALLED 1N CO �163e. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only' WITH TITLE 5 - ENVIRONMENTAL CODE AI,'.F TOWN- OF BARNSTpf- "- Y 'fl BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... &>171 ..................................................................... TYPE OF CONSTRUCTION ..... Q ..1.-.iC4241- I...7C....................................................................... .......................... -. /...7..19.. 6 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....��/��..�..�.�.�......... �.t.�/1. �.��.�.. �..f..✓..�......� ........ P ' ProposedUse Sir. - ....................................... ........ ................ ........... Zoning District ... './...........................................Fire District ...... ..... ,1. ................. � ) P � • Name of Owner ....L/�ll. lr. ...✓..... C�J. Address ....1.<..v�.... C .X.....�. C�....... Nameof Builder �..�........................................Address.................... .................................................................................... t : Name of Architect ...............J..!.'. .��..... �!.1.�............Address .....0 ff"I 'F.7`..Si .... 17 Number of Rooms ........../.... ...... ...Foundation ....... e. CXC:.... Exterior ....... 'Al .. ../...... . .I.G.! Roofing .......Gr .1 ... G1. ................................:. V..(. .. �..r""' .. (.•.. ............Interior ......c�. . �..�..... Q.�- \... Floors Cl� ................................. A _ Heating .................................... Fireplace ./!/... ���� Approximate Cost..................................... ................... ... /............0 Definitive Plan Approved by Planning Board -------------------------------- -------- , Area ..... .7......................... i qd Diagram of Lot and Building with Dimensions Fee ./ .g .................... f SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 +i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......... . .. ........ ......... Construction Supervisor's License ...0Q.l�.�.�..... DACEY, WILLIAM E. III No ........5.. L Permit for ...Addi.t.ion Single Family..P:i��in�i ......... . ......... ..:...... . ..... Location ....Lots 20 & .60, 204 Green Dunes Drive ..................... ...................................... Centerville ................................................................................ Owner .........Wil.i.i.am..E.....Dac.e.y..III.....*......... Type ofonstruction Frame ...... . ......................... ................................................................................ Plot`-.......} ................. Lot ................................ V Permit Granted �..... .e...2 3.!... . Jun...... . .... ....19, 86 Date of IAs-Pection ................................. ..19 Date Completed . ......................................19 U1 jL* �1 Vfyly' 9S f ' f ZI '' ' •tt s,�.F O •I fit' ' , IN /ice t _ _.. � n \ . � i � A � �{•, nay' aLry f1 I l.all, �. cv.vS�. "1 -41 , bow+r •� �' 4f No. 17 !: T. N6►'E ....d2dl�t,✓AL Lsr `:. J� , P�lwfS I z 792:, ':5MtWr FY i�!✓RFY� G2o5Si (¢, 7N� �X/5ri.✓G ;� as ro AE' n,.✓� �3� ;:k , Sil CTZ ' 6AGCs 'f#41 3 U J G>�� .:.. LT .A 4 KS . CERTIFIED PLOT PLAN. z L�/277 77-04- -Ml s Lo—, /s 1-,07- Z-.C-e4fZD is 71C� /� YEl�2.. moo zar�: f►5 ��oTS f ZQ 2�!c�, b q: oept-i� Sy -pfe Ay, v a Goo: 9 /1"�SU/1/A*iG� �� ✓/'1+�'P N/J, 2,5CSOO/-000S/4 'rr r ; IN u , Y Z r S.CALE�:/ DATE �. 3- 3I 8w GEE QI EE lfli(r .1 tAl 4A I. CERTIFY THAT' 'THCLIFEW E ESISTERE® RE®ISTERE&I SHOIAIN ®N PHIS -PL.ANA LOCATED K CIVIL LAND. 400 a0. told 1 ON` THE GROUND :AS INDICATED- AN;fD', ' ENGINEER SURVEYOR ,®Yl . C®I�FO.RM TO .THE 'ZONIN9 LAWS OF 84Ri•rS.TA6� ;MASS. ram} Tt2 MAIN STREET . CH.®Y$ HYANRI5 SHEETHAS$, .,:,,,,®F/_ A E , REG. LAND SIIRVIYnR xY_ ry.. Assessor's office (1st floor): o ME Assessor's map and lot number . .� oFTtO� Board of Health (3rd floor): �f h - / c— �o Ca fO�Q ♦� Sewage Permit number ......!.. BAgg9T11DLE, Engineering Department (3rd floor): ' �, JS. F 9°os,M6 9• e� House number 'E0 MpY \ APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only Cr TOWN OF BARNSTABLE Fit' BUILDING INSPECTOR A- APPLICATION FOR PERMIT TO ...... / 7I d C/�/�. . .�a.............................:0" ................................ //�f ... . —� TYPE OF CONSTRUCTION ......(..�J ,� r`� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..../G'!.......................t........................................ .......................................................................... C�(...... . ...... r /{ �_��, ram, ProposedUse ................................................../.. '. ..................................... !...................................................................... .! r Zoning District Fire District ...... �... ........ .�........................... Nameof Owner ....................................?.f.............�r............Address ..............7:.... ..... r .. .......... Name of Builder �'� .....:..............................................................Address .................................................................................... Name of Architect .................).....�.�5..........` ....Address C. Number of Rooms ........../.... � -'-�'« 5 ...Foundation .. ..........f� :.... Exterior ......V. .........`......./....... ............Roofing ....... .................... ................................................... Floors r..(.�I..�-�... .. .,fi.�'� P.. .............Interior ......- . ..... Q. Heating5 .... ..:..........Plumbing <.. ..6 ................................. Fireplace d1� CIOs'................................................Approximate Cost l 5/ Definitive Plan Approved by Planning Board ------------- _____19________ . Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... _ .......................................'.............. . � Construction Supervisor's License .................................... DACEY, WILLIAM E. III A=245-025 _ 29541 Remodel &No ................. Permit for ..........................�,ds3�.tion Single. Family Dwelling..................... Lots 20 6 Location ............&....Q. 2Q.4...GxsszL..Duue Dr. ....................CentehY7 ,J..................................... Owner ....... E,...Rg.CP_y..,.iz.......:....... Type of"Construction Frame .......................................... ................................................................................ Plot ............................ Lot ............................... June 23, Permit Granted .....................:..................19 86 Date of Inspection ....................................19 " Date Completed ......................................19 RM COMPLETED 1/1 q� Assessor's office'(1st floor): F 7NE Assessors map and lot number T Board of Health (3rd floor): . Sewage Permit number ...................!�=.n....... j BAHB9TADLE Engineering Department (3rd floor): �O / JS 90rb 9• eon House number 7 'Fp M I a� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE U ��B�UILDING INSPECTOR APPLICATION FOR PERMIT TO ..�-/....... . ......C'.:r.7.......:�.._�.�,<..�:..�'.?.v7.�,i �G.2�....................... _lI TYPEOF CONSTRUCTION ..... -.... .... ................................................................ .c..................... ..................... .....�...=%� ----19---r� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...,.. r' Proposed Use ....... R.J) ...id1!f!'t: ........ .: ... ............................................... .................................................Zoning District ....... ...'...!......................................Fire District ...................... ............................................. Nameof Owner ................�....�'.:!'1........................................Address ............�...f;.l...........1. Nameof Builder .......... .........................................Address ........................................................................0........... Nameof Architect \..............................................................Address .................................................................................... 4 G l Number of Rooms ........................................... Foundation �t�u.�C ( C.l Exterior ...........................Roofing �..................................................................... L ........................ I I Floors ............................................................. ........................Interior ......... �— Heating ................................................... ...............Plumbirig .........r..... �..C. ........................................................ Fireplace .................................................................................:approximate Cost ... .5.. .. C7 ...................................... Definitive Plan Approved by Planning Board _______________________________19________ . Area .......,.... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH a` OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .:.!j..;,!!;/.�,; ....,..!.... ................... Construction Supervisor's License1� ��. .......... GREENBRIER CORP. A=245-025 No ...30103... Permit for ..Build Swimming Poo' .......Single Family Dwelling Location ......Lot #20.z,_. 204„Green„Dunes .......................Hyannis........................ Owner ......Greenbrier„Core.�......................... Type of Construction ....Frame .......... ............................................................................... Plot ............................ Lot ......................... Permit Granted October 28., 19 86 Date of Inspection ....................................19 Date Completed ......................................19 V Lo-r ' t oni 5 70`08'5 0".E —� U \ t k r-Te R.- tent . Sr ._ lot pT 3 Go lD N I0 �CP05 e7b I°cv[tal: \ � TAoux 46,4(o To c. 7o.,Z 1 k N , ' o � i 1 I �z d �.1 DtA, v a= 141.z5 M / �=13�7.�5 5G 90 W ZodE 3 S(oC� �tJ � AFL. CI GC 1-IF I CERTIFY "THAT THE PROPOSED BUILDING 4?*-L SHOWN ON THIS PLAN CONFORMS TO THE ZONING LAWS OF 114E !_sM1 MA. LEGEND DATEI — PROPOSED SPOT ELEVATION EXISTING CONTOUR ---0- %<: PAUL PROPOSED CONTOUR 0 �= on�I� '\ \`" = LEVY +� NOTE THE LOCATION OF ANY UNDERGROUND CC IVIL- w�Y �\�No. 106I7 N SEWERAGE WELLS OR OTHER UTILITIES SHOWN ON No.31115 �/ g , �„ -O 4" THIS PLAN IS APPROXIMATE ONLY AS DETERMINED Ay�� wore �' ����r',7�� o FROM RECORDS AND/OR VERBAL INFORMATION. °�F CASTE% 4rjy THE CONTRACTOR IS RESPONSIBLE FOR THE G1 0 . VERIFICATION OF THE EXISTING LOCATIONS IN THE FIELD. '�' N'j%IQER ER LEVY & ELDREDGE ASSOCIATES,INC. CLIENT P D PLOT PLAN :t Zoo Ccees-xJ D U Q D P-I V C- EN(31NEERS - LANDSCAPE ARCHITECTS JOB NO. IO (Lon zo e'(-o LptilD coU/z.T *r560>+-D) PLANNERS - LAND SURVEYORS DR. BY% �_, IN 889 WEST MAIN STREET CHKD. BYt CENTERV ILLE, M.A. 02632 T.I OF L SCALEt I "= q0 DATE t ti Assessor's office (1st floor): ; �? �� ;-: s.; SEPTIC SYSTEM MU o Assessor's map-and lot number_ ....... ... f Board of Health (3rd floor): � � g Sewage Permit number ................... 4).....4..... INSTALLED IN CO ......... WITH TITL Engineering Department. (3rd floor): 02� i / IRON ENTAL �"�9, House number .................................................�.....................: j"t�k`Ay ERE��LA pv a� APPLICATIONS PROCESSED 8:30_9:30 A.M. and 1:00.2:00 P.M. only A P P R O V ETOWN OF BARNSTABLE ns able Conservation Comm Sssoa I L D I H V I N SP E C T 0 R 3 Dato 11 _ • / fined APPLICATION FOR PERMIT TO . .` C.%;..... l ! ... . o:!............................ TYPEOF CONSTRUCTION ....... .. .. :........................................................................ ..................... t K ...................... . ....�..1>.---19..,5;�6 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accord' g to the following information: ` r , 2* kn_ Location .. .........v . . ........... ��. ..��. .... c ................��............................... ................ ProposedUse I.. (.! .. .. (. C?.C7 (...................... ........ ................................................... ll ZoningDistrict .......R.. t ..........1......................................Fire District ...................... ...... ..................... ......................... Name of Owner ...... 47760...Address Nameof Builder ........... �..M .P� Address .................................................................................... Name of Architect ... .. ..........................Address .................................................................................... ................................. Number of Rooms`.............. ...................................................Foundation ..C��Q.C-S.<.�' .....C-O/�C�C. �...i Exterior .....:..................................... . Roofing................................... ................ ............................ Floors ......................................................... ...............:............Interior .............................................................. ............. Heating ..... ...............Plumbing :..... ..41.. .................................................... Fireplace ................................................................................ Approximate Cost .... .5..f..� ...............................!...... Definitive Plan Approved by Planning Board --------------------------_-----19________ . Area ..... ... ........................ .... Diagram of Lot and Building.with Dimensions' Fee SUBJECT TO-APPROVAL OF BOARD OF HEALTH Poe— OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Ba stable regarding the above construction. Name ..... ....... Construction Supervisor's License � /�;��,�. .......... GREENBRIER CORP. kuildigwimming Pool _�0103..: Permit for ...4.... .................. No ... ......... M Single- Family ...................... Dw.e.-.1..1. i ng .................. .. . .... . ... ................ 0 Location Lot #20, 004 Gre . Dunes ............... ...... r ........ . ..................... 41 ......A7y5c .. ... ....... _4 .............. . .... tea................ Greenbrier Corp-. Owner .................................%,........ ...................... 0 V"- Frgme Type of Construction ........ �J.A.................. I............................... ............... ...................... Plot ............................... 'Lot ......................... ......... Permit Granted .....October 28, �19........................... 86 Date of Ihspection ....................................19 7 Date _.C6rnpleted ................ .............V 9_ `7 M C) V 0 'ieR jL tv j