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0256 HOLLY POINT ROAD
ALP /kill F 1 , o - e' PROJECT NAME: ADDRESS: Coll PERMIT# �O ► `'C �U �"� PERMIT DATE: 1 1. Mom. 3� - �3 1 CADGE ROLLED PEAKS ARE O f $Loy . Data entere P d in MAPS program on: G . B Y: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map c�3Z Parcel 3� T ''WN OF BARNSTABL Application # /� ;�, /Health Division (_� Date Issued conservation Division �V A"_ gPQ��a►( 6�3�IIS Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ``'` ' ` Historic - OKH _ Preservation / Hyannis Project Street Address Z S62 41'N i"UWT OWL Village MA-. . Owner _ CU,�flN hooy-e Address I W?- CeA L VEMeZAAkM, Telephone 161.406. 57D0 0Z4"Z. Permit Request 3 -CQ W s: A m N 4" k)4L virce 2emmwe RpLixoft),a' )AW 1-6All-PVC-1, t��li z C I �►do Aare Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District _ � Flood Plain ?C- Groundwater Overlay-LB �S Project Val ation r� Construction Type , Lot Size 4 ��S Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 3 No On Old King's Highway: ❑Yes ❑ No C�Basement Type: Full ❑'/Crawl ❑Walkout '❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new 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 fgNo If yes, site plan review # Current Use S('OUe. DP:--►b Proposed Use won>oo--w'Ck - APPLICANT INFORMATION. (BUILDER OR HOMEOWNER) Name . ��( Telephone Number I. 60S• 4�9 •91,e�9 Address ffl Nrz vo V1`z. License # CS'©Z 1 oqo 3 I3•I(p mh ,)pT* Movoll Home Improvement Contractor# 101302 7•711 Email o IN @ 1:0M . NET Worker's Compensation # U 6.9 08 M 1 • V S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r c \DM V,1 'I-1UC- SIGNATURE DATE Jr ZD 15 1 s' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ; MAP/PARCEL NO. ADDRESS VILLAGE OWNER 'S DATE OF INSPECTION: ^FOUNDATIONAV FRAME �i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. s DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE T60MIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)trust be endorsed- If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rightsto the certificate holder In lieu of such endorsement s PRODUCER CONTACT NAME: NORTHWOOD ESHBAUGH LNS PHONE FAX 540 MAIN STREET (A/C,No,Ext): (AC_No): E-MAIL HYAATNIS,MA 02601 ADDRESS: 2'IJDD INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: 'TRAVELERS INDEMNITY COMPANY OF AMERICA ROBERT K FOX BUILDENG CONTRACTOR INC INSURER B: INSURER C: INSURER D: 44 WATERLINE DRIVE S INSURER E: MASHPEE,MA 02649 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBEM THIS I. FY THAT THE POLICIES OF INSURANCE LISTED BELOY3 HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CM`TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE SSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLIMES DESCRIBFD HUE114 G SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMeOD'�.YYYY) (URDDIYYYY) LRdTTS GENERAL UABIUTV ZACK OCCURRENCE COMMERCIAL GENERAL L1A31LCTY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. REMISES.(Ea accurrence) ED EXP{Any one person) $ ERSONAL&ADV INJURY S GEN'L AGGREGATELIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY PROJECT LOC 3 RODUCTS-COMI OPAGG $ AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTCS (Per person) HIRED AUTOS BODILY INJURY S NON-CWNED AUTOS (Per accident) PROPERTYCIAMAGE S: (Per acciderd) UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATEFl. DEDUCTIBLE S S RETENTION$ WORKER'S COMPENSATION AND we STATUTORY OTHER EMPLOYER'S LIABILITY YM JB-9908L771-15 0104/2015 0110412016 LIMTS ANY PROPeRfrOWPARTNEREXECUTIVE M WA E.L.EACH ACCIDENT $ 1,000,000 OFFICERtMEMBEH EXCLUDED? (Mandatory In NH) EL.DISEASE-EA EMPLOYEE $ 1,000,000 Ilyes,describevnder E.L.DISEASE-POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS belnev DESCRIPTION OF OPERA11ONS/LOCATIONS,'VEH:CLES1RESTFAC710NSfSPEC1AL ITEMS TMS R:^PLACES ANYPRIOR CERTIFICATE ISSUED TO THE CER'E'IFTCATE HOIDER AFF'ECTINry WORKERS COMP COVERAGE CERTIFICATE HOLDER : ., CANCELLATION TOWN OF MASHPEE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 16 GREAT NECK RD NORTH BEFORETHE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTVE IvIASHPEE,MA 02649 at L` +: ' : ACORD 25(2010J05) The ACORD name and logo are registered marks of ACORD' 198&2010 ACORD CORPORATION. All rights reserved. ' Deparbrr etrt aft ldm&AdAcddez& • O#Zw oflmesh`gafioar o"600 ffi¢rhbvim S&eet • www.>7r�r�gtav��a Worims' Compensation Ibsln=ce AffidacviL-B Mdets/CmdmebrsMec 3Lidan&Tlumbers Applicant Information Please Prnit LeeZ bk' City/SfeteJTp: DZ Phase#: G¢�S Are you an employer? the appApride bmc I.❑ I am a emplayrt wiHi ` �Q 4. []I am a gmQal=t ctor and I' Type of project(req�ed); empinpees(inII aad/ar pmt tmm).. have hired the s . 6 ❑New conslmc'fiam 1 2.❑ I am a sole propde r or partner- r listed om the afiarhe,d sheet I ❑BemndrJing ship and have m m%loyces These mb-•cm&aO¢s have `• 8. �Demolitia� wan9dug forme is any capacity. . mi IJMCes m dhave worlceis' [No wm3a='�.msmm= gyp-bmn mmt 9• ❑BmZding addrtiom 5. Q We are a cmporatinn and its ID. Elecbricalrepanrs or admons 3.❑ Ism aho� doing an work offices have exea-cisod their 1LE]Pbmbingrepain;or additions nusdf[go wm3axe camp. .. ughtpfe=mpfion Per MC 12• Rnofrcpairs mcr,rsmrr+"Y'J'�"'�-1 t r.LA§1(4),sad we hate no ` emplarm[NO warms' I3.❑Other !2ej<, CmmP•insmBnce *AnY gVlicmVbxt ehedh box#I most also JM omthn seefioa bo w shmft bccswmlma'CIDE%X Lion polay minmaiiem. ' t gomeaw-M who soh®ittbis afbdWVk io&Zfmg&7 no doing xU wmk m d ihm hie vaWde uro4aci mod sabm$a=W aindavit mdir. r-ga�. " �Coahartms that ebeckthis box most et>ached an additional thrrtsbowiagibe acme oftbe soh- aad stab:whdha ornotthose amities have .. employers.Iftbe sob bave rugby_,they mastp•o &then wodm a=op pnrey monb= I am arc eapIoyer•ffW isPTVZ lmg]vorkas'compensation iarru==for jW m pTayam Balmy it the poky and job site . >nso�CO�-pmYxame: lY►�W Q��I»Pl�'1nrl n�-��AACA.: _.. a_" + t Policy#or self-ins.Lic.#: U $•99 O S L-.TV•1 5 FJ:piraftonDain: I.0+•1�0. rob sAddress:Z5(oIlp MA Atfarh a copy of the vTorkrxs' pr=zHou porky declaration page(slotting the po&cy nrimber and en,dat�). Fa'h=to secmo coverage as rmpfird madw Secdm25A ofUM o.152 cm Im d to tho impositim of aI praaliies of a fnn asp to$1,500.00 andlar ane-year figm some as weR as civfl pm shies in the form of it STOP WORK ORDER and-Etna of asp to$250.00 a day ngaf L t the violator. Be advised t3zat a copy of t3iis stdc meatmay be forwazdcd to the O$ce of hmmdgadons of the DU tnrmsmx=my=ga vmffic a ion, I do under the pahu and pergNa ofpmjmy that the mformagon providrll above is 4 and coirerl Phone#: p 'l I��� =r O idd use only.,Do nohvrite in this area to be completed by city or Irmm o_P:fML M1 ., 17 or Town: 'pr rNf,rrn�. M _ -- - -- — - Autho ' cu-cle one):%.� B _ a .. =L Board of Health 2.B&bngDepazimant C&fyfTMM Clerk .-IlechimlI pednr -EPhonbfnglnspector° 4 xCanctPerson: - t Please� ' Information and Instructions M&Manseft Grtraal Laws cheptw 152=Ionrs all emglopers'm parade workers'compensation fur their employees. Pursaa otto this st&fr,,an apbyre is defied as=.every person in t&e service of err under day contract ofli eapaEss or implied,oral or When." An a Vkyer is defied as'Et individual„pmtoecship,association,corpma ou.or odver legal entity,or any two or mote of the foregoing engaged ia.alomt eoferpasq andiar_nrrTn lb legal=esentW=of a deceased m3ployer,or the receiver or trustee of an fia&idn l,•partneasbip,assodafl—or offies legal enfii7,employing employees. However the owner of a dweHing hwse havingnotmoie then Hires apartments and who resides there m,or the occopm3t of the- dwelling house of another who employs persons to do cmokacton or repair waxic rm such dwelling house or on.the grounds orbrpdmg 1hwAD sball not because ofsuch eoaploymcutbe deemed to be an e:mployea." MGL cbao=JA§25C(6)also states that'every state or local licensing agencyshall wNhhohh the issuance or renewal of a Ticense or permit to operate a bII Ness or to construct buildings in the commonwealth for airy applicantwho has dot produced acceptable evidence of cdmptiance with the izrsnraaca coverage required." Add iti oneIIy,MGM chapter 152,§25C(7)status'Neithm the=mngmwealih nor airy ofits political subdivisions shall ...... enter into Ecay duct for thep co ofpublio wmkuag acceptable evidence of compIiap =v th the msorence,. lcgah eats ofthis chaPirrhave beenpxrsentedin the conirad$ng anfhouty." AppIicaats , Please fill out the wogs'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,st�ply sob-cod adrn�s)name(s).addtess(es)and phone numbers)along With ce tic e(s)of ins=ce. Lmmifzd.Liability Companies(LLG)or Limited Liability Pminersbips CLLP)wino employees other than the membeas or partners,are not rimed to rainy workers'compensation msmzoee. If ea LLC or LLP does have employees,'policy is required. Be advisedthatthis afhdaykmaybe suhmitfmd to the Deppdment of Indushial Accidemfs for cnffmmaflm of fiom nce mve n gm Also be sure to sign and date the affidavit The affidavit should be refmmed to fie city or town that the application.for the peonit or license is being requested,not the Departmeof of Indrist dal Asdd to Shouldyou have any questions regarding the law or ifyou arc regrdmd to obtain a workers' eampeusadianpolicy,please call the Depmtment at the snnnber listed below. Self-insraed companies should ewer their self-insurance license number an the appropriate line. City or Town Officials . Please bo sore that the affidavit is cnn3pIeta and pxh*d legibly. The Depa rind has provided a space at the bottom of the affidavit for you to M out in the event the Office of Investigaiians has to contact you regmudmg the applicant. Please,be sure to fill in the pcu/I Cmse comber which v M be used as a reference giber. In addition,an applicant that mast sabmit mnitipIo pemit/liceose applitations in any given year,need only sabmrt one affidavit indicating cm-eat policy fi fonaafim(if necessary)and tnder'96b Site Address"the applicm¢should•Fall locations in (city ar town)_"A copy of ffie affidavit that has been officially stamper or mucked bythe city or town may be provided to ffie applicant as proof that a valid affidavit is on file for future peonita or lirxnses. A new affidavit nnut be fried out each year.Wheae a home owner or citizen is obtaining a license or permitnotrrlatrd to any business or cnmmeacial ve uilaa CLm a dog license or penal to bmn leaves etc.)said pmsom is NOT required to completes this affidavit The Office of IayesfigEdons wouldlike to thank youin advance foryour coaperati.m and should yam have any questions, please do not hesitate to give us a call. , The Department's address,Wephone and fax nambea: ' - • : the�o�n'�.t13r of Massac� - DMPEMI M t ofl6hstdsl Amilwts (Vice of�t. tia� • 6Q(�Wash�tan Sh•� �a�ort,IAA E�I1� Ted,#617-727-4900 eft 406 4r I477 MASSAFE Revised 4-24-07 Fa 617 727 774 _ Massachusetts 7Department of Public Safe#y � Board of Butldtng Regulations and Standards-• Construction Supervisor License: CS-021090` t � ROBERT K FOX, �r 44 WATERLINE DR Mashpee MA 02649 may' S ``` Expiration. Commissioner 003/133/20-16 eQmttX ' Oftie of Consumer Affairs & Business Regulation. 1 j . ME IMPROVEMENT CONTRACTOR:r �g'istration: .3302 Type: . xpiration: 3 _ = : Private Corporatiq S R► K. FOX BIJI!1D€ t:=;E TOR : Rpoert Fox 44 Waterline [fir.; -Ma .0-ee,.IMA 02649 �{ '� :undersecretary ' r 111-0" OW A 'k ,� ,:r'�'*o ., x -t'��°`•`. _ ..-� .. ... .,. :g,,�a'S :��'i a•-,:.,s,. .F z.,,..t�'�: _„.:'.€�� �... :«+� ,'s.A ti�`�d: ,.za�4 , t.: '-t�. ",�:R s,i��'��r -: ;a;� ",�^r..N„.��.�,' ..: �,+,..p ;: Wr- ,,-5 y:y`. .e?:: ,t .,..,h,a. ,,� �{:_ � ``'�,Wi ;r sir,h,. t.. F •y:,�`' -, .. �� .'f: .�;' - :�>`��`' ..��r;•'w :;a a ?'•a � 9�::.:fi�_ ,� �g t � .-Y-. ,,:x�..�. s;.. .;.n. ;,,.�, e .�t. �-'1°- q 7 E, s:.�" 2.. ..r� r7�. a� ^ d G'$:>:.s 6Cr �t 'i'�� �.. .1�a. ,s aSt .Fi.•s '^ r t r �': A� .i z t u�:•;�, ,� .,r,7�.. t' c.:i��5 ..'�,.� r s,..� y;�' ... .n- ,; .�,�, '--. ,,. ,+.,, ..�� .'.,•..•„�'�T ':'ar.+ti'}�"'a. ; y r, . ..-,:, ro gyp.. �� ::-Y•' ,a.i- a� �;k,�� t, :w <$ ��,.�".. .t .-'., . '�-,:.:•x� .. .': '+A. ,= .-. e. -.', .�.:�'. 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Y: Y fir. �7'cC i�al:i'... �;`• i n M s'�`� 32'�.�•X ,ky�9`'.a,.'��r kA.,•s+�A' ,� � {r.a '..)`.� tr,LS A r .'h;�, �`.x'�le ,r✓ ��:�'£1p��•,�,�3,� �• (� 4�ri �.3�rw! ! �-^' :.' �,ti Ar _� � � �' „- �Z �' "7" a#��. r"wt* �rE.-;�'3�t = � �:7��` 'ds-,r. � $ x• Ay ._�" -, -i 1 +f ti:v� ''���- ,,ta . -Z, Y II " " M -F K �1 lit f AIR 1 NET ...........;n r top m z 5"e�*M'.ea�F9�tamsr,�fl ;.� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 'l Z Parcel Q , Application # Health Division Date Issued ILlis Conservation Division Application Fee Planning Dept. Permit Fee eik, ("A!2 • ZI Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Z&P f40N T01W+ Village ` ` MA ©Z(o 2 e ny �U.S JU E, M E ?-q- Address Z v►Zam C�249Z r..-Telephone—:`,..-E?i ,'460-6"7OO .—Permit-Request 2.kit-we OAL`fl 0Ue. W)A*)J 0LdS 400n I ei ro s Pep f e ' a IAAA Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay CP_rojectTValuatio 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 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 w d/coal stove: I Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Ba existing. ❑ w size_ r, ti 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 TelephonetNurrib`er� 6 6•4 19 •cuQ Address I�l(�T� UN� 1 Vim._ License # M . ©Z� Home Improvement Contractor# I d 3�'L Z•1(� Email Worker's Compensation # t. r •/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO b SIGH NATURE �DAT-E_,_A_h ry _. ZO(Jr FOR OFFICIAL USE ONLY P APPLICATION# " DATE ISSUED MAP IPARCEL NO. ' ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 6` GAS: ROUGH FINAL i FINAL BUILDING K 9 DATE CLOSED OUT ASSOCIATION PLAN NO. Ko F U ' 44 Waterline Drive Mashpee, Ma 02649 508 477 9665 Rkfoxbuilding@comcast.net www,Rkfoxbuilders.com Susan Moore 256 Holly Point Road Centerville, Ma Exterior: 1. Remove faux stone chimney and install a cupola in the same location. 2. Remove 2 small Andersen windows and install 1 new window in the same opening at 2 street side elevations. 3. Remove cladboard on the garage and the front walls of the house and replace with white cedar shingles. 4. Add one non supporting decorative column to the existing front platform 5. Change the metal railing to PVC Intex railing. Interior 1. Cosmetic paint,tile and new light fixtures. 2. Remove existing gas fireplace in the living room and move to a new location in the living room 3. Replace kitchen island with a new style island,existing island plug will remain. I . C,5n=CMf=I&afmassac ffset�s rye . � Frs ffoskxr,.MA 02M . wec�w.r�.ff�x.gv�rlux W(z-kers' Ccmpess tkmIn=-anceAjffidav:it:RpiTeiersf h7acturs[MectriciansTluffibers AppEgmt Infarwatian Ptease Frig Name A-e�ycF an employer?Ch ckffic�a-KTapriafe bG= Type Ofpx°aeLt crtql�r d-)= L7 I am a employer urifft 4- ❑ I 9a a gmerg cmtmctl r=d I 6- Near you =Ffoyees(fun-worpart=frme). havdl ir,✓slf ❑ 2-El am a sole prop�or orpartner lisf�3 are the attached sheet �+- Cad inc� ' slip and have no employees These sab oo4fracfazx leave g. ❑ISifiou woddug fB-me in any capacity_ employees and have workers' Q- Elguihimg addiEion [No-wo�' Camp-iasm-nre Comp.insmrar�l ream b6Lj 5_ ❑ We are a cmparatian and its 10-0 EL-LE11Cal repair or additions ❑ I am a hom=amrr doimg aH wort_ officers have exercised thew . I I.-❑Plumbing repairs or additions =Yself [No worh='conT- rigIf of en=ptionperMGL Imo❑Roofrgnirs mgmanre ed.I F c.152, §1(4,aadwe have.no e-p1oyees-[No worimm- L-❑Offiff comp-ins=Cf--requirz&j 4sxy�p�xaaf i$at c5erks bus�l list also fiIl oIIt t�section beimv shoceiag weir wo�exs�co��sssfio-u pa�i�-avfri FLo-mmctn�a�sz-cbmYi his fi��_Yu;,-+,,-<+�=g fey ice�am�=II::�-_**�t�hie a�isi�couhnctms sect seat a n�a�idscst mn`3rst�sar]z TCo�rzr,rs thst rhr�Tr tlxis bas must stlsd�ffi¢dri;ti r,.,si shed sIib�g�mane❑f 8ie��s�uhet�❑cziatfnflse Ti-va �io3'�. If tie sob-ca�dzus�-re e�plir�c�s,tae�Est gmuide thr�•crarh�s'tamp.p Qiicp u�bez lam urt arxla3 ihr¢isPk ti orkers'cotian izrsttrrutc$for rrz� ertr�u£ny�cs. �eiatF is f�Ee p�&cp artd�ob srtg zrr�at�m�ir.?n. L,syxanr-p Companyl`wne_ �ILI� 1 Q)NPAA) 1 1�11 e 110ECT f,ar Self-ins-UC4- to a( j•9 9 o S�.�7' � '�� Fxgirafiou Date= • b�'`'/t Job§rf--�Z 5 �� r'State! v(`I �P= Attach a copy of the vMmrkers'co eusafiion policy declzrat%ou pave(shoving the PaBzy number=a�ataon Este}: Fzilnm to secure covi=age as reqaire-dunder SLctioa25A oEMCTL c- 152 can lead to the imposition ofcriminal penaflies of a Eme up to-�L5010Q andlor m weU as civil geaalfim in the.f 6:on of a STOP WORK ORDERL and a fine of up to$250-00 a day apaiust the.violator_ Be advised that a cDpy of this stair r aent maybe fnrwardsd to flue Office of lure:&gafiom of fbe DID for mmr nc5 covt�iaga vEaEca Dn t�tr FaKr c�rftfp fir-tlra pains ulrhpanahtias ufIser, wy irnd correct giynatum: in Dal,- Phone 9-- ` •�'?�•���� crirt crss MIT,- DO-rrat trritg itl ffas rrrecr,fa bg CQRgdew by ci5�p or turrn officbL City or Torn: # ' L Baard of Health 2.RwIdmg Deparf=ut I C iti pTawu L`=k 4.FIecfrical Erspectar S.PhaEbEag hnptctor 6.Q#hher Contact l'ersaa I} �rne • 6 Massachusetts General Laws chapter 152 req� aII errrployers to provide workers'compensation far their employees. Purs ar to dds statz±e,an erT&yee is defined as 5'person in the seavice of another undex any contract cflsire, express or impliad, oral orwrit�.n." ` An anpLZyez is del ned as'm individual,partnership,association,corporation or other lc, a entity,or any two or mare of the faregging engaged in a1omt eatrgnisa,and mcludmg the ID representatives of a deceased employer-or the association or other le en em Io employees- However the receives or trustee of an individual,parinershrg, � �-Y� P Y� the o ant of the e � hanse having not mare than tiuee artments and who resides thezem,ar ccpp owner of a d•� Uing vmg ap - d_weili g horse of another who CUIPIoys persons to do maiateaaace, construction.or repair work on such dwelling house or an the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MOL chapter 152, §25C(6)also stars ffitt"every state or local licensing agency,shall withhold the issuance or renewal of a license or permit to operate a bainess or to construct buildings in the cornmonwcalth for airy applicant who has'not produced acceptable evidence of compliance with the insurance.coverage required.-' . Additionally, M&L chapter 152, §2SC(7)stains`Neither the commonwealth nor any of ifs poIiticai subdivisions shall enter,into any contract for the perfomance of public work until acceptable evidence of compliaice with the in crrra„ce requ cnts of this chapter have been presented to the contracting authority.' A-Pplica..nts Please fill out the wozkers' compensation affidavit completely,by ch(--ckiag the boxes that apply to your sitortion and,if necessary,supply sub-contracfnr(s)name(s), abdress(es)and phone number(s)along with their cersicaic{s) of insurance. Limited Liability Companies(LLC)or Lino t Liability Partnerships(LLP)withno employees other than the members or partners,are not required to carry workers' compensation insurance- If an LLC or LL`i' does have employees;a policy is rez,� Be,advised that this affidavit may be submitted to the Department of Industrial Accidents for canfirmafion of incrrrAnce coverage. Also be sure to sign and date the affidavit. The affida3Zt should be retumed to the city or town that the application for the permit or license is being requested,not the Department of Indusizial Accidents. Should you have any questions r affard�-Le law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-iT1CRred companies should enter their self-io=once license number on the appropriate Line. City or Town Officials Please be s=Eat the affidavit is complete and printed IegiKy. The Department has provided a space at the bottom o f the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding lh e applicant Please be sure to fill in the penmhdieense number which will be used as a reference number. In addition- an applicant that must submit multiple pen Ylicense 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 M' (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for flue permits ar licenses. A new affidavit must be filled out each year.Where a home owner or citima is obtaining a license or permit not related to auy business or commercial ventoTt (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 taxntumber: ` '��E�o����aliht Qf I�assachus�tts .. . Dip tat c Inaustdal.ACIc eufft _ -- - �-��f�f7x��•s -��us 603 washingtan �astaa MA G21I1 TeL A 617- 7-49-�O(�xt4-0 6 Qr I-9 -hL4,'�SAFE g 6I7--727- 45� Revised 4--26-07 �rdz� r DATE(MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE T IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER_ IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the Polley(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does riot copier rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT NAME: NORTHWOOD ESHBAUGH INS PHONE FAX 540 MAIN STREET (ANC,No,Ext): (A/C,No): EMAIL HYANNIS,MA 02601 ADDRESS: 2'71DD INSURE R(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: `TRAVEL.ERSINDEMNI'IT COMPANY OF R[CA ROBERT K FOX BUILDING CONTRACTOR INC INSURER B: INSURER C: INSURER D: 44 WATERLINE DRIVE S INSURER E: MASHPEE,MA 02649 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER; THS 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 PERTAW.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE-REIN 6 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAN& INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF WBURANCE L R POLICY NUMBER (MMQDIYYYY) (NWhDD%YYYY) LIMNS GENERAL LIABILITY EACH OCCURRENCE COMhAERC1Al GENERAL LlA31LITY AMAGETORENTED $ CLAIMS MADE ❑OCCUR. REMISES(Ea occurrence) VIED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEML AGGREGATE'.LIMIT APPLIES PER: 39ERAL AGGREGATE $ POLICYPROJECT LOC RODUCTS-COMP;OP0.GG $ AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT(Ea acciderY) ALL OWNED AUTOS BODILY INJURY SCHEDULE AUTCS (Per person) HIRED AUTOS BODILY INJURY S (Per accident) NON-CtNNEDAUTOS PROPERTYDAMAGE $ (Per accident) UMBRELLA LIAB OCCJR EACH OCCURRENCE S EXCESS LIA3 CLAIMS-MADE AGGREGATE DEDUCTIBLE RETENTION $ & A WORKER'S COMPENSATION AND x 114C STATUTORY I OTHER EMPLOYER'S LIABILITY YM JB-9908L771-15 01/r9420}5 0i/0412016 UMTS ANYPRDP=WTORFPARLNERIEXECUTIVE WA E L.EACH ACCIDENT $ 1,000,000 OFRCERIMEMBER EXCLUDED? (Mardalory in NH) E.-L.DISEASE-EA EMPLOYEE $ 1,000,000 It ym DESCRIPTION OF O E.L.DISEASE-POLICY LIMIT $ 1,OOOv000 er ASCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VE141CLESIRESTRICTIONSISPECIAL ITEMS THIS R,?LACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECIING WORKERS COMP COVERAGE. CERTIFICATE}COLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE 11HEREOF,NOTICE WILL BE DELIVERED 230 MAIN ST IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT VE HYANNIS,MA 02601 ACORD 25(2010105) The ACORD rrame and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Massachusetts - Department of Public Safety i Board. of Building Regulations and Standards - Construction Supervisor License: CS-021090 } 71 ROBERT K FOX,- 44 WATERLINE DR Mashpee MA 02649 Expiration Commissioner 03/13-2016 Ofia.�e of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR - { 9 'straticin: 163302 Type: xpiration: 7/7l2016 Private Corporatio F OGIL: R; K. FOX BUIL.DiNG CCNTRACTOR Robert Fax - t 3 44 Waterline Cyr.p Mashee, MA 02649 .Undersecretary i a W q a ... KN € yt��' � C� � xg , mi €Ev zElla - M € 1 NOT val "PS Wy �7 t € PR3 "F Z SAW a Nat, v x gI , ;.=¢i Ny 'S" :r Z ffi .,'`:;; q K� i,. , ina•.`er. 'i .lk ,P'.:: 4 fN"q�e.'�f.iYY '' ` :.'.. � ,� :A �., r�� 1'. �•.rr �P _ 4 e 9s I,�.03 sx$.�' ��yc��/ ?s 05— ,;�,:%,L?'E.s! s{,: '}�'.: r•A` .D- K ( -Egg. „fie, y yk ,�' f�.�Y�'" D.✓"'£..:"k � 3r ,i '�,- � ,���SS..- �`' c a�'„ � ����� `} :,:Ik lot -men`� .. R'::;,. ¢s�'� i , J / .,,'. s .3.. 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FLi33'c::;: NNE.. < S }c�`: t.. :.t}z } + i#t# s L f:L s } t f` •'tt #r /.,//,%,. #, $- ,:�k,.,:;..,•<•{tft,,{. ,t( ISS S S' :......x.•::.:::.tw;::.r:::i;w.r,}rv.:•r..z:. •. ,% .ri:r:r: :....,. : .. ...::� :!•t:,.r .r.Srir,Sr.,.rt Ff:3.•,•/4it$ ::.:-:;....,.v..... ::•:v::;....w,{�-•:: / „r,.r+::::: :.:.. .:t 'tttt ttSSfS•S .,,tt. ) {; , ., f<` r v : man t /f !taec'{td+ is f { y , n AM Town of Barnstable Regulatory Services i"R"&M Richard V.Scali,Director " a � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us - Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 5 U S CM E. M Oor�— ,as Owner of the subject property r herebyauthorize k to act on my behalf, in all matters relative to work-authorized by this building permit application for. Sty 011� �0�n�- R�1 Cec•�ex+�i��� MR C@, 3 (Aciciress of Job) j '`_Pool fences and alms are the responsibility of l:he applicant. Pools are not to be filled or utilized before fence is Mstalled and all final inspections are performed and accepted. �ir.c�, �.• mt� Signature of Owner S atume of Iicant j SuSA+J E: Mooce. 1 Print Name T Print Name SorNU 3I S Date QIORIMS:O WNERPERVISSIMOOLS f DWD ENGINEERING, INC. 5 MICHAEL ROAD EAST BRIDGEWATER, MA 02333 (508)378-9602 domdean@aol.com September 2, 2014 Mr. Jeff Lauzon-Building Inspector Bar rstable Building Division 200 Main Street Hyannis, MA 02601 RE: Garage Rough Frame 256 Holly Point Road-Centerville, MA Dear Mr. Lauzon, Based on my site visit of August 31, 1 certify that the as built rough frame, including the shear walls, is in conformance with the International Residential Code- (IRC 2009) with the Massachusetts State Building Code Amendments (8t' Edition). If you have, any questions concerning this letter or if I can be of further assistance, please do not hesitate to contact me. Aomerely, enic W,:)D '�t01 President DeANGELO Cc: HPA Design, Inc. (20130178) STRUCTURAL y Ivan Biesty A9 RNo.350620Fly G/STEP ��,m FSSlON DWD ENGINEERING, INC. 5 MICHAEL ROAD EAST BRIDGEWATER, MA 02333 (508)378-9602 domdean@aol.com June 5, 2014 Mr. Jeff Lauzon-Building Inspector Barnstable Building Division 200 Main Street Hyannis, MA 02601 RE: Rough Frame 256 Holly Point Road-Centerville, MA Dear Mr. Lauzon, Based on my site visit on June 3, 1 certify that the as built rough frame is in conformance with the International Residential Code (IRC 2009)with the Massachusetts State Building Code Amendments (8th Edition). If you have any questions concerning this letter or if I can be of further assistance, please do not hesitate to contact me. S ereI W. d Do 1.ems' a eA�%el Pre" i t STR 101URAL Cc: HPA Design, Inc.(20130178) ® No.35062 Ivan Biesty ski FSSION Al i Q0 ` M i Home Energy Raters LLc BTorYey @Energycodexelp.com Box 989,E.Sandwich,Ma 02537 888-503-2233 Duct Leakage Test Address 256 Holly Point Centerville, MA 02632 Date July 28, 2014 Contractor John Wade Test Type Post Construction Leakage to Outside Includes Air Handler/Furnace Conditioned floor area =2500 Sq FT. (Area Served) To comply with Section 403.2.2 Of the 2009 IECC Code in this home the Maximum duct leakage CFM < 163 CFM (2500/100 x8 =163) Duct leakage tested = 140 CFM This Home complies with Section 403.2.2 Of the 2009 IECC Code Test Mode - Pressurization Test Pressure = - 25.0 Pascals Equipment - Series B Minneapolis Duct Blaster Duct Leakage as Percentage of Floor area = 5.60% Contact our office with any questions, Bruce Torrey, Certified HERS Rater Home Energy Raters LLC . .,f L,. �,' •ti. . -, ... ,�wr ,,f,..rW.rrra--r1`,,T...,,�ti'`,,.,,'+. .ti.y_ �.x ..Z . ,,..' i. ,.....-...-..� ...- -.-..... ., -•- ._. .... �oF,NE Teti Town of Barnstable BARNSTABLE. ' Regulatory Services 9 MASS. t6M MP �0 Building Division - plFO a, 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-710-6230 , Inspection Correction Notice Type of Inspection Flel� Location 6 H-t)t_L U 00QJ 7 tell Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: t Please call: 508-862-4038 for re-inspection. Inspected by Date o � 16-1► WEQUAQUET LAKE LOT 50 .048f ACRES EXISTING 0 DWELLING 4 0 N 0 0 10.6' CONCRETE FOUNDATION R=519 . 82 ' 43.83' A=57 . 60 ' HOLL Y PO/NT ROAD FOUNDATION PLOT PLAN DCE #13-062 PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE LOCATION 256 HOLLY POINT ROAD CENTERVILLE, MASS. PREPARED NOORE FOR: SCALE 1" = 30' DATE JULY 29, 2014 SU► 4_ Ail SS REFERENCE ASSESS. MAP 232 PCL. 31 i°o` G .,i!EI_ i`� I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. . off N8-362-4541 `�.J '1 fax 508-362-9880 downeape.com 0 4S RV F/ own eape eftgifferind,ine. civil engineers l \ \ / -- land surveyors. ----------------- 939 Moln Street ( Rte 6A) ------------ YARMOUMPORT MA 02675 DATE REG. LAND' SURVEYOR TOWN OF BARNSTABLE BUILDING PERAPPLIC TION _ r Map _ Parcel qKpcatio Health, Division Date Issued Conservation. Division � Application Fee _0 Planning Dept. Permit Fee y �1 N Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis l Project Street AddressJI Village , `�! ,o Owner 1SI e6oQ4�.. Address Telephone Permit Request Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 'Project Valuation 5 moConstruction 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 v Basement Finished Area (sq.ft.) Basement Unfinished Area (sq$) c Z Number of Baths: Full: existing new Half: existing neW— y -. Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Ro m Count= —a Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other in rn 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 Telephone Number Address /� 3��[ lZfl ��' License # �� — �+ 0Ci Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED M'AP/PARCEL NO. ADDRESS VILLAGE OWNER ; DATE OF INSPECTION: FOUNDATION ® FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLVIVIBING: ROUGH FINAL- GAS: ROUGH FINAL FINAL BUILDING D�rTE CLOSED OUT ASSOEIATION PLAN NO. Hw Commonywd i of-Massachusetts Deparhamt o,f,�'�drrst>'ctriA cidents Offwa o,f Invesaga iarrs 640 Washington Street Bastan,MA 02I,I wnmtvanass gav1dia Workers' Campensaf on Insurance Affidavit.Builders/ContractorsMectricianMumbers Applicant Information Please Print Legibly Name Aaddre—ss- ] -I �C.�L—�f�/Z�O 67*11 city/stattlzip: �j one - /� .... ...... Am you an.employer?Check the appropriate_bo�- ------ --. . ___T of o ect. r ' -- - -- l_❑ I am a employer with 4. ❑I am a ge=-al contractor and I layees{full and�'ocparY-#ime)_ * have hired the vib-contractcns 6 ❑Neva dun 2 I am a sole proprietor ar partner- listed on the attached sheet`": .7_ ❑Rt'gaodeliug . drip and have no,employees These soh contractors have g- 0 Demolition employees and have Woticers' w�ng for g18 in any Capalst�r _. 9_ E]BntIdmg addition ' [No workers' comp.iusuranre Comp-mcnrance I ,eqaired-1 5_❑ We area corporatianand its 10.0 Electrical repairs cr additions 3_❑ I am a homeowner doing all work officers hn-e exercised their 11.0 Plumbing repairs or additions mysel warkm' right of exemption per II GL 110 Roof repairs re f[No j 1 c_154§1(4} and.we ham no 13_0'€flier employees-[No wMkers' comp_insurance required.] *11tty-PN-nitthatchecksboa-91most also fM out the section below shncQ7agrhea waders'0D=PE SatioaPflIMFinfer t Homeownem who submit this aflidsvn m&cstiug they are doing an ruck and then hoe outs&coniracmrs mast submit a new atfidarst mfc$ting sorb- Csnt3Lcmrs that check this box must attached an additional sheet duywing the name of the -doss and state vrhether or not those¢Aities have aglayees. If the suh-coutactan have employees,they rmrst provide tNr warless'wing-police aumbes . I tim ara Rmgliryer thatisgrot g tt�orlters'cartrltetisrrtion irisrtratrr for rot}r Rmlt£�yec BeZatr is thegaiicy and,}ob site in•forrrratiart_ - ` l asuumce Company Name: Policy#er Self-ins_Uc.4: Expiration Date: Job Site Address citylstatelzrp: Attach a copy of the workers'compensation policy declaration page(showing the policy number and cxpSation date). Failure to sec>ge coverage as regairednader Section 25A of MGL 6. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.Oa andlor one-year impris t,as well as civil penalties in the form of a STOP WORK:OPDER and a fine ofup t o$-250.00 a day against the violator_ Be advised that a cagy of this statement maybe forwarded to the Office of Im estrgations of the DIA for insarance cmmrage veriffcation- Ido her-e4 under thspt ins ndpenatfks ofgedu y that the information pro�sddedabm is and correct Si2riature: Date: Phone#: QW cr"aI rase only. Da not Write in this area,to be courpl'eted by tdty ar town officiaL City or Town:. Permit/License# T suing Authority(circle one).: 1.Board of Health 2.Building Department I f itylI'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Gther contact Person: Phone#: 6 - Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an e7Vtoyee 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 Iegal 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 sus 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 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-contractors)name(s),address(es)and phone numbers)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with Do 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 Departm-ent•of Indt<i.al 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 me 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 idled 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 requited 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. Thy Commonwaith of Massachus(tts Degaxtmcnt of lndustdal Accidents Office of jawstigaiiaxts 600 wasj z zaa sb=t Boston=MA 02111 TeL 4 617 727-49 0,�xt 406 or 1-7 MASWE Revised 4-24-07 Fax#6I7-727-7749 - v,�.znassgn�ldia - TMF Town-of Barnstable { Re.gntory Services MASSs Richard V.Sca14 Interim Director Budding Division Tom Perry,Building Commissioner 200 Main Street;Hyannis,MA 02601 wwW town.barnstabkma.ns Office: 508-8624018 - ,• Fax' : 508-790 623:0 Property Owner Must -Complete and Sign This Section y If Using A Builder ° C. ,as 0wnex o£the#subject -. � l Prop" hereby-authorizes, P9Z ! `to act on my behat in all matters relative to wotk.authwized by this building pettuit (Adders of job) a Pool fences and alarms are the ,responsibility of the.applicant. Pools " are not to be Rued or utilized before fence is installed-and all " 'Y inspections are performed arxd accepted.` Signature o£Owner . Signature ofApplicant e u say;.E: ao�� PL �, e Print Name - Plint Name Da I LA q•.FoRua--0WM Et u=aWoors iotr3 • Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor 1 & 2 Family License: CSFA-064780 PETER L NORDS�ROM 121 BULLARD S I Walpole MA 02091 )rw ` Expiration Commissioner 07/16/2014 Vhe Tpamunaarecuea`C�a��la�a�ia�icoreC�� � License or registration valid for individul use only Office of Consumer Affairs&Business Regulation j UV'Exp OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: tegistration 175233 Type: Office of Consumer Affairs and Business Regulation iration 5/1'/2015 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 BCC ,; r PETER NORDSTROM` rJ 121 BOLLARD ST WALPOLE,MA 02081 Undersecretary Not valid without signature ".- Details Page 1 of 1 Licensee Details Demographic Information Full Name: PETER L NORDSTROM Gender: Owner Name: License Address Information ddress: ddress 2: City: Walpole State: MA Zipcode: 02081 Country: United States License Information License No: CSFA-064780 License Type: Construction Supervisor 1 &2 Family Profession: Building Licenses Date of Last Renewal: 7/10/2014 Issue Date: Expiration Date: 7/16/2016 License Status: Active Today's Date: 7/18/2014 Secondary License: Doing Business As: Status Change: License Renewal Prere uisite Information No Prerequisite Information Discipline No Discipline Information Documentum http://elicense'chs.state.ma.usNerification/Details.aspx?agency_id=1&license_id=25373O& 7/18/2014 MST,PIER Uc.1110M-` WEQUAQUET LAKE egv rd fP 375 SF.PROPOSED lake - PLANTINGS emsnNC NGTE:KEEP PATIO ID B77 PIER 0QS' SF YA%AT WIN.32'OFF PIER G PIER WETLAND TO NORM WTH , P EMSTING PROPOSW ' MITIGATION S SIX A TACK SET LOCUS MAP 02 te• •12• e-; ..� SCALE i•e20DO'f P OP.PATH 40-T 1 •\= - ASSESSORS MAP 232 PARCEL 31 SAN 29" PROPOSED WALL tow 42 LOCUS IS WITHIN FEMA FLOOD ZONE B A C H ( DATUM: WEOUAOUET LAKE DATUM SYSTEM STK A TACK SET 4<?-+-p�, BE REMOVED • HIGH WATER AT EL 34.8' DUST.DECKS TO ( ) 1 ' ( REPLACE PROPOSED WALL TOW 45 LANDSCAPE TIE WALL WM NATURAL WALL � / \ J� NET INCREASE IN HARDSCAPE(PATIO) ZONING SUMMARY STONE � 4` prt WITHIN W-50'ZONE 211 SF I ZONING DISTRICT: RD-1 DISTRICT - PROP.520 1S IOEK Fr 4 / MIN.LOT SIZE 43,580 SF MI 20' -. P NTAGE IANn N.LOT FRO NGS ( REMOVE BULKHEAD " wBON SD' MIN.LOT WDTH 125' M Z BUFFER / ' 0 MIN.FRONT SETBACK 30, a MIN.SIDE SETBACK 10' ` 0 0 - ENCLOSE PORCH INTO HOUSE - iMIN.REAR SETBACK 10' r (ppp O EXINEWNG OO FOOTPRINT p 0 TOP FNDN EL-45.9' - SITE IS LOCATED WITHIN RESOURCE PROTECTION OVERLAY,OP,AND ESTUARINE PROP.STEP STONES WTHIN LAWN TO r PROTECTION DISTRICTS O - O I EITHER SIDE OF OWMIMG G OWNER OF RECORD b ' 4,2.' EMsnnG - SUSAN E.MOORE EMSTING(TO BE OAR.(CONVERT TO LIVING SPACE) 1302 CENTRAL AVENUE REMOVED)DRIVEWAY O PAVED O I . - - NEEDHAM.MA 02492 AREA WITHIN 100'OF DRIVEWAY �� ] WETLAND 903 SIF �( OVE� / O C. - - - - - _ PROP.S HIGH STONE RET.WALL TOW 415 0 0 / PROP.WOODY SHRUB BUFFER �� REFERENCES �41.e n CERTIFICATE 197835 HE DRIVEWAY 4.6' LCP 20239C ( - - PAVE W 'o \` / - • ' PAVEi4 ON CRUSHED STOKE) t • - NEW AREA DRAIN 2e H-20 [41.5] 4 ' TH P FAG ON 089 30•x3(r CURB INLET WTH O'SCN40 �p I , ' TO TWO 4.23'x7.1 3030 - 1NFILTRATORS-WITH SPLASH '/ I.]�I I �T DaSTING 3 OR.SEPTIC SYSTEM INSTALLED 2010 BLOCK-SET IN CLEAN SAND �I M _ CONC.BOUNO FWD. �.]'� ���T EL HANDBO% Y 3`42 } 1� //�\0.�E5M: ` •L2.5 0 L�57, / - BENCHMARK:USE EL HAN080% - aoo� x _ `SITE PLAN, OF HOLLY C.BOUND FND. POINT ROAD 256 HOLLY POINT ROAD CENTER VILLE . c PREPARED FOR on 5D5-3s2-454/ SUSAN MOORE lax 506-362-9880 JUKE 18,2Di3 .Oowncape.com o" D - REV. 7-2-13(AREA DRAIN IN O/W) �_V J REV.3-24-14 d wn cops engineering,Inc. . � Y land engineers go ScGle:1"=20' /ond surveyors 939 Mo/n Street (Rte 6A) ,�13-02 YARMOU7HPOR7 MA 02675 DATE DANIEL A. OJALA P.L.S. ` FLAG'AT COR,BOB WE LAND 0 10 20 30 40 50 FEET TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TOWN"OF AR 31 Map Parcel I Application #C� �I " Health Division 2.1j , - - Date Issued yhh -t Conservation Division Application F S� Planning Dept. - Permit Fee ,1n3 D_ _.3. , - Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address ' J� ✓ 6 Village Owner `—e�� Address ! - s Telephone ,Permit Request r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatior,O 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 f new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including bath`s): 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 0 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) /:;z Name � ✓2, � Telephone Number Address 4S6.�Z_«1W S% License # 7 Home Improvement Contractor# � � Email _ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE h V DATE 111,4 c� r � FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. I ' i ADDRESS VILLAGE r OWNER ' t � i DATE OF INSPECTION: FOUNDATION ' FRAME 6 �� INSULATION V FIREPLACE 4 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH . FINAL GAS: ROUGH FINAL FINAL BUILDING h I r DAT€ CLOSED OUT ' �' ASSOpl".ON PLAN NO. r . y 77ze Commonwealth of Massachusetts _ Department of Industrial Accidents Oice of Inves6gations ' 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): P4272�6Z � Address: ,ay 96e_4-C ,' City/State/Zip: ne Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I , �Ioyees(full and part-time).* have hired the sub-contractors 6. ❑New construction 2.Lid l am;a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling' ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. ;employees and have workers' [No workers'comp. insurance comp.insurance. # 9. ❑Building addition 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.❑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'. T3.❑ 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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb under the pains and penalties ofperjury that the information provided ab ve is tru and correct Si tore: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official R City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6:Other , Contact Person: Phone#: Information and Instructions v ' 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 o_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 (Le.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. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of T.ntvestigations 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.m=.gov/dia MHK-dr-db14 11:1d FKUM:CONVEXITY CAPITAL' 617 236 4284 T0:508 660 7779 P.1/1 B -ton Carpet Cleaning ` 508-660.7779 p.1 x ' To" of Barnstable Regulatory Services ' - `- �.a ; - - •_ Tbo�uas F.Geiler�Direr - • _ Sui[diug Disiou __' Tom Ptr y.BniiL ag Cammiiptaaer' . 200 Maiu Sheet,Ryan*MA 02601 -wwp►.mwio.bar�sEable.aeaas Office: 508-862,4Ua8 _ Fax:.50$•790-6230 Property Owner Must . ` Complete and. Sign This Section 3 A, 1cirilder . - r, 5 u SLI;r' Nt c- r -as Ow=of6C su�`xa Frope y E27hcrcbv au hqt ize --P— f.-.,: o i t,S -T d KN-1 to act on my Lr1mt� in all=v=ze!aiiove to vmk s cthor zed M this L ml&ug (A&Wm oaf Job) Pool feaces sad a?a=s are the MponsfUiXity of the applicam. .Pool are not to be fired or utilized br-k to fenC.Q is isxSUALd acid all ftd inspections-are petfouned and accepted. siglat17IC Of OVIIAL 4 Sigaace of APt C-� •1 V U 17 .?�-Nam. - Pdat Naani P*t Namie, _ Dat • . Q�xr�ssowconr.�ors+��� •. - --• MAR-27-2014 11:08AP7 F :50B 660 7779 4 ID:CGiVEXITY CAPITAL PAGE:00'1 R=96% artment of Public Safety y ' Massachusetts DeP ulat s and Standards Board of Building Regulation eg Family enisor 1 3c Construction Su CSFA-064780 . License: ^`.,, r'y PETER L NORDS�R _ 12113ULLARD ST G ; Walpole MA 020$1 �-'w ' '/I .` Expiration 0711612014 . ssioner Comm (92e ipanunaowivealCli�d 6411�a�cc�coJeCZ License or registration valid for individul use only . Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: (VOME IMPROVEMENT CONTRACTOR Type. Office of Consumer Affairs and Business Regulation egistration 175233 10 Park Plaza=Suite 5170 Expiration ---— 15 DBA Boston, VIA 02116 BCC G PETER NORDSTROM _ �, 121 BOLLARD ST G'a ��•, Q__� III VVV WALPOLE,MA 02081 Undersecretary Not valid without signature F } Y • • • PROJECT . NAME: LA o ADDRESS: pa. ,24 PERM7T# O 14q 0 1 r8�j LP PERMXT DATE: y Z �: a3a 031 .BARGE ROLLED PLANS ARE BOA 1 SLOT Z Data entered in MAPS progra�ri on: B Y; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2�Z Parcel 0 J� Application #r� o Health Division Date Issued Conservation Division Application Fee ,� I Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner ` /L-T�= Address ` _ Telephone �/� '�?ZZ' Permit Request�i4®A Gc i� ��,��--r5✓"�7� �- � Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay -Project Yaluatid-4/1�70i4�"' 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 Kilt Highw� ❑PAs ❑ No Basement Type: ❑ Full , ❑ Crawl ❑Walkout ❑ Other co Basement Finished Area (sq.ft.) Basement Unfinished Area (q.ft) 0 Number of Baths: Full: existing new Half: existing riew n Number of Bedrooms: existing —new w 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 _ Barra: ❑ 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 i� 2 � � Telephone Number 4/54 Address �� ��e-4,0�� License #�� Home Improvement Contractor# / 7 SOZ�� Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE�� �.o DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED t MAP/PARCEL NO. ADDRESS i VILLAGE OWNER i a r�- DATE OF INSPECTION: r E FOUNDATION f r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i I FINAL BUILDING 8w DATE CLOSED OUT K r ASSOCIATION PLAN NO. At M Home Energy RaterS LLC BTorrey @EnergyCodeHelp.com Box 989,E.Sandwich, Ma 02537 888-503- 2233 Duct Leakage Test Address 256 Holly Point Centerville, MA 02632 Date July 28, 2014 Contractor John !Made . Test Type Post Construction Leakage to Outside Includes Air Handler/Furnace Conditioned floor area =2500 Sq FT. (Area Served) To comply with Section 403.2.2 Of the 2009 IECC Code in this home the Maximum duct leakage CFM < 163 CFM (2500/100 x8 =163) Duct leakage tested = 140 CFM This Home complies with Section 403.2.2 Of the 2009 IECC Code Test Mode - Pressurization Test Pressure = - 25.0 Pascals Equipment - Series B Minneapolis Duct Blaster Duct Leakage as Percentage of Floor area = 5.60% Contact our office with any questions, Bruce Torrey, Certified HERS Rater Home Energy Raters LLC Town of Barnstable - Regulatory Services - - F�> To�ti Richard V.Scali,Interim Director °-� Building.Division i RARNSMA M : - Tom Perry,Building Commissioner •- 9� 1� 200 Main Street, Hyannis,MA 02601 �ED MP'1 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6210 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB.LOCATIQIcI: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityltown 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. DEFIlVITION 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 reMonsible 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 Appi-oval 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 1091.1-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 be/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. oFTME Teti Town of Barnstable Regulatory Services iiARNCTARM ngsT -Richard V.Scab,Interim Director Building Division Tom Perry,Building Commissioner 200 Maim Street,Hyannis,MA 02601 www.town.bamstablema.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete.and Sign This Section If Using A Builder as Owner of the subject property hereby,authorize to act on m7 behalf, in aE matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms ate the responsibility o ap lican . is are not to be filled or utilized before fence is inst ed an all inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Information and kstfuctions 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 tnrstee 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 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 applicantwho has not produced acceptable evidence of compliamce 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 certificait(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 Indusiriak Accidents for confirmation of insurance coverage.• Also be sure to sign and date the affidavit The affidavit should be retumed 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 pezmitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town).-A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would hike 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. MF commonwealth of Massachusetts Dt paAment of Rid-us izial Accidents Q�Zoe Q�1�ves��atFaz�s 600 Wa katc n stv=t Boston=M&02111 TeL#617'27-49QO Qxt 406 or 14 MASSAFE. . . Revised 4-24-07 Fax#617-727-7749 www ma s gav/dia De Comlroyoc th ofMassachmselYs _ Deparftumt rgf.,€adu3&id Accidents - Office rr ' igatiarrs 600 Washington MYeet Bosfaq Ml 02111 wnw rnass.gaVdia W,arlrers' CgmpensafiaaInsuranaeAffidavit:Builders/Contract-orsMectricianMumbers ApWi-ant Infarmatian Please Print L&y_ibTy �driress=• I,2� � � �� BIZ� S� , GityfSfafi-Jap: WA\ o l L1 � �20 8Ohom I � �017 5?0- � T Are you an employer?Check&apprapriate bow: T of a ect r 4. I�s a�onizactor and I 3'Pe PT' 3 C���= L❑ I am a employer with ❑ h_ ❑New can5k tdioa employees(full andlorpart )-* have hiredtbe sub-:ontEac. 12- I am a sole proprietor or partner- listed on the attached sheet 7- ❑Redm&ling II \\drip and ha-ve no employees These sal-coutractars have 9- ❑Demolifina working for are in any capacity employees and have workers' 9- El Building addition FNo worktrs'carup.in u ancg C[Sm13_tnct�rarrr-R required] 5. ❑ bite are a corporation and its 10❑Eler hical repairs or additions 3_❑ I am a homeowner doing all wad ofE��"e exercised their I I E Plumbing repairs or additions myself INC)worken,comp- ri�of§1(4), ndwehwffL 12[]Rnofrepaiis c_152, �I(bl},andwelra�s�enar inmumnce required.]F a WoikriS' 13-❑Other empl ayees-(N comp.Insurancerequ reAl * irf spphmut that Cheer box#1=ast also EU out*e saC uabelow shawing 01&WO&ere a ttapensadMPORCYi T So-Smevwn.orlro submit this maids v t k&c dry ase doing n-. 3 sad&en Jae t)mtd a contm mrs mush submit a new affidavit mctnr nc sruh kbnttacma that check ibis boat mrast sttarhed as additional sheet showing the name of(te sdb-tears and stste uhetlie r Dnot$lase efiries have emplayees. Ifthe sib-couthadats hype employees,they must piwide their warps'Comp.polity member. lam art employer that is pm idiag nrarkers'congmnsra6vn irmira ace for ray empLayeaa Below is thepaUcy arad jo b s&e informa-t IL Insurance Company Name: Policy#or Self-ms-7ac.& Expiration Date: Job Sife Address. �PC) Yy City r'SfatrlT.tg: Attach a-copy of the n-arkers'compensation policy declaration page(showmg the policy number and cr-ation date). Failure to secure•cm-erage as required.under SectiDnL 25A o€MGL a 152 can lead to the imposition.ofcriminal penalties of a fine up to$I,500.00 andlor one-yearitnprisoumemt,as well as trial peaalf=in the form.of a STOP WORK OR=and a fine of up to$250.00 a day against the violator. Be advised that:a copy ofthis sbdement maybe forwarded to the Office of hnrestigations of the DIA fir inatsrancg coverage 4rerffitation_ F da Ftere c,etfi rtncIer tkepaurts andpenalties ofpedwy Biat the infornratign prinidczd aba ve it h7w und.correct Phone 9: Z GOj cial u--w anTy. Da trot writs in tills area,&be campietad by city or town offlcLA City or Town: Per►dtUceme 9 Issuing AnthanLy(circle ane): 1.Board of Health ?.Building Department 3.City frown Qerk 4.Electrical Inspector 5.Plumbing~Inspector 6.Other Contact Penan: Phone if: 6 Atlas Insulation Energy Cert i f i cate Date: June 13, 2014 Address: 256 Holly Point Road Centerville, MA Area Material Thickness R Value Rafters Half Pound Open Cell Spray Foam 9" R38 Slopes Two Pound Closed Cell Foam 5" R30 Floor Two Pound Closed Cell Foam 3" R20 Unfaced Fiberglass Batts 9 1/2" R30 Crawl Space Two Pound Closed Cell Foam 3" R20 TPR Intumescent Paint Basement Ceiling Two Pound Closed Cell Foam 3" R20 TPR Intumescent Paint Exterior Walls Two Pound Closed Cell Foam 3" R20 Atlas nsulation Co. Inc. • 4111 3ht 1►� Commonwealth of Massachusetts Sheet Metal Pere"t Map��a`Parcel �J J i oo/q6 `I S Date: .. /�" MAR — 6 2014 Permit f Estimated kb-Cost: $ D :� Permit Fee: $ Plans Submitted: YES NO�TOWN OF EARNSP Reviewed: YES NO Business License## J/ �j Applicant License# <r'3 BusinessTnformation Prop Qy Job.Location Information: Pe?t3'' �,, Name: Jy /Y -c Name: Street: jq J^, L4 Street.-,�256 City/Town: 0, D u:(�f- 7 City/Town: Telephoner" ��� T _ Telephone: X L7 7-7 1 . Photo ID.required 1 Copy of Photo I.D. attached: YES. NO i 51aH Initial ` J=1/unrestricted license J-2 I M-2-restricted to dwellings 3-stories or less and commercial up to 101000 sq. &/2-stories or less i Residezztia 2.family Multi-family Condo./Townhouses Other Commercial: Office Retail Industrial Educational i Fire Dept Approval Institutional_ Other Square Footage:. under 10,000 sq.ft over.10,000 sq.ft Number of Stories: Sheet metal Work to be completed: New Work: Renovation: HVAC V Metal Watershed Roofing Kitchen Exhaust System - I Metal Chimney/Vents Air Balancing i Provide detailed description of work to be done: �- -��-V,) r 1 J am- INSURANCE COVERAGE: j . f` I'have a current i'rabilibi insurance policy or its equivalentwhich meets the requirements of M.G:L Ch.112 Yes Nc Q If you:hiave checked Y,:tndicate the 4".of.coveraoe by checking the-appropriate box below: A liability`insurance.palicy :❑ Othertype of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER.I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the ! Massachusetts General Laws,and that my signature on this permit application valves,this requirement ! Check One:Oniy Owner Agent ❑ Signature.of Owner or Owners Agent j s By checking this boxEl,.I hereby certify that all of the details and information I have submitted(or ordered)regarding this appiication.are true and accurate to.the best of my knowledge and that all sheet riietal work and installations performed under the permitissued for this application will be In compliance with all pertinent provision of the Massachusetts Building'Code and Chapter 112 of the General trews. Duct inspection required.prior to,insulation installation:YES. NO ProgMs IaWections Date Comments Final Inspection Date Co==ts l Type.of Ucense: 3Y ❑Master Q Master-Restricted �ityfrown ❑Joumeyperson Signature of Licensee �e[rnt QJoumeyper>on-Restricted License Number Check'at www-mass.aovldnt . . l nspectorSignatur'e:of Permit Approval The Commonwealth ofMassachusetts • Degm�ment of Industrial Accidents . Of,jZ'ce of Investdgadom 600 Washington Street Boston,.MA 0.2111 www.massgov/dia Workers'Compensation Insurance Affidavit:Bixilders/Contractors/Electricians/Pluxnbers Applicant Information A- / Please Print Leably Name(susi a organizatimdadividnai): 'J o r` 19 Address: �a oo t" City/Sta&zip; . C4 61i4 'o j'J Phone. Are.you an employer?Check the appropriate box. -Type of ' am general contractor and I project(rl 1.El I am a employer with 4. ❑ I a g, 6. ❑New contraction . loyees(fall and/or part time).*. have hired the sob-contractors 2..Z I am a'sole proprietor or.partner- listed on the'attached sheet: 7. ❑Remodeling ship and have no employees These sub-contractors have 8: ❑Demolition working for me m any capacity. - employees and have workers' addition 9. ❑Bnildmg [No workers'.comp.insurance comp.insurance$ required.] 5. ❑ We are a corporation and its 10:❑Electrical repairs or additions 3.❑ I am a homeowner doing all work - officers have exercised their 11.❑Plumbing repairs or additions ' myself:(No workers'comp. right of exemption per MCrL 12.❑Roofrepanh mice rued.]t c. 152,§1(4),.and we have no �to o workers' 13.❑ Other . employees.[N• comp.insurance required_] *Any applicant that O=ks box#1=at also fill oat�swd-below showing Owir workers'com .pansatim policyfi fUrmxti t Homeowners who mamit&is affidavit indicating they are doing all'work and d=hire outside canlr, 1;must submit a yew affidavitmdicafng such. tc=ftactom-thatcheck this box most attached as additiaosl sbeet sbowiag the name of the sub•conbaetocs and state wbe9ier ornoi those entities ban easployees.Edit s*contractors bade eniployees,they mustpravidt their wod='comp.policy nomber. ram an employer that is providing workers'compensation insurance for my employees. Below is the policy and joh site information. (� Insurance Company Name: Policy#or Self-ins.-Lic.# EapizationDate: Job Site Address: LI A) h� pelf CiVSta&Zip: Attach a copy of the workers'compensati n policy declaration page'(showing the policy number and expiration date). Failure,to secure coverage as required ender 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 imprisoumcad,as wen as civil penalties m 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.statemezit maybe forwarded to the Office of Iuvestiaations:ofthe DIA for..msurance coverage verification. I do hereby certify under the.pauss andpenalties of perjwy that the information provided above is true and correct Sig�atxae: Date: Phony# Offtcial use only. Do not write-In this area,to:be completed by cfty or town official City or Town: Permitff icense Issuing Authority(circle one): I.Board of Health. 2.Bailding Department:3.City/Town Clerk 4.Electrical Inspector:5.Plumbing Inspector 6..Other Contact Person: Phone#: j . i t i Town of table : . RegriLtoa y 5eces Thomas F.Geiler,Yfirecfior' s � Buis&Mg DivWon Tom Perry,Buildiag Comiae OUer .200 Main Sheet,Hyannis,lVlA 0200. Www fowa barnstable mane Office: 568462-4038 Fad 508-79FU-6230 n J roperty Owner Must Complete, and,Sign This Section if using 1A.Rtaflder . k Y, �7G-�� r'� ;✓°�'�t��t� as Owaet.cif the °"' • subject property hereby authorize to id an`my behalf, in all naatrers relative to work ands prized by this bmil�pemmit ' (Address of job) ro - *Pool.fences-and-alas m are'the responaib:Wty of the_appi cant. Fools are not to be filled.before fence.is installed and'pools Are not to be utilized.until all final inspections are pesforsned and accepted. XSk4_A G-k^_ Signature of Owner t Signature,of Applicsint a Print Naine Print Name Q. Y . ,. NWE,gLTF! OF IUTASS1 CLil B ID SHEET METAL WORKERS ISSUES ,THE ;FOLLOWING L Pt E NSt ,: aS A: 1ASTER UNRESTRICTED. ijl JOHN C �-4i c� 440-1 3 °PLA k�f ST ,ry Ma ;ozo72z 3kzo � 148 0�/28/16 1814"65;v i -ir TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION • 11` �f ? O Map` Parcel � Application " ( `lication # (Jul Health Division Date Issued Conservation Division Application Fe3 Planning Dept. Permit Fee l.L/ Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Qroje`c-t=Street Address Owner ��L, Address/ P11�� I.ephon�e % 5 7��c)— 16 Square feet: 1 st floor: existing proposed . 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay FP-r`ojectiValuation %�1 `�' -Co s uction 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 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roan Count o Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove=❑Yd!P,❑ No 6 �» Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ e sting mew Sze_ -o 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-— � Telephone Number7� Address= :ECf `�l1 License# Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE" DATE_ FOR OFFICIAL USE ONLY APPLICATION# t DATEISSUED MAP]PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 7 FINAL BUILDING: hEck &W7 ���, tblj/I l C P DAT-E<:CLOSED OUT- ASSOC IATION PLAN NO: v D 3 Zl V6,54-5 G0,11-1 2AQ, TO orl r 56 l�f �. P _57 G�l ,1. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel03 Application # 13±) v2 Healthbivision Date Issued 2 I 3 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board L�3/ly3 Historic - OKH _ Preservation / Hyannis Project Street Address7`^� �1C.,� Village Owner Address : oo° Telephone ?f ` Permit Request / e , Square feet: 1 st floor: existing proposed 2nd floor. existing proposed Total new :Zoning.District Flood Plain Groundwater Overlay Project Valuation '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 rawl ❑Walkout ❑ Other --a Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) ,- Number of Baths: Full: existing new Half: existing .new _ Number of Bedrooms: existing _new � - . rrs Total Room Count (not including baths): existing new First Floor Room Couet Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other , 6-�+ 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 Telephone Number Address �a`� ��� � !25- License # C_i5 i�`�� �+��✓ Home Improvement Contractor# ?� Email : Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE q _ DATE r _ FOR OFFICIAL USE ONLY ;i APFILICATION# I DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE OWNER " DATE OF INSPECTION: c .FRAME — — — — :INSULATION.t LI — - _ FIREPLACE F ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING;: '1f�L�QUN S t _ rF • DATE CLOSED OUT ASSOCIATION PLAN NO: Me Commo>,mwahk of Massacbuse& Deparhaent of huksttrlAccidents ' Office o,f fnves a#ions 600 Mighirigton S`trreet 4 Boston,M,4 02111 n%,jv,Ynasmgouldia Workers' CompensatiouInsurance Affidavit:Builders/Contractors/E ee.tricianstNumbers Appficant Infarmation Please Print Legibly Name Ousiness/Organization&dMdnal7: 1�Z Address: 1- l Ci /Stathe/ *7 � - D one 4- 509 669 /7/0 4 �5IJP 8/l r Are you an employer?Chq k the appropriate box: Type o e r��� ❑ 4_ I ate a contractor and 1, 3l�of:� � 4ct� , 1.Ellam a e aployer with 6- ❑New CDnSt Ction loyees(full andlorpart4ime * "havelireslthe subcontractors 2_ I am a sole proprietor or partner listed on the attached sheet +- ❑Remodeling Re - ship and haxte no employees These sub contractors have S; ❑Demolition working for me in any capacity_ employees and have workers' 9- ❑Building addition i [No.Workers' comp.rrimxanre Comp-inset ml 5. [Tire are a corporation.and'its 10_0 Electrical repairs or additions 3.El I am a required] officers hnve exercised their 11-.❑ g repairs airs or additions a h homeowner doing all work myself[No workers'comp- right of exemption per MGL 12_.E]Roof repairs instumnre required.]T c-152, §1(4),and we have,no employees_[No workers' 13_❑Other comp_insurance regdued.j *Any Wlicm t that checks boa#1 mast also fill out the sectioa belowshosxing then woiken,compensation policy infarmatiob TEE...who submit this affidavit indicating they are daiag all wards sad die.hire outside contt:act.ts mast sub=a new affidavit indicatin sach- tContcact.rs that check this boat must attached an additional sheet shoving the name of Bm soots-rnatactan and state whether ornot these m ides have empiayees. IMP mVcontmctots here employees,they nmtst provide their warlen'comp.policy number. lam arz employer that is pnwidirzg workers'.comperuw ion insurance f or my ampLayeas. Belotr is the po&cy and job site information. Insurance Company Name: Policy#or Self-its Uc-4: ExpuationDate: 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 regniredunder Section.25A of MGL c. 152 can lead to the imposition ofrriminal penalties of a fine up to$1,50G.OG and/or one-year inTrisomment,as well as civil penalties in the,form of a STOP WORK ORDER and a fi=. 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 Imr-estigations of the DIA far insurance coverage verification_ I do here certify under t`hapairis aiidpenaWas ofpedury t�tatthe infornzation prini d abase is bus a' d.correct ai tttte: —� Date: /`L l 7 Phone# ( [� 5 �-2, ci=� 01kial erne onty. Do not write in this area,to ha completed by city or town offitiaL City or Town: PermitUcense if Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cterk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instruction Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 IocaI 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-contractors)name(s),address(es)and phone nuunber(s)along with their cerificafe(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 carryworkers' compensation insurance. If an LLC or LLP does have employees,a policy is required_ Be advised that this affidavit may be submitted to the Depai rent of Industrial Accidents for confirmation of iris rrance coverage. Also be sure to sign and date the affidavit The affidavit should be retumed 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 pert it/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/Ecense 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 u-u (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 Gommo malth of Massachusetts ' Depai9ment of Industrial Accidents Office of lmvestigafiGm 600 wasibgtoa Stz=t Boston=IAA 02111 TeL#617-727-4900 at 406 or 1-8 MA$SAFE Revised 4-24-07 Fax# 617-727-7749 www.im=,,gov/dia I C��e`�pa��vvrao�uueal�a�vaLaQOac/iccoeC� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: '176233 Type: Office of Consumer Affairs and Business Regulation xpiration: ==8%1/2015 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 ` NORDSTROM CARPENTRY k PETER NORDSTROM) 121 BULLARD ST r z g lQmQ WALPOLE, MA 02081 Undersecretary Not valid without signature Massachusetts - Department of Public Safety Board of BuildingRegulations 5 and Standards , Construction Supers isor 1 & 2 Famil License: CSFA-064780 PETER L NORDS_TROM 121 BULLARD ST Walpole MA 02091 Expiration Commissioner 07/16/2014 a — �, -Town,of Barnstable Regulafory=°Services �fr Y •.; t S s ♦ Richard V.Scab,Interim Director , ' 039. ��� f••it4 r I• r. _ r. x �. •, - � F fir,' � � • � . Buildini Y.ii , , Tom Perry,'Building Commissioner , r +4 { 200 Main S, treet,Hyannis,MA 02601 www1own.barnstable.ma.us r Office: 508-862-4038 F. Fax: 508-790-6230' Property OwY er MV st Complete and Sign This S, e..ct_ ion'.�, If�Usi� A Builder .. r a , - .. I � �R 3 lf,� r. q1y�A „ � A..a ,�„ ,� `l: sy �c '(` ♦a ✓ 4, - �... ' xas'Owner.of.the sub ect x>� € �• �, r , �,j i R ) property ,� _,� hereby alithbriie - — - - ,-to`act on my behal f ' in_all tteis'rdaive'to:work authorized•bp this but pert ,�ldtng , _. r, � �., :�. 6 -, .�-1����i�Imo, c���1zo�c�:�- ' • /��)\jam (Address of Job)' *Pool fences''and alarms are the responsibility of the iPP licant. Pools' _..D are not to be filled or utilized before fence is installed and all fin 'la 1"*v inspections are'performed and accepted: ,w AKA Ok[\' ►`ti 1 UUL � 3:. «."��rfS" ll €�.. • �'S' i'` 'Sn' r..l;f} " Signature'"of Owner _.. ,Y_.;, . r. �z r �3'ignature of Applicant m `T f* c 4 +r ti 4rr +it, 4o / V'b 7z1z-Tq Print Name ..... dt 4. Print Name - Q':FORMS:OWNERP. r+_k ERMIssiorrnoors iwi3 t '. � � � • Regulatory Services .: giehard V. call,Interim Director d` S DiVIS1UII Building . ' Tom.Perry,Building Commissioner • ` ' ' . 260 Main Street, HYmmis,-,MA 02601 - pwww.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 HOMEOwNIIt LICENSE SON a " {, Pleme Print DATE: JOB I,OCAITOI+i stre� •ua number -HOMEOw11ER": 3 r home phone work phone name CURRENT MAILING ADDRESS: zip code cityttown fi , state. .:.- on for"homeowners"was extended to include owner=occuied dwellings of six emits or less and to allow The current exempt< ------ homeowners to engage an individual for hire who does nF o>riti'pITON OF H MEO ssess a license,pwNER that the owner a II A to be,a one or two- ' parcel of land on which he/she resides or intends to reside,on which.there is,orwh constructs more than one Persons)who owns a p accesso to such use and/or farm s.ractures• A P Official on a form family dwelling,attached or detached structs rY Section home in a two-year period shall not be considered a bemeownnsier�l for such work erf, ed under thee Building l g ermit acceptable to the Building Official,that she shall _ k, 109.1.1) licable codes, ersi ed"homeowner"assumes responsibility for compliance with the State Building Code and other app The and gn bylaws,rules and regulations ection es that he/she.understands the Town of Bamstable Building Department minimum insp The undersigned"homeowner"certifi 1 with said procedures aAd:regnir'ements* procedures and requirements and that he/she will comp y Signature of Homeowner , Appioval of Building 0Miciat with the State Building Code Three-family dwellings containing 35,000 cubic feet or,larger will be re,uured to comply J Note: M Section 127.0 Construction Control. HOMEOwNER,S EMOTION performing work for which a building permit required shall be exempt The Code states that: "Any homeowner p of construction Supervisors);-provided that if the homeowner from the provisions of this section(Section 109.1.1-Licensing ervisor" for hire to do such work,that such Homeowner shall.act as sup engages a person(s) - onsibilities of a supervisorthat they are assuming the Many homeowners who_use this exemption construction lion 5 pervisors Section 2.15)re unawareThis lack of awareness often - (see Appendix Q,Rules&Regulations for Licensing unlicensed persons. In this case,our Board cannot results in serious problems,.particularly when the homeowner hires Su ervisor is roceed-against the unlicensed person as it world with a licensed Supervisor. The homeowner acting1. P art of the 1' uire, . p ultimately responsible. responsibilities,many.communities req To ensure that the homeowner is fuliy'aware of his/her resp permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. Ou the last page p PP ' issue is a form currently used by several towns. you may care f amend and adopt such a form/cei tification for use in. of this . your community.. forauS.doc 4 v Q:1wPFILESI 0M&%bwlding Pe Revised 061313 i. Town of Barnstable *Permit# F-rpires 6 mo s,from i ue dpta� Regulatory Services Fee (,v w snartsrrasi,e � 6 a Thomas F.Geiler,Director � � 3y. �� � IL Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY 22 Not Valid without Red X-Press Imprint Map/parcel Number. PropAddr I I Value of Work (Z Ccco Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addresses S ( Contractor's NameQLOn l �Q y��` 'D' Telephone Number Home Improvement Contractor License#(if applicable) (( Cons ction Supervisor's License#(if applicable) � ?_bSz,< 0 Foul 0 Workman's Compensation Insurance Check one: OCT 1 2U12 ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insur/ayn�ce NSTABLE Insurance Company Name b P'�} ���� �� BA� Workman's Comp.Policy# W C "' Ll Copy of Insurance Compliance.Certificate must accompany each permit. Permit Request(check box) c Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to lcj�l ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof).. f ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum 35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conten ation,etc. ***Note:, Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors.License is required. SIGNATURE: C:\Users\decollik\AppData\LocalWicrosoft\Wind s\Temporary Internet Files\Content.Oudook\DDV87AAZ\EXPRESS.doc Revised 072110 ?lie Counnonwalth of Massadiusetls Department of Industrial Accidents Office of Intrestigations 600 Washington Street Boston,ALMA 02111 nrnntr mamgm,ldia `Yorkers' Compensation Insurance Affidavit:Bu®lderslContractors/ElectricianslPlumbers Applicant Information p �Please Print L,egibl Name(Business/organizationtlndividual): � � S• �7�t b1 , N-C-- Address. (fl�l f'Y\Vn SwEej— City/StatelZip: J1 �- �1,� ©"�5 Phone# 21— f -7 Are yo an employer?Check the appropriate box: Type of project(rewired): L B I am a employer with JP 4. ❑ I and a general contractor and I 6. ❑New construction 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. 8. ❑Demolition w°ice Y c for me in an employees and have workers' capacity. x 9. ❑Building addition [No workers'comp.insurance comp_insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself[No workers'comp, right of exemption per MGL 12.❑Roof repairs insurance regaired.]i c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] ;Any appticaffi that checks box#1 mast aLso fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidastir indicating they are doing all work and then hire outside contractors mast submit a new aftsd"indicating such. lContractors that check this box must attached an additional sheet showurg the name of the sub-commctors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Yarn an employer that isprotridirlg nrorkers'compensatdon insaararice for my enTloy^eem Below is the policy and job site. information Insurance Company Name: C� Policy or Self ins.Inc.#: '®1 Z Expiration Date: (7; 43 Job Site Address: l'1 ��'In .' t Ci /State/ ��V I a ty Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration slate). 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 6v71 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 cerhf'y under the pains and penalties of peijyury that the information pm ided abmfe is bate and correct Si tune: Date: —I is 2- D 1?i Phone##: �' ( (-7'� Official use only. Do not write.in this area,to be completed by city or town official } City or Town: PermitUcense Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: s I v �— -- _ Office of Consumer Affairs and Business Regulation ' 10 Park Plaza - Suite 5170. Boston, Massachusetts,02116 r Dome Improvement Contractor Registration ' Registration: 103714 Type: Private Corporation y_ 'Expiration: 7/9/2014 Tr# 228652 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault - 1031 MAIN ST OSTERVILLE, MA 02658 • p Update Address and return card.Mark reason for change. L Address Renewal Employment Lost Card DPS-CA1 0 5OM-04/04-G101216 /zear/L-�nQra�uealll o` j(�aasuc�r�aeli F Office of Consumer Affairs&Business Regulation License or registration valid for individul use only =—, before the expiration date. If found return to: ff ;,,HOME IMPROVEMENT CONTRACTOR ; — . r Office of Consumer Affairs and Business Regulation =1 Registration: 103714 Type: Expiration: 7/9/20.14 Private Corporation .10 Park Plaza-Suite 5170 - —% p Boston,MA 02116 PAUL J.CAZEAULT.&SQNSINC.;• Paul Cazeault ) 1031 MAIN ST -` Massachusetts -Department of Public Safety - <� *--� Board of wildingeguiatior,s and Standards -Construction Superiisur _ ._icense: CS-026325 , r PAUL J CAZEAULT 1031 MAIN ST. OSTERVILI-�E MA 62.655 Expiration `.Commissioner 10/20/2013 41 w , Property Owner Must Complete & Sign This Form If Using. a Roofer / Builder. I (print) Q Scan M 00`(L. , as Owner of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job 4011� Signature of Owner ci., Mailing Address of Owner v 1�e--e d hg�, f AN O a,y Qk- . Telephone# �- Date OI 15 112 - (Please return this form to Cazeault roofing along with your signed contract; It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you) ff 1,MO 10/4/2012 11 :29:39. AM PAGE 3/003 . Fax Server ,aco CERTIFICATE OF LIABILITY INSURANCE °A `"N°a""""' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFRRMATIVELY OR NEGATIVELY.AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRooucER Dowling & O'Neil Insurance Agency �ViACr NAiJE 973 IYANNOUGH ROAD 2ND FLOOR PHONE INC—___... t 2 EM,(Nr,No 21 Hyannis, MA 026011990 INSMEFX A9zQMNGCO4ERA0E MC# _.. INSURER A! Libam Mutual Ins ran _ PAULJ GAZEAULT& SONS ROOFING INC NsuREFZB: 1031 MAIN STREET INWRMC: OSTERVILLE MA 02655 INBURERD: INSURER E• —...... . _. INSURER F: _. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLIdES CF INSURANCE USTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIGATED. NDTWTHSTANDING ANY REQUIREMENT,TERM OR OONDmON OF ANY a TRACT OR aTHER DOCUMENT 1MTH RESPECT 70 V"CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAJN, THE INSURANCE AFFORDED BY THE POUGIES DESCRIBED HEREIN IS SUBJECT TO ALL 114E TMIVIS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAINIS, TYPE OF rnsta4NCE VAM POLICY M MBER uMl3 GENERAL LIABILn7 EACH OCCURFENIM $ 0CAMAEfCIALCM9aALlJABILfTY aoanbKe) $ - QAMS-MADE OOCLIR MM EXP one PERSCNIAL&ADV INIURY CENERALACGRQAATE $ GENLAGGREGATEUMrTAPPUES PER PRODL1MS-C hV OPAGG $ xxx�r P Lnc _ $ ANY AI Jm ®DOILY i NuuW(Per phi"^=$ sz n kL� ED ��UUM f30DILY IN1�LIf Y(Per eooderl);g HIKED AIlCQ; N NON C M ED O U AUTO6a _.. ,$ y, TUN RE-A LIAR O=JR EW.H C=FFENCE h--,$ EXCESS LIAR J CLAIMS MADE AGGFeGA-M CEO FMEMMCN$ ! " A VVORKERSCONVENSAMCIN WC5-318-386670-012 .8/1012012 a/101413 .1 ND � A ENPL.OYOW LIABILITY Y/N ANY PRDPRIEroRiPAR tEk EXECLRIVE 0MCI WffMEi EXCWDED7 FN N/A ELEACJ I ACCJDBJT $ 100006 . Wdalory in Nhq E.L.DISEASE-FA BvQ' $ 100009 If yes,describeurdhr D IPTIONOFOPERAnCNSbelow EJ_DLSEASE-POUGYUW $ 100000 OGM:FMTI ERATI /L Tl r (AVam ACORD 7D1.Addnkmal 119marks u%if more space is regUra4 Workers compensation Insurance Coverage applies only to the workers compensation laws of the state of MA_ CERTIRCATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NanCE WILL BE DELIVERED IN. 200 MAIN STREET ACCORDANCE WTTM THE POUCY PROVISIONS. HYANNIS MA 02601 AUT ORIZEDRHPRESEWATIVE Jeff Eldridge 01988-2010 ACOAD CORPORATION: All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of.ACORO SETS No.;,13922010 C{IMU C'CDE; 16J.9182__ Mzia hn*zcun 8/,23/2012.5;56029 TM Peon 1 of 1. NOTICE OF CANCELLATION [7DATIE(NIM DO IYYYY) 10/5/2012 AGENCY/PRODUCER CANCELLATION DATE(MM/DD/YYYY) DOWLING& O'NEIL INSURANCE AGENCY 10/19/2012 973 IYANNOUGH RD HYANNIS, MA 02601 POLICY NO. (508)775-1620 WC5-31S-386.670-012 INSURED PAUL J CAZEAULT TYPE . WORKERS COMPENSATION PAUL J CAZEAULT&SONS ROOFING INC 1031 MAIN ST OSTERVILLE MA 02655 ATTACHMENT (508)428-1177 Fax: SUBJECT REASON Material Misrepresentation Your company is currently named as an interested party on the certificate of insuran ce issued through this agency for the below named insured. As such, you may be entitled to notification in the event any of the policy(s) shown on the Certification of insurance are to be canceled for any reason prior to either the normal expiration date. This correspondence shall serve as notification that cancellation of the policy(s) is effective as of 12:01 a.m. on the date shown above. If you wish to verify this cancellation with the insured, our records reflect they may be contacted at the address and phone number listed above.. CERTIFICATE HOLDER TOWN OF BARNSTABLE '. � ' 200 MAIN STREET HYANNIS MA 02604 AUTHORIZED REPRESENTATIVE NOC(07/11) - _ NOTICE OF CANCELLATION . CERT NO.: 14339572. CLIENT CODE: 1614182 Katherine Nicholos 10/5/2012 11:49:06 AM Page 1 of 1 This certificate cancels and supersedes ALL previously issued certificates. - _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 'Map 232 Parcel E D3 Application# C�?, 66� Health Division Date Issued 16 S (3 Conservation Division Application Fee Tax Collector Permit Fee -4 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 156 1461Iu t%i N+ Rd Village Ceg)Apx V l l le. ' Owner Evda,%1W Address X 143 <40(-6 ldd� Rd► Cis v�llei Telephone SOB g14— 1-700 i -- j Permit Request X4edo r d 1fi c a ,o ? • misse 4 r i t� s header' at �- r a. use- , Square feet: 1 st floor:existing proposed 2nd floor:existing proposed i Total new C� Zoning District B r. . Flood Plain it C Groundwater Overlay NO CW#Q6'6 Project Valuation $$O.OW- Construction Type Wom n-)e_ ' Lot Size ����gs Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. / NO ex"WeAm rna��F�cA-'na�ts Dwelling Type: Single Family C� Two Family ❑ Multi-Family(#units) Age of Existing Structure QgjS �W?d Historic House: ❑Yes Oslo On Old King's Highway: ❑Yes O<Io Basement Type: O'Full ❑Crawl ❑Walkout ❑Other C.Rft WL N01&'. bLO ;ZQAVAnQl4 WOQIC Basement Finished Area(sq.ft.) da Basement Unfinished Area(sq.ft) 9 S 1 a Number of Baths: Full:existing c:2 new mo Half:existing_ new Number of Bedrooms: existing 3 new C%dfiPHlils� NR! C*Ar►&Q Total Room Count(not including baths):existing (o new First Floor Room Count NO Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing I New_0 Existing wood/coal stove: ❑Yes 4% go C-WOV46L Detached garage:❑J existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:6d existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 2 No If yes, site plan review# - -- Current Use Rom` f'I<—: Proposed°User NO BUILDER INFORMATION Name VPg-L) RE" &- PNEUPM64T' Telephone Number J74 7!3—" --1357 Address P-4 . SdX. ZI License# C,S -7(0 332 Ba.Cn5tabL, HA 02 iB Home Improvement Contractor# Ib'�5'(022 Worker's Compensation > L �?f�- 4�4R'�y�IQ� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO WME53EP " WeEC01t- COWPHAM tees SIGNATURE DATE 9 O FOR OFFICIAL USE ONLY �b APPLICATION# �IYATE ISSUED } MAP PARCEL NO. ADDRESS _ VILLAGE f OWNER DATE OF INSPECTION: ",► FOUNDATION _n - FRAME olG `II?/OF INSULATION FIREPLACE .� ELECTRICAL: ROUGH FINAL r � PLUMBING: ROUGH FINAL . GAS: ROUGH FINAL FINAL BUILDING 0 l d ` = DATE CLOSED OUT ASSOCIATION PLAN NO. x ry ; L �pFTHE 1o� Town of Barnstable. r Regulatory Services a a Z RA MAASSS..LEg Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 012 F9V77WrXT Estimated Cost �O0 0 Address of Work: Owner's Name: Date of Application: D I hereby certify that: Registration is not required for the following reason(s): QWork excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY hereby apply for a rmit as the agent of the owner: qlllog ate Contractor Name Registration No. OR Date Owner's Name Q:fomis:homeaffidav The Commonwealth of Massachusetts Department of Industrial Accidents Office of Itevestigations • ' d 600 Washington Street Boston,MA 02111' wrdw.mass.gov/dia Workers}Compensation Insurance Affidavit: Builders/Contractors/Ele.etricians/Plumbers Applicant Information -1 Please Print Le�ib1Y Name(Business/Organization/Individual): ��D Re �� A DMOO Al t Address: P.O Bo)( 2_1 City/State/Zip: LA) Phone.#: Are you an employer? Check the appropriate bp: :Type of project(required):. I.❑ I am a employer with 4. LvJ 1 am a general contractor and I 6 New construction . •employees(full and/or part-time).* • have hired the sub contractors 2.❑ I am a'sole proprietor or partner- listed on the•attached sheet. 7. Q Remodeling ship and have no employees These sub-contractors have 8. []Demolition employee$ and have workers' working for me in any capacity. 9. ❑Building addition [No workers' comp.insurance. comp, insurance.$ 5. 0 We are a corporation and its 10.❑•Electrical repairs or additions ' required.] ' 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 13 [] Other employees. [No workers' . comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box mutt attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provi&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.#: Expiration Date: th�.lsl �l: RA, c¢�R.V �l�l 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$250.00 a day against thq violator. Be advised that a copy of this statement maybe forwarded to the Office of Investi ations of the bIA for incur ce coverage verification. Ido hereby certify der the pains•and penalties ofperjury that the information provided bove is true and correct. Si ature: Date: 8�7 Phone# 17� � Official use only. Do not write in this area, tb be completed by.clay or town official. City or Town: ' Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: ' Z'9Are dx7�n(eacstanec� ' PmeriptiieP9eksgd for CGIund-r7i a-t+R.taz'fipRaldCAdalBr�ildlapllestra�r9t41 Fpals ' , . �Pr4A.Xfrii�8 Ceiling Wail Floor A15�11�i1NA Slab •IieatinglCooling B rnt E[6acn Ar='(9/2) Ll-valuCr It-v4uLJ ' R-whm' X-y4 W WBII Pale A-v3lue� &Ya111C1 . . • • S'10I to 6500 Hcatlagl3rgmD:ys' , ' 12%. 0,40 38 I3 19 10 6 Normal j iZf C53 30 19 l9 10. 6 vonwd ' g . I21 p.50 38 19 10 ' 6 T i3 . 036 38 13 Z3 WA • • NIA: �'iotmal' iJ 15'/■ 0.46 31 19 19 10 N0 y 15% 0.44 31 13 23' NIA,' NIA ii5 AFiJE pI 13% am 30 19 19 10 85 AFVE IaV/. 032 38 • 13 Zi NIA NIA Normal y 11%, M2 31 19 1 23 NIA NlA' N0=z1 z 18% 6.4Z 31. 13 19 Id S 90 ARM l a'/o 0-.30 30 19 19 TO 6 90 AME I, ADDRESS OF PROPE',Ty" ';29e 101'N C.E/VMAMI LLE MA Z, SQUARE FOOTAGE OF ALL.EXIMOR WALLS; 3, SQUARE F00TAC3E OF ALL GLAZING: 4, % bLAZINO ARRA.(#3 DTVMBD BY'#2): ' 5, SELECT PACKAGE(Q--AA o sea chap abaye): '�0�; O�AMORE It�-VOTIVED METHODS OF DEi'EANIINIl�IG ENER;G�''REQUn3�'TS ARE AVAILABLE, ASK.•US FOR THIS TNFDR.MAT 0N&' BMI)ING'LKSPECT.OR APPB.OVAL: YES; 60: q_��s-�oG301z • Tanta is LID tcuemana u prtsesiptira Pncirsgd far sae and TYra-F'asnc0'RuldaatW$alldtAV VCZte@ t+9ii�Fosiit'I•'Pels ' I4iAXf Ifim MINi1Mt1M Cilaxing Glaano CeiIirsg Walt Favor Alxmtat Slab -13mtinglCaalimg ('��) U-unfurl R-v'a. ' Ft-vsiutI R.y4UL4 R'all Palm t E!1•iacac . Palo R-vahie, R-n+lusr $791 to65D013csci1agl3egrcrDn� 1 IZ°/, • 0.40 38 I3 I9 10 6 Nanasl R 12% M2 30 19 -. 19 10. 6 Nans�l g I2%a Q.50 3B 13 I9 10 •6 gS-AME Iil+ 036 31 13 73 -NIA NIA. Normal' T Maraial ' u IV/d 0.46 32 19 19. 10 S. y 13Y. 0.44 31 13 23 N/A 1`�lA U AFUB �y l3Y. 0.57 30 t9 19 10 S ACE 13'l. 092 31 • 13 23• N/A N/A ?+larmal y 11Y. 0 4 39 19 23 NIA NlAg Notraal Z 13% 0,4z 31, 13 19 10 6 94 AFEJB 11% {t50 30 19 19 IG 6 90AFUE I. ADDRESS O-F PROPERTY: Z, SQUARE FOOTAGE OF ALL.BXMUOR WALLS; 3, SQUARE FOOTAGE OF ALL GLAZING, 4, % bLAZINO AREA.(#3 DIVIDED BY•�2): SELECT PACKAGE(Q AA-see chmt abayu); ; DOTE; OTHER MORE INVOLVED METHODS OF DE MKW G ENERGY REQUMEME--NTS AREAVAMABLE..ASK,US FOR THISMORMATI N, • DING'INSPECTORAPPRDVAL; NO: q-h�ns-f�ca303a • i , 1 ke a[t� � eo: .m¢nt, Inc. Subcontractor List Re: 256 Holly Point Road, Centerville, MA Aaron M. Strom DBA. D&S Construction, P.O. Box 2703, Mashpee, MA Christopher Dougherty DBA CMD Construction, P.O. Box 70, East Sandwich, MA Robert Penney Jr., 189 Lothrups Lane, West Barnstable, MA DeCharles Plastering, 10 Harvest Hollow, Harwichport, MA /t& vovo62 ccyop 1 Post Office Box 21 0 West Barnstable, MA 02668 o Ph: 508.833.6189 e Fx: 508.771.3496 0 www.bdcapecod.com RightFax HI-3 7/27/2007 6: 36: 56 AM PAGE 003/003 Fax Server ACORD. CERTIFICATE OF.INSURANCE. DATE(MMkDMYY) 07-27-07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PAUL PETERS AGENCY INC HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 680 FALMOUTH ROAD ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 1290 COMPANIES AFFORDING COVERAGE MASHPEE,MA 02649 COMPANY 28LBR A AMERICAN ZURICH INSURANCE COMPANY INSURED COMPANY B- STROM AARON M COMPANY P O BOX 2703 C MASHPEE,MA 02649 COMPANY D COVERAGE THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE 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. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDWY). LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTORS PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Anyone person) $ AUTOMOBILE LIABILITY ANY.AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS .NON-OWNED AUTOS PROPERTY DAMAGE $ GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH.ACCIDENT $ AGREGATE $ EXCESS LU\BILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-9917A463-07 05-13-07 05-13-08 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERS/EXECUTIVE INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE-EACH-EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR STROM AARON M. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF MASHPEE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR,TOMAIL 10 - DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO.MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY 16 GREAT NECK RD KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. MASHPEE,MA 02649 AUTHORIZED.REPRESENTATIVE ' W A Bolinder ACORD 25-5(3193) ' t . 08-07-07 02:59Pm From-AIG +973 391 8599 7-998 P.001/002 F-231 st C,ERTI.FICATE OF. I-NS--URANCE . 8/6/2007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Paul Peters Agency Inc - HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 680 Falmouth Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Mashpee, MA 02648 .COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY INSURED . Christopher Dougherty DBA CMD Construction PO Box 70 East Sandwich,MA 02537 COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOT WITHSTANDING 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 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. cc LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE q WORKERS COMPENSATION AND CMPLOYERS'LIABILITY IE•PROPRIETOR/ LIMITS PARTNERS/EXECUTIVE OFFICERS ARE: INCL❑FXCL `4470494 7/13/2007 7/13/2008 STATUTORY LIMITS OTMER Covoraps APPUea to MA Operations Only, EACH ACCIDENT $.100,000 DISEASE POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/VEHICLEWSPECIAL ITEMS DISEASE•EACH EMPLOYEE RE: 166 HOLLIDGE RD,MARSTONS MILLS MA-THE WORKERS COMPENSAI ION POLICY DOES NOT PROVIDE COVERAGE FOR CHRISTOPHER DOUGHERTY, CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE .sm6ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE BUILDING DEPT EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL J4 200 MAIN ST DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT HYANNIS, MA 02601 FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILITY OF- ANY KIND UPDN THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE , ». r , T' l Sep. 17. 2007— 3: 19PM Lovelette I n s u r a n c e 'A g e n c y No. 7732—P, 1/2 ACORD- CERTIFICATE OF LIABILITY INSURANCE oTE(MMI D oi) RODUCER ('508)715-4559 FAX (508)775-4577 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Nfar shal I K Lovel et t e I ns. Agcy. , I Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 396 Whin Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. Q Box 836 Mbst Yar rout h, NA 02673 INSURERS AFFORDING COVERAGE NAIC# INSURED ROBERT PENNEY JR INSURER A: The Providence Wt ual Ins. Co. 000004 189 LOTHRUPS LANE INSURER B: VEST EARNSTABLE, M4 02668-1360 INSURER c: INSURER D: INSURER E: COVERAGES 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CPPOO6416801 08/09/2007 08/09/2008 EACH OCCURRENCEI $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50, OOO CLAIMS MADE n OCCUR MED EXP(Any one person) I $ 5, 000 A t PERSONAL&ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: :..• PRODUCTS-COMP/OP AGG $ 2, 000, 000 "POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS " BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ .(Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ • OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND. WC STATU- OTH- EMPLOYERS LIABILITY � TORY LIMITS ER $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT ` OFFICER/MEMBER EXCLUDED? t E.L.DISEASE-EA EMPLOYE $ yes,describe under S ,. E.L.DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below " OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS _CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL B & D Realty & Devel OPrEnt 10 _DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO Box 21 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY ` 1050 N4 i In Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. f Vibst Bar nst abl e, NW 02668 AUTHORIZED REPRESENTATIVE �A John NESheral JOHN . ACORD 25(2001/08) FAX: ( 508)771-3496 ©ACORD CORPORATION 1988 r 9/17/2007 Time: 5 : 40 PM TO : @ 9, 15087713496 Page: 001-002 - ACORDTM CERTIFICATE OF LIABILITY INSURANCE 07/05/D°I007 o7/os/2oo7 PRODUCER (508) 892-8133 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION George McKenna Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER.THE COVERAGE AFFORDED BY THE POLICIES BELOW. 4 Pleasant St. Leicester MA 01524- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Norfolk"&-.Dedham Mutual I NOR Decharles Plastering INSURER B: 10 Harvest Hollow INSURER C: INSURER D: Harwichport MA 02646- INSURER E: COVERAGES 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L `b - POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MMIDD/YY) LIMITS A GENERAL LIABILITY R0205918 01/22/2007 01/22/2008 EACHOCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY+ DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 CLAIMSMADE OCCUR MEDEXP(Anyone person). $ 5,000 PERSONAL&ADV INJURY 5 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ 2,000,000 A POLICYF71 JET LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO - (Ea accident) 5 - ALL OWNED AUTOS / / BODILY INJURY SCHEDULED AUTOS (Per person) $ HIREDAUTOS BODILY INJURY NON-OWNED AUTOS - (Per accident) $ PROPERTY DAMAGE (Per accident) S GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO FOTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY / / EACH OCCURRENCE $ OCCUR F—ICLAIMS MADE AGGREGATE 5 DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND WEND2435 07/04/2007 07/04/2008 TORYLIMITS 5 R EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT Is 100,000 OFFICERIMEMBER EXCLUDED? Sole Proprietor excluded E.L.DISEASE-EA EMPLOYEE 5 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER d- DESCRIPTION OF OPERATION S/LOCATIONS/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER' CANCELLATION ( ) (508) 771-3496 SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED BEFORE THE Kevin Boyer EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL .ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT B&D Realty, Development FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �G ACORD 25(2001108) ©ACORD CORPORATION 1988 p?_,-INS025(0108).05 • ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 I _ t i 71. ioard of Building Regulations and Standards }} Construction Supervisor License k I Licet se CS 76332 f + I ;Ex 12P?09 Tr# 4218- �:�. R�sfrtctio' -OQ.W KEVIN BOYAR C r is l i ' PO BOX 716 N.�zy_ i�,.�. W BARNSTABLE,MA 02668 Commissioner 1 i I ✓fze -Vamimo�zuiec�,� a�✓�aaaac�uco�,lta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrationn......1Y55622 r Expiration 4/26/2009 Tr# 255175 I� Type Individual KEVIN M BOYAR KEVIN BOYAR /xf! 1050 MAIN ST W BARNSTABLE, MA 02668 Administrator A o f °f Town of Barnstable • j}lE ". Regulatory Services s�xrrsr�stE, _ Thomav] .Geller,-Director . B—gmc g Division " TomPerry; Building Commissioner . 200 Main Street, $ya=ds,MA 02601- www.town barnstable;mama Office: 508-862-403 8 Fax: 508-790-6230 • r. a Property Owner Must Complete and Sign 'This Section If Using ABuilder as Owner of the subject property hereby authonze:' ��' L7 �Z ,� � P 7 ° 7 to act on my behalf, in all matters relative to work authorized bythis building permit application for: (Address of Job) !7 D 7 Signature of Owner ate Print Name RENOVATIONS TO EUDAILEY RESIDENCE _ - tittle teeotel. 0 O 256 HOLLY POINT ROAD ��roncR 6¢6 noxcR. CENTERVILLE,MA o0¢a omn �� Nrviuu % ws--1 uou:own LAUNDRY r¢umr wnww' i xEw m G15nwG GMnfYD PaMW6�'- �G9M, f 11 --- g --1---- m Leonard J.Staffa I _ KITCHEN 1ST B DROOM GARAGE I KITCHEN GUEST BEDROOM 96BACE 6SEARS ROAD MILTON,W 02166 -- ----- tttt.te ------ — — - I I r ---------- i PARTITION TWE LEMM }} JI 1 II °'" ,POST"'I"PPm i - i aosn i IISIPM73MIN. I R II O^t1191G - /mNf Y M,C w.11 I II 1 1 ������g�Qw y� �uLN �d' Twrt.6bN�E fYt U SND m '� IV IN 0 g _ I ' IN LIVING POOM. - i _ ,fwD ovx w.0 N mmnJ mn.ou. I $ a.w 1 i srn:°°QeNO i ; ; 1 I E _ 1 ro» Ev�000as i ii � 1 trr �.�. r ttu 11 1 t p 1 1 M 10',N�ax� 1 i J 84ngC w41 ; I I ' I 11 wWYMS 111nC.11 �� 11 11 _ - AT indi w�04 - I I ME1NA- II• ` 11 RFYOK� Sfw _ I MASTS&WROOAI pFOR00M. gE S 11 MAST ROOM M - 11C1R' rc" 1 I 3 _ - � i I I I II 1 _ II O JM mm ❑ o ® ® ® RED ARC","" DEMOLITION PLAN J S, e" NEW PLAN FIRST FLOOR y r No_6650 . - l MILt�TA am■a t art �p s VIEW F-R_S--T—1100 t _��PLA MT—FLOOR DEMOL ON AN "` S @Nwm A-1 l I xFW FlMsx .. nwr,m,.�mw.vro RENOVATIONS TO EUDAILEY RESIDENCE I I I I I C4oWN5 I I - 1I a,«o sn I i i I •nwxo sn i I 256 HOLLY POINT ROAD .I I m.WWWs I I-I ccuans I I CENTERVILLE,MA I I I I I I I I Wain Dorn orcWuc g Leonard J.Staffs WA¢6o.ND 63 ROAD MILTON,MA 02183 INTERIOR ELEVATION —LIVING ROOM GARAGea to 90016 d 'CDs eiW PARTITION TYPE LEGEND lam",3•r, _ - ______ FWWnw ro — �.xDro�Ec Y 1 x u+nrgx - .Al�r uw Fxo a• _ 0'aG M nuNOTE. mlc,uWF IT 1p Olt,1p MSMG aWasw ua r.�of snn ro / N NEW wiLWgP - �- F.,m, Dasnxc swF . W/NRFIxGiF.V 9 a SnluCMff 6M Po51 - i cW ao a 6r aRom+asrz. - EXISTING SUN ROOM I ' EXISTING LIVING ROOM - 9,RCM ae MASTOOM !'A I WFW SiFP OOS)W6 COxf21E — sancrts'�.cm xEw� Foao,.m,.Wua G\SSEREDAgChij FRAMING PLAN ry��q�px w5` [ Fr%LFH1. .EXISTING BASEMENT ❑ �� �PilDJ sry�F WALL SECTION L + 'So -V • ELEVATION E, Na6650 H -- O MILTON. OWALL SECTION AT FAMILY ROOM FRAMING PLAN — � MA nd to Bede 1 F N p56P snr ns. A-2 Apr, 29. 2008 12: 57PM Viola_Associates No. 3450 P- 1 6L42) ?go— attj ent, Inc. Cam- v J� • -�-29-o0 WI-1416- /NSVZAfiO/V %I "SUAI JeM AKI PoSC Qf ice..$ox.2�' !Test'$amstable,•�MA OZ•668:'R Pli:'.S.b8:83 .6 8� !?,F ct:508.7' 4 4.!wviiwbd ' e od:co iii . ., ...:.........::�.. ;,,...::n.:,: .., ...,;�.:..-,...,...,.:.....,.,.,.�01:•_ ....:rv.rp�•,..,:;.tl',-.�"h�. .t+�1�`•� ... n.,.—..:aY�. -, ;!ui.r;'. ri2:= �E Apr. 29. 2008 12: 57PM Viola-Associates No. 3450 P. 2- IN QUALITY INSULATION WSW 8 Kendrick Rd - Contractor Wareham, MA 02571 W 503-273-0137 F 508-273-0269 ___......................._.._......._�..__..,.,....__...._.,..:_..__._.:.,,, Foundation Watelrproofing - Insulation- Fireplace & Surrounds - Garage Doors - I Seamless Gutters Closet Shelving Fax To: From: Seth Heany Fac /;7j-:s'��� Pages: (including oover) Phone: Date: Re: Q Urgent ❑For Review 0 Please Comment ❑Please Reply ❑ Please Recycle •Comments: -may Seth Heany/Cell 508-962-2071 1 Fax 608-273-0269 Email: seth.heanyO-mascocs.coen Sales Representative Apr. 29. 2008 12: 57PM Viola—Associates No. 3450 P. 3 COMFORT FOAM 178 Series INSULATION SYSTEM PRODUCT DESCRIPTION; � COMFORT FOAM 178 is s closed cell polyurathene system utilrang an EPA approved.zero ozone-depleting blowing agent. It Is designed for use in commercial and residential construction applications. COMFORT FOAM 17a Is compatible with most common oonstruction matenals. The benents of COMFORT FOAM 179 Include: • Superior Insulation performance • Control moisture infli!ration Controls air infiltration • Ease of application • Non-fibrous 1 APPROVALS AND CREDENTIALS: ) ASTM E- •Llstad.at SG§US Testing Co. Inc. NFPA 7� I CIe641 8 Inch wen SPF Thickness 4.0 Inches 12 inch ceiling Flame Spread Index 25 with 15 min.thermal barrier A Smoke Development Index 350 Tested at Intertek ETL Semko Test Report Number: 3116019-OOZc Attic&Crawl§2206 Tested at InteReK ETI.Semko Test Method SwRI 9-0-02 Test Report Number.3116311-002c '-This numerical name spread rating does not reneet hazards presented by this or any Other malenal under actual fire condition.Polyurethane roam systems should not be left cxpoeed and must bs protected by a mlMmum 15-nimute thermal banner oro(hcr cod"Ompnent material as allowed by applicable building code(a)and Code Officials. Rullding Codes provide Quldollnoo mpresanling mitilmum redulrements. Funhsr Intormnkn it evmllsble all vM w,lg p. Conault all Au►horities having juRsdicdoh over gn area for additional or specllit requirements prior to beginning a pro)eat. TYPICAL PROPERTIES': � - PROPE[i�C VALUE TEST M6TFlQD �p Liquid Resin—As Supplied Specific Gravity C 707 1.180 ASTM D 1636 Vlecoslty Q 70'P(opa) 440 Broodela As Cured Iao;Resin MIX Ratio(vol:voD Density,core(pef Q 2"lift) Nominal 2.0 ASTM D 1622 Compressive Strength(py) 22 ASTM D 1621 Tensile Strength(psi) 28 ASTM D 1623 Type C Glossed Call Content(%) :PBo ASTM D 6228 Initial k-factor(Btu iplft'hr•F) 0,165(11=6.11in)'" ASTM C 518 Permcance(perms) 1-82 ASTM E 96 Permeability(per,inch) 1,82 @ V SPF ASTM E 96 0.91 . ®3'SPF 0.46Q4'SPF Air Permeance(LWIT2®75 Pa) 0.000025 ASTM E 2175-01 Alr Leakage(UeJml(§76 Po) 0,000026 ASTM E 26349 Dimensional Stability(Wolume Change) Dry Age 26 Days(158'F) +8 to+12% ASTM D 21,26 FrePYe Anna 14 Dsaya G20°F1 +f1,Q tQ-0.21% ASTM D 2126 •Tne&9 physical pmpehV vale=are p picel(or this matenet as applied at our development recxtf under contm/led r:onvffam. 3PFp0,1o01henOB one ectuel pnyalcal properties will very with d4elencea 1r7 eppecoaan(7.e.omorant aand6one, Process equipment and sedirim,meteda)throughput sto. Aa a result,these published properties snorxd oe rased eb Fuld4/7-xotelyYof the puryose of evaluarlon PIIYalcel phopenb apeo Seetiorta should be tkfVmJMd from aotuNpNduOtlon merit ' 7ho obom data waa ealRetcted from eamptee prepared using pre fbtlawlnrg ogtdPrnQntaotdtgumfion: • Gusmat•N-2Q/3bprePvfionBrsef a(1:!voq�rne ra0o with 5D R aI neared deWeN hose - GualmAGX--7"y-gun eon0gurad miM a 61 rnrx moduic and rt70 PCD mote GAP spriio pun oonfIguned WM e of r*chatmm Pmww tetrrpetefum metCngs. deooyensts 190'f,'flesh T90'R.'Hose 130'F • P/oCess pressure; 1000 pslg mirdnMnm untie apreying COMFORT FOAM 17a Ices shown acceptable'ornsha ped armame with fafflosratum satlirrys in fbe range of f 10'G- 190'F for Isocyana fe,Resin and Hose. Evcry/00 Vile and xcr orombierif rauo*tr wiravfm are dlAbrmr(tlronforo, one set of pwasa■@Wnyx may not atbllr W wary vAvetlon. It to Me t*rponsW#W of Me spplator ro evakrme pre on- OW comdlffem and bran deloardne Me rpprvpdalo irrteaaNv*and pvocots.iafbngs. `^The dare chart shows the R-value of this houdaf a. 'R"means realstance to neat now. Tho higher the R-yekle.the greater fne lAwlsong power. Cionipara Insu/adon R-values b*bre you buy. There ate Omer factors io consider. Tna amount c Innai daflon W11 depend upon fhe'afrmats,the ape and s/ze of yourhoum,and fine lust use patters and/OtNty BtZe• If you Ouy I=muds insukifoo it hrpl coat you more than what y01t vifll save on hied to aaAleve proper R-Valdes a la veverroel that diJa IrtsLleGon o01"411ed oroarry. Thomas N. George, Attorney 17 THACHER SHORE ROAD •YARmouTH PORT,NIA 02675 • (508)362-6906 • FAX: (508)362-7804 A March 7, 2007 Department of Environmental Protection Waterways Regulation Program One Winter Street Boston, MA 02108 Re: Simplified License Candace H. Pratt L 256 Holly Point Road Centerville, MA Dear Sir or Madam: Enclosed please find an application in triplicate for the above referred simplified license. The fee of$65 is also enclosed by check of the applicant. Notification of such has been sent to the town of Barnstable Town Council, Conservation Commission, Planning Board and Building Commissioner by mail postage prepaid. Please correspond with me as attorney for the applicant in all future matters. VKge T TNG/rl Enc. Enter your transmittal number ♦ W122943' ; Transmittal Numbers, Your unique Transmittal Number can be accessed online: http://mass.gov/dea/service/online/trasmfrm.shtml or call MassDEP's Infol-ine at 617-338-2255 or 800-462-0444(from 508,781,and 978 area codes). Massachusetts Department of Environmental Protection Transmittal Form for Permit Application and Payment 1. Please type or A. Permit Information print.A separate p Transmittal Form` lt�(��O(o dbtry`d�l r�ee �,Lcb��c�sa must be completed 1.Permit Code:7 or 8 character code from permit instructions 2.Name of Perrkit Ca gory for each permit d�� Wt 4ta b.t. application. 3.Type of Project of Aolkity 2. Make your check payable to B. Applicant Information - Firm or Individual the Commonwealth of Massachusetts and mail it with a 1.Name of Firm-Or,if party needing this approval is an individual enter name below: copy of this form to: ??1 A � t C��D�� DEP,P.O.BoxR 4062,Boston,MA 2•Last Name of Indivi al 3.First Name of Individual 4.MI 02211. 2.5b A:& 361vii 5.Street Address \ 3. Three copies of t,�A . G�.�'�WIlkL ) OZ./o3Z I'4'OV':0S6ZZd needed.s form will be 6.City/Town 7.State 8.Zip Code Mr.9.Telephone# 10.Ext.#. ak44 -r"yu a-S I C �'a Rq 2 ►-Tat 367.blab Copy 1 -the 11.C ntact Person 12.e-mail address(optional) original must accompany your permit application. C. Facility, Site or Individual Requiring Approval Copy 2 must C1��-C{-. accompany your fee payment. 1.Name of Facility,Site Or Individual Copy 3 should be �,y(o 1_6(,`y O 6K retained for your 2.Street Address r records Qe%-% .J t X MQ. 02`3 Z. ►-ad I.wS'OZl:+o 4. Both fee-paying -3.City/Town 4.State 5.Zip Code 6.Telephone# EX. and exempt /-�aP 36L 69+Qb Ca" Ttdofe) applicants must 8.DEP Facility Number(if Known) 9.Federal I.D.Number(if Known) 10. BWSC Tracking#(if Known) mail a copy of this transmittal form to: D. Application Prepared by (if different from Section B)* MassDEP P.O.Box 4062 11 , Boston,MA 1. Name of Firm Or Individual- 02211 � l 1+ L1-ek Sko re 2.Address !� "Note: yQ?LV�-0"*e, T a�'t�` A0k, 6 Z(Q 3-5 I-rd P'` 34z, 4?b(0 For BWSC Permits, 3 City/Town 4.State 5.Zip Code 6.Telephone# 7.Ext.# enter the LSP. ► ��0 M 4P 8.Contact Person 9. LSP Number(BWSC Permits only) E. Permit - Project Coordination 1. Is this project subject to MEPA review? ❑yes &no If yes,enter the project's EOEA file number-assigned when an Environmental Notification Form is submitted to the MEPA unit: EOEA File Number F. Amount Due DEP Use Only Special Provisions: 1. El Fee Exempt(city,town or municipal housing authority)(state agency if fee is$100 or less). Permit No: There are no fee exemptions for BWSC permits,regardless of applicant status. 2. ❑Hardship Request-payment extensions according to 310 CMR 4.04(3)(c). Rec'd Date: 3. ❑Alternative Schedule Project(according to 310 CMR 4.05 and 4.10). 4. []'Homeowner(according to 310 CMR 4.02). Reviewer: Check Number Dollar Amount Date } tr-formw•rev. 1/07 Page 1 of 1 The Commonweafth Of JKassachusetts No. N SIMPLIFIED LICENSE Applicant must fill in pages 1 and 2 of this license. BRP WW06 66A k ?( CL+ of the Town/City of: in: Applicant's name Town/cityCounty County and Commonwealth aforesaid, has applied to the Department of Environmental Protection for a Simplified License to: Please check.• ffmaintain an existing(pre-1984): ❑construct a proposed or maintain an existing(post-1984): Please check all that apply below. Please check all that apply below., [pier/dock ❑ pier/dock ❑ boat ramp ❑ ramp cramp %.0 ❑float(s) [;tfoat(s) ❑ pile(s) ❑ pile(s) ❑ boat lift ❑ boat lift ❑ pile-supported boat house ❑ boat house ❑other ❑ retaining wall/seawall ❑ bulkhead ❑ rip rap/stone revetment ❑groin(s) ❑ Nonwater-dependent(NWD)residence ❑other and has submitted plans of the same; and whereas que notice of said application has been given, as required by law, to the[Please check one.] J Board of Selectmen d City Council, of the Town/City of: �►r,.v+��a.�i l e � C�,��.r�1�z1 Town/City NOW,said Department, having heard all parties desiring to be heard, and having fully considered said application, hereby, subject to the approval of the Governor, authorizes and licenses said Licensee, subject to the provisions of the ninety-first chapter of the General Laws, and of all laws which are or may be in force applicable thereto, to: Please check all that apply. Please check all that apply.' [R'maintain existing structure(s)for: ❑ construct and maintain structure(s)for: [r]'non commercial docking/access to navigable water ❑ non commercial docking/access to navigable water ❑ shoreline stabilization ❑other ❑ residential, NWD building ❑other �ctr ' Z tJt ` lao in and over the waters of: in the Town/City of: Wate way Town/City and in accordance with the locations shown and details Indicated on the accompanying License Sketch Plan No;DEPhvSE ONLY (total number of Sheets):FRi �pi License# > ; - Page 2 The total area of the combined structures, measured below mean/ordinary high water shall be no greater than a total of 600 square feet for proposed water-dependent structures, or for structures built or substantially altered after January 1, 1984 without any fill. For structures or fill constructed prior to January 1, 1984 and not substantially altered since that date: any structures and fill, either water-dependent or nonwater-dependent, total no more than 600 square feet. In both instances structure is not a marina(i.e. does not serve ten or more vessels). Dimensions of all structures are shown on the accompanying plan(s). "I hereby make application for a License to authorize the activities I have described herein. Upon my signature, I agree to allow the duly authorized representative of the Massachusetts Department of Environmental Protection to enter upon the premises of the project site at reasonable times for the purpose of inspection. I hereby certify that the information submitted in this document is true and accurate to the best of my knowledge. And, upon my signature, that I have read the License and conditions and agree to the terms and conditions set forth herein." BOX A: C lk IYA Lrn E 4 t Print Name _•.�/jVt�ljj�g Address Cityrrown(not village) State Zip Code County .S—oi- OZZo cse. N (area code)telephonVe TO Croa 21 a �4dk 1-4-d II~ e" Notification: Your signature to the right certifies that 36Zl1&( you have notified the entities as checked off in the �J boxes below. Signature f applicant D Notification of application � has been provided to:(please Q Local Conservation Commission iWoard of Selectman check) Malepawd City Council [Zoning Authority 15Planning Board and has been sent by certified mail to:(please check) [butters ❑ Interested Parties ❑Landowner(if not applicant) BOX B: If site address is different from mailing address: Site Address of the structures CitylTown State Zip Code County BOX C: If the applicant is different than the owner: Owner Engineer/Agent NOTE: This License is not valid until such time as it has been numbered and signed by the appropriate State officials(see page 5)and recorded at the Registry of Deeds. zJ License#6�1 . 0 Page 3 USE: The structures authorized herein shall be for private non-commercial use of the licensee. The structures shall not be used for commercial purposes, leased, rented or otherwise let for compensation. Any change in use shall require an amendment to this license by the Department. The structures authorized herein shall be limited to the following uses: noncommercial docking and boating access to navigable waters. TERM: This License will expire fifteen (15) years from the date of License issuance. By written request of the Licensee for an amendment, the Department may grant a renewal for the term of years not to exceed that authorized in the original license. WATERWAYS CONDITIONS: 1.ACCESS: In accordance with any License condition, easement, or other public right of lateral passage that exists in the area of the subject property lying between the high and low water marks"or"below the ordinary high water mark", the Licensee shall allow the public in the exercise of such rights to pass freely over, under or around all structures within such(intertidal)area. Accordingly, the Licensee shall place and maintain, in good repair, a public access sign on the easterly/westerly or northerly/southerly sides of the pier/dock, authorized herein or at each property line,adjacent to the high water shoreline. Said signs shall comply with the Department's signage guidelines (see instructions)and shall be posted immediately upon license issuance or completion of construction. Nothing in this condition shall be construed as preventing the Licensee from excluding the public from portions of said structure(s)or property not intended for lateral passage. In partial compensation for the private use of structures and/or fill on tidelands and/or private tidelands and/or Great Ponds which interferes with the rights of the public to use such lands, the Licensee shall allow the public to pass on foot, for any purpose and from dawn to dusk,within the area of the subject property lying seaward of the high water mark or,for Great Ponds within the public access way delineated on the License plan/or within 5 feet of the ordinary high water shoreline. This condition shall not be construed to prevent the Licensee from taking reasonable measures to discourage unlawful activity by users of the area intended for public passage, including but not limited to trespassing on adjacent private areas and deposit of refuse of any kind or nature in the water or on the shore. Further, the exercise by the public of free on-foot passage in accordance with this condition shall be considered a permitted use to which the limited liability provisions of M.G.L. c.21, sl7c shall apply. 2. This License authorizes structure(s)and/or fill on: ......... ..... ... .... ..... .................... ........... .......... ........... ......... .......... ............. .......................... ................ ..... In accordance with the public easement that exists by law on private tidelands, the Licensee shall allow the public to use and to pass freely upon ❑ Private Tidelands the area of the subject property lying between the high and low water marks, for the purposes of fishing, fowling, navigation, strolling and the natural derivatives thereof. ... ......... .. .. ......... _...... ... ..... The Licensee shall not restrict the public's right to use and to pass freely, ❑ Commonwealth Tidelands for any lawful purpose, upon lands lying seaward of the low water mark. The Commonwealth holds said lands in trust for the benefit of the public. . _... _ .__. ......._._ _ .. �.,�__... _._... __.._.___._ ___....._.__ ....__ .. .___. _ __. .. ..�...._ ❑ Great Pond The Licensee shall not restrict the public's right to use and to pass freely upon lands lying seaward of the high water mark for any lawful purpose. ..... .. .... .. ...._.. .. . El Navigable River or Stream ; The Licensee shall not restrict the public's right to use and to pass freely, for any lawful purpose, in the waterway. 3. Unless otherwise expressly provided by this license, the Licensee shall not limit the hours of availability of any areas of the subject property designated for public passage, nor place any gates, fences, or other structures on such areas in a manner that would impede or discourage the free flow of pedestrian movement thereon. No restriction on the exercise of these public rights shall be imposed unless otherwise expressly provided in this license. License#AWtuib Page 4 4.Any change in use or any substantial structural alteration of any structure or fill authorized herein shall require the issuance by the Department of a new Waterways License in accordance with the provisions and procedures established in Chapter 91 of the Massachusetts General Laws. Any unauthorized substantial change in use or unauthorized substantial structural alteration of any structure or fill authorized herein shall render this Waterways License void. 5.This Waterways License shall be revocable by the Department for noncompliance with the terms and conditions set forth herein. This License may be revoked after the Department has given written notice of the alleged noncompliance to the Licensee and those persons who have filed a written request for such notice with the Department and afforded them a reasonable opportunity to correct said noncompliance. Failure to correct said noncompliance after the issuance of a written notice by the Department shall render this Waterways License void and the Commonwealth may proceed to remove or cause removal of any structure or fill authorized herein at the expense of the Licensee, its successors and assigns as an unauthorized and unlawful structure and/or fill. 6.The structures and/or fill authorized herein shall be maintained in good repair and in accordance with the terms and conditions stated herein. 7. Nothing in this Waterways License shall be construed as authorizing encroachment in, on or over property not owned or controlled by the Licensee,except with the written consent of the owner(s)thereof. 8.This Waterways License is granted subject to all applicable Federal, State, County, and Municipal laws, ordinances and regulations including but not limited to a valid final Order of Conditions issued pursuant to G.L. Chapter 131, s.40, the Wetlands Protection Act. CONSTRUCTION: 9a. The project shall not significantly interfere with littoral or riparian property owners' rights to access and egress their property from the waterway. All structures shall be set back, at a minimum, at least twenty-five(25) feet from abutting property lines,where feasible. 9b. Structures shall not extend beyond the length of existing piers used for similar purposes; in no case shall the length extend more than %of the way across a water body and shall conform to the square footage requirements as stated in Construction Condition 9a. 9c. Within areas of salt marsh, structures shall be constructed with a minimum height of 4 feet above ground level measured from the bottom of the stringer, and maximum width of 4 feet, or at a 1:1 ratio so as not to have an adverse impact on the salt marsh or aquatic vegetation. Whereas, the width of the pier maybe equal to but not greater than the height. Any ladders shall be constructed of durable materials, shall be fixed to the pier in such a manner so as not to rest on the marsh, shall have a minimum width of 2.0 feet, and shall have adequate railings extending above the pier/dock decking in order to facilitate safe passage. 9d. When removed, all seasonal structures shall be stored landward of the mean or ordinary high water shoreline, vegetated wetlands, dunes and all wetland resource areas. Said storage shall be in conformance with any applicable local, state or federal requirements. 9e. The float(s)shall be constructed with an appropriate number of piles/pipes, legs or stop blocks attached to the float structural elements in order to maintain at least 24 inches of clearance off the bottom at extreme low tides. 9f. All work authorized herein shall be completed within five(5)years of the date of License issuance. Said construction period may be extended by the Department for one or more one year periods without public notice, provided that the Applicant submits to the Department, thirty(30) days prior to the expiration of said construction period, a written request to extend the period and provides an adequate justification for said extension. DOCKING OF VESSELS: 10a. Motorized vessels shall be moored stern seaward of the float and shall have a draft no greater than that which provides a minimum of one foot clearance from the bottom at extreme low water. Where eelgrass is present, vessels shall not have any adverse affects on eelgrass in the area. I y License# s> ` Page 5 10b. Vessels shall be moored such that they do not become grounded at any tide. 10c. No dredging(including, but not limited to effects of prop wash) is permitted herein. 10d. No boat moored at any dock may block or unduly impede navigation within the waterway or the use of any adjacent dock. COMPLIANCE The Licensee,within sixty(60)days of completion of the licensed project, shall submit a written statement to the Department that the project has been completed in substantial conformance with the conditions and plans of said license, or a copy of the Certificate of Compliance for this project issued pursuant to the Wetlands Protection Act(if the project was previously issued an Order of Conditions or Superseding Order of Conditions under said Act). This License shall be void unless the License and the accompanying plan(s)are recorded within 60 days from the date hereof, in the Registry of Deeds for the said County. Acceptance of this Waterways License shall constitute an agreement by the Licensee to conform with all terms and conditions stated herein. This License is granted upon the express condition that any and all other applicable authorizations required due to the provisions hereof shall be secured by the Licensee rp for to the commencement of any activity of use authorized pursuant to this License. THE COMMONWEALTH OF MASSACHUSETTS IN WITNESS WHEREAS, said Department of Environmental Protection have hereunto set their hands on this day of in the year date month. year Commissioner • Department of Program Chief Environmental Protection THE COMMONWEALTH OF MASSACHUSETTS This License is approved in consideration of the payment into the treasury of the Commonwealth by said— CAY40 c8 Prtae t t of the further sum of t(A! dollars and zero cents ($ (05 .00) Applicant Amount The amount determined by the Governor as a just and equitable charge for rights and privileges hereby granted in the land of the Commonwealth. Boston Approved by the Governor. Governor i2m,etleYertI, 1 i; -'•ter t:a<utt�ato�t�omylipnct► 5,a FICo.1 � tae its.. TO Can6a;e t, irsi: :5E lio]]s P•iat �J„ Co.evro?!]r•02E31 - •� Nil QcQ�ber 36, i?9l e„ a �bGft�lOakWtOreQfiteC+daa6�enOrCOr�t(`q,q�yifNl�tlm c{'ndates A. vr�rt t•i':.� —�------....iraaet�ieyene�±tom#w COtL�-l/1t10a '� mug ow ftwaA,r�ar�."v%4gaveWq�6,raCo�rlpniw, p�t�MyOys«u�ettitaNyiK�obpaer,pDanoeao[therronehi d0yt+e"I.FltK• ii•� �%'s4�OKdC.OngiOp�ytMK9�MrYhNWOCktyip�l�hiklMMi�AtiEipt�WCplllp�tlC� � .., doatpl•+bbdstlr�Map�p�.t,WwfYr�t�iOrMont�i�lu9�,,, - rH a. a r twwr obis tntt n.wax �r;`= WV eaNra+xan"tv fYoear Ca �tty a oov�etKt�oe t7ontt�o,re ww �Q�i8g0iAlA�M+O'i�'',�iSti1� 7031C�,YY�.M3t{�yrp "k%coa4ftrAm bo ovhm ma wil�OY 46, qw N0Y0�OJ M1lM1 "v8 ` Y 6-t ' 4 � t •s ..,tip..•:• ... .•:.i•�� i f a A �4 ce^l.tytt tJK..be re.:v hep e+KSE$4egms-v V Dt•aat tx+6 COcut Cr9 IN Cstnt t., i wnCr.lhfyntl�aWGlaC �!C+roerra.aOr-GManyr�AetOH:d: - a:a^!Ra,�Vt�. t i`ti•0' .�,F}CMa._ _;� - - �tttll�t - . C rl' 7 z g I 't!![Io.rflO CpttAF041 C'fMO+LArS�G�X:IRI!!S!l!t><lH+ryOtM!0.hl+nf ctlNtN'tl0 M1%�a!Q':r suc'+1t�ar•e^once Cr n°Gnw• tre s �.e,rgr.Nt bLSn;4W tGaidny�r ry«r-0 7 The pier ca fie zafntnincc aver ;iae Lonstitent with the -,!an of recur: and :Ge special rorditivas•df the order Of t,nditioas. ! / htY0tll7yr. ll, �i-S�.QrsJtEY'iar�W:..r`n�.,�AL'" bYL�GvrsrreboaG�mlnewelnaCer!0,04tnWaw89qlsCy�ingrollyeianwmbuir d+lrts ]E t r —..,.�•.• �yay.M October r+oora4ctl._.._ FTtc Strauda """"' tiv9tlr+deatrrEeO�se+O a'•WtsYw:e6lntt lgre �� y...96 nb +„ ttaa• . tM JS n+s n!r Irk OGt Ono �iLMKJ ak+'JrtIMC irp pr#,g`tc( tvy DOW94 Mletlae 1.N fM Wwe, }.:•.: .• t7�n rotlam Ciammixatim ::ice,�• 9 004/0.11 ..... ...o'ar7lfwa't • .r.�t+a ,t TnMttxo Mtlm-nstes ^cenae;yKkton Gositliom•4rODyfd%*Vol tmtoo*% w 0�t1tAML!1 ftMrY.M smarnx wAh ttq Pwlormsnce SatnoVos lfet:orm tt +too iittonf.tODtetlCl theme r<fm- in 6000 ee watt auo eons --- aekas trot a wOrR rho tie tte romp; wo av Witt the fiat ce to fii0'JratowIcea so0vo To tie extent e:w:.ft to rrD oondfiorss^IWt or dNer aom ftp tafaM fntvlKatonf o+other r of ows ft»mgtaa wrtn tM►st ae dkknf ft WOW*Vorawra S ��f:aebebea - i. �aiota,noyrwlhwaoroma+asweanwaee.lnowut�twiteo •,' - ' utu,atW oe OWMO o+»!b*woke a momy'the Greer taY}utfn and newreQufnary meta* t Z dpf ttai tfrfry t^y DrODerly flQraf oru:y 0><dYfn!tirra6�ate ai OoOe h0.sulN00t:e ray rit+6y .. >�'Y at 01 prnttt caplets �. 2fie fJrFer ctoaa nit retr,ree tee (attar otmnmee er anrr other De+fort d ttq rafteae.-1y d eer+atyMQ wan at 1,• awfase:�e feasrs,stele a btY aaewtef.afswnl;ef.by+twt a tapapytgras �-° 4' rfae Yen lrc*.the O"Of""Ordlf+rtfesr� � t'•' , filter Ot flee ppw io1 ttw.aat seowufrvnee**OVQ Mwluwot+aee+aa+t+fe tot Mte tune tr CCRI�te:ron h!i beat t„fatato W s tDeeAea fkm n+f>r iftl n truer years.brat ims then 4. >rvetreara ht7aeM!fleteataseueratyen00Wihat Ulf andDte1f�glCrtxatarleftaAfstrarrynAatU tta taaanoed sues De w ate set tome ttr.(f 1m. 9• Trt4 0rtfft XWy os eetftrotd oy the Isla np SOW,)for Via of f'ore i, f9s of vo to three aestf"CAaRo^ff 0�eaf q+ett tla aaowap arthonh at tetfl30 days aara to ths,Swim data of Ina Order 0. Any is VW n=11-VOwn wan ft prCteat e11e oe itetrt te,rauc - • brat.fnauarng Drat nyt fraa:fea ro ftftlbet,b+cnt.Dtestet,wn.tafh�.�W�rafn,roffw.rtmtwan or oa rerrgarattxs Dftotr,Cwrdbawd.Dino.wa.sstps. .rwtorreh�ys or aa•.eo:a:+y o}txr tsregoafq ir. NOwbk ataatfi OeunaetteYinaraHi aN admplSirgea,e.WN,eW OtrOffa k¢allep CtEer hale ftrih ar appen hu beta W".until ae emviolo%ow a.A Droeeeer+ps Deter atw eom�etr +7pcertrnaf�t+wt Wan a 8. I40 rrwk VW b!wftntkan N M 1fg W W Ctf1C hes beret r ecorded n; 'qo wrY of owaos or ftp Lana r , Coed%r uIt"lrr ten w?tich do land as fotwed.wrnrn ttae Chan OI ftwr"!, amactta txoparty.N tw woof rtcaal6 fend.fie Fwar •' OrOttsuanyso0emtedantheRaCyle ,( rro+lof &unaierinan me .• 0!Ike Otfner Ot try stag arprn whaph 1M araDowa w•9tta a to bt Oe+1af h;�jly iest fs1 ety�atre0 ttv4.>•+t 1�; '.. Frtat Offsar atnanatao fN tgtfFd on trot Lena Coon CertAraata oI Trtre 01 ttig`b.a„K of"tang vw wrvco bteprotwfwJwottist9GrtsonwTtwtaoora e1 � ��"AlftaeE�fU4\°fl+t(ed t0(ht_Caamiaaten on fIf farm ft la�teea of fha Crow{"to san+nfanec�Mnt ofInt w Y ` 2. A tips an"be c oum attttf:set tat refs tw two ::n sa�.�ut feet or may#YfWot ttxae er4t>lre tf�tl Mf¢a Qaarkap fh!warJt."MafsaCh'af9ttf DIDLrf ntint Of>rr,rYormentw:Qudt*nG.ntercp.. a"" sae NLMbsr_ t 0-Wtwo the D"-%mwt at fnrKO.xntntfY Ovait Er nQeran d reoue b ttsue a 8froea y C ; mfke t aelarrn,rtst�r a�a lino M f�rder.tt a Curaftervn cre coaennfspra"I be t►�kt�i'�o et agency pructaa nps belat►they De9anmtatl. _ c 9 t.Span GOm06U0n of tDe rta74Slxferrela flna0ar.taf ewom ftr ttNtM�tAthrwOuettla wtRetg ttaeta cmutme of Co apgnct to rssarte sionC Ihsf tax actors he$been set�Y�Ctarortomftfotaly tl.The Wont ereeeoM,m,10 try tafewanpDftnfa�6 sDeealrwnanw tf .r , fit.-•.< • - . A Z 005/011 d Pratt MT-0054 L'+; plan of Reeordl Undated sketch 8p0014l Conditions: s 1• within one moth of rsceipt of this order of Conditions md ai prior Caaeoi-alh Condi�tlon�aaabexf`aaY Moak approved shalt be complied vith. (Padiag psge) 2. The Conaereatioa Cawi Sion, its employees, and Stet:' agents shall have a sight of eatrp to ins'" or compliance with the Proriaioas of this Ord Conditioss. 3. 7►t the coapletion of work, or Meant pssnit, the aW!,. nt shaper p ation of the �. a Cartifioate of Cag>liance for ttin writing L e Pesaitted. �., work herein 7„' d• !'his Order does not relieve the s' s 412 peralttin r per=ittes:;.o any and .. . q egniraaeata off thin Mp 9tit trinYe gelation program, ((Ch. 91 lieaasixg). formation r • ?i please Phone w at 117-292-5695. At the occasion of next iaintsnanee, the fallora� oenditian � •^_ atoll apply] . ` 5. Mo creosote-treated wood shell be used yr..�• e� . _ r Z 006101 1 •;� �CaaMr+•aoo4 C�io� lop "� ,� •� 0.tli. MIS triItie Ra4p M�iwptb�lY W�loa>,wpid the%,Vim js,r i6 a� �+o!he� �dae°°f�ditl d�c Ygi7 ��y t 7tipyoomthewoa.is to Is svOR tOPMwd►r�YtOW�e.avw�ordlwa�ba 4� y -are? ?(ifti wr(LM tKy r twoja*%W r61W o .. .yMirrYTt+o09�d t . +to4�►fIko mdalrpbitwryu w Exim"4,"a ' ..w�^daitLt.w+Ki< f deb• 1+.+,taao.mioo boom f* damtGf%lw IMn��r C�mbr e.aw�p rm i ..7t:' rii.i'C•' t � � l. t •�1 z ?: OA , 13rARsF POND hk qb 3-3 7l Ale, �1 RM, ffo-lilevre� p�n{ircuilk i r Adi Wd � x xxxx xxxrax ��« *15 NO `._� 00, Mir— r ���, �`� ' .� ,' N•, Al \` Lou Ak -ems, 10, 1 rill • R 2.10"I5 PILES ON B' CENTERS Z.10",�MOORING ►1`ING$ TO BE LEFT STANDING 4 N I CiENTER$TO •i • ABOVE DECK IFITT 3TTANOINO uovt MNw 1 $1' 4 1$' 2".X B" OtCK 75ULKMCAO x t CAPS S/B" NUTS AND BOLT$ D STRINOCR3 10' 10 MNw EXIST BOTTOM ro►IlE B"0►ILE 1IC LONG 20' LONG 2S' LONG'MLE WITH IQ' WITH 12' WITH 11" IN IN GROUND IN GROUNO GROUND SECTION A•A DENOTE$ DIAMETER 4' 0 4' B' wo tw - c zz\, v r • Al .. . not Fee w La -0054 rt.ww«wotoE• qy9 Centerville twr� �,,, Pratt My t. . Order of Conditions = !DO�BARi5fL1t;OIf,1011MC=i. RR"ICti 1I911 ••hs Fran IarnateDle Conservation er>al r r TO CanA.e ?ratt Sam IWme Of ApplKar,q (realrr or aawy Owner) 256 5011y Point Rd. ;: : •�,:; Centerville. ata 02612Ad** Address - ee ' " Number 212 Parcel number 11 - The Order a riNlep en0 tle •p at Iw i t] q ItNd d•lnery to epDlrcanl a r•aettentnlve on `" -(dale) ►, rt•tia a by tMOMd MW.r•bnn rec•rpt►• Ml•d on_ October •. 1"1 (eat•1 TltKpWI isbtateda 256 Boll Point Rd., Centerville �' ����� TM Or00tr7 is r•C01010 a1 the Repytry 01 Deeds In Barnstable Bonn 266 ppe 76 CertRrclteid'v"lend) 120625 r TIN Nowt Ot MMent for dty protect Wai fled On_ July 10, 1991 T*epj*tt/are Was 010W0, Sept. 2e, 1"1 l'��.• Fbrdrge i•,'���• ' The - nas 1er0we0 the som-r Y rrtera ero t>'av erw na r+ere a put>re Mrrp a tna r Dime)Baer on tna nbrrvoen ererate to ere sr . s1lrYeune.IN�JIUM �Ids dettnnne0 aw •��•• VW eyes on WrilCh Ina Drop""Work It's""'S isa"u egnnwu to the toeaM,•p nrerare n eCeorpsnCe emn "%r umoeerra<&enmWlee seta Ind reprpt+one Ipr esCn keg SAW Ill Proleclon Urtoar Ina `•� `~�AN(Hreot el epproaetel' ►'.. .. .• •r„.p 0 ►use Waar wpwy ® Fftd contra O ►eaa Water supply Storm o Land oenu Wins enNtlon � Groun•Water guppy Dammam prevenli0n Qi Fisheriespp y (< Prevsn40npl pplyl pn ® ProlKw of Wr-0lde naonat � �4a G — ri Tow FAM Due t caprpen Ibraarr i 1 MCLS 27 Oalrr M toy0 3 r O hDllo Tryst uybt. Q a,riceltsre a araloa Coarrel .��� Q tauaoultars aecreetloaalC.�{t Efl•piw 11l1W60 Q Rietwic B aesebetlo t tt L:'. JL-:.:.: ' L t Thereface.0*1saznatable Conservetiod Cosniaeloo:,;,reby finds Mo this it"conatgrgWe 1140"Wy.in xxvioance we the Pelomwel Stenuaros sel forth in the regtrtaWo.10 Prow,those Inter OM Chociod above The se..+..s.,. apes[het aI work wW be perfor"a rn eCCO MMS wdh said conddrans and with the Notce of Inform relerenceo tibovID TO the extent lost the Ip bw'inG CO 4404 MICIVY or Offer ham the Min sotc44at4ons or other drop0ws 84th"1e0 with the Notice of trident a»ovrdeone shot connrr Oearsl Corl0ttlonl 1. FAn 10 CWft with lie CorrQaere aialta heron.end with so Mood stskoft end ow requie"Waves- door-tithe be Deemed MAID 10 revoke or modify th4 Oraw 2. Thio Order does n01 grant tiny property rpnfs or tiny @Xck*"pnv"S.a does not euthonie any ryury 10 ffnrele WOW ly Or i MIWr of fygns no is 3. Tfra Order does not Mklve OW demMtee Or oft athtir oerson of the ravcess1y of t ontptymg wort� artier appbcsW fea -ilete or ftM stalules.erderanMs.by-owl or regulations t~ 4• The 1rOrt amftffe d lr wo~lhea be ool 4*100 W~MN yens from the date of"Is Or0w tones[ P eater of we 1osaw"spot' 14) here work is s RWIllynce dredg'rtg Protect"aovaed[Orin Inc Am or tbi ter time far CWM*ton nos been sAlsnoea to a spWilo au more than three years.but lets men rvs yarn.from the ale 01 awuettCID and both the:ale tin0 fhe edacel OlcufhetenCes wWWMC the*Mlinded Ine psnod are 80 forth on the Ckler. S. Thle Order may be extended by the iswd'p euthonly far one or mote penods of up to force yeas WIN , UW t1pp4Caton te the oaunp Guth"at least 30 days prior to the owstron ate of the Order e- Any H used n CWW4Cton with this prolecl stW be~M.Canfenng no boon.refuse.rubbish or de• bns.nOkfdng OW rot felled 10 turhber.broths,plaster,wore,loth.beer.Mrdb0erd.pipe.tva,aiftes. 111111114e410111.motor vehicles at pens of any of the foregoing 1. NO work 00 be Ur4Wtaken unN ore e0merstratrve appeal freroa from the Oran have of "a W.d i s suer an OPW hes been feed,and W Praeedmgs before the Deovtment hew been comroleled •- NO work of W be vaertaken unt+the Fanol Order Ms been recadad In the R"alry of Deeds or the land • Coat for 11*141ftf In which the W+d 4 tMtea.written the Chen of title of the anected t><00erty.In the am of reewaa lend.the POW Order"I Moo be noted Inn the Regisuy'a O►artlor rtdax under the nerve o[the owner of the terra uPfn which bav Proposed work is to be done In the Mae of reg*W*d veto.the { ; Fast Order W W also be noted an the Lana Coup Co"cote of Trite,01 Ine owner of the wid upon wrrcn the proposed work is to be done The recording nferntaton she4 be submitted to the Conwi■slan I on pre form at the and of tors Craw prior to Commencement of the want 1 Y. A sign sh M be d"Ityed of"WI Ate no less then two sque s feet or more then[+tree"We fat In srie beaft the words."Massachusetts Department of Environmenta:".;y Engneerrng, Fda Number___MT-WSa t 10.Where the Department of Enwornentsi Ouahty Engxteerng 4 requested to make a atemwtatron and 10"M a Superseding Order.the COheervaton Commission she be a party to an agency Proeesdd'gs end heerrtgs 001001100 Department. 11.,upon Comtpeton of the work described holed'.the adO COnt SW forthwith request n wtaatp that a CerMrCall of Corttpsartce be'mod oiling thet the work has Men ut4faCtardy Completed 12.The wont snW conform to the f0ffowng plens and epticist Conditions S•2 d . t r • i f J . r Y.✓. � 1"sfi -rim.;* ----._._..a.r = - - -.Y_.��.'�'-r -.- t Ippab By sareaubl! - Cpefarvrim Ca®rioo It,Ord;item bar iped by moor ty d the Coen.d.CommilIN& on this uv b of octeber ..6 91 P-malk Imearld Rriati!Rapp penear themtbed i eed vhe meapd tie det.datd hro m m and aelmd d.daee that h..t: frdii .fit. - • we hir p[t and deed. . K7 C?r..t4 fb pYean tM are.,w perm sRwvtd by war order.may,wear of lend abatumS tie Ind apse wbah do reposed eerh a to be dome or mar tea mdow of do dy or&owe a wberb nee teed a leratad are h+by woufid of thr n$M 0o n- the Departseset d fm" mmul Qu Uty Empewmd to imm a Supwmdinp Order.ro•W f the m fmn u Bede by cmuAW eel a heed debts to tbo Dgrtmmt within ae dye bm tie dau of anew/f this Omar.A oW dd a moom Ad e h eeme tree bt rest bl aelti8od maw heed ookmy t!the Caaserrsefee Camu m end tie apphm, F; - 1 . v y fj. 53GW7 f`w. ja At \r r ,r y1 Tr r� ,. } Y r , P %ARNGTARL�AUNTY EGISTRY F DEEDS A TTR-USE COPY,ATTEST JOHN F.MEADE,REGISTER t r , � ,. _ - - - DATE JJNE 6,20 "+ .a �. 1' _ - .. , `�T:. ,r. 14 ,e ' - . . .a. t DRAWN BY DEY 4: v ��#FF 12 w L I. _ .. .: - _ 6}/- - contort®hpode5lcya.corra aP" a' r< z x +i. _.. , 1 _. a MATGH EXISTING CHECKED BY: HPA/DWD A.. :; iRIMSMnLL.rinTcfl _ .., . -, .' ,- , 'R, > ,. "EXISnNb NOUSE ;: _ ,: :_ I , -r t'' ��' ;a i'.: ,,.s. - .. w ' . , . .. '- RIDGEVENF,: .. ,' 190 ' _ i x „. '' . -r i:� r y^I- FIBERSLAss ROOF SHINGLES o _ . ,u., . :. ..: - .,. 1 ..i :� MATCH EX15TIN5 HOUSE s PATH: . � .. : ROOF SHINiLEs 3.: ? :, ° , x--, ., 15#FELT. � s - 20130118-MOORS „ ,J� .. J . SHIELD. =.. - :r ME✓ ,;: ...... DIME ^ 1- ,. _ ,. : -_�_-_-______ ) X P YWOOD SHEATHING - ,. e' F " m' .: 4 �„' ,y m 3-0GWIDE ICE b..WATER SHIELD: - - ..." .. NA - `• ".', T iOPFIATE- c , `ROOF RAFTERS(SEE FRAMING PLA ) DRAWING TOPIPLATE .. 5'{[N..B7Lk�.. ....: 1 x .. .. .. ..-.- - ,•, {e ^.fit SC.AIE SEE . ,. »- ,,. .. MIN AIR SPACE ;' y _ t v .p �; .. e 4 ro :. 2° a REVISIONS 't ,;t .. - -r • 'DATE. DESC.' p : , : tsDNe,wmrcx-/: ., *. . TOP OF PLATE ALUM:DRiP EDGE .,.,: ! 4 / \ SnNG HOIfiE• ' -Q t _ �£ - - , ® � 1.7 99 q4 o Gmn4 ISs r'°oTe eoNs F- ? Coo d b :, ..` ON `Iz.FASCIA BOARD(M.E) "' _ NERI M DR „t F .^:Y -: ',.r- - Ix3 STRAPPIIN6®I6D'O.G. ALUM.GUTTER ' AS SEIEGnE `Q .: WATBtT MATGH` - , ; z..9.T ... . ,, ^ - EXIsnN6 HOUSE , . . - _ , , ' .... .. ,.. _TDL -..... .,. .. .,. .•. h PLATE:: SCREENED;,yy .:. - t 2 2x6'roP TDL. .......-... - . 2"CONTINUOUS -. - -. :-.-. .-.-.- - .. STONE VB�L WttGH ., . ': IXI TRlG _ ', .. .p ALUMINUM SOFFIT VENTS C . 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RASE I T e x ICI c f 14 — N 0� emu' , 10 SONG I4 I� I ' I4 ; 4° TUBE 0-4 t I � -----`---- I �i BIG FEET [ FRAME DOOR 0 1 0 2x (0 I 2 2X6 _ EA I HINGE I I 1 > Pp ST f IX4IPE 2X10 2X4 2XI : + DECKING 1500R I (7 INTEX $ r ; ' 7 RAI LING f ' s j ff p.' x I $ N I i I N. COL MN GAT E ,�i EXIST. PIER LIC. # 11846-tea a WEQU AQU ET LAKE Locu 375 SF. PROPOSED PROPOSED NATURAL STONE Wequaquet PLANTINGS WALL TO LEVEL PLANTINGS EXISTING Lake PIER EXISTING PIER _--- _ OB WATER � o�' #2 EES 8 \- 19 STK & TACK SET LOCUS MAP NEW WORK LIMIT LINE SCALE 1"=2000'f 2 -- EE=ROP. PATH-40--A- #1 AROUND WALL ASSESSORS MAP 232 PARCEL 31 Nt' PROPOSED NATURAL STONE SAND v'� WALL T.O.W. 42 TO LEVEL B � '29" SLOPE LOCUS IS WITHIN FEMA FLOOD ZONE B & C NE SIT LI PROPOSED NATURAL STONE DATUM: WEQUAQUET LAKE DATUM SYSTEM STK & TACK SET .. _- --�2 WALL T.O.W. 45 (HIGH WATER AT EL. 34.8') LANDSCAP _ _ �S'� m PLANTINGS OR FENCE FOR Now9� ANY REVEAL > 30" REPLACE EXIST. PROPOSED DECK LANDSCAPE `� �`�� I — 1 I (REPLACED PREVIOUSLY TIE WALL WITH I / O ��. PERMITTED PAVERS) ZONING SUMMARY NATURAL STONE WALL PROPOSED 8X10 PATIO Z I -r 44 ZONING DISTRICT: RD-1 DISTRICT PROPOSED NATURAL STONE £ _ 15 I ��.�, rf o WALL T.O.W. 42 TO LEVEL / v \ N MIN. LOT SIZE 43,560 SF SLOPE REMOVE BULKHEAD MIN. LOT FRONTAGE 20' PROP. 1250 /� / -- ' MIN. LOT WIDTH 125' SF OF I- p PLANTINGS, � MIN. FRONT SETBACK 30' 520 SF / p �, MIN. SIDE SETBACK 10 WITHIN 50' ( O p MIN. REAR SETBACK 10' BUFFER { 17 3/ ENCLOSE PORCH INTO HOUSE ZONE p EXISTING FOOTPRINT o o I DWELLING p I o_ O TOP FNDN EL.=45.9' PROPOSED ROOF of O SITE IS LOCATED WITHIN RESOURCE DRYWELL (TYP) I PROTECTION OVERLAY, GP, AND ESTUARINE j PROP. STEP STONES WITHIN LAWN TO EXISTING (TO BE �{ o / 0 I EITHER SIDE OF DWELLING PROTECTION DISTRICTS REMOVED) DRIVEWAY o OWNER OF RECORD AREA WITHIN 100' OF (p \/i tea= - ��y_cc-_� 3 94 WETLAND = 952 SF ��%p = - O (EXIST.), EXISTING SUSAN E. MOORE GAR. (CONVERT TO LIVING SPACE) 1302 CENTRAL AVENUE GARAGE SLAB DRIVEWAY O PAVED �\ �� � NEEDHAM, MA 02492 �` ELEV. 42.5 �,` (REMOVE) �� BUFFER ZONE HARDSCAPE TABLE PROP. 3' HIGH STONE RET. WALL TOW 42.5 /� Q = r- o EXISTING CURRENTLY PROPOSED PROP. WOODY SHRUB _ \ - ,' k�� APPROVED REFERENCES � � BUFFER ���l � y r�l 0-50 530 SF 741 SF 613 SF CERTIFICATE 197835 r rr 14.6' LCP 20239C PROP. NEW DRIVEWAY r o r; r;� z 50-100 3349 SF 2617 SF 2742 SF (PAVERS ON CRUSHED STONE) TH W TOTAL 3879 SF 3358 SF 3355 SF NEW AREA DRAIN 24" H-20 Ell F&G ON DB9 30"X30" 40 rr i CURB INLET WITH 6"SCH40 42.0 ri -1l I EXISTING 3 BR. SEPTIC SYSTEM TO TWO 4.25'X7.1' 3050 INFILTRATORS- WITH SPLASH 4T�� hrr 01( \1-% INSTALLED 2010 TO REMAIN BLOCK- SET IN CLEAN SAND �llr V1j 50 CONC. BOUND FND. 2 %err wl 0.48L8AACRESt / EL HANDBOX •8 i� [42.5] ��� = L=5 7. BENCHMARK: USE EL. HANDBOX _ X_ AT ELEV. 42.4' SITE PLAN zxmtz OF - CONC. BOUND FND. HOLLY POINT ROAD 256 HOLLY POINT ROAD CENTERVILLE 0. PREPARED FOR off 508-362-4541 OFMq �tHCFMgSS SUSAN MOORE fax 508-362-9880 trC`Tj" -ANIEL DANIEL 9cs OFM4ssgcti I downcape.com © (o' A. o A. �, �° DA G ELA. JUNE 18, 2013 . I<- )JALA oJaLA OJALA ~ . REV. 7-2-13 (AREA DRAIN IN D/W) down cope engineering Inc. „ No.40980 r A No.40980 CIVIL CA CIVIL REV. 4-30-14 (DETACHED GARAGE, REDUCE ADDITION, WALLS, DECK) T)- svoEar nqa � No.4602 o o No.46502�° REV. 6-3-15 11p (DECK FOOTPRINT)civil engineers ess\ 1 �GISTE land surveyors SUR'4 F GIST Scale: 1"= 20' ION /oNAN 939 Main Street ( Rte 6A) 36.80 >2 YARMOUTHPORT MA 02675 DATE DANIEL A. OJALA, P.L. FLAG/ATFLAAT COR, BOB WETLAND 0 10 20 30 40 50 FEET