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0067 JOYCE ANNE ROAD
in F a rs P s w r �+J a1 h i € t4 r r .,f G t + RG ky ' ..a! r3', .s �, pr. i..l ,� �.. ,, �db�, ^�. oY� 'a. ... }�'., y NI --a, rr, 4 .«i �,...* ..�. �.At h: to �.'S�, .sd,• .y;•7'�IaY .� „:�sl t i'..k n y..P'Y..A""a'A,i''I� �r '+6'S4 'r a�, e�.• :5ti' '1�' t ..a. .tlt- ,+tti, �I. v^ r,yc�a'sr `' 4t, + +aid.I a, 7t, k P u.f u j, ,j a •p a r 1 4 i I� Y li .. A r I A n ' i ,47 a c� hQj ?6C+ V nacv LV L. �l. Lauzon, Jeffrey From: Lauzon, Jeffrey Sent: Thursday, February 13, 202011:23 AM To: 'taramaher6096@gmail.com'- Cc: Lauzon,Jeffrey Subject: ViewPermit, Permit No:TB-18-3752 Applicant, Please be advised building permit application TB-18-3752 is deemed abandoned as per 780 CMR R105.3.2. If you wish to proceed with the project, a new building permit application will be required in order to obtain a building permit. Please do not hesitate to contact this office with any questions.Thank you. Respectfully, Jeffrey Lauzon Chief Local Inspector (508) 862-4034 Jeffry.lauzon(cDtown.barnstable.ma.us y 1' /t ::J ^• Lauzon, Jeffrey From: Lauzon,Jeffrey Sent: Tuesday, November 20, 2018 9:33 AM. To: 'taramaher6096@gmail.com' Cc: Lauzon,Jeffrey Subject: ViewPermit, Permit No:TB-18-3752 Applicant, Please be advised that the above application has been reviewed and the following is noted: 1) No Construction Supervisor License or Home improvement Contractor Registration submitted. The application is denied pending the submission of the above required documents.And, if aggrieved by this notice;you may file a Notice of Appeal (specifying the grounds thereof)with the State Building Appeals Board within forty-five(45) days of the receipt of this notice. Respectfully, Jeffrey Lauzon Chief Local Inspector (508) 862-4034 Jeffrey.lauzon(aD_town.barnstable.ma.us 1 ` F�"Et°w� Town of Barnstable BAR;ST,BU, : 200 Main Street Tel.(508)862-4038 (� MAS& ow A•EOMA�A INSPECTION REPORT Permit: Building - Insulation - Residential Use: Date: 11/13/2018 3:39 PM Inspector: barrowsd Permit Number TB-18-3752 Name: JEFTS, DEAN H &JOAN M Address: 68 JOYCE ANNE ROAD, CENTERVILLE Unit No. Inspection Type Inspection Item Status Comment Building Admin - BA- Home Improvement NIC need copy of licenses attached Solar& Insulation Contractors Registration (if Residential and Applicant is Contractor Inspection Overall Comment: Overall Inspection Status: FAILED Re-Inspection Date: r Inspector Signature Owner Signature Total Score: 100 Town of Barnstable RcEi�-r " e"KASS M ' 200 Main Street, Hyannis MA 02601 508-862-4038 `639. 61 Application for Building Permit c �� Application No: TB-18-3752 Date Recieved: 11/13/2018 Job Location: 68 JOYCE ANNE ROAD,CENTERVILLE , U�LJ Permit For: Building-Insulation-Residential N--e oes Contractor's Name: MICHAEL MAHER State Lic. No: CS 089 Address: Plymouth, MA 02360 Applicant Phone: (85 0-6096 (Home)Owner's Name: JEFTS,DEAN H& JOAN M Phone: (508)753-3714 (Home)Owner's Address: 68 JOYCE ANNE ROAD, CENTERVILLE, MA 02632 s A Work Description: air seal,insulate the knee wall and attic Total!Value Of Work To Be Performed: $5,500.00 Strualvre Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568).. I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Tara Maher 11/13/2018 (857)210-6096 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $5,500.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $85.00 11/13/2018 $35.00 XXXIX-XXXX-)XXX- Credit Card 5429 Total Permit Fee Paid: $85.00 11i13i2018 $50.00 1 XXXX-xXXY XXXX-I Credit Card 5429 Mwl THISS NOT ,APERMIT .....mv., ...... �X$$YF, A"n� f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION To�Map Parcel `) �N BARNSTABLE Application #-,?a�� Health Division r _,. : f; Date Issued01 Conservation Division Application Fee 5 -9 Planning Dept. Permit Fee 0o 1�) TSs0?k- Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 7 /cc Village Owner ►„C 6,,vc Address S'\ r--�- Telephone € —g.)L-C —07c 2 g ' f Permit Request We Cef����,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 ❑ 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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 'N4ike. N4eCgirt➢9y Construction Telephone Number PO Box 52 Address West Dennis, MA 02670 License # Cell (508) 250-6964 C-SL 5,8633 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L a_4 SIGNATURE DATE Y FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED �a MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION t FRAME INSULATION FIREPLACE r- ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I 6 Town of Bainstable Regulatory Services • *" M ' Richard V.Scali,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis.MA 02601 wsvw town.barnstabie.ma.os Office: 508462-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Y, as Owner of the subject property her�eby'authorize. � tQ¢�act on mybehalf, in all matters relative to work authorized by this bulding permit application for: IN � 0 2-b -� � � � (Ikddress of job;. '' -Pool fences and alarms are.the respons bili 7 of the applicant. Pools are not to be filled or u�Lecl before fence is installed and all final inspections are performed and of accepted- a rgm of Owner Signature Applicant Print.Name Print Nam Date Q:F0RMS:0%vrE"Mttss10?V00LS i as Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC)AR ::.. PO BOX 52 W DENNIS MA 02671 P' 0 Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cont factor Registration Registration: 169393 Type: Individual Expiratio /2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY =+ --- x r P.O. BOX 52 - - -- WEST DENNIS, MA 02670` - --- Update Ad ess and return card.Mark reason for change. ID Address Renewal - Employment -1 Lost Card -osn zoo 1 f The Commonwealth of Massachusetts Department of Industrial.Acchlents I Congress Street,Suite 100 Boston,MA 02II4-20I7 wwlv.mass.govNia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plifmbers. TO BE FILED WITH TiiE P)'Ri flTT]NG AUTHORITY. Aprilicant information lease Print Legibly Name(Business/Organization/Individual): " Mike McCarthy n aAx�lp Address: West Dennis, MA 02670 e280-6964 City/State/Zip: r v -486M#: HIC-169393 Are you an employer?Check the appropriate box: LrYJ7/ ,)/ Type of project(required): 1. 1 am a employer with employees(full and/or part-time).+ 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8, ❑Remodeling any capacity.[No workers'comp.insurance required.] 3. i am a homeowner doing all work myself. 1 9. ❑Demolition ❑ g y [No workers'comp.insurance required.) 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. i will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 5-❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 12.[J Plumbing repairs or additions These subcontractors have employees and have workers'comp.insumnce.t 13.❑Roof repairs 6.❑we are a corporation and its officers have exercised their right of exemption per MCL c. 14• `90(her 152,§1(4),and we have no employees.[No workers'comp;insurance required.) 'Any applicant that checks box#I 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 9n 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 fur my employees. Below is the policy and job site Information. N Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 7 All 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 MGL c. 152,§25A is a criminal violation punishable by a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER-and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DiA for insurance coverage verification. I do hereby certify rut t! al s and allies rjrr13,that the,:information provided abo is trite and correct. Si shire: Date: I r— Phone#: Official use only. Do not write in ills area,to be completer!by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: i zi WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMA I ON PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 26158 POLICY NO. I VWC-100-6017656-2014B PRIOR NO. VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc , DBA: Mailing address: P 0 Box 52 FEIN:*-***3862 West Dennis, MA 02670 Legal Entity Type: Corporation Other workplaces not shown above: See Location: 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000,each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTEA 0712979 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy,including all endorsements,is hereby countersigned by �� 12/15/2014 Authorized Signature Date Service Office: Bryden&Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 Burlington MA 01803 So Dennis, MA 02660 F��w WC 00 00 01 A(7-11)Includes copyrighted material of the National Council on Compensatlori Insurance, used with its nermiscinn- �J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z0 Parcel Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 2 ' Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address �� Village ( ZU Idle Owner _q cu Address. Telephone S5s Permit Request _ A-,eNou ATE 1% b ►A y— took vv-�?2 I-WO-0 F 'J"( — Square feet: 1 st floor: existing proposed 2nd floor: existing � proposed Total new Zoning District fL L Flood Plain Groundwater Overlay Project Valuation Construction Type ,Lot Size .3°\ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 1 2 Historic House: ❑Yes (14,No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 5LA-7 Basement Finished Area (sq.ft.) Z) Basement Unfinished Area (sq.ft) d-') Number of Baths: Full: existing 2- new I Half: existing new Number of Bedrooms: existing b new ry: Total Room Count (not including baths): existing g new First Floor o om Cou_n`"�.,, Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑Other "~ - Central Air: P Yes ❑ No Fireplaces: Existing New Existing wood%coal stove: LitAs ❑,No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing newt,size_ Attached garage�4 existing ❑ new size _Shed: ❑ existing ❑ new size Other: w 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 N Telephone Number 7 2)(2-- Address ,_b ���id License # _ L4 — (�ft o Home Improvement Contractor# Email \_, f,, 1VtN w)(_ • L 4(A Worker's Compensation # 5U V) 'rJ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � -� SIGNATURE DATE ✓ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. a ADDRESS 7 VILLAGE G OWNER f 1 F DATE OF INSPECTION: FOUNDATION FRAME ll`! INSULATION' :- (0 tMo FIREPLACE ' ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL `r GAS: ROUGH -FINAL i /J FINAL BUILDING r -7 �9/1/ --ll ®k q / 16 D ATE-CLOSED OUT _ r ASSO:C�OON PLAN NO. r l The Commonwealth of Massachusetts Department of IndustrialAccidents • Office 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): (--W f-it_ (a Address: 6 �elc City/State/Zip: Phone#: 2`Z 5 (2- Are ou an employer?Check the appropriate box:. Type of project(required): lI am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or have hired the sub-contractors 2.❑ I am a sole proprietor or partner- . _ listed on the attached sheet. 7. ❑,emodeling ; ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp:insurance 1 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' 13.❑Other comp,insuraumrequired.] *Any-applicant that checks box#1 must also fill out the section below sbowing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractms 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:, "�/,t��UpZ_ Q q Policy#or Self-ins.Lic.#: I T �V� V t 75 � l axpiration Date: Job Site Address: ( L� N City/State/Zip. i�lct Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fy under the pauis and penalties of perjury that the information provided above is true and correct Si ature:Y�5�� Date: Phone# 21 S ..`�S C 2— Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ti Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in*a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfoffiance 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 lime. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 Westigations 600 Washington Street. Boston,MA 02111 Tel,#f 17-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749. vww.m=-gov/dia LINECON-01 CMEINE ,�►co�o® CERTIFICATE OF LIABILITY INSURANCE DATEYYYY) 31612016/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ROgers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c No Ext: JAIC,No):(877)816-2166 South Dennis,MA 02660 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:ACADIA INSURANCE COMPANY 31325 INSURED INSURERB:TRAVELERS INSURANCE COMPANIES Lineal Construction,Inc. INSURER C:Lloyd's of London Group P.O.BOX 1118 INSURER D: Barnstable,MA 02630 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INqR WVD POLICY NUMBER MM/DDfYYYY MM/DD1YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X CLA017561116 03/29/2013 03/29/2014 DAMAGE TO-RERTMY— PREMISES Ea occurrence $ 250,00 CLAIMS-MADE Fx-1 OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO-JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ A ANY AUTO MAA031843613 10/22/2012 10/22/2013 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ 1000000 AUTOS AUTOS > > X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE X CUA028696614 03/29/2013 03/29/2014 AGGREGATE $ 1,000,00 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N, -^+.x, - , —�.�� - X TORY LIMITS ER B .ANY PROPRIETOR/PARTNER/EXECUTIVE .-,• 7PJUBSB99546913 06/18/2013 05/18/2014 E.L�EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER..EXCLUDED? "-" '" N/A';.: ..,,R�s (Mandatory in NH) - _ 7 'r+v ..A:t x c r ,"'i^ ..-1 E.Lj DISEASE-EA EMPLOYEE $ 1,000,00 If'yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 C Professional Liab S609100082 04/01/2013 04/01/2014 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Harvard Real Estate-Allston,Inc. is additional insured for liabiity as required by written signed contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Harvard Real Estate-Allston Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1350 Massachusetts Aven.Suite 980 Cambridge,MA 02138 AUTHORIZED REPRESENTATIVE , _ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation - g 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 146367 Type: Private Corporation. Expiration: 4/14/2015 Tr# 239879 LINEAL CONSTRUCTION INC. BENJAMIN LAMORA - P.O. BOX 1118 BARNSTABLE, MA 02630 _ Update Address and return card. Mark reason for change. sCA 1„.0 20M-05n [] Address Renewal Employment Lost Card Office of Consumer Affairs& Business Regulation License or registration valid for individul use only F - !DOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - registration: 146367 Type: office of Consumer Affairs and Business Regulation a ,Expiration: 4/14/2015 Private Corporaticri 10 Park Plaza-Suite 5170 Boston,MA 02116 LINEAL CONSTRUCTION INC. BENJAMIN LAMORA 3328 MAIN ST gT BARNSTABLE, MA 02630 Undersecretary Not valid without signature Massachusetts - Department of -Public Safety Board of Building Regulations and Standards Construction Supervisor ' License: CS-105200 BENJAMIN G LA�AORA}_;,� 5 CENTER IONGSTGN NIA. :02364 ` ► s�,t >� ��� �� Expiration Commissioner 05/01120/5 2014-Apr-09 12:14 PM Hyatt Regency Santa Clara 4089803990 1/3 Lim M& na IM 11 TX 14M, 1F4WA% LiNL.. 1 ARCHITECTS & BUILDERS P.O. BOX 1118 SARNSTABLE, MA 02630 PHONE w 608.275.7512/FAX-608.632.0444 H1C Contractor registration# 146361 Construction Supervisor#087579 Conatr ibn Agreement Between Owner and Contractor Between the Owner: Bonnie Bryce 67 Joyce Anne,Centerville MA And the Contractor: Lineal Construction Inc, P,d.Box 1118 Barnstable,MA 02630 Projeot Name* 67 Joyce Anne Bath renovation ' This agreement made this day of Tuesday the P of April 2014,by and between Bonnie Bryce herein referred to as M d S 7 L Li 1 Ci tl Inc. 1 i 'Contractor. -o uOW[1er,and rail 4�Mfirq,ai�iiind�wri5tiuiru�iri� i'tnr6ln roior'i"siG�w as 40nuuGtvr. 2014-A.pr-09 12:14 PM_ Hyatt Regency Santa Clara 4089803990 2/3 T hii3 Cv^ill—M In�ivdes la�or and r gtgrlal9 to-0n?plete the work described to the attached document°87 Joyce Anne bath remodel quote revised 418'which Includes the revised scope of work and allowances based on architectural oo drawings"67 Joyce Anne Bath Remodel Fur dated 3.14,14,AliowEnces and final desigii are 6Saail%1Q11y WV 1- complete at this time.Process is currently ongoing to narrow and define the scope of work.Owner and contractor In consideration of the mutual covenants hereinafter set forth agree as follows: Contractor shall fumish all labor and materials necessary to complete the renovation to relocate one bath and add a second oath to the as.orld flcor,The exlo:ling master bath will bPcome a walk(n c(oset.-The contractor shall fumish and pay for all work,labor,materials,equipment,tools,and furnish everything necessary for the prompt execution and proper completion of the work in all accordance with the Contract Documents. Contractor shall construct the structure In conformance with the plans,specifications,signed by contractor and owner,and will do so in a workmanlike manner.Contractor is not responsible for furnishing any improvements other than the structure,such as landscaping,walkways,driveways,patios and aprons,appliances etc.,unless they are `specifically Stated ii1 u1c braeakdGwil,or added In v change order. Owner shaii pay contractor the slim of 10, " (Se6 pi7yn'ient 5Gi1ed'uie beiv4v]lift inata'iiii{entg€o ayt firth In the escrow Instructions or the primary lender's schedule(whichever Is applicable)signed by owner.In the event any Installment is not paid when due,contractor may stop work until payment is made and for five(o)work days }hereafter.in the event any Installment is not paid within seven(7)days after it is due,contractor may take such action as may be necessary,including legal proceedings,to enforce its rights hereunder,including choosing to 1__r<_aL_`_ 1.�f.� 1y� L,_...:..,,s aba.,..., f i..,, eaAlnna Oho r.nt tr4 of ruriadiriinn VAII be Barnstable terminate theft pai'v pation In t11ti pAWiGbll 11/u1p Uca8 o1,�,a1 procoo —to .IIV VVVI.V. �•.�•• County, This agreement serves to start the project planning,schedule the construction date and to collect at deposit.Deposit to purchase soma material and to hold schedule Is$4,000[payment 1,paid]Payment schedule for the balance of the budget will be paid incrementally In four additional payments,Payments are due within 7 days of invoice, r+._b_ • 4�a:.A 4%,a 1,,.t�a vuO,�M as,,.ill be bflllar{fn owner of rnnfracfnra relief;as nurchased by contractor. ��a►�assoeialW\INtl1 t110110 11 ,tanL'�.� V I,IVY _ by items purchased by owner and provided to contractor will be noted as such on the schedule of allowances,and not billed to owner 0 contractor,Any scheduled allowance not fully exhausted during c6ntrnct aiao'v`nii not be billed to owner. Any overages to the allowances are the responsibility of the owner and will require owner approval. Any owner requested items or services not currently listed in or in addition to scope of work purchasedipaldlerranged for owner by contractor will be billed to owner at contractors cost plus 20%overhead and profit. Site will be kept neat and broom swept at the and of each work week.Contractor will store materials on site where work will be progressing,along with brie out house and one dumpster a3 neWW1.lntontlon I;to minimize disruption and to keep the site useable for homeowner use during the period of construction where home owner occupancy and construction will overlap,Access to the house will be provided through the existing front door and by a new stair to the second floor master bedroom, CONTRACTUR-AL_IMFORMA77ON REQUIRES BYMA HOME IMPROVEMENT CONTRACTOR PROGRAM Lineal Conotruct,on.Inc Information: � 2014-Apr-09 12:14 PM Hyatt Regency Santa Clara 4089803990 313 Street Address:3328 Main Street, Barnstable MA Federal I>a#74-3114170 All home Improvement contrac-6_and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; 01rec"PII i 101 110 1111provement Von tractor 101-giotrG C^ P.O.Box 871 Taunton,WIA 02780-0871 Tel: (508)821-9375 The homeowners three day cancellation rights under MGL c 93 s 48; MGL c 140D a 10 or MGL c 2550 s 14 as may be applicable. All warranties on the owner's rights under the provisions of 780 CMR R6 and MGL c 142A Permit Notice: Every contract shall contain a clause Informing the owner of the following: a.any and all necessary construction-related permits; b.that it shall be the obligation of the contractor to obtain such permits as the owner's agent. c,that owner's who secure their own construction-related_permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract "The contractor and the hor;eo:;,nar hereby mutually agree hi advance that in the event that the contractor has a dispute concerning this contract,the contractor may submit such dispute to a private SPoit7aiivn SorViv i which liu5 u;rcil approved by tho Of"ce of:CnvM/ie0r?,:`81.0 on.'.6u,11 US a4 ulvti=.^. and the consumer shall be required to submit to such arbitration as provided In MGL c 142A. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signed Owner: Owner Name: Signed Contractor; Contractor Name; y N TICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution Initiated by the contractor. The owner may initiate alternative dispute resolution even where this section Is not signed separately by the parties." ' 1 AR NSTAB LE TOWN 11 2 13, .� 110 ,a-5• , EXISTING VjNDOWS AND SLIDER TO BE RELOCATED FROM EXISTING 3- - -SEASON ROOM 4 EXISTIN EXIST .� ,•-'= -: ° SEASON 2 NEW axDERs OR ED. 9 ROOM BATH AEOROOM EXISTI�1,� Z:f C', ` ? V" . v,0.voows 0 TO TO GA RAG A REM IN REMAIN TO 0. O REMAlO� 7 fAMll " 3 HEW ANDERSON OR ED. ROOM WINDOWS NEW HEADER PAD fL00R TO B g FLusx w rx ' - DUSTING FIRST I ARCHED OPENING - _ I - FLOOR - I WITH COLUMNS 'W - •VFY LOCATION' - " BENCH SEAT WITH LID TO _ O I 1 :D ,CONCEAL WATER METER °v LIVING WINDOW AND DOOR SCH.EDULE: ROOM IfY TAG SIZE FINISH - BRAND - MODEL NOTE.S : . REMOVE OR COVER DOMING _ ' I I I --" CCO'ET _ 1 'PX4'BAY WHITE PA BRAND MODEL NOTF4 Y SKYLAHT ——J I I ,....,,, - 2 216 CICRCLE WHITE P/F BRAND. MODEL NOTES 3 rams ON WHITE P/F BRAND MODEL NOTES - 4 r8X4'8 ON WHITE P/F BRAND. MODEL N POTENTIAL SEWER LINE 6 r8%1'B DN WHITE P/F BRAND MODEL NOfE$ Lcafior 14 , ._ ..., .• 75'-1 7/8• �..{ 6 r8X4'8 DH WHITE P/F BRAND -MODEL NOTE 2 'I�3s' 4'•13/8• 3'-6• I DINING 7 r8X4'8PH WHITE P/F BRAND. MODEL NOTEg + f NEWY NFICULARWINDOYY O 1 1 _l I I 15 2NEW DOUBLE HUNG 8 r8%4-B gH WHITE P/F BRAND, MODEL NOTES ' I WINDOWS " 9 5'OXB'B SLIDER W/P/F BRAND MODEL NDTE� -- 10 2'8X4'8 PH WHITE P/F BRAND MODEL NOTES �' d'EXISTING WALL TO REMhN 11 r8X411 DN wHRE P/F BRAND MODEL NOTE ' • d :.NEW WALL 12 r8X4'8 ON WHITE P/F BRAND MODEL NOTE§ ' 17 16 13 r8Xd9l1N WHITE P/F BMND, MODEL NOTE y 13'-11 - '- KITCHEN 310 VERIFYCOLUMN AND FAILING 1l rB%d'1 tlH WHITE P/F BRAND NOOEI NOTES COVERED 2 NEVIOU LE HUNG -LOCATION 16 rBX49.H"WHITE P/F BRAND MODEL NOTES �qc DOWS 16 r81M'1 H wHTTE P/F BRANDS MODEL NOTE PORCH a a 17 2'BX4'4 DH WHITE P/F BRAND MODEL NOT - 1 1ST FL OR PLAN I ; A3 3/16"=1'-0° L J , I OPTIONAL BOX B.RY WINDOW 4'-B 15/16' 9'•6 314• G3GGAS p ��` D. 4-2, �I . G�lSO� a� 167'FLa UmEaL omc .Aff'ohoQiacaa BuRd®fra 7 J OYC AN N E LAN E PLAN Fdroau b 1110 3ARNSrTA®I.E,RAA 0 a11IsW i1 a 7a12 CENTERVILLE,MA _ Leek ` afiace - - _�✓�rkcit6na area of master aulm:etl �.master arse - aDFG' unnmeuetl Low .. 10 celMtl - anm . o oamca wxi,amewx 1 SECOND Fl00Fl.fLAN - P ' 6 .1 81-3 3/41' ................ __._..._... -1 I . ._.. - ---- ..:_ 1 BRYYCE'S BATH `� i I -- . - --- _:� _ J. -- ............. ... Co NEW M'STER BATH ll l - -- L_ .� 14'-81/411 «- . . P �..% _ C� C cxg �— Town' of Barnstable �"E Regulatory Services Richard V. ScaG,DirectorAAA • snaxsreet4 Building Division BARNSTABLE t eaxme�•aertFmnt•cmurt•Ircwnis MAS& A _ r MYS*OKS MILLS.OSIFRVNF.gKf01iNSGBIE s63q. �0 Thomas Perry, CBO Yesv-zoza Building Commissioner 200 Main Street, Hyannis, MA 02601., w ` www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 i February 9, 2015 Lineal Construction Inc. Attn: Benjamin Lamora PO BOX 1118 Barnstable, Ma. 02630 RE: 67 Joyce Anne Rd., Centerville, Map: 209 Parcel: 119 Dear Mr. Lamora, This letter is to inquire on the status of building permit application number 201402021 issued to remodel the above referenced property. As you may recall,this office issued a building permit on or about April 11, 2014 and to date there is no record of final building or plumbing inspections. The last inspection appears to be a final electric inspection`on or about September 19, 2014. Please contact this office immediately and arrange for inspection or provide an explanation. Thank you for your anticipated cooperation in this matter. , Respectfully, L. L� azon ` Local Inspector j effrey.lauzongtown.barnstable.ma.us (508) 862-4034 ' _ s VWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map Parcel Application ✓ Health Division Date Issued Conservation Division 2L Application Fee �� Planning Dept. - Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address , OSACRQ hA t d. cev%4e yt ( Gad 3 Village nn Owner rn�t 1>C!1c-Q- Address Ar6dir Crd-,e- 1,Sh wt O 7S_ Telephone S0'6 S D-lo 4-0-7 Go:� - Permit Request , wQM rcw0-Ve Est K��eJ6�.� -Evr�LAO .r+� gut . s�e oiace- s �.e,w� S, t MOO 64�-VCIC \.,`►� -�,-3 sNot", Pam-, c ,V%. �Ceye_ "f c4N.-I -+CtJtA 6ACOg- U�-Om ; Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation cQ-0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family L*/' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes N,P o On Old King's Highway: ❑Yes 9 ISO Basement Type: ❑ Full ❑ Crawl ❑Walkout Q/O ther_ lC-L-) 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 VIectric ❑ Other Central Air: ❑Yes 44o Fireplaces: Existing_ New Existing wood/coal stove: ❑Yes axo*" Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size Barn: ❑ ex ing ❑ new size Attached ara e. � g g -Q/e"xisting' ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Aut ization ❑ Appeal # Recorded ❑ `7 Commercial ❑Yes o If yes, site plan review# _ Current-Use Proposed Use 3. -_ -= - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name _ r,�e�x��- Telephone Number '9,44, —�� Adilress C), o-C 0 V, aLx 0- License # Home Improvement Contractor# Wo'rker's Compensation # ALL CONSTRUCTION.DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i' I ` FOR OFFICIAL USE ONLY 1APPLICATION# f , sDATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: t FOUNDATION �,�4Itt ` FRAME ►�s.J6 9�1y i c i 3 INSULATION 51A oK PF 7-Z3—iZ FIREPLACE - ELECTRICAL: ROUGH FINAL_ PLUMBING: ROUGH . FINAL i ;y GAS: , -• ROUGH FINAL F®INAL BLUILDING-, t s= g t DATE CLOSED OUT .t ASSOCIATION PLAN NO:. The.commonwealth of Massachusetts Department offridustrial rlcczdexis ' Off ce of Ficvestigations,., 4 400 Washington SYreet- _. Boston,M14 02111 www.mars gov/dia Workers' Compensation Inslarance'Affdivk: Sunders/Contractors/Electricians/Plumbers Applicant Information Please Print I,e�'b Name(BusimsdOrganizatianaad;9;cl,al) Address: I'D f\64]' r,Vie\ City/State/ZiP: I�ANr M Qi, 'Phone.# g: �- O-7 (e—c)• Are you an employer? Check the appropriate box: ., -Type of pi•oJect(required):, 1.El am a employer with 4• . am a general contractor and I employees(fall and/or part-time).* have hired the sub`,-contractors 6. ❑New construction . 2.❑ I am a•sole proprietor or partner- listed on ihe-attached sheet- 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me' irt any capacity. _ employees and have workers' [No workers' comp.insurance coin.incuran� # 9. []Building addition e• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing aII work officers have exercised their I1.❑Plumbing repairs a' additions myself [No workers' comb; right of exemption per MGL 12.❑Roof repairs insuranm required.]t c. 152, §1(4), and we have no . employees. [No workers' 13.❑ Other comp.msurance required.] _. tAny applicant that checks box#1 mast also f U out the section below showing their workers compensation policy informafioa t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a.new affidavit bdicatmg such. . �—mtra-1 3a thitcheck this box must attached as additional sheet showing the name of the sub-cantractors and state whefher ornot those entities have employees. if the sub-cant ar t m have employees,they mustprvvidt their worke[s'comp.poTicynumber. 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.Lie.# Expiration Date: Job Site Address: Ci3y/State/Zip: Attach a copy of the workers' compensation policy declarafion page'(showing the policy number and expiration date). Failure.tn,secure coverage as regmred under Section 25A of MGL c. 152 can lead to the innpositiou of crhi3al 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 W ORK ORDER anal a fine of up to$250.00 a day against the violator..Be advised that a copy-of this Rtatumo3 f may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under thepains•and enalties 7fpm*U that the information provided above is true and correct S e: Date: Phone# official use only: Do not write in this.area, tb be completed by cfty 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 Inspectar 5.Plumbing Inspeawr` fi. Other Contact Person: Phone#: [ Client:44075 LINECON ACORI) , CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4/2712012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ONTACT CAME: Pat Marini N Rogers 8r Gray Ins. Kingston PHONE 508-746-0055 FAX 877-816-2156 63 Smiths Lane -MA L°'Ext: ac,No ADDRESS: pmarini@rogersgray.com Kingston,MA 02364-3700 SOS 746-OOSS INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance 31325 INSURED INSURER B Lineal Construction,Inc. INSURER c P.O.BOX 1118 INSURER D: Barnstable,MA 02630 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER. MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY CLA017561116 3/29/2012 03/29/2013.EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES R NTUED nce $250,000 CLAIMS MADE I OCCUR MED EXP(Any one person) $5,000 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- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ . HIRED AUTOS AUTOS Peraccidenl $ rA X UMBRELLA LIAB OCCUR CUA028696614 3/29/2012 03/29/201 EACH OCCURRENCE $1,000,000 EXCESS.LIAB.. HCLAIMS-MADE AGGREGATE $1,000,000 DED RETENTION$ $ WORKERS COMPENSATION WCA021184915 3/29/2012 03/29/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY _ YIN N ANY PROPRIETOR/PARTNER/EXECUTIVE - - E.L.EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER CANCELLATION Bonnie Bryce SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ry THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 67 Joyce Anne ACCORDANCE.WITH THE POLICY PROVISIONS. Centerville,MA 02636 AUTHORIZED REPRESENTATIVE ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S81019/M80563 Sip TIIE Town of Barnstable 4 Regulatory Services auttMs'rnar.E, : Thomas F.Geiler,Director 'OIF1 l3 Building Division. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 1+2 JOB LOCATION: Le nGteC C ✓1 f � /` n 2�'t Ili 1 0 3 number street ,.,, q ^ village \e o "HOMEOWNER": '(\f)vp Q U U �d�U��� ;5 q-7(.) 1�0 E name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be;a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. ' The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and req i u ents. Si ure of Homeowner 1 Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0.Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a.building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work;that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. - To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently'used by several towns. You may care t amend and adopt such a fomi/certification for use in your community. Q:forms:homeexempt o TINGE Town of Barnstable Regulatory Services EARN au+Be Thomas F.Geiler,Director �Ep Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:O WNERPERNOSIONPOOLS II Y Ag a GUIDE TO WOOD CONSTRUC,TION ■ ao ' ■ Checklist 1.1 SCOPE Wind Speed(3-second gust). . .................................................................................................110 mph WindExposure Category.........................................................................................................................B 1.2 APPLICABILITY Number of Stories .............................................................. (Figure 2)............... stories <_2 stories RoofPitch ......................................... ............................... (Figure 19) .......................... <12:12 b R- _ MeanRoof Height ..............................................................(Figure 2)..................................._ft. <_33 Building Width, W ...............(Figure 4) .., _ <ft. 80, BuildingLength, L ............................................................. (Figure 4)................................. ft. <80' 10 ..............(Figure 4) <3.0:1 Building Aspect Ratio(L/VU) ................................ ................................. Vkl55 1.3 FRAMING CONNECTIONS General compliance with framing connections? .....(Table 2) 2.1 ANCHORAGE TO FOUNDATION l Type of Foundation (Figure ) 6A' � ............................................................. Fi ure 5 ................................. .'�© Foundation Anchorage Proprietary Connectors 2l'� Uplift. .....................(Table 3) - p Lateral..................................................................... (Table 3)......................................L=1 PH Shear......................................................................(Table 3).....................................S PH ./ 5/8"Anchor Bolts BoltSpacing ......................................................... (Table 4)..............................................vi in. BoltEmbedment.....................................................(Figure 5)........................ ... ...... in. ✓ Washer Size...........................................................(Figure 5)..............!.-7.in.x�_in.x�in.thick 3.1 FLOORS n Floor framing member spans checked?............................... (IRC or WFCM)............................................... I Maximum Floor Opening Dimension...................................(Figure 6)...................................-b-ft. <12 V7- M Maximum Floor Joist Setbacks ✓ n Supporting Loadbearing Walls or Shearwall.................(Figure 7)..................................... ft. 5 d A Maximum Cantilevered Floor Joists r" Supporting Loadbearing Walls or Shearwall.................(Figure 8).............. ft. <d FloorBracing at Endwalls................................................... (Figure 9)....................................................... ` Type .......(IRC or WFCM 3 A'OvArg0Q Floor Sheathing T e................................................... ).......................... Floor Sheathing Thickness..................................................(IRC or WFCM)................................... Floor Sheathing Fastening..................................................(Table 2).................................................. 4.1 WALLS Wall Height N / Loadbearing Walls ..........(Figure 10 'b ft. s 10, ✓ Non-Loadbearin Walls _ 'g ................................................(Figure 10).................................�'ft. <20 Wall Stud Spacing............................................................... (Figure 10).......................... in.<_24"o.c. Wall Story Offsets...............................................................(Figures 7-8)................................ Gin. <_d LA 4.2 EXTERIOR WALLS / Wood Studs (/ �esdbeitag Its _=- (Table 5) - nn s (Table 5)..... ... ble 2x S in QQQMaKO,I, a - f- FS & AP_ER ASSOCIATION. 2 r 77 CHECKLIST OoO �- r E Bracing Gable End Walls WSP Attic Floor Length.................................................(Figure 11)............................. ft. >_W13 Gypsum Ceiling Length.................................................(Figure 11) Ay ft- 0.9W Double Top Plate SpliceLength............................................................... (Figure 13)........................................7!, ft. Splice Connection(no.of 16d common nails)..............(Table 6)............................................... — Loadbearing Wall Connections Uplift.(proprietary connectors).................................... (Table 7).....................................U=.- b lb. Lateral (no.of 16d common nails)................................(Table 7)................................................ Z Non-Loadbearing Wall Connections -�I Uplift. (proprietary connectors)...... .......................... . (Table 8).......... . ......................U L Lateral(no. of 16d common nails) .............................. (Table 8) ............................................. Wall Openings Header Spans.............................................................. (Table 9) ...................... .._L ft. 0 in.<_11' T Sill Plate Spans............................................................ (Table 9) ...................... .-t ft._Q in.< 2' Full Height Studs(no.of studs)..................................... able 9 Connections at each end of header or sill Uplift.(proprietary connectors).............................. (Table 9)............................................ lb. Lateral (proprietary connectors).............................(Table 9)............................................. ►Wb. Wall Sheathing Minimum Building Dimension,W Sheathing Type..................................................... (Table 10).......................................... EdgeNail Spacing. ............................................... (Table 10)........................................ in. FieldNail Spacing.................................................. (Table 10)......................................... in. _L Shear Connection(no.of 16d common nails)........(Table 10)................................................_.4�. Hold Down Capacity...............................................(Table 10)............................................ ......... ]&Ib. .... ......... .......................... ........ Percent Full-Height Sheathing................................(Table 10)............................................I % Maximum Building Dimension,L Sheathing Type..................................................... (Table 11). ,_Ld'Z Edge Nail Spacing..................................................(Table 11) ...................................... . I in. 117 FieldNail Spacing...................................................(Table 11).........................................—lL' in. T_ Shear Connection (no.of 16d common nails)....... (Table 11) ............................................... HoldDown Capacity...............................................(Table 11)..........................................�I b Percent Full-Height Sheathing................................(Table 11) '1(L°10 ............................................ Wall Cladding Ratedfor Wind Speed?.................................................................................................:............ .......... 5.1 ROOFS Roof framing member spans checked?.............................. (/RC or WFCM).............................................. RoofOverhang.................................................................... (Figure 19).......................... ft.s 2'or U3 Truss, I-Joist,or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift............ ....................................................... (Table 12) ...........U= lb. ✓ Lateral.................................................................... (Table 12) ...................................L 1,1L. lb. Shear..................................................................... (Table 12) ..................................S= lb. Ridge Strap Connections-Tension .................................. (Table 13) ...................................T= plf Gable Rafter Outlooker.......................................................(Figure 20)...................._�_ft. ft.s 2'or U2 Outlooker Connections at Non-Loadbearing Walls Proprietary Connectors II Uplift.............. ................................................... (Table 14)...................................U=; lb. Lateral.................................................................... (Table 14)....................................L= t lb. Roof Sheathing Type..........................................................(/RC or R WFCM)............................ os .. .......................................V >_...................................... in. 3/8"wsp p� �FcT &[►mg..... .........................................(Table 2).......................................... 0.0 V-V AMERICAN WOOD-COUNCIL jai O -k _ - j t v ' TOWN'OF BARNSTABLE BUILDING PERMIT•APPLICATION Map �G / Parcel �G Permit# n ,� r Health Division ., ';L, Date Issued - 2 !) 7 Conservation Division o a B d °� �e "L.97 j Tax Collector 00 C2 Ic e Via; 00 Treasurer -- PI- Planning Dept. Date Definitive Plan Approved by Planning Board 1 ' Historic-OKH Preservation/Hyannis !w c x Project Street 1Address 7 `:Village Owner, Address 5 ip/11E. iy 4 ' Telephone Permit Request /�1�/ arP. �a pl/el' Cam'. , 4g�-. /3Y Square feet: 1 st floor:existing ;d v proposed 4— 2nd flog exis in. roposed Z.2& Total new ZZ Estimated Project Cost 1lyowe,4;�IA5:;Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size 47f�y Grandfathered: 0 Yes )a No If yes, attach supporting documentation. b Dwelling Type: Single Family O'�" Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: 0 Yes A No On Old King's Highway: Cl Yes �'No Basement Type: ❑Full ❑Crawl ❑Walkout. M Other S��glj f 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' 4 Electric ❑Other fi Central Air: ❑Yes ;4 No Fireplaces: Existing S ` New Existing wood/coal stove: ❑Yes, ANo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:,Uexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes,site plan review# Current Use o!!5.9izle� Aft P Proposed Use BUILDER INFORMATION Name&%��_ ���y ,�SpP�l�LisT. 5 Telephone Number Address 2rZ License# 4224512 3.Sp 5 Home Improvement Contractor# Worker's Compensation,# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE f FOR OFFICIAL USE ONLY . .- r 1, "+PERMIT NO. c : - y - i= DATE ISSUED '• a r w -r MAP/.PARCEL NO. • � # ' :` t t # - ' - ADDRESS `.. �. VIL'LAGE G fs r OWNER- r _ r F.... ,� • r •t. • ,-, ' t _`,t� .• `;: �,. - ''. � . DATE OF INSPECTION., FOUNDATION i., 3 FRAME INSULATION # n, - FIREPLACE 'r 'ELECTRICAL: • ROUGH FINAL: , PLUMBING: ROUGH- d ' FINAL • _ T , GAS: ROUGH.,- FINAL', FINAL BUILDINGlZI DATE CLOSED OUT ASSOCIATION,PLAN NO. 4. t r RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 / Alterations/Renovations •$25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$961sq.foo �� `7�a . - x.0031=\4, 7, plus from below(if applicable) ALTERATIONSIRENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. , >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: , square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost v • NWP`pFtHETp��� The Town of Barnstable BAR`1STABLE. ' Department of Health Safety and Environmental Services 2639. �0 PTeDMP�a Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: L � core"3e-Tr Map/Parcel: Project Address: G J011G6 ti� The following items were noted on reviewing: Reviewed by: Date: ////,7 Za q:building:forms:review 'WE t The Town of Barnstable B�xsrnsrE. = 9� a �,� Department of Health Safety. and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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: ads AKWIZM� Estimated Cost Address of Work: Z; -PJ yGL° Owner's Name: X"e(9 7' Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law [31ob 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 I hereby apply for a permit as the e t of the owner. .d t' Date Contractor Name Registration No. OR t, Date Owner's Name q:forms:Affidav i 1 ` LL zo 2�t�Y �I�w ►to +c •3 + ` so 4.pt7. L!U 1 S bI5Po5At. PIT - u5a= loco G�. J ISO SF c 2.S + s 75 G.P.D. s BoTTo"A _ ToT�L �ESIGIJ = 425 G.P.D. Tt>TA t_ 330 6.PD. Pmwc-oL Tlot.J tZATE : Cio 2MIu' omLr-.%. OF PG •r x' .:�,. .•�" '.";,`,1v � U Al.4tQ JONI it ' 1 P- 3p / Tor F•►10 •wp.o 40AW �•ape tuv. loco ICJ 5�6SolL 17-0 'p,Pp Dt'5T Iw. G�aI.. 97.B -sox 97.E SEvnc ". " �V. l 7A N K. l000 GAL_. cn,Z 47 ;•; o� tAlaS LEAcH I of PIT SA o y (wd w Iz WAS�IED r STow�fc 9to Fv-oT=-t LE: L bCAT 1 O fJ C EUTV-V.1"A o /2 ►..I o rGAL - IL 4' UaAT ga S�IQ lB2 GGIZTI{=�( TgAT tNC-- Pou4DAT1ol4 Suo�utJ Pt.AQ IZE=ZEV.1Ca t-tL.�L=aI,3 CcrwtPt_�(S W tTN TI-1r: SI�E.LI►-lam LOT 2.0 A.1.ID SETl3AClG 1~'CQUI�E�GI•l�'S OF T►aC. , �I -�o�w� of �A21.S51-A131.� , pc_• aIL 3 I S P,:. 2Z- B.&)(TctiZ RCGIS ItR�D t�.�1a Sueva ?0 TI-Il5 IPL-AN i� WoT O'S'TE.QV%L.LG o MASei, WSf�t,JJtnC=IJ.i <il�F:�/t_�{ -TIaL- -T' The Commonwealth of Massachusetts Department of Industrial Accidents Office uffniv 6931fons 60O Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit MRS namr; location: il�Z e- J�i/we City pi phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. company name addresq- city: Y.�il//� phone# insarana co .SSfc, �" 1�1-r��'�,e 5 policy# 1�VCG.'f�yZ9��I200�-- I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who h. the following workers' compensation polices: company.name: address:. phone# insurttnce_cor: � poficy# cQmoan.v::name: ctty. phone#• i insarance co: policy# Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/ one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. t do hereby certify under the pains and enalties of perjury that the information provided above is true and correct Signature Date Print name °, ,, �� G�t�G�G`.t/ Phone official use only do not write in this area to be completed by city or town official city or town: permit/license# t 7Building Department Licensing Board ` check if immediate response is required E]Selectmen's Office 0Health Department C: contact person phone N; I-1Other l� L f e,Ile ell"I/ c`, llz��ca<.l ct�eCl Board of 131111diug Regulations and Standards HOME IMPROVEMENT CONTRACTOR �.r Registration: 101014 ma y, (Expiration: 6/24/04 —� Type: Private Corporation CAPE COD HOME IMPROVEMENT I�obert MacLaughlin 25 lyanough Road Hyannis,MA 02601 Administrator BOARD OF BUILDING REGULATIONS j License. CONSTRUCTION SUPERVISOR Number: CS 010350 Birthdate: 07/23/1941 Expires: 07/23/2003 — .Tr.no: 11905 , RC�II II:LCd To: 00 ROBERT A MACLAUGHLIN _/ 25 HARVARD ST S YARMOUTH, MA 02664 Administrator k Permit Number MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.2 Release la Checked By/Date TITLE:Mr.&Mrs. Corbett 67 Joyce Anne Rd. Centerville,Ma. 02632 CITY:Barnstable STATE:Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family,Detached HEATING SYSTEM TYPE:Electric Resistance DATE: 11/05/02 DATE OF PLANS: 10-25-2002 PROJECT INFORMATION: Hobby Room Over Garage Connected to Existing 2nd Floor Bedroom(per board of health). COMPANY INFORMATION: Home Improvement Specialist of Cape Cod 25 Iyanough Rd. Hyannis,Ma. 02601 NOTES: Home Improvements are constructing a weather tight shell and the home owners are taking care of the finish phases. COMPLIANCE`Passes' G- - �Maximum:UA=92 j Your Home=89?! 3!3%'Better__Than Code Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value U-Factor UA Ceiling 1: Cathedral Ceiling(no attic) 256 30.0 0.0 9 Ceiling 2:Flat Ceiling or Scissor Truss 100 30.0 0.0 4 Wall 1: Wood Frame, 16"o.c. 710 19.0 0.0 37 Window 1: Vinyl Frame,Double Pane with Low-E 48 0.320 15 Door 1: Glass 40 0.320 13 Floor 1: All-Wood Joist/Truss,Over Unconditioned Space 324 30.0 0.0 11 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release 1 a. The heating load for this building, and the cooling load if appropriate,has been determined using the applicable Standard t Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125%of the design load as specified in Sections 780CMR 1310 and MA Builder/Designer Date • �1 MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.2 Release 4a DATE: 11/05/02 TITLE:Mr.&Mrs. Corbett 67 Joyce Anne Rd. Centerville,Ma. 02632 Bldg. Dept. Use Ceilings: [ ] 1. Ceiling 1: Cathedral Ceiling(no attic),R-30.0 cavity insulation Comments: [ ] 2. Ceiling 2:Flat Ceiling or Scissor Truss,R-30.0 cavity insulation Comments: Above-Grade Walls: [ ] 1. Wall 1:Wood Frame, 16"o.c.,R-19.0 cavity insulation Comments: Windows: [ ] 1. Window 1: Vinyl Frame,Double Pane with Low-E,U-factor: 0.320 For windows without labeled U-factors,describe features: #Panes Frame Type Thermal Break?[ ]Yes[ ]No Comments: Doors: [ ] 1. Door 1: Glass,U-factor: 0.320 #Panes Frame Type Thermal Break? [ ]Yes[ ]No Comments: Floors: [ ] 1. Floor 1: All-Wood Joist/Truss,Over Unconditioned Space,R-30.0 cavity insulation Comments: Air Leakage: [ l I Joints,penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] When installed in the building envelope,recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated,manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated,in accordance with Standard ASTM E 283,with no more than 2.0 cfin(0.944 L/s)air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.571bs/ft2 pressure difference and shall be labeled. Vapor Retarder: [ ] Required on the warm-in-winter side of all non-vented framed ceilings,walls, and floors. 4 I ' Materials Identification: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. [ ] Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. I Duct Insulation: [ ] I Ducts shall be insulated per Table MAT 1. I Duct Construction: [ ] I All accessible joints, seams,and connections of supply and return ductwork located outside conditioned space,including stud bays or joist cavities/spaces used to transport air,shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] I The HVAC system must provide a means for balancing air and water systems. I Temperature Controls: [ ] I Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. I Heating and Cooling Equipment Sizing: [ ] I Rated output capacity of the heating/cooling system is not greater than 125%of the design load as specified in Sections 780CMR 1310 and J4.4. I Circulating Hot Water Systems: [ J Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] I All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] I HVAC piping conveying fluids above 120 OF or chilled fluids below 55 OF must be insulated to the levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Rater Pipes. Insulation Thickness in Inches by Sizes Heated Water Non-Circulating Runouts Circulating Mains and Runouts Temperature(F) Up to V Up to 1.25" 1.5"to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Piping System Types Range F 2"Runouts V and Less 1.25"to 2" 2.5"to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate(for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water,Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD(Building Department Use Only) 0 EM EM 0 Perspective View of Hobby / Storage Room over Garage Ernest& Ruth Corbett Date: 10-25-2002 PAGE Home Improvement Specialists of cape God Inc. 61 Joyce Anne Rd. Scale: 1/4'= 1' 251yanough Rd. Ph.508--l-15-2815 Centerville, Ma.0202 Designer: Pad&,Ve Hyannis, Ms.02b01 Fax. 508-115-2881 SMOKE DETECTORS O.K. ARNSTABLE BUILD NG DEPT. r � rA ,W-1 • in GARAGES` LIVING Existing Garage - }' - Ernest& Ruth Corbett Date: 10-25 2002 72. Home Improvement Specialists of Gape God Inc. b1 Joyce Anne Rd. Scale: 114"= 1' 25 lyanough Rd. Ph. 508-115-2815 Centerville, Ma.02632 Designer: P./ Hyannis, Ma.02601 Fax. 508-115-288-1 } • J Cutback Existing Rafters and Hang with simpson Joist hangers Install 3-1 3/4x9 314 microlam. —ems•—� beam gang nailed Install new post supports per New Floor Joists 2x Groove F 16"o.c. 3/4 Tongue& l engineers specs. R Install R-30 Fiber Glass Insulation DECK Install 51b type X flrecode sheet IV-If sw rock on garage side of Gelling ---- a ih ,. ! i II Hobby %t § I Room I s I HALL II II a ? ( N II II I r 4 GARAGE \x �r•a• ♦•�rtr�r�• xe• ram• r� rr ( I s i b MIL 3-1 3/41x14'ganged together N I Simpson Joist Hangers per code. a I Existing Floor Joists 2xbkd 16 o.c. Hobby Room Over Garage Floor Framing (Front Joist Exisitng Rear Joists New) Ernest 8 Ruth Corbett Date: 10-25-2002 PAGE Home Improvement Specialists of Cape God Inc. 0 Joyce Anne Rd. Scale: 114"= 1' 25 Iyanough Rd. Ph. 508-775-2815 Centerville, Ma.0202 3. Hyannis, Me.021501 Fax.508-115-2881 Designer: PaaB.S'ao�e Ballustered Railing PT 36"tall 4' between ballusters tx4 mahogany decking 25 year roof shingle similar to 2xbpt joists 16"ox. existing �- 2xbpt ledger lagged to house with 151b.felt&Ice&water shield 31US 112 gaiv.boltslb'o.c.doubled Soffitt&Eave venting ? on ends White aluminum gutter&doom 2xb smpson joists hangers spout rear of garage a 3-2x8pt girt stick 1/2"osb sheathing Simpson LCE4 or equal(Attaches 2x10kd rafter 16"o.c. girt to post) 1x3 strapping 16"o.c. 4x6pt posts R-30 fiberglass insulation ur/vapor Attach 4x6 post with Simpson G546 barrier (poured into concrete 112"sheer rock 10"x 45"sonotube foorings per plans Visits T-1-11 siding ®®a 2xbkd studs 16'o.c. R-1q Insulation 000 1/2"sheet rock DOD Floor system ® 3/4"kd plywood decking on 2x10kd joists 16'o.c. R-30 fiberglass insulation W/vapor rn barrier 1)d strapping 16"ox. 5/8 type X sheetrock Pressure treated stairs 1x4 mahogany treads 2xl2pt stringers 2xbpt cap rail J 2)Qpt ballusters 5 1/2'on center \ Small concrete pad at base Eliminate 5t i�o Grade Elevation Details Ernest& Ruth Corbett Date: 10-25-2002 PAGE Home Improvement Specialists of Gape God Inc. 67 Joyce Anne Rd. Scale: 1/4"= 1' 251yanough Rd. Ph. 508-775-2815 Centerville, Ma.02632 Designer. Pa�rBd'ama 4, Hyannis, Ma.02601 Fax. 508-775-2887 Ernest& Ruth Corbett Date: 10-25-2002 PAGE Home Improvement Specialists of Gape God Inc. bl Joyce Anne Rd. Scale: 1/4"= 1' 25 Iyanough Rd. Ph. 508-115-2615 Centerville, Ma.02632 Designer: PaaBsaea 5. Hyannis, Ma.02b01 Fax.508-775-288-1 The Town of Barnstable a�srsresr.�, ASS �e� Department of Health Safety and Environmental Services - " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION cif lil 1 2 V v i l A q Location of sh d(address) Village 39 Property owner's name ' Telephone number x is 'C) 9 Size of Shed Map/Parcel# Signature Date j1 Hyannis Main Street Waterfront Historic District? x Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) }� y THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg 2a4t L:,q ;rL vi Ito V. •s +C '33o G•RD SEFrt-tc. TA4-4tC = 33ov ISO Of'. • 4.156.P use t o0o GAL.. _ IGI'150 r.N v► b15PO5A1. PIT uss l000 GAL.. ISo SF 'd 2.S . 377S 6.P.V- p 13err-MAA MZMA So a--. SO Srs: IL 1 .p ti 60 6.PD. irq,e q ,eoP TcrAL -Pe.SI&W = 42S Is.RD. �•1 `�_ >�.wK . TDTA I- vat L-( FLOW = 33D 6.PD. ` ti° mop PEUGDt mo U v&mz : 1"it l 2M I u•o¢ L26S. qa s ZS fo -pill' OF Y w Ji N� 19 Al AN •. i.c� •�.,��-i JON[ Q •\ 1, I'4: n (G /�Q• vL 'r s1' P'230 _99, Tor ;*40 soo.C, o._.. •. I-lo-f- 3•/6� /�G'cj o- ' A•9 s�a'� r'�a 40,0/� ,;y .. LOAW sl �oe loon QN. ' Se6SolL 17-9 'Awe IW. GAL. 97.8 97.E Sepm Z' Box I o a: �f0 �3�SC�tit 4loo0 h,v Iwv G.AL. q7.Z 97•� Pam LGA 4 of PIT a CAvoy l tam. .1/a�6•��k WAfNED - 9/.p • c_I=¢Tt1=tal:) PLo'r PtZp�1L� LOCATIOW CENTV-vi"z C � . RL I2 rC.AL -- ( IL 46 37ATE s'IQ J02- do Wes. I GGtmi=-4 . TI4AT T14M PoU4JDAT 014 SNa`'v� PLA1.1 R��cREti.10E WE,LyMa14 CoVt,PWS W 1't•1-N T1 G: LOT. %0 *A? AWr.> SETL,AGIC lVC4Ujre .AEWTS OF THC -rowti of $A2t�,1"Q'F3Lt� - • 31C 3 IS p. ZZ s1191 DATE r.� B A XTCtZ �. WYE 1wc. RCGISi'ClZ�D 1.Aatc7 Suev�Yo _e TI�IS C7LA1-1 1'�, UOT Li�D►SE.� v�'d AN OSTEQVII..�.G o MASS. tIJSI'etJ�t:1JT �iUc':�/t=�{ Tt{L- UFCS�T�i SI�GWL� 11PPL1 . . -- — -- .�_ .._ .-, .� ..�� t nY 1 �IJ�=!_ /�.. ,._.r �/!/ .�•�-ter 1 ,Engineering Dept. (3rd floor) Map 2m Parcel Permit# -3 2 tY House# Date Issued f/�;tpl Pr►"1 y(� t'Board of Health(3rd floor)(8:15 -9:30/1:00- -30) I Fee Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) A l ' Definitive Plan Approved by Planning Board 19 ,4S�a���T• Aic DDS.7 E oS lvl_lm®1 . LE. • .. iI m"Tt°1 AND TOWN OF BARNSTA WF- Building Permit Application Project Street Address 67 SB,yVz* &29Y 1z A"PA40: Village Owner ,?.'rA.Ale S,7e Ry Cp&C 77 d` address �1� Telephone 790'3"3V0 Permit Request SG h eax/ AM4dl r• ,First Floor )g '7# F' square feet Second Floor " square feet Construction Type W2&,D /2�9�f�J P� �i vo Q,f,�(���r s//i,,jf�/.'G Estimated Project Cost $ 90 E7 O Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family S Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ",,dNo On Old King's Highway "❑Yes JdNo Basement Type: Full ❑Crawl ❑Walkout (Other S),fiA �jc�,s Tli1/ Basement Finished Area(sq.ft.) p Basement Unfinished Area(sq.ft)— O-- Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing [e New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes A No' Fireplaces:Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) _ ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Po If yes, site plan review# Current Use Res/D Cd"-IA G• Proposed Use jg,E gA,l b�GH Builder Information Name, v, �i>y1°k'pll�Iyl�'.d"r <SI�L°�Cl�Y_ S Telephone Number Address License# 19AYJ_47 Home Improvement Contractor# ZDLp,I�Z Worker's Compensation# •NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,y SIGNATURE DATE BUILDING PERMIT DENIED FOR TH FOLLOWING REASON(S) r FOR OFFICIAL USE ONLY _ PERMIT NO. -- DATE ISSUED _ - .. � ' . � - - • - - , MAP/PARCEL NO. ADDRESS - . ' VILLAGE_ • OWNER t DATE OF.INSPECTION: FOUNDATION • l e .. "IN _ FRAME - INSULATION FIREPLACE - w ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL? ` GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT"- ASSOCIATION PLAN NO. i , 1 � OEPAATNENT Of PUB M SAFETY ' CONSTRUCTION SUPERVISOR '.itfNSE Mu�be r. ErDires: Birthdate: I CS 111351 07/23/1911 Restricted Ts: 11 1fd� � ROtltRT A NAtIAtlfiNIIN A HARVARO ST I ; YAPOPUTN• NA 12664 HOME- IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 101014 Expiration 06/24/00 Type - PRIVATE CORPORATION CAPE COD HOME IMPROVEMENT SPEC . Robert A . MacLaughlin f 25 Iyanough Road Hyannis MjL, +<?26Q1 • IGti' c � L.K 1r vow a l+o +� •3 • 3'30 G,P•V. . �,(� _ 0 rA&.4 v ~ d t...O 7•. (G1'1 cis k o00 POgAs- .c �• 2f AOSA TClf�L -vES1GN s .42S .RD. ` To>r =>A1_.14 F D1 OV 330 6.m. iPT GOL�Tl0�.1 SZDT E 1"i�.! �LJK i w* 0¢ TV 133.81= J. r � ' - TeT Cwo .ieo.e p•163d 9bto '^' �'P�� .I coo rw •�' J JAW 97•e �W. GAL. ••; Sraso�L 4 pob �+s`r 47� �Seonc io '':' �.�o A GM bar "Box .• %W. l 000 wv. T t, C-AL• 9'1 l .� Cat�6xS LsAG►1 �3 cF S,edoy WA4MIL'O sro.+fo 9/:o . C E,QTtF1ED PLC"?' PLC Pccl='t Loe-ATIOW CEti.lTiwi $ r „, 12 llo W�.rsA. '•, T pt.A►.� 'R��EcZE►�cE GcaT1 t= T64AT . TNG. �7°U4t>A-HO J Lo-f �.1��t;oW Ccw��PL�lS W ITN TNT 'SIDE.>`I�.tEY iwm ASETLNACtC C.'CQvt�E,NaNTs OF T►�G 4owtiJS'19 u•lE. .luc. AT6, B Ay RCGIS rC.RGD U►Ltfl 5vev�Yo'`� • . , "V" p.,i os�Eev��1.� . o titasS, u o•c �t�►Sco TtAC:. UFCSrcrt, S1�GWl� AhPt..1GA�1T_ ��:. - 3 n a a n n. .G .. r g F _ a e , T i • 9 y a a.. .#' r1._ -C ? � _ � "� a .. C n 5�r - rE :g^�` -- • _ � z -.. . .a .. PORCH: v ' .1 T4.198 - ------------- - - 9" 34 2 34 7 S 3' 34 31/4 3• 7 N4 Corbett ' 67 Joyce Ann rd. Centerville e _ r 504 • rj Knee wall above existing roof W rafters � � 1,� �'�1 B sheathing and asphalt roof shingles 4,. exposure Existing house 1 . ILO '- Son,-Aen panels r,- Ca CN LD _ ' . 5 � - x4 frame knee wall with cr) T1-11exterior siding r-_ Le s : = Existing concrete slab - Scale 1 r4''= 1'la' 1 11 and footin Corbett Residence Home Improvement Specialist 67 Joyce Ann Rd. 26 Iyanough R d. Centerville Hyannis, Pam. 0 601 _�---- 'i :� v � f �..-r- •� ���- - � § � � .r� ..r j �� •� -� ..�„ � ,.,ate ` S- . € �; t - �� � �� #� ,A. � F� � '� ♦E��q � _ ;'`�-' i�, '� �; aft#�' e 1F �� a�Y� F k `f �'i pp1 { 7 I 1# 3} 9 } ' f e� � 5�;�� � s�.y.: y,..• - '-i� .i�,• � '. #�� ,�+..........•....�.....-.�,..._..�....�-+-.w...••..-.. �,+......�.�....- ate...--�_.�.�......�.. ... .-'�'... ��rye �_ �.-.�,_.`._ _ _ ^..�.�...�,.�-.,�- ......,,..-,.........�.�.M ....-�.-+� ��,n...o�...�.�.-.. ,.._...........�,...._.y-n.+.,...o...'_.wR_..�,...._��-.�....-►-,. 5�.. j.. . — �..........M i _,.�._.. � ...._..,.....,........�._....,...,.,._�....-,...�._�_ _r.....4.r......., i.vim..,._.,.» ��_.,._.. �..... ._R__.�..d._._ _._.. _ __.. ._...._ { ,, s� _ � ? � 1 s ; f=- — - — .. _---_-_.,�._..._... .�____.a.....�. � ti '' :� . , (r------- ------ r ------------- od PORCH b g C 1 T4 x 198" -- - - r _v . FTT 6- 74 T 34 2" - 3 3- 34 311A 3' 73/4 M 18 - _ - Corbett 67 Joyce Ann rd. Centerville Knee wall _,,.—above existing roof W rafters wi,1 t2" a S B sheathing and asphalt roof shingles 4P exposure i 'Existing house -� Screen panels � ca CN - � x4 frame knee wall with CO T1-11 exterior siding101 � r - Existing ooncrete ilaf} Scale 1 r4"= 1'0' i �d � and focyting Corbe t Residence Horne Improvement Specialists 67 Joyce Ann Rd. 26 lyranough Rd. CentervilleHyannis, ha't�. 02601 i s E The Town of Barnstable • a�►attsrast� • Department of Health Safety and Environmental Services 14 . Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissions For office use only 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:.5 CASP/� ®/Q Est. Cost Address of Work: Owner's Name �'�N$sT t lPvr� GoRBe�T Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under SI,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 I hereby apply fora permit as the agent of the owner: Date :#—��4ontract r i amr Registration No. J OR Date Owner's Name The Commonwealth of Massachusetts .................=-_ � Department of Industrial Accidents l Orrice of/naestigatians — � 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole ro rietor and have no one workin in anv ca acity (� I am an employer providing workers' compensation for my employees working on this lob. company name address:: city 'Alva -5 insurance co. /9 Te. 57-R Roliev# WG ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name address. diN `phone#. insurance co oil # company name address: city. phone#. insurance co. o icv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date �''f�B /5"7 _ Print name Phone# 72 1�611c°le.� � /Q ��oZ�i(� official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Offlce ❑Health Department contact person: phone#; ❑Other (revised 9/95 PJA) Information and Instructions ; Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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 r Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be reftniiA io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Invesugadons 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 met Ls( Flow %to V. •$ • sso G.pv. ,eFrr1C T4*-1K = -ssov (So % 4-qr.6.P USA- 100cn� CMIb,c..,. S)ISPOSAL PIT - USE. lOoo GaL. �. J 1 C'UGWALL Icjc) SF A2.S • 3"7Z G.P.D. p BcrT�mAFXR QQEA r�0 ST=. 4848 \� ToTAL 425 la.RD. i 1_ �.wK , ~ Tt�To L �a�04 F'Low - 330 6.PD. J PAP ��'�a' /oe P,r °' VE2GOLQT1oLj tZATE : J"'I 1 SAMW•ORLF-%. �s --�-- 254. f II M/,/ 'ti OF M�;k isv f 47 A L A^i LA JONI e`' +r41^• t p [� `1 1 j I• ..r sr P-23v ` Tor r4o +ioo.o 3-16 B/ FG a9 �� 4- .. ean� �1'Ppe iMr. .A iuv.•9�0 I o00 Srssoi� 4'w� iw. 6A�. 97•B Z 'Box 97.& Sepnc (o ?:•7 A N iJ0 l( IUV. K. .., 4 gar 1000 7•9 IWv 97 �. or A� �A�EXS LH 97.L Pi-r _ A. WA5MF STOWF-- IWO C_EtZTtF1ED PL(5-r PL./iV.1 ' LoCATIM-4 Ce AZVILL� CAL — IL 46 32 m G liq jag F �o Wal- t i c-rwrt►=-.t T�-AAT TNT PoU4t>AT1014 SUo .1 Pt-At.1 'RG>:EVM► Ca 4-1F>;t_t���l Cc�N1Pt_�(s W ITIA TN` 51DE.L,1WE- I o-� Zo A1.Jt� SE7l3ACIG vGQvIRE4AawTS of THC. L Tow Li 01= s A2tJSrAP3U3- .. RCGIS'ItRtD 1.ANC7 5U2v�Yo�S - TI-�15 t7LA�-1 I LIOT ZAe>GV v" A4.1 OSTEQ�/iL.t..G o A�KASS. 1149M JJV�C:I.iT ""A.) �/{_�{ T�� UFCS�T�i S��GWLa AP CA.ti-J r Nvr ar•_ U�>c�� to wercetit�wt.: Lo�c- ��W� -- Assessor's-map and lot number .......... 4s.... Sewage Permit number .......... .............................................2C i f SEPTIC $ 1�T EIi ;MUST•. i-NST LLEC OlV CO 9 oO ll ��t� T l rbaHouse number .......... ,...:G.7....... WITH TITLE j 1 -39-0yNpI+ � ♦0��i S' 0 ' TOWN OF RAR N SC"` rd- s .. N.UILDING I,I SPECTOR ' APPLICATION FOR PERMIT: TO ............... ........................ 0. .. ... .................................................. y TYPE' 011 "CONSTRUCTION 4 A) 9 "� J . .... ..................... .. .. .......................................................... AA.. .....!............19....... 4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: t o.... .. 1.:...:..:.moo.u . .. /�Location � /U'4� C...... 1.. '� �/�1 T....` .p. `.. .. f. Proposed Use .............�J I.G...I-.L...1..(".. ....... ...... .... ...... ......................... .................... fl Zoning District ....... �J �1�/ b........ Fir� District .. .... ........................................................ t; Name of Owner ............. ........ .................. ......Address es!. b.Y . ....................1a....I`'. ...... TIZ-1/1 LLt ` " C�. (Y ► :......... .............................Address .....'............................................................•...............Name of Builder Name of Architect ... :.� .........................Address.......:.......................... i Number of Rooms ....5.............. .................................... Foundation Ex ..(.. ........:................. Roofing ..... �� `{ � t.r ' s ierior ................. Floors 1. "�!..G. � ....................... ..................Interior . .. 1•, ��---0�-(�- .L- '.�. ..........................................Plumbin ..... Heating .. ...... . Fireplace .....L... .. ......t...................................................Approximate Cost ......... ................. .:.................: ............... Definitive Plan Approved by Planning Board'-------------------_-----------19_______. Area ............... Diagram of Lot and Building,with Dimensions Fee � .'�.v................ .. .................... SUBJECT- TO APPROVAL OF BOARD OF HEALTH 1 V 0 t , i 1 ya OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS /�. hereby agree to conform to all the Rules and Regulations of the Town*of Barnstable regarding the above construction. '7 Name v.... .................G�/ COLETTI, GUY ? -24069 One Story o ................. Permit for ...........::....................... Sin le Famil llwllin g.....................Y........ .........J............. e Location ....Lot...#2.0...U...J�..y.G.p... 1111...RQa w Center vi 1 0. ............ k Owner .. y i r Type of Construction .........Fram.........e ..... R 1 .... Plot ........ .�.............. L rt ................................ May 20, , 82 Permit Granted .......19 r Date of Inspection ....................................19 ` Date Completed � .........19 s r L� �Q, :21 Assessors map and lot number .. ........ ..... '. „� /�A 5 PL O f 1NE TO Q Qy �♦ Sewage Permit number ........... ? I-7--..rc�.���..0 ..................... r Z BABBSTADLE, i House number .............................'`°t.. `........................... 90O 1639. 0� 0 OR a� TOWN OF BARNSTABLE BUILDINA INSPECTOR - APPLICATION FOR PERMIT TO �� U G 7 ..:........ `�..� .... TYPEOF CONSTRUCTION ..................................................................................................................................... ..........ji:f....:...............r...........19... " TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies,for a permit according to the following information: j Location ...... �� ....... .... ...... .. ti..... . ... s; ''. ................................................................ 11 ... �l L.... r. i. ...... ProposedUse .............t ,1<c ..�:..L...I�.. �....... ............................ .......................................................... ZoningDistrict ....... ... ....................................... :.:'Fire District .... ......... .......................................°........... ..:.... V LLE Name of Owner ... .. .. : . �. ..Y�rr. ......Address ..�. .::�.rC} ` .. i.!V.:`... ...... .� . ..... •. . Name-of Builder" -........:.Address ' ..Address Name of Architect . ::............................................................ Number of Rooms Foundation id.�! � 1 — . . . 0 ...r.............................................................. ..................... .............. Exterior ............a.—..r��...�........:...........:.....................................Roofing ..... ....... ` . a... ........................................ Floors ( r '2 .LT'.. .Interior .. -: � •, -........................ f .......:.... .......... ........................................... ...... G _. Heatingi-..........�...�:...�e.........:...................................Plumbing .....��..ff:�.................................................................... ` � <` oCa (0 -Fireplace ."-� Approximate Cost (-+.............................:................................................... .................................................................... Definitive Plan Approved by Planning Board -------------------------------19--------• Area .................................!...... Diagram of Lot and ,Building with Dimensions Fee ... ........................................ ;.� ...........�.... ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH r \� I � i Q �) OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS , r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... i A 09-119 COLETTI, GUY e No 24069 permit for , ne Story Single Family Dwelling .................................................... ................ Location Lot #20 67 Joyce Ann Road Centerville ............................................................................... Owner .....Guy Coletti ......................................`........ Type of Construction Frame ................................................................................ Plot ............................ Lot ................................ May 2 Permit Granted 0 r 82 Date of Inspection ....................................19 Date Completed .......................................19 M k-r e� C g3 �J sal F i k WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company Burlington, Massachusetts - (800) 876-2765 NCCI No 40959 t POLICY NO. WCC 5002919012002 PRIOR NO. NEW BUSINESS ITEM 1. The Insured Cape Cod Home Improvement Specialists,Inc. Mailing Address: 25 lyanough Road Hyannis MA 02601 (No. Street Town or City County State Zip Code ❑ Individual ❑ Partnership ® Corporation ❑ Other FEIN 04-2611089 Other workplaces not shown above: 2. The policy period is from 07/04/2002 to 07/04/2003 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part,One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100, 000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100, 000 each ernployee C. Other States Insurance: See Endorsement WC 20 03 06 A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4 4. The premium for this policy will'be determined by our Manuals of Rules,Classifications,Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Estimated Per$100 Estimated Code Total Annual of Annual No. Remuneration Remuneration Premium INTPA 027200 SEE EXTI NSION OF INFORN ATION PAGE ,OF 7HE)py� The Town of Barnstable BARNSTABLE. ' Department of Health Safety and Environmental Services Y MASS. e i639• �0 prEUMPya, Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 5.08-790-6230 Inspection Correction Notice Type of Inspection F`t `\,\1\11 i Location A� [� c. Q Nnn �;�� Permit Number /,1 ,� Owner t �_�v 91 1 Builder c,c.. ;A One notice to remain on job site, one notice on file in Building Department. The following items need correcting: C- l I V1077� r G Please call: 508-862-4038 for re-inspection. Inspected by Qr-/J% 41--' ,' Xl Date f ?- �l TOWN OF BARNSTABLE permit No. 240_&_g _ Building Inspector cash -------------- OCCUPANCY 8 0.0 d) wa —- - a�a � PERMIT Bond -----__-------- Issued to Guy Col.etti Address Lot 20 .67 Jovice Ann Road. Centezyi7le Wiring Inspector Inspection date Plumbing Inspeetor.�,//"/ ..t— 1, �s Inspection date Gas Inspector Inspection date xEngineering Department ,� Inspection date C Board of Health 4f ti� '{,�., ` Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. - .... � ,,v...._.:�.._..�.._.........., 19� :. .....k.. Building Inspector 80M STRUMM TO ADOIRON - ADDITION Mmue S11tl1ata TO R6NANI .. 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