Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0082 HAWSER BEND
�c�w�e� . � . . 0 3 �� .. _ � _ a. � .. o 4 a a Town of Barnstable F- s V& 6rmnft fronr issue date Regulatory Services Fee := a9. Richard V.Scali,Interim Directori� fop- Tom r l/ Building Division MAR 29 � Perry,CBO,Building Com," �, l 200 Main Street,Hyannis;MA 60f 1� Office: 508 www.town.bamstable.ma.us �u °���� -862-4038 EXPRESS PER HT APPLICATION - RESIDENTIAL ONLY 08-790-6230 Map/parcel Number 19 2 —tj Cl'O Not Valid wit/tout Red X'Press Imprint Property Address aw se r. .��en cf t�pn�p ✓�1 e Residential Value of Work$ Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address /� e; S ✓� �� �� . e d' Cep-le c 1 e t� ,/ 3 Z Contract ors Na BRMA) Name � pt)S /SDI Telephone Number fD/-ZZe 7906 _ Home Improvement Contractor License#(if applicable)/73 4, Email: Construction Supervisor's License#(if applicable) B QS7Q7 kyorkman''s Compensation InsuranceChek one: ❑ I am a sole proprietor a I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name ,g .. Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old-shingles) All construction debris will be taken to -------------- ❑Re-roof(hurricane nailed not stripping.. ( s❑ sideGoing over existing layers of roof).., Ly'Replacement Windows/doors/sliders.U Value -3 t] (maximum.35)#of win ows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required_ Issuance of this permit does.not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. "'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is requir d. SIGNATURE: Q:IWPFILESTORMSIbuilding permit formsTYPRESS.doc Revised 061313 Reenewal Agreement Document and Payment Terms b, dersen dba:Renewal By Andersen of Southern New England Madeleine&Sven Borglund MIAC....1 Legal Name:Southern New England Windows,LLC 82 Hawser Bend RI #36079, MA#173245,CT#0634555, Lead Firm#1237 Centerville,MA 02632 26 Albion Rd I Lincoln,RI 02865 H:508-775-1534 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s)Name: Madeleine &Sven Borglund Contract Date: 03/10/17 Buyer(s)Street Address: 82 Hawser Bend , Centerville, MA 02632 Primary Telephone Number: 508-775-1534 Secondary Telephone Number: Primary Email: mborglund@aol.com Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $8,274 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $4,137 Balance Due: $4,137 Estimated Start: Estimated Completion: Amount Financed: 8 to 10 weeks 8 to 10 weeks $8,274 Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: Taxes paid Barnstable. Finance at 6.99 percent for 5 years. Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s)1)has read this. Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign., YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 03/14/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renew By Andrn off Sou hern New England Buyer(s) Signature of Sales Person Signature Signature - Gino Montesi Madeleine Borglund Sven Borglund Print Name of Sales Person Print Name Print Name UPDATED: 03/10/17 Page 2 / 10. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-095707 Construction Supervisor - BRIAN D DENNISON 7 LAMBS POND CIRCLE r CHARLTON MA 01507 -�-."x �-� CA-- Expiration: Commissioner 09/0812018 �- •_. ��e �a'�n��a7a'��rcfer�l�f �-J�'�•CY.:iJC(G✓?�G1G�• Office of Consumer Affairs And Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type- Supplement Card Expiration: 9/19/2m SOUTHERN NEW ENGLAND W INDOWS.:LL:.,,_-_- BRIAN DENNISON = - 26 ALBION RD LINCOLN,RI 02865 - _ Update Address and return card hfark reason for change. su i•a zo;arsm E]Address DRenewal r Employment ❑Lost Card ,:�/,.•rr,:,,.,,..:,,,,:�„lip.fin/%,1:,,,%,,,r�r: _- =-oTiice of Consumer ARoirs&Business ft btion Registration valid for individual use only before the ' `�• �.� `:' �"�N09AE IMPROVEMENT CONTRACTOR expiration date.If farad return to: nGi!" Ogre of Consumer Affairs and Business Regulation =�' s ', Registr T...1732�: Typo: 10 Park Plaza.Suite 5170 ' Fxpiratlon 9/79/2018> Supplement Card Boston.NIA 02116 SOUTHERN NEW ENGLAND WINDOWS I.I.C. RENEWAL BY ANDERSON,.,: - BRIAN DENNISON 26ALBItNdRD LINCOLN,RI 02865 ll)hde Not valid without signature o e The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 0 www mass.gov/dia IYorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business(Organization/Individual): Sp,y ��n he-,j &16 IGn A LIJ 10 J ZX J� Address: a& 41 b;o,-% . City/State/Zip: Lill l) S Phone#: 40) Z 2g- 9 S C>O Are you an employer?Cbeck the appropriate box: Type of project(required): l.cil am a employer with !�Q�employees(full and/or part-time)-* 7. ❑New construction 2.O I am a sole proprietor or partnership and have no employees working for mein 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.E]I am a homeowner doing all work myself[No workers'comp.insurance required]t 10 E]Building addition 4.❑I am a homeowner and will be Luring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions S.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q p Roof repairs 'These sub-contractors have employees and have workers'comp_insurance i / 6.❑We are a corporation and its officers have exercised their right of exemption per MGL d 14.[t.other GJ r n a t 152,§1(4),and we have no employees.[No workers'comp.insurance required.] /P�/atCAt4+1t5 *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 insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Name: �on rle��A (n/e35�e�� Ins• Co Policy#or Self-ins.Lic.#: W C- A 313 I Q a I Expiration Date: 7— 1 n Job Site Address: 8 Z /'1Gl W Se r hie l►d'/- City/State/Zip:eP4 f!/'d j t!e Attach a copy of the workers'compensation policy declaration page(showing the policy number and expi ation date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the r Y andpenalties of perjury that the information provided above is true and correct r Siartature: Date: Z / Phone#: (4l0 I Official use only. Do not write in this area,to be completed by city or town off ciaL 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#: 1 i SOUTNEW-01 UOLLINGER CERTIFICATE OF LIABILITY INSURANCE DA,E(MMIDDNYYY) 7612912016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: If the certificate holder is an ADDITIONALINSURED,the policy(ies)must be endorsed. If SUBROGATION IS WANED,subject to the terns and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CoBiz Insurance,Inc.-CO NAME - 821 17th St acr a FAIA303)988.0"6 AI Nd:(303)988=0804 Denver,CO 80202 ADDRESS.CoBi7Jnsurance@pobizinsurance.com INSURER( AFFORDING COVERAGE I NA1C# INSURED A:Continental Western Insurance Company 110804 INSURER B• 1 Southern New England Windows LLC INSURER c- DIBIA Renewal by Andersen 26 Albion Road WSURERD: Lincoln,RI02865 INSURERE: INSURERF: { COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY.THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.'UMITS SHO WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L'rRINSR! TYPE OF INSURANCE iNSD W VD POLICY NUMBER I POLICY EFF ! M Y D� { LArIrS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE i S 1,000,000 { i (CLAIMS-MADE n OCCUR ICPA3136080 :0710112016107101/2017 J PREMISES Eaocamence is 100,00 M ( one ) S 10,000 ! ED EXP(aml person) ! PERSONAL&ADVINJURY I S 1,000,000 HN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I S 2,000,000 X I POucY PRO- { { ' 1 !JECT LOC ! 1 I PRODUCTS-COMPIOPAGG i S 2,000,000 OTHER { ' EMPLOYEE BENEFI !s 2,000,000 I AUma+oalLE LIABILITYeeSINGLE LIMIT 1 S 1,OD0,000 A ' !r ANY AUTO i CPA3136080 07/0112016 i 07/01/2017{BODILY INJURY(Perpemon) I.S_ I ALL OWNED _SCHEDULED _—• ---• AUTOS ! AUTOS t ;. !BODILY INJURY(Per aoddent){S NON-OWNED i r=HIRED AUTOS AUTOS PROPERTY DAMAGE (Peraeder 5 I I !S 1 ' 'UMBRELLA Lu16 i1 OCCUR + j I 5,000 0 t I i I EACH OCCURRENCE s , 00 A ExcEss LIAB ! r CLAIMS-MADEI I �CPA3136080 10710112016+07/01/2017<A EGA;E is DIED I X I RETENTIONS 0I ! ! t [Aggregate is Si0001000 I WORKERS COMPENSATION ; AND EMPLOYERS'LIABILITY Y 1 N 1 I I I I I STATUTE ERA A ANY PROPRIETOR/PARTNERIEXECUTIVE i WCA3136081 .07/01/2016!07/01/2017 E.L.EACH ACCIDENT is 1,000,000 OFRCER/MEMBERDCCWDED? ❑ NIA; I � (Mandatory In NH) 1 { I I I EL DISEASE-EA EMPLOYEEJ 5 1,000,000 If yes.describe under 1 DESCRIPTION OF OPERATIONS below I { i .I ` E.L.DISEASE-POLICY LIMIT I S 1,000,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Raman.Schedule,may be attached IF more apace to required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name1 u ' 92 (r �v !� TelephoneANumbe `7 1 3 'Addr_e License# (,u rn -. Home Improvement Contractor# 43 Worker's Compensation # ` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C:7SIGNATURE-"� DATE /I 2 O r Q 2 .1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0 q Application # Health Division Date Issued Conservation;Division / `. ` Application Fee Planning Dept. d` Permit Feb Date Definitive Plan Approved by Planning Board F Historic- OKH Preservation/Hyannis Project Street Address2 Village �V a r. c J Ur— Owner SJle&0% � T! Address S— 4vwSer lbav%d Telephone b FS '�-7 S- 1 S.4 Permit Request 1Z` x �?_�` C4c�ar'c' oh �r r�SwT c c o f cxm Square feet: 1 st floor: existing tlwproposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Va►uation'2.,OW Construction Type Lot Size ( ,wo Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) j 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 7i new Half: existing new Number of Bedrooms: �xisti _new , m Total Room Count (not including baths): existing new First Floor Room CoRt : Heat Type and Fuel: )(Gas ❑ Oil ❑ Electric ❑ Other <1 LO Central Air: ❑Yes No Fireplaces: Existing New Existing woo/coal stove: 21.Yes No n ; Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existingp❑ now size_ Attached garage:existing 0 new size _Shed: ❑ existing ❑ new size _ Other: a 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, � �V\�i�cr11 -�'t-LSZ�bti�o�,,� Telephone Number 15�10 �'Address 66X Y00 License# kmo+ 0 17 Z 1 Home Improvement Contractor# / 32,3f5 Worker's Compensation # (I L ZO!J(,( WO& ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE / 1 Z^0 5 .T FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED s r MAP/PARCEL NO. '{ ADDRESS VILLAGE OWNER J`i DATE OF INSPECTION: t FOUNDATION s FRAME I Z�Ib�as INSULATION w. 1 } FIREPLACE 'ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL . f GAS: ROUGH FINAL i FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1 x 1' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly N�Name(Business/Organization/Individual): V 0(J o VLA-d (L� dress: L �t!✓USf 12I �1 City/SState/Z p��(?L;& tIZ,)-�l,,L.,'� h4A OaL3X Phone.#: `7 -7 5 / Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 40 P4 am a general contractor and I employees(full and/or part-tim.e). * have hired the sub-contractors 6. New construction 2.❑ l 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.$ required.] 5. [J We are a 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. M Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of 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 ce un er th ains and e alties of er ury that the information provided above is true and correct. Si nature: j Date: G G Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 lega representatives of`a aec'—eat emp oyl er,or the— or trustee of an individual partnership,association or other legal entity,em Toying employe es. However the receiver ,p p, gP 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-contiactor(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 permitilicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" I.he applicant should write"all locations in _(city or town)."..A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid.affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and 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 Investigations. 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia �oFVEr, Town of Barnstable P o Regulatory Services snRNsa+Bm ' Thomas F.Geiler,Director WLAM �6"rfA.e� Building Division Tom Perry,Building Commissioner Hy_anpis,MA 02601_�,_ www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION p Please Print DATE JOB LOCATION GT�t-� [ 1 J UJ1J(� �j�'� t,i C`L number street village "HOMEOWNER'r, ��>✓ 6 �-L y►�n. -7 7 S= -34 name (� home phone# work phone# CURRENT MAILING-ADDRESS: D ii �&YL . g-VI �rrn tz� v 61((Z�_ Ayl B 2.G 3 2 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. DEFINPTION OF HOMEOWNER Pcrson(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 minim ection procedures and requirements and that he/she will comply with said procedures and re eme ,!:tSi— a . Hom er —� 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 hues unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a,form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forrrms:h omeexempt IHWE Town of Barnstable Regulatory Services tMAM LE Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If PropejU Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERM ISSION The Cornm-onwealth oJ`. CLS'sactt.useus Departmont of Industrial Accidents Office of InvestigatLons 609 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name (Busiesss/Organi7zation/individual): ' Address: City/SiateJZip: �tn,�r� 7Z ( Phone.#: f3 Are you an employer? Check the appropriate box. Type of proje,ct(required): I. I am a employer with 4. ❑ 1 am a general contractor and I 6. New constt action . employees (full and/or part-tint:).* have hired tb.e stab-contrd.ctors 2 ❑ I am a'solc proprietor or partmcr- listed on the attached sheet. 7. ❑Remodeling : These sub contractors have g• ❑ Demolition ship and have-no employees working for Mr,in any capacity. employees and have workers' 9 Building addition [Ni)workers' eQn1p.ITlslrranCe comp.insurance.$ S.❑ W e are a corporation and its 10.0'Electrical repairs or additions rbgtnrrA tbcir I I.❑Plmnbing repairs or additions 3.❑ I azn a homeowner doing all work myscl£[No workers' comp, right of exemption per MGL 12.❑Roof repairs ian ancc required•] t c. 152, §1(4), and we have no cmployecz. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that eh=l=box#1 mart also fill aut the section below showing their work=,eorop s on policy inforroatioa. t Homoowr)=who submit this d56avit indicating they arm doing all work and tb=hire outside contractors must eubroit a new;LMdavit indicating such. xContractors that cbock this box must atfacbcd an additional sbcot cbowing the name of the sub-contracture and stale wbether or not those cntitus have cmployeu. If the sub-contracture have employ=,they mat providb their workers'comp.policy nwmber. I am an employer aid is providing workers'campensa,ion insurance for my employees. Betow is The policy and jab site information. Insurance Company Narn �— Policy#or Self ins.Lie. #: W Ci `�o(4 Q V Ob Expiration Date: �r Q Job Site Address: 2- 4tC- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration da-te). Failure to secure covcragc as required under Section 25A of MGL c. 152 can Iead to the imposition of mina ial penalties of a 5ne tip to $1,500.D0 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.DD a day against the violator. Be advised that a copy-of this statcmerit may be.forwazdc.d to tho Office of Investi Kations of the DIA for insurance coves c verification. I do hereby car*under the patns-and penaldees of perjury that the information provid8d above rs true and carrecl. Si>;nature. r c_ Date - /L "C'fJ . Phone# �- Of d use only. Do not write to this area, to be completed by city or town offu iaC City or Town: Permit/License# Issuing Authority (circle one) 1. Board of Health 2.Building Department 3, City/Towu Cleric 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: z pursuant to this statute, an employee is defined as "...every person is 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 represcntativcs of a deceasedd employer, or the receiver or trustee of sn.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 an tba grounds or building appurtenant thereto shall not because of such employmcnt be deemed to be an employer. MGL chapter 152, §25C(6) also states that"every state or Iocal 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 notproduced-acceptable-evidence of compliance with the insurance coverage required." Additionally,MGL ohapter 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 widener, of compliahec With.the in.Ree requirements of this chapter have been presented to the contracting authority.' &Pplicants °lease fill out the workers' compensation affidavit completely, by checking the boxes that apply to.your situation and, it iecessary,supply sob-conk-actors)name(s), address(cs) and phone numbers) along with their ccrtificatc(s)of nanrance. Limited Liability Companies.(LLC) or Limited Liability Partnerships (L12)with no-employees outer than the ncmbers or partners, arc not required to carry workers' compensation insuance. If an LLC or LLP does have :mployees, a policy is rcquircd. Be advised that this affidavit may be submitted to the Department of Industrial Lccidcnts for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should ro returned to the city or town that the application for the pest or license is bring rcqucstcA not the Department of ndustrW Accidents. Should you have any questions regarding the law or if you arc required to obtain a workers' ompensation policy,please call the Department at the number listed below. Self-insured companies should enter their elf-insuranw license number on the appropriate line. ;ity or Towit Officials ]case be sure that tho affidavit is complete and printed legibly. T'hc D epartment has provided aspacc at the bottom f the affidavit for you to fill out in the event the Office of Investigations has to conlactyou regarding tine applicant lease be sure to fill in the permitlliccnse number which will be used as a refcrcncc number. In addition, an applicant fat must submit multiple permitllic:nse applicafions in any given year,nccd only submit one affidavit indicating current oIicy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or wn)."A copy of the a$idavit that has been officially stamped or marked by the city or town may be provided to the )plicant as proof that a valid affidavit is on file for Rif=permits or licenses. A new affidavit.must be filled out each' sar.Where a homy owner or citizen is obta'�a license or permit not rotated to any business or commercial venture .e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. ie Office of Investigations would like to thank you in advanec for your cooperation and should you have any questions, case do not hesitate to give us a call. e Department's address, tcicphonc•and fax number. Tba C6mmanwoalth of Massachusetts Dq)aa.rtmDnt of Iadustrial Accidents Office of Investigations 600 Washingtan Street Boston, MA 02111 TO. # 617-727-49.0.0 ext 4.06 w 1-UWASSAFB Fax# 617-727-7749- d 11-22-06 www.mass.gov/dia 10/29/2008, 02:05 FAX 16 001 ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDrrM) PRODUCER 10/29/2008 508-393-9327 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION FARM FAMILY CASUALTY INS CO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 88C MAIN STREET HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR JOHN T. OAKES ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTHBOROUGH, MA 01532 INSURED INSURERS AFFORDING COVERAGE NAIC# INSURERA; FARM FAMILY CASUALTY INSURANCE C SHAWN FITZGIBBONS INSURER B: PO BOX 400 INSURER C: ASHLAND MA 01721 INSURER D: COVERAGES INSURER E; 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 PE:SPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' LTR 9 InE OF INSURANCE POLICYNUMHER POLM:YEFFECTIVE POLICYE�PIIRATION LIMITS A GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERrA�L LIABILITY 2014X0567 PR 1 a Irenco S 50,000 CLAIMS MADE X OCCUR 01/i4/2008 01/14/2009 MED EXP(any one person) S 5.000 PERSONAL&ADV INJURY S 1.000.000 GENERALAGGREGATE $ 2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMP/OP AGG S 2,000,000 POLICY 17P LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ee accident) ALL OWNED AUTOS $ SCHEDULED AUTOS BODILY INJURY(Per person) HIREDAUTOS NON-OWNED AUTOS BODILY INJURY $ (Pereoddenq PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG s EXCF&UMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS FADE AGGREGATE $ $ DEDUCTIBLE S RETENTION $ S WORKERS COMPENSATION AND WC STA _ OTH- A EMPLOYERS'LIABILITY 2014W6508 01/14/2008 01/14/2009 1 FIR ANY PROPRIETORMARTNERMAECUTIVE E.L.EACH ACCIDENT S 100,000 OFFICERIMEMBER EXCLUOE07 Ifges,describe Under E,L.DISEASE-EA EMPLOYEE S 100.000 SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT]$ 500,000 OTHER j( DESCRIPTION OF OPERATIONS/LOCATIONS I VENICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISION; # { THIS WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR SHAWN FITZGIBBONS — a N �rJ 3> ry :� CERTIFICATE HOLDER CANCELLATION Ell SHOULDANYOFTHEABOVE DESCRIBED POLICIES BECAN ELLEDBF.1• THE&X (RATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TP MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAM=TO THE LEFT,BUT FAILURE TO DO SO SHALL TOWN OF BARNSTABLE SAPOSE NO OBLIGATION OR UA ILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR BARNSTABLE MA 02630 REPRESENTATIVES. 10 AUTHORMM R VIE. ACORD 25(2001108) ®ACORD CORPO ION 1988 �/ze'�on�.raazuealC/ o�,�,aaaac�uaetla . Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return to: Registration'132359 Board of Building Regulations and Standards Expiration 1/1.1/2009 Tr# 126936 One Ashburton Place Rm 1301 'i'j s Type Individual Boston,Ma.02108 Shawn C.Fitzgibbons / I Shawn Fitzgibbons~ � _ f j� 65 South st. -' westborough,ma 01581 Administrator ithou'sig Hato �- �,�.r.u� ✓J2C IOO�I9Y/IZO�IZI(/��fL oo���/vGQd6G�� � q. r z ,: Board of Building Regulations and-Standards I� Construction Supervisor License License: CS 75144 j Birthdate1-1/4/1963 # J Ex iration Ia 1�1I412008 Tr# 8518 1 Restriction 00 .� �l - a� S n"'HAWN C FITZGIBPONS, I—= v d PO BOX 400 ASHLAND, MA 01721� `° Commissioner i �pF"ME roy� ToWn of Barnstable o� R.egula to ry Services s�xxsreaM v MAsa. $ Thomas F. Geiler, Director. lFnn+ata Building Division Tom Perry, Building Commissioner 200 Main Street; Hyannis, MA 02601 www.town.barnsta.ble_ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner must. CoMplete and Sign This Section If Using A :Builder Z \ 1= U Lu , as Owner of the'subject property ' hereby authorize� i�) \z l <�P� s to act oa my behalf, in all rnatters relative to work authorized by this building permit application for: v ( (Address of Job) J Signature of Owner Date 'W Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on th'e reverse side. Town of Barnstable ��op•tHe ray°. . , Regulatory Services N -�BARN&TABLE, Thomas F. Ceiler,.Director . MASS. i6Jq- ,�� Building Divlision PTfD �a Tom Perry,Building Commissioner . 200 Main Street•, Hyannis, MA 02601 ,Kw town.barnstable_ma.us flee: S08-862AO38 Fax: 508-790-6230 HONIEOWATER LICENSE EXEMPTION Please Print DATE: JOB LOCAT)ON: number Street village "HOMEOWNER": ^ name home phone# work phone# CURRENT.MAILING ADDRESS, city/town state rip 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. Th-e 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 hate Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that. "Any homeowner perfomring work for which a building permit is required shall be exempt from the provisions f this section (Section 109.1.,1 -licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such rork.that such Homeowner shall act as supervison" Many homeowners who use this exemption Ric unaware that they are assuming the msponsilbilitics of supervisor(see Appendix Q, .u)es&Regulations for Licensing Construction Supervisors,Section 2AS) ']his lack of awareness often results in serious problems,particularly hen the homeowner hires unlicensed persons. in this case,our Board cannot proceed against the unlicensed person as it would.tidth a licensed ipcivisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of hivhQ responsibilities,many communities require,as part of the permit application, at ale homeowner certify that Wshc understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by vcral towns. you may cart t amend and adopt such a forrn/ccrtification for use in your corrurrunity. r`^� Assessor's map ,and lot number ............................................ + � µ F THE TO Q� v Sewage_ Permit number . .. yEP/Tp yBC SYSTEM ss ,'; > o� ..... INSTALLED 1N 4� OM 7 31•AnLE, i .a House number .............. ............................................... ro .� s v sITH TITLE 5 1639. •� 0 d ENVIRONMENTAL COD '"�c �a. MP TOWN OF .-BARNSTA PLATIOMs .. BUILDING' INSPECTOR . . APPLICATION FOR PERINIT TO i.........1...C:l.. (7� C! /f .. .......................................:.......... TYPE OF' CONSTRUCTION .............. ,1� ....'....................................................................................... .......................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .... t 0....: F.!r..............��/!�!...�a........................................................ ProposedUse ...........F..( .................:................. ................................................. ZoningDistrict ..................:.................................:...................Fire District ............... �....................:........................... �- Name of Owne�//���.....4 /.��� �.02..1....Address .. ..../Yl� �t �....s�7 ...... 6 Name of ...............Address .....1I. !�! �5 Name of Architect .................................................................Address / /..7P ..........:.................................................... Number of Rooms` ................ f:.....................:.........................Foundation ... . Exterior ..........4 .4 ...T......../ Q. ....................... .Roofing ............, /......... ............................... Floors. .............. .... ................ .Interior ............ g ?lv`�.'!!. Plumbing � — Heating ................................. ........... .......... .......................................................... Fireplace .....................................................................................Approximate,Cost .............. . .:.........:................... Definitive Plan Approved by. Planning'. Board -----------------------_--------19--------, Area ...... • . ......!���Y.®. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF .HEALTH o X�S7-iG /7(®USL L• 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 .1. �I� A�ROC:CI, FRANK '77 C i t No 2...... rmit for ..Add...TO...n..We-1.li Sirxgle Family Dwelling ... . Location '"Hawser _Ben............. .... - Centerville I ................... .................................... Owner ....Frank- Piermarocc _ w ' Type of, Construction ......Frame.... ........... ............... .... ......` Plot ............................ Lot .' .......................... � �} � �"^May lO'Y t Permit Granted ..19 82 s Date of Inspectior3__..�?*:.Sf.=21...................19 { "',Date Completed .. .............. � 19 s - •; �• a e, .�, yf. •, � � T rl ». l � � 9 1 Assessor's map and lot number .........................................'.. �oFtNETo` Sewage Permit number' ...... ro``Q ♦°► 0 fl"/ham Z MMSTADLE. i House number ....................................................................... ro MAO& o a63 9 MR-1a\ TOWN OF BARNSTABLE BUILDING INSPECTOR ,���,��APPLICATION FOR PERMIT TO ..:..,.�;�...;/..�'",�....,��,,./��,�,/...............:..........................................:.......... TYPE OF CONSTRUCTION !��:! �`� .............. P ..................... s ..19 a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ., s /��!� ..... i //i�f ......1 .. ..... ...... ............... ProposedUse .......... .. a �� ..................................................................................................................................... Zoning District ........................................................................Fire District ........... ................................................ Name of Owner..,.......................... ... ... ..............:...............Address Name of Builder/�....... 4VXAI ..............Address ' „" h�J'��' Oaf, f�f •..... Y. /�/� �5 Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .............../...............................................Foundation G'�t� �.,............................................ Exterior t l $1.....!<,o4n 0..........................Roofing ............ ` .af'! L. ........................................ Floors /a�// '� � ........................................Interior / ....................... Heating ...................:' .` ...........................................Plumbing ...........:! 11/V. ................................................... p Approximate Cost Fireplace .......................................................................... ................,.. .......:................................. Definitive Plan Approved by Planning Board -----------________-----------19________. Area ..... <.� ©... Diagram of Lot and Building with. Dimensions _ Fee �"�'----........... :5 i.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i i V S' j C e I i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS �N41-. I hereby agree to conform to all the Rules and Regulations.of the Town of Barnstable regarding the above construction. .� Name ................., ...,............... ., ..........:........................ PIERMAROCCI, FRANK A=192-90 240:A,jbp,L - f ADDITION No ........ rmit or .................................... .......Sinc le_..Fami.ly...pwe,jjj�4.q.............. Location ...H wser..J3.e.n.d.jjj� ........... ........ .................... .............................. Frank Piermarocci Owner ...................................................?.............. Type of Construction F.r.ame............... .. .. ....... .............. .............................................I.................... Plot ............................ Lot ................................ Permit Granted .....MAY...,10...................19 82 Date of Inspection ......0..........I..................19 Date Completed ......................................19 00 04/0 5100, C- y TOM"' ' TOWN OF.BARNSTABLE 21883 Permit No. --------------------- x. Building Inspector Cash ------------ .,� OCCUPANCY PERMIT Bond __ Nil2P D No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Sandra J. Bays/CreatBlVVee Address 4 Ventura Tray, Yarmouth 32 hawser Bend Road Centerville Wiring Inspector t Inspection date,2, Gt Plumbing Inspector fs Inspection date Gas Inspector Inspection date Engineering Department . � � Inspection date 90. THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE .00CUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. � � _ _ .... , 19».».»»» Building ..Inspector ._ A I 1 5 IPA 1{ I 1 /., o 0 30 -7 p .S 77 4 , IS blo ;/-, /7 SILL tLE✓--:----lZ,1- " ,40O✓E P'4.,J.D PLOT' PLA ,1V r->LA/V 2E FET'EnICL : L 07 �w 'o 02 3 to NET�E8Y' CENT/f Y TAaA 7- THE EX:1.57- /NG FOUR DA 7/0N L0CATiON /5<fOReEC AS SHOv v VAi A� 0_ COniF .�M WI OTH ��' +,�� �rL�,' � THE SU/LD/NG SETf3/aCX.T2EQU/PEM�vl OF THE TOWN OF 7 J1,fjT 1f 4v/e-,OW sr. >'AiZMO U7777-1O.0T M<J. A essor..:� map and lot number ofTHEro� ; r . Sewage Permit number ..... SEPTIC SYSTEM NSTAUAD IN CO ' . , R C � r House number .............. WITI'I TITLE M"&. E, •.......................................,....... ENVIRONMENTAL C ` ab39 TOWN OF B A�R N S T A�LTEGULATION fir, BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. ...`'��� f ��G Y...............::........................ ...............................:.............................. TYPEOF CONSTRUCTION .........l��P..1�......... .....................................................:................................. .................... ..........19..7.E TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... l %/'Tfv.S�/e ,2� �J� �C�f/j�iC�UlC�G�/ �J� ..... ....... ... ..... .......................................s.........................................7n' . 6 . .................................. ProposedUse ............................................................................................................................................................................. Zoning District ........................................................................Fire District eUIGL.L� ' QST(iQU/C.L.�'............. Name of Owner ..................... ..................'�' `�` '4S ....CtQ.�c?Z!�.�.G N52dress 1` ��vTCl �'�7 � �'/7f ?�..... ...9� �:. .y ... Name of Builder �/ ..................................................... ..' ..�.. Address ...v ........... ................. ...! �1��.............. .Name of Architect .......,.............................................................Address .................................................................................... Number of.Rooms .....(Q....... Foundation ...... ...................... .. . e ... Exterior ..Gvao� S�f!/UE L�. ........:.....Roofing SPiy G ``rr r..... f........................... ...........}....�............................ . ......... Floors , 7' �1 U ....T..LU U 2 5...............................Interior .l/ 'g ....................................................... Heating .......................................Plumbing .................................................................................. , Fireplace �.�2�G/C...... '........ ............................Approximate Cost ... d�.4!):v. ..................................-�.,.�.... Definitive Plan Approved by Planning Board ________________________________19________. Area .........1.Ul...Z()............... aB_ Diagram of Lot and Building with Dimensions Fee ..................... r........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH --BOXAD � y I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name > ...... . . ............................ Sandra J. Hays Ub/a Creative Homes F No 21883..... Permit for ....one:. .9rY............. F S ... wg1liug....................... Location ...........82..Haxaer..Ben d..;O-A . ..........................entervi center.vine............................. Owner ...Sandra..J....Hay.9...d/.b/.a..Creati.ve ; Homes n Type of Construction ........frame....................... ................J ........................................... _ ........... ; C Plot Lot ...............#29............ Permit Granted ..........DQ:C:@Illl?Pr... 1.....i g 79 f �,1 o Date of Inspection ... .. ................19 . Date Completed .�..�..................19 2/2���� i PERMIT REFUSED `" .................... ................................ 19 . . ................................. . ......... i w` ....................... _ M r� .' Appr .................................. 19 � AJ .. ...' .................................................. r Assessor's map and lot number ° :���-'� r. �' � � 1,2 - 1~ THE TO Sewage Permit number ................................4........................ a y �y Z BARNSTABLE, i Kouse number ...............mot .................................... 90 rasa O 1639• ♦� RFD MPY a\ N . TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....................................::..✓...•.... ..................................................................... TYPE OF CONSTRUCTION .42IM�.....f off�f l`'" ............ ........ ............................................................................................... ..................... ..................19.Z f. TO THE INSPECTOR OF BUILDINGS: The undersigned..hereby applies for a permit according to the following information: Location ......... .1....%�.r' Gt1SF: .....:.:.:':.......<.> f j:... +'!!/ }.. ..... ................................. •; ProposedUse ............................................................................................................................................................................. TG�LI/C.-C_t Zoning District Fire District/`�a!LchcG'.�GC L " Name of Owner ............................................'C .. �?.,�;.t;:?:�,r,";4�n�Acldress ....:` % G T. ffr... ............ ?;r Name of Builder A.....!1 :..�-L C�fiCa'ti1........................Address ?.......... . ,f.. ��... /.•5�'�Jfi' ! ��... • T' Nameof Architect ..................................................................Address .................................................................................... ' ...........Foundation.........OLl,�'.....' ....�:.e'li! fF=,�...... Number of Rooms ......;................................................. ............. ......................................... Exierior ...........Roo , � � ..................................................... • ..�.��!)f1 .��i'����`��' s-~' Roofing 'n'� . Floors , F`? /1�/!Ff1:�.....:..r.pGA'.:... ...............................Interior .,..! �.... ..'... .-....................................................... 3 r, Plumbing .....................Heating f„f�!/.0 ...�. ?:........................... g ............................................................. ... Fireplace /�/r�l !<' .....................Approximate Cost r? G ........................................ ............. Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ..........,?�;.�...l .. ............... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH • ,f, I�� IFi4 4.0 n I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. J �x Name ............................ Sandra J. Bays d/b/a Creative Bomea � � ~ ` A=I921�190 ^ ^ No —. Permit for ...Jae...otor.y............. --..s.i.n.gle...f amilv..d.v.Q.jj' ...................... Location .............Q2..�amsvex:..Bsuzd � ' ............,............'. .........................'' ^ - Owner ' Homes ` Typo of Construction —.fraoe--------- . � ----.---------------------- � . � Plot ............................ Lot ...........#2—g.............. ' Permit Granted ....Deuember..II___..lq 79 ^ Date of Inspection ------------l9 ' Dote Completed ...................................... . PERM�" .............. /./.............. 19 --'-- ' .—...~.—~—.—.-------.---.. ' --^~-----'i—�--^^—'---~^' —^—^~------^^---^'--^--'' Approved .................... ......................... lV -----------------. ........................ ----------------~''--^^^—^' ~ . S '`, i^d _$may.- - -t '" 3f. .* - V h K `� 4i .s '''2 II it " �` a f c,v y. - r—e"'T.. i b } ,,,:.c ? j t ,� ', _ ,- .��ma1 t' -. tin°'�" -.t s T.: 4 t-4' L 1 9 k D p�. ql a ° S..i F. $.. A�6 x t 5 k , x -Ol .- �Zl .,..,,• ..,!,-c _, �..,,�3 m ,,, ^'ir k r is r. x •, i7� 1' r k. x r 1 I� J L, .�Q �.. 7 t 3 { [— -_ ��� � , ... Y j - U•- I -, f �t .p. �, �r , .' r . I E.L tom`/ J9 i 4 4 hV\ 1. i. T__. .�._ _ /_—. // ,)) ' � a !- �„,:, sr t„ �' \' -fit z,•^�c,^);r� .- - . 1 01..i c',. iv,f a,Sf+ 1 Y 4 a W til6 (yp ?� `fi- ,� I . l I �' t- �- 7 '1` N�. I fi r E t_-N/'' 11,4`. ,f�� r'� (�y,_ .<z_- "__"",.,.'.."�"_'-'-'�^ :^mod` Y �'� r+J a l v:, �. ,1 C.' r'S K... _ _ _ ,i M I I,_�J,� ` bt_ Itk,~.`tl '�' v-,l�:; t,;-.)n' .`.. A Y.A ILA fit:-...,. : g `i +: i� . ��(� J': c I r z - f . ,i .. �r 4��. It - - 1. - . ) : . . rc, . . . 1. �llj :a a,n-- ` 5 �x \ } .. .._....— `u _ nr ' ,5r•a 9 W: . _�__`_.. ry _ : I. .. . , - ... - - . . .- ' - °/V/n!1.1J2,/ . /V9/ .. . /1 cJ_ /`v//vv S E7 3 /\ ecru/ �M 'TS S Cis; 3 �, /v T s/ aft _' G1�0�c7.5EL7 . F// r . I ... . 3 L3F D20oti/ -__ SEPT/C . 5 y5TAM .CONS•T20CTlJN, ; 4 :. `�HAc_-L GOnJFO,-Z-i ,7 TO _�'IASS'. 11 . 0 � y OES/(3/v TL_ � ' �7� SAL//L7 A LNi//eON/yL-A/7, �OD� T r r-,- le E.v'/S E..� 7-�=7 7 S /_ L C 4 C �1 /2�l TE . �• � M/A/.1lel , //�/c:.c/ x Przc�_� v CAA R 1, L��c TaP OF NEgG TN. TZ��CJLA='TiONS O�oS - ��� . . Lz� �. , v / U E.AC �•1 /� ' 2 'oF��E.a s7o/v� �. ._ , _ - A/,//-/O�� �CO3L/T`_7p �)c7EnIT�,,7p �NI/7L=I21//QC1S GaVE� 1. Tn �2 - 1n+// T/-//N °/' --_ VENT G/ic/c-S - , OF Fin// H. LD �;��,n c�E, -< Tzoi z: a . o i/ `q /N T� T/ �0 / I � - G-/Z.S� _ DJST. ! i \ �TowE /�I,- ; uiU x . . /O / ; 'V ��y��. 2/ `, 1."� o.Ge IDE '�1 JT /i2a _ _� . I 3' � Z�'11//DC al��� N/ 1- `� nn tit _J `� a/A. ,., ,•;g��r r /� i� � -z PST f/ I - F.1 oau z-/wE Mi ,)� -._`4 a/4. 1. �..i /O �`.4,✓;,.v . I.' >./�,. / T /Q"M/ N. .�i TGf/' -.— _- L_ 4 �/T, \ D C,i" � Fn0 �/ /4„ /4'i FOOT, 2 Min/ /�i rc fi � ^ �- �,¢" ' D/A. ,t -y- 1C��� M� - %4`'�F40T -; ti� 6�;, WASNEU S _ 1 I G 'l L L D ID/ - - M///E L�T i /, C �I I - STONE ; /NVf_�T ± LA'7� 4C / TY C I I SE�T/C -: 4.�/� ,` ��-E V: A 2 O vn%o I1 �WA rL/'z•T/6/-/T� . /n� / %;::' / �' I �C�T/OM dF �.~ .; �� ''C ! piT'I. /w v T. NO GA'�E3a�E C;cJn,���2 . . .� I // - . . _.- { f. L 3A " Ir . -. - _ _ G�<.:.A 7 Dom/ ��r�13, �� *�% r- l'�', .��-- -__ . f .. �F�l�_'�nl Elr _L�� == 5 --3��. g .4� ,i . `.Ian y SEa7rJc= TAN,e/ ,4D/571.P2i4 L5U7 N 8OX 1�L_PL-(N. _:_ _�,�Q e,-. _a��12 '..__ A_�E-j6_L _ C5 OUTLETS -I OTC —3 ;`;� , A/vD L E�1C�//n/G .a/7 ;i y, / { TO /`_3E' O� 7ZE//�✓F�ll�CE17 GdiIfCTZGT� y I J. , ':�^ONG-/ /ta j 1, j 7 a' . I�� "r P. ° TEE TE 5 T;EG c/GTJ� ODO psi /�-///, -- - �0000 y r7 �-. , -,� «tt ,^C - ti; �O LOAD r G / \1.� j / '' . %% . t .'^i { �+�s•-, �. ' -� •� , if < t r .� z'`.t"'^f C fJ L�f J VE VL.•�>� ah/�T TO .;BE .L ._,.,�,q --, . �' e:� <.` �, 1 3. ,� L e7 /i�".;? I 1'i '=� / C?V�.� 5�'S TE%L-7 U/�l L E-� ' f/ "�Q L t -i :CERTIFY THE C3L)I1 .C1t1N1 J- �,f) C 1, E)d�� T,1f/S �`. . �� �'=� ����ES/cv%V L��L�/.vv /5 t SELD. ;� rA�y' J. -;'�€: J.`. P..U� .'r'f1.J '!'� CT.I .:J .%t{�.r _ yry\ ` �\ _ _ , r r .� t 7 h4 •'� f f l i s b. p P h Z� 41,�L4 :;�- w:fa _ t ,n p / F �.: _ - I•F t"_./°.'`f".1 �.!� �.! ��✓✓/I .`G`'. �.1 a :../ r n>r+4 6.� -:5\ �7. . ,: q.� �' ___F.. RGG� .it 1 � 7 M :. L. s .' T G--` •'/� ` —f ,�i..,le - l•'" `f J ='! >t. 4 Pik 0 - II ,N 1. . �z3 �r /, : �jp ' _ 1V h " 'r �: '�' � r .. - ' . �! _ _ _._. __..__._.. . .. a 1i 6 2x10 LEDGER LAG BOLTED TO EXISTING STUDS 16" O.C. 10 6 SIMPSON JOIST HANGER: LUS28-_ALLOWABLE UPLIFT ■ 00 LBS_ ACTUAL UPLIFT- 203 LBS WILL NOT PREVENT GARAGE FROM . . SLOWING AWAY AR�OR�' ROOFING FOR ON 5/8"CDX SHEATHING �° ON 2X8S 16" OC. `o 2X8S 16" OC. B O R G L• V N 2x4 TIES 32" O.C. 2-2X10 BEAM u 2-2X10 BEAM RESIDENCE HURRICANE CLIPS AT EACH RAFTER j� (x I �7 4x4 PT POSTS 8 2 �A W S E R BEND 44 PT POSTS POST CAPS Lyi ,n 12 DIAM. CONCRETE TO FOOTINGS V �� CEN7ERIL• LE I IA I I 4 -0 BELOW GRADE POST BASES ANCHORED IN 12 DIAM. CONCRETE FOOTINGS TO 4'-0" ` SIMPSON COLUMN BASE EP544A: BELOW GRADE UPLIFT ALLOWABLE LOAD ■ 1100 LBS ACTUAL UPLIFT LOAD ■ 702 LBS w. LATERAL ALLOWABLE LOAD- C135 LBS .o ACTUAL LATERAL LOAD ■ 726 LBS �n SHEAR ALLOWABLE LOAD 815 LBS ACTUAL SHEAR LOAD ■ 726 LBS SIMPSON COLUMN .BASE EPB44A: SIMPSON COLUMN CAP PC44 UPLIFT ALLOWABLE LOAD ■ 1100 LBS o UPLIFT ALLOWABLE LOAD ■ 1000 LBS ACTUAL UPLIFT LOAD ■ 702 LBS ` ACTUAL UPLIFT LOAD ■ 702 LBS LATERAL ALLOWABLE LOAD- q35 LBS LATERAL ALLOWABLE LOAD ■ 925 LBS ACTUAL LATERAL LOAD ■ 726 LBS ACTUAL LATERAL LOAD ■ 726 LBS SHEAR ALLOWABLE LOAD ■ 815 LBS ACTUAL SHEAR LOAD a 726 LBS SEC7ION 1/4"=1'-0" SIMPSON COLUMN CAP PC44 F007I NG/FRA>-( I NG PLAN 1i4 -1 0 UPLIFT ALLOWABLE LOAD ■ 1000 LBS ACTUAL UPLIFT LOAD ■ 702 LBS LATERAL ALLOWABLE LOAD ■ 925 LBSQ'`ar,, ACTUAL LATERAL LOAD ■ 726 LBS w o.5 • 7a sY MA 1 Issue Description Date PJKA PETER J. KARB - A R C H I T E C T 33 GREEN STREET ASHLAND, MA r� 508-881-0767 ALL DRAWINGS AND WRITTEN MATERIAL HEREIN CONSTITUTE THE ORIGINAL AND UNPUBLISHED ` WORK OF THE ARCHITECT,AND THE SAME MAY NOT BE DUPLICATED,USED,OR DISCLOSED I WITHOUT THE WRITTEN CONSENT OF THE ARCHITECT. f 45 EGREE ANGLED f Architect: PETER J. KARB BRACES WITH SIMPSO STRAPS Drawn: PJK Check: ( I Job No: OW Scale: 1/4" 1'-0" U U U U U U PLAN SECTION ELEVATIONS Title: REAR EL.EVA71ON 1i4 =1 -o SIDE ELEVATION 1/4 II= III 1 -o FRON�7 ELEVA710N II I II II I II •, Sheet: • 00 2x10 LEDGER LAG BOLTED TO EXISTING 1'-0' STUDS 16" O.C. .e' SIMPSON JOIST HANGER: LUS25 ALLOWABLE UPLIFT ■ 4q0 LBS ACTUAL UPLIFT■ 203 LBS CARPORT' WILL NOT PREVENT GARAGE FROM BLOWING AWAY ROOFING - FOR f ON 5/8"CDX SHEATHING .fl - ON 2XSS 16" OC. un 2XSS 16" OC. SORGLUND 2x4 TIES 32" O.C. RESIDENCE 2-2X10 BEAM u 2-2X10 BEAM HURRICANE CLIPS AT EACH RAFTER 4x4 PT POSTS 52 S R 5END 44 PT POSTS ail POST CAPS `n 12 DIAM. CONCRETE FOOTINGS TO C E N T E R V I L L E M1 14 4'-0" BELOW GRADE POST BASES ANCHORED IN t 12 DIAM. CONCRETE FOOTINGS TO 4'-0" x ` SIMPSON COLUMN BASE EP844A: i BELOW GRADE `�' UPLIFT ALLOWABLE LOAD ■ 1100 LBS ACTUAL UPLIFT LOAD x 702 LBS LATERAL ALLOWABLE LOAD■ q35 LBS ACTUAL LATERAL LOAD ■ 726 LBS �n SHEAR ALLOWABLE LOAD ■ 815 LBS ACTUAL SHEAR LOAD 726 LBS SIMPSON COLUMN CAP PC44 SIMPSON COLUMN BASE EP544A: r UPLIFT ALLOWABLE LOAD ■ 1100 LBS `t UPLIFT ALLOWABLE LOAD ■ 1000 LBS ACTUAL UPLIFT LOAD ■ 702 LBS ACTUAL UPLIFT LOAD ■ 702 LBS LATERAL ALLOWABLE LOAD■ q35 LBS LATERAL ALLOWABLE LOAD ■ q25 LBS ACTUAL LATERAL LOAD 726 LBS ACTUAL LATERAL LOAD ■ 726 LBS 1 SHEAR ALLOWABLE LOAD ■ 815 LBS I C � I ACTUAL SHEAR LOAD ■ 726 LBS S E C 7 1 ON 1/4"=1 _ n SIMPSON COLUMN CAP PC44 UPLIFT ALLOWABLE LOAD ■ 1000 LBS FOOTING/ IC R A M I N G FLAN 114 n-1'-0 n I ACTUAL UPLIFT LOAD ■ 702 LBS LATERAL ALLOWABLE LOAD ■ 0125 LBS 4a >i ACTUAL LATERAL LOAD ■ 726 LBS £Ow ,I I 10-27-08 rr, issue Deseripdon Date PJKA ij I PETER J. KARB A R C H I T E C T 33 GREEN STREET ASHLAND, MA 508-881-0767 ALL DRAWINGS AND WRITTEN MATERIAL HEREIN _ CONSTITUTE THE ORIGINAL AND UNPUBLISHED WORK OF THE ARCHITECT,AND THE SAME MAY NOT BE DUPLICATED,USED,OR DISCLOSED WITHOUT THE WRITTEN CONSENT OF THE ARCHITECT. Architect: PETER J. KARB 45 DEGREE ANGLED BRACES WITH SIMPSON STRAPS 77 Drawn: PJK Check: ii II I � II II II Job No: 0859 Scale: 1/4" 1'-0" L L L LL U L PLAN SECTION ELEVATIONS Title: R EAR-�ELEVATFON SIDE ,ELEVATION FRONT ELEVA71ON 114"=1'-01' Sheet: • � i 4