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0090 LAKE DRIVE
,y' ,- . ,. I'r : A '•gyp � F�11� -�' t ° �; - C 3 � .# z - _ ,., ,. .a c a. _ .: '' .4�f a' � .r { y.�• c ,r ,s "q.ar. .,�,e � � ,tixt;. 1 .< r�. ;n `r, i ��. 40 r r, - 2 • y a A Town of Barnstable �THErok'I Building Department Services S —aq- L9 °* Brian Florence,,CBO sresr,E. • Building Commissioner pry- � 200 Main.Street, Hyannis,MA 02601 www.town barnstable.ma us Office: 508-862-403 8 Fag: 508-790-623 0 PExn #` — I ° FEE: $35.00 �'r r SHED REGISTRATION N t3� RESIDENTIAL ONLY 2; 00 p 200 square feet or Iess . Irocation of shed(address) Village co Property owner's name Telephone number Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Consetvation Commission(signature is required) Sign off hou:rs for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WY=THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BF, ACCOMPANIED 13Y A PLOT PLAN Q-forms-sbedreg REV:08/6/17 l a 'Town of Barnstable 'Building IPost°This Card So That rt is Visible From the Street Approved Plans Must be Retained on Job and=this Card Must•be Kept uzrrae Permit 1639. Posted Until Final Inspection Has Been Made f y $. ; ita Where a Certificate�`of Occupancy i"s Required,such�Buildmg shall Not be Occupied uhtd a Final Inspection fias been made « y _.,. Permit NO. B-19-4167 Applicant Name: William Callahan Approvals Date Issued: 12/17/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 06/17/2020 Foundation: Location: 90 LAKE DRIVE,CENTERVILLE Map/Lot: 230-0.82 Zoning District: RD-1 Sheathing: Owner on Record: BRAZEL, BRENDAN 1 8c JILL M ContractorName:; EFFICIENT BUILDINGS LLC Framing: 1 Address: 6 GOLF VIEW DRIVE Contractor License: ,169944 2 HINGHAM,MA 02043 _ -Est .Project Cost: $3,300.00 Chimney: Description: Attic Insualtion Permit Fee: $85.00 Insulation: Project Review Re Fee'Paid. S 85.00 j q Final: Date 12/17/2019 a - Plumbing/Gas Ruh Rough Plumbing: ' . Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorised by this permit is commenced within six months afterissuance. All work authorized by this permit shall conform to the approved application and th6,approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and steuctures,shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public.mspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit. z Minimum of Five Call Inspections Required for All Construction Work: l 7 Service: 1.Foundation or Footing "' Rou h: 2.Sheathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest fluePlining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: t Application number:. :(.. ....�2.5. #! Fee 4_5...00. ' ` Building Inspectors Initials...Kol .*.. MAY 28 2019 Date Issued.... ............................ ................ . . TOWN bNR �Lp/Parcel....... ....... . �..... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOW S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: Q6 tjt/w-' 411,14e;` tenvacal i/_6 NUMBER STREET- VILLAGE. Owner's Name: R 45ZC-z_ Phone Number �7 i SW kkW Email Address: r }' ° Z.N) 6`0044 V%= /kf-Cell Phone Number '7,</S-W OW Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: . Date: TYPE OF WORK RY Siding Q Windows (no header change)# Q Insulation/Weatherization Q Doors (no header change)# Commercial Doors require an inspector's review Q Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's naine _. Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY.IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. I APPLICATION NUMBER `4 *For Tents Only* ' a Date.Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one:this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No ,if yes, a gas permit is required. Natural Gas Yes No -if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pnL Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: aX� � Telephone Number tbgy Cell or Work number &Y I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature '`Date V16 F_ APPLICANT'S SIGNATURE y . . Signature Date � All permit applications are subject to a building official's approval prior to issuance. L `1INNThe Commonwealth of Massachusetts Department of Industrial Accidents u` Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 'Name(Business/Organization/Individual): I& A,'J Address: City/State/Zip: v�� /" Phone#: 7 i SCS Are you an employer?Check the appropriate box: Type of project(required): 1.El I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have A g• ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• $ 9. ❑Building addition [No workers'"comp.insurance comp.insurance. 10. Electrical repairs or additions _ required.] 5. ❑ We are a corporation and its ❑ P 31-I`am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13:❑ Other - -�� _ __ _ comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and.then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date:: Job-Site Address: 96 Llye7- City/State/Zip:" Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the`Office of Investigations of the DIA for insurance coverage verification. I do hereby certify it er t e airs and penalties ofperjury that the information provided above is true and correct Si mature: /� C---Date: Phone#: Official use only. Do not write in this area,to be completed by city or town:official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1% 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." i An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." } MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must 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 WWII)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4904 ext 446 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 w .mass.govfdia . Boise Cascade Double 1-3/4`�' x-7-114" VERSA-LAM® 2.0 3100 SP Floor Beam\FB01 Dry 1 span No cantilevers 1 0,/1'2 slope February 19, 2016 10:13:54 BC CALCO Design Report Build 4516 File Name: ..BC CALL Project Job Name: Brenden Brazil Description:Designs\FB01 . Address: 90 Lake Drive Specifier: J'Madera City, State, Zip: Centerville, MA Designer: Customer: Rich Marcel Company: Shepley Wood.Products Code reports: ESR-1040 Misc: 13 13-00-00 BO B1 Total Horizontal Product Length= 13-00-00 Reaction Summary(Down/Uplift)!(lbs) Bearing. ;. Gve`,., Dead Snow. Wind Roof Live 80, 3.1/2" r ; 5$'5,/0 600/0 BTI 3-1/2`" ,, k� 585/0 600/0 'Live Dead Snow _Wind�Roof Live Trib. Load Summary Tag Description. Load Type Ref „Stan .End. ':100% 900/6 1156/6 16&/°:125% 1 Standard Load Unf. Area,(Ib/ft^2)' L 00-00-00 13-00=00 20", : ..,. 10, 04-06-00 2 Unf. Lin. (Ib/ft) L .-00=00=00 13-00-00 40; " n/a Controls,Summa.r' value''. %;Allowable Duration Case. >Location Pos. Moment 3,585 ft-1bs 42.8% 100%. 1 06-06-00 End Shear. 1,022 Ibs 21.2% -.100%_ 1 - b` W 10-12 Total Load DO. U33'0 (0.457") f'. x :8% n/a° 1 f ,06.06 00 Live Load De-fl. U668 (0.225') 53.99/6 - n/a 2 '.06206-00 '° Max Defl. 0'457" 45.7 o n/a. 1 06-06 00 ' Span/Depth' •20.8 . n/a n/a 0 00-.00-00 r r %Allow "/°Allow Bearing Supports . Di".,,(L x w),.;, Value, Support Member • „Material BO Post 3-1/2"x 3-1/2< 1,1851Ibs n/a 12.9%. Unspecified B1 Post 3-1/2"z 3-'1/2" 1;185'lbs n/a 12.5% Unspecified- Notes Design meets Code minimum (U240),Total load deflection criteria. Design meets Code minimum (U360) Live load deflection criteria. Design meets arbitrary(1") Maximum total load deflection criteria. Calculations assume Member is fully Braced. Design based on Dry Service Condition; . Deflections,less than 1/8"were ignored'in'the..re"suits:. Fastener Manufacturer:TrussLok(thi) 0 ,t Page 1 of.2 ®Boise Cascade Double 1-3/4" x7-1/4",VERSA-LAM0 2.0`3100 SP Floor Beam\F1301 Dr.y `1 span ( No cantilevers 1 6/12 slope February19, 2016 10:13:54 BC CALCO Design Report P Build 4516 File Name: BC CALC Project Job Name: Brenden Brazil Description: Designs\FB01 Address: 90 Lake Drive Specifier: J Madera City, State, Zip: Centerville, MA Designer:.{ Customer: Rich Marcel Company: Shepley Wood-Products Code reports: ESR-1'040 misc. ; Connection Diagram Disclosure. I b d — Completeness and accuracy of input must L� be verified by anyone who would rely on a output as evidence of suitability for • • . particular application.Output here based on building code-accepted design properties and analysis methods. - • i • • Installation of Boise Cascade engineered wood products must be in accordance with current Installation Guide and applicable e building codes.-To obtain Installation Guide or ask questions,please call a minimum =2" c= 3-1/4 (800)232-0788 before installation. b minimum =4" d=24" e minimum =.1 AJS BC CALC®,BC FRAMER®, TM ALLJOISTO,,BC RIM BOARDTM,BCI®, All TrussLok screws may be installed from one side of multiple ply'VERSA-LAM beams.= BOISE GLULAMT" SIMPLE FRAMING All TrussLok screws may be installed from one side of multiply Versa-Lam beams. SYSTEM0,IVERSA-LAM8,VERSA-RIM , PLUSO,VERSA-RIMO, Member has no side loads. VERSA-STRANDO,VERSA-STUDO are Connectors are: FMTSL338 trademarks of Boise Cascade Wood Products L.L.C. a r i .I' 12JI-A Town of Barnstable *permit4261 ^� qL11 Z,�� GmontluJr wiw w dale Regulatory Services DAWMIULUM PLO .e$ Richard V.Scali,Director DECBuilding Division row/V Gam((.. 9?815 Tom Perry,CBO,Building Commissioner Or BgRn j 2001v3�Saver,Hyannis,MA 02607. , SrgB�E www.town bam_staol=ans office.. 508-8624JO38 Fax;508-790-6230 ESPRESS PERMIT APPLICATION - RESIDENTIAL ONLY C-� Not validwMwrd zdx-Prezr�„s Ma�lp..,,.l Numb.. AA// Prope,-iy?ad3essab Q/ Lam Lmt e [I Residential Valve of Works - wmim m fee of s3s.00 for work under?b000.00 Owner's Namo&Address Contractor's Name rlAi5e - ( fi,'J� v;,r r�,e� / Telephone Nunnber o q, - 4 7 -- Z- Home bvrovement Contrutor License#(if applicable)_L 2_14i3 I� Emaal: �>�: � cc�� Construction Supervisor's License#(if applicable) 2'Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner M�Jfhzve Woaker's CcfTmsEtionbism uce Insurance Company Name l-7 r^n;,14 5�c,4� r- Workman's Comp.Policy# Copy of Insurance Compliance C'er fide mte_st ai ecompaay each permit Permit Request(check box)® Re-roof(hurricane nailed)(stripping old shingles) All construction debris wzll be taken to 5ti4 j6V 1 ❑Re roof(hurricane nailed)(not stripping. Going over a sting layers of roof) ❑ Re-side ❑ Repaammeut*%r dows/doo_ra/stlid=.L7 Value_ (ma)dmum 32)#ofwiadows, #ofdoors: ❑ Smoke/Carbon Monoxide.detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Whera reg wt&issuance of this pemvi dotes not exempt crnaplm=w5th offer town depattatent tegaiahons,Le.frxtmc,Consavadon,etc. ***Note: Property Owner must sip Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WF WF0M Z1buldmg e 1 Rsvisod 040W.5 Ill- The Can=amveakhqf3&nadr=e&s Departitrart-rfrndrr&iat Acdderztr Offire of gadow. 600 Was7rhVtou Speet Bustan,?CIA 02111 Workers' Compenim ianInsur=ceAffisiavit:Builders ContractorsMectriCianslPhmsbers £armation / Fl eFrlut 'Na= C0n45—i L,:41,'�[ . FeSS: Ci r L4 CitgtSYafefZils (G Phone;n c - 4 7—r.-- Z Z':9 > Are you an employer?Checkthe appropriate bo= Type of project(required)_ 1.["I am a employes with. 1Q_ 4 ❑I am a general cord actor and I 6. ❑New construction employees(fa f=Morpart-#ime).* have hnedfhz suib-conbartoas 2.❑ I am a sole proprietor orpastues- listed m the attached sheet 2- ❑Remodeling ship and have no employees . These sub-cmdractors have g- ❑Demolitiom waddnb for me in anycapadtp employees andbavevrorkers' ' [No wodm&comp.iasutaace comp.insurance-, 9_ Building additiaa required.] 5. 0 We are a corpotatiun and its 10 Electrical repairs nor ad€tiow 3.❑ I ama homaoumer doing ail wodc officetshaveexercised their iL0 Plumbsngrepai s or additions mpsel£[No workers'camp- Tight of exeenpfian per MGL L.❑Rnafregasrs im�fegpixgd-J i c.152,§lM andwe havenD employees.FI'Oworkere 13.❑Other `AcyWScmt&stch2dksboxTltmsY also SIlouE9t�secGoabeiowshaAiags�e¢wv�c�es`""eampeasatins[poT�cyiafamrsPiaa -T Ssmev.ne=Who snbm3ft dais afiidar$ &ey um dacin.-O wak and dmhim eutsiag co amst snbm5c sne�vs xfxxaxeit uzdieara�=cz- Zcc-,y cta1 thzt ehecicthft box test�ttrer3 as sddi�al stze�t sting tine naase of dee sub coaCactars xorl staff�rhetha ar aotthase entitiesha� ' e�3c, .'1#'�e - FaBve em�Ios+ks,d��rprava3e•r�sr urerb�'csma paiTey r+ lam an¢uipiayet f7iatisprouiriingToarlr¢rs'caarp¢rtsatt'an uisrcrante fur ass'cmPPv3�ees. S¢tosv is thgpaJcy ar�riJob sib informcFhbrL _ ' lasurance Company Niame= ,-,A ki le— (/'/�V - l'aficp or self-in s.I.ic. ___ .o ol q, S 04 0- -- - - ExpindaaDate_ Job Site Ad&v= city/S at.e Attack a caPe of the workers'compensationpolicy declarafion page(showing the policy,number and e=pu ation date).. 1=aiture to seeum covi--age as retired under Sack=25A of MM—c-- 152 can lead to to impasftion.0f eriminalpe ses of a fine up to S 1 OUG andfor one-y ear vmlxisortm-d.as vo&as civil pettalfies in the form of a STOP WORK ORDER and a f of up to$250-00 a dap against the violator. Be adt+ised ifrat a copy of this skdameut swag be fwvvarded to the Office of Iuwesiigations cDhe DIA.for irts=ame coverage re lion. Ida hereby certr,fy under din andparraWks of ury tbat8Es iqfornm#f=prov&W abm�a!s bars aced correct Sir�eatnre r I Phoneme 0 age only. Da iW write in fUs ima,to be cnTretad by city ortrncn official Cky or Tay= Pernatll iceesse;9 '=iMg As=rity(dreie one): L Board of Health 2.BuMing Depar txmmt 3.C tyftown Clerk 4.Electrical Inspector S.Ph abing r 6.Other Contact Person: Ph*ne#: 6 ISSUED BY .CK INSURANCE CONIP&tNY HEREIN CALLED THE COMPANY GRANITE STATE INSURANCE COMPANY 0103090-00, WC 009-93-0601 13102 Q13-82-0915-50 • P N YLV N •FRASER CONSSTTRUCTION, LLC AIG P.O. BOX An AIG company EXECUTIVE OFFICES; SEE EXTENSION OF ITEM 4.OF THE INFORMATION PAGE WC99NIO 175 Water Street I.D# 000 New York, NY 111036 06 6 MA UI#: • • KEATING GROUP INC THE WORKERS COMPENSATION AND EMPLOYERS 144 TURNPIKE ROAD LIABILITY POLICY INFORMATION PAGE SUITE 150 T R GI MA UZZ24moo INSURED IS PREVIOUS POLICY NUMBER LIMITED LIABILITY COMPANY RENEWAL 009930601 OTHER WORKPLACES NOT SHOWN ABOVE SITE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE- WC990610 ITEM 2 POLICY PERIOD12A1 A.M.standard time at the Insured's mailing address FROM 09/26/15 To 09/26/16 ITEM 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 the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ S00,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE- WC990612 ITEM 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. Premium Basis Rate Par Estimated Classifications Code Number Total Remuneration $ 1oo P Re. Estimated R'86� []X Annual❑3Year munerationnual ❑3Year SEE EXTENSION OF ITEM 4, OF THE INFORMATION PAGE- WC7764 TAXES/ASSESSMENTS/SURCHARGES EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) MINIMUM PREMIUM $00 MA TOTAL ESTIMATED ANNUAL PREMIUM If Indicated below,interim adjustments of premium shall be made: © Semi-Annually 11 Quarterly E Monthly OFPOSITPREMIUM 08/25/15 PARSIPPANY 82 desuv ftle IsauFn Office 9 ,AuthoriatlRf,presoneytlivg 4MCOtI.iSflflaA 39SR(Redd 04108) f s Office of COnmimerAffairs—,-d 3asin ess RBgr•].goz I ON&plaza.-St&P,5NO Boston,Mamcbmetts 02116 Home lImprorvement CimtractorRegaist�kn rta € 172ms E)V[M6 523120?7 7ss2MV FRAS==R CONSTRUCTION CO. DEAN P.O.BOX 1845 COT f.UJT,AAA 02635 �aa a�r�r-: - iJ'.dsidress Q 3taneae-7 �"1 T3mgicq-..�t �_T.a�i'.�¢ ��o�. l�a�6v�as�a2a O:fixo:Cc & 3a�ay ar:t 2s�iSfbritmoiad use Otly O ZvpmVmms,—.CONT2ACTOP. bdflmtaeexca ioa Sfio�c snrr � 9?2a6 'pn� OSusoPCan�t�lend$sfsaess3eba�Eoz � F.-Tzmr==-32 2a - Oak 3.01197"1=-SubeS170 mast COiNSTRTJ ON co_ eFALMOMI-LMADM& Q��,Q� YatcrlidsvlNia�sr� r • 4 • )�s NSassacnus =-�� _ran a i� afi�Ty CovamcTion Slip CT1•ISI>T - ®i:° u r15Z:CS-097668 104 7WIYM VIEW FAST EALMOUllB-MA.-:02SM ✓•G- Jl•� - 06107r1017 i W9 • Fraser Construction, LLC 31 Bowdoin Rd. Mashpee, MA 02649 Email: info (Ofraserconstructioncapecod.com www.fraserconstructioncapecod,com FAX 1-508-428-0123/ PHONE 1-508-428-2292 ITCH#112536 CS#97668 PAR T"IAL►� - 00F\PR0 P 0SAL► Date �f . . _�w ..11. 1•.l" ,1 1._ - Name j,r <$ Jill Brael Email /' ,�`` ,, 1 brendanbrazel@doincast.net Phone (781) 249-1341 t � Job Address3;r" '`,3 90 Lake Dr, CeAterville4, ! % ' 1f 7 ! r �V F'RASER CONSTRUCTION hereby proposes to,perform the following services in a neat, professional.manner in accordance with the & ufacturer's specifications'and loocd building code. " p CeriainTeed S O ttalm Best ,. Shin es 'tandmark Landmark Pro Landriiafk TL e Resistant. 10 ears 15 years 15' ears.,- Wind Warritnt' , ' , 1WMPH 130 MPH 130 MPH Wei t/a uaro ` 240lbs f 260-270 lbs ' -305.lbs Shingle design Two-Piece 1 Two-Piece Tf ree-Piece Color Palate Standard 1 Max Definition-' Max Definition VaHeys Closed cut , Closed cut x Open copper Investment ' $6,200------: dl$7,600 $12 400 "'a r * All above shingles quotedawtth CertainTeed SO`yer non prorated 4-Star warranty <k' Shingle Selection: Color: -` �" Initial: Price does not include low pitched°°section water side or shed right side. FRASER CONSTRUCTION guarantees the shingles against Blow-Offs for 15 years. Please note that all pricing is contingent upon current market pricing. If contract is not accepted within thirty days of date of proposal, change in price may occur due to deviation in. material price. Any deviation or alteration from above specification will.be executed upon written orders and will become an extra.charge over"and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry necessary insurance upon the above'work:. We, if not accepted within thirty days may withdraw this proposal. `•;• ` Work Permit- I +� {Sign iVatne) give Fraser Construction the,?ermission to pull a perm tfor#lie'work,be ng.done.at Address FRASER CONSTRUCTION, LLC:Curries Workman's Compenisation and Public Liability Insurance on the above work, certificitte a it ble upon,request. DATE OF ACCEPTANCE: �' /Aop F 11'\X r Homeowner Fraser CaostrtictionLLC OF N 01 r J,,y e� SIR I r' b 2 Commonwealth of Massachusetts Sheet Metal Permit / 10/28/15 Date: Permit# n SPERMap 1 Estimated Job Cost: $ 7650.00' Permit Fee: $ J� Plans Submitted: YES NODE 2 3 2015 Plans Reviewed: YES NO Business License # T1%JIN OF BAR N ST�IIR 11: ant License# 1226 Business Information: Property Owner/Job Location Information: Name: Balanced Hvac Inc Name: Brazel Residence Street: 15 Jan Sebastian Dr Street: 90 Lake Dr City/Town: Sandwich Ma City/Town: CENTERVILLE MA Telephone. 02563 Telephone: 781-540-8084 Photo I.D. required/Copy of Photo I.D. attached: YES + NO Staff Initial J-1 /M-r-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family * Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: INSTALLATION OF ONE 310AAV036070 NATURAL GAS FURNACE. INS_TALLATIO F_ NF 113ANAn3n nl lTnnnR rnNnFNc;FR ALL GALVANIZED TRUNK DUCTWORK AND FLEXIBLE BRANCH RUNS. INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes E No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box®,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and 'accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments 4 Final Inspection Date Comments Type of License: By ® Master Title ❑Master-Restricted LinefnlStubbs City/Town ❑Journeyperson Signature of Licensee Permit# , ❑Journeyperson-Restricted, License Number: 1226 Fee$ ❑ Check at www.mass.gov/dal Inspector Signature of Permit Approval �a COMMONWEALTH OF MASSkCIiUSE SHEET METAL 1NORKERS ,; ISSUES THE:;FOLLOWING LICENSI=AS A `�<, pgASTER UNRESTRICTED rr;r �� �a LINCOLN T.STUBBS r .r EiA#ANCED HVAC,►KC I . 15 JAN SA B.A9.. ION OR 1j tr SANDWICH,MA 02563 ".. 1226 ;> g712812017„ ---� :w.,a....a-� „7•„7 -ch Along All Perforations COMMONWEALTH OF RfiA_ CHI: ET°TS& ® ® ® • � BRp OF SHEET I�IETAL WORKERS ISSUES THE FALLOWING LICENSE: <AS A BUSIN; SS Ic' i� L..140LN T STUBBS !� 1ALANCED H11►C;, I NC 15 JAN SEBASTIAN QR nWICH SAN - I+9A 02563 0 D• M3-�SALCHUSETTS L C SE +Us ?''.<S;t ENU 4d NUMBER 1-4 n �n E�w Q` NONE S56562736 s , z 0. 2015 07-24-1971 P IS SEX At !e,=6.04 is NONEEISS z i LINCOLN T ' 78 JOHN EWER ROAD " }`" SANDWICH,MA 02563.2605 f41'9*•L �U✓ S DD 0&iB-E&f7 Rav O)-132gD9 The Commonwealth of Massachusetts Department oflndusti id Accidents Office of Investigations" 600 Washington Street Boston,MA 02111 ' www.mass gov/dia Workers' Compensation InsIIrm.ce Affidavit.Builders/Contractors/Elects icians/Pluambers Applicant Information Please Print Legibly Name(Business/ocgani= ioallndividua1):. 5s I ig n C2) w-,�yq c a A] t Address: f S i-A yy 6e to f GI�= City/Sta&Zt: �"'�� Phone-#: : e- Are yawa employer?Check the appropriate box: 'I`ype of pcoj ect(required): 1.2fam.a employer with <f 4• ❑ I am a general compactor and I 6. ❑ employees(full and/or part:tame).*.. have hired fle�-contractors New construction . 2.0 I am a'sole proprietor or parb=- listd on#he•attached sheet: 7. remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity employees and have workers' 9. []Building addition [No workers'comp,insuEance comp.insuzance.t required.] 5. We are a emporation and its 10.0 Electrical repair or additions 3.® I am a homeowner doing a-Il wort officers have exercised then 11.❑Phlmbing repairs or additions myselt workers'oworkers'c' right of exemption per MGL required.)t c. 152,§1(4),and we have no 12,❑Roof repairs i employees.[No workers' 13.❑Other comp.insuzance regWred.] *Any applicant that checks box#1 must ab;o fill outthe se lion below showing du:ii woriccrs'compensation policy inforuation. t Homeowam who submit this affidavit indicating trey are doing aU woric and then hire outside contractors must submit a new affidavit indicating such. *Contractors that cheek this box unit attacbed an additional sbeet showing the name of the sub-contractom and state wbedw ornot those entities Dave employees. if fe sub-contractm.ban employees,they must provide them worlan'comp.,policy number. ,Tam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: 7��i r Policy#or Self ins.Lic.# U2u U i�E F/40- i S Expiration Date: 3 i Z o l 4, Job Site Address: 9 n I-A t o I r t V c- CiV/State/Zip: �✓�l 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 crime 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 instmance coverage verification. I do hereby eerhfy antler thepains-and penalties of perjury the the info ma ion provided above,is true an'd correct, S' tore: Al Dater Phone Offuial use.only. Do not wrhe.tn this area,ta.be canTleted by city or.townoffrciaL City or Town: PermitUcense# Issuing Authority(circle one): .'A.Board of Health 2.Buuildiag Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r Town of Barnstable ' .� Regulatory Services MAM Thomas F.Geller,Director a tMla�` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable,ma.us Office: 508-862-403 8 Fax: 508-790-6230 i Property Owner Must Complete and Sign This Section ILU—sing A Builder I �d'--114,J 7�1,ilZ as Owner of the subject property hereby authorize 26 6 n c.e-d ! V V?I C T W C- to act on nay behalf, in 0-matters relative to wo&authorized by this building permit 90.. �-fil<e Dr (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 Ownet Signature of Applicant Print Name Print.Name Dat Q:FORM&OWNERPOWSSIONPOOLS Page 1 Residential Heat Loss and Heat Gain Calculation 12/23/2015 In accordance with ACCA Manual J Report Prepared By: Balanced HVAC Inc ' For: Brazel Residence 90 Lake Dr Centerville, MA Design Conditions: Centerville Indoor: Outdoor: Summer temperature: 70 Summer temperature: 95 Winter temperature: 75 Winter temperature: 0 Relative humidity: 50 Summer grains of moisture: 94 Daily temperature range:Medium Building Component Sensible Latent Total Total Gain Gain Heat Gain Heat Loss (BTUH) (BTUH) (BTUH) (BTUH) Duct 1,151 0 1,151 4,630 Floors 0 0 0 2,044 Walls 1,911 0 1,911 5,010 Ceilings 2,013 0 2,013 3,083 People 1,200 920 2,120 0 Fireplaces 0 0 0 6,917 Misc 11200 0 1,200 0 Windows 10,210 0 10,210 6,324 Doors 237 0 237 621 Glassdoors 3,445 0 3,445 2,686 Skylights 0 0 0 0 Infiltration 2,787 2,688 5,475 19,613 Whole House 24,154 3,608 27,762 .50,928 ( 2.5tons ) HVAC-Calc Residential 4.0 by HVAC Computer Systems Ltd. 888 736-1101w Load calculations are estimates only,actual loads may vary due to weather and construction differences. l idi/IS VE Town of Barnstable � Permit# 2 o f.sd1a 3 VC O 1 2015 Expires 6 month from issue date Regulato �SServices Fee ®e 14 _ AWN OF BARNSTI, //11 1 1639. �� Richard V. Scali,Director BLF & HIED MA't Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY G Not Valid without Red X-Press Imprint Map/parcel Number 30 n Property Address qb � �^�`� L ��P/� M 4 O o1(p 3 [residential Value of Work$ �� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address V tP � r�Y1�4!'1 Bra Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email- Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor [► -1'am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Z replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑' Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE; QAWHILESTORMS\building permit forms\EXPRESS.doc Revised 040215 vy 2he Commornvealth of Massachusetts r Deparhrrerrt of Indzfsi al Accidents - 0.0ke of£rz eshgairons b00 Washhvzgion, `t eet. y.. Boston,MA 02111 ��.�rvau rrrassgo��din . Workers' Campensation Insurance Affidavit.Builders/ContractorslEIectricianslPlumbers Applicant Infmrmation . Please Print f egibI� �e�13os�ess�Drgaatr�onffnal}: J Addrtss: Cityfstatel Phoneluk Are you an employer?Check the appropriate to bar: Type of project(required): I.❑ I am a employer with r-4-O,I am a general contractor and I employees(full azrdl`or part-time).* have hired the sub-coaitractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet:. 7- ❑Remodeling ship and have no employees. These sub-contractors have g_ 0 Demolition wading for me in any capacity employees and have workers' [No workers'comp.,'nsra„re comp.msurangy#� 9. �Buildtn�addition �equired J 5. We area corporation and its 104 0 Electrical repairs or additions 3.YClst am.a homeoumer doing all urork officers have esercised.their 11_Q Plumbingrepairs or'additions myself [No workers'comp. fight of exemption per MGL 12.❑Roof repairs . insurance required..]B c.152,§l(4h and we have no employees.[No workers' 13.❑Other comp.insurance required.] ;Any appPicantdiat checlstws#1 mnst also fillautthe sechoabelowshnwing their�watere compensa&npoliryinformaaon. #Homeowners who submit This d6da«t indicatng they are rlaing all woak ant dm hire outside contractors r®st submit anew affidavit indicating sacb- atzactvFs,that check�This bmc mast attached ag additianat sheet shouiagSbe name of the sub-contwAm.and state whe&er or natthaseeuddes lisp �empimlees.If the sub-caatactoeshave employees,they moutpmv-ide their workers'camp.gal cy nimmber. I arlr art euepla r t)tatis prarzdrirg workers'corrrp¢resalian insrrrarrce for avr}*¢nrlvi es Below is thepolicy and job s&e information. Insurance Company Name: Policy'or Self-ins.Lic.t Expiration Date: Job Site Address: citylStateizip: Attach a copy of the corkers'compensation policy declaration page(shoving the policy number and expiration date). Failure to secure:coverage as required.under Section 25A of MGL c 157 can lead to the iruposition of criminal penalties of a fine up to$1,50a 00 andfor one-year imprisonment as well as civil peualties.in the form of a STOP WORE ORDER and a fine of up to$250-DO a day against the violator. Be adidsed that a copy of this statement may be forwarded th the Office of , Investigation of the DIA for insurmce coverage vetcation. I do hemby certify a ter the paurs and ponalt es ofprtjury that the information prmrided abM d is hUe arrd:rarest Simature: A 17 Z�ate:,. / /!�I ' Phone# . Offidai use.only. Do not write in thb area,to be campietted by city or town offidal. City or Town.: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityiTown Clerk 4.Electrical Inspector S.Plumbing InspectOF 6.Other Contact Person: Phone#: ... . Information and lastr actions Massachusetts C neml Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pm suantto this statute,an.empfayr�is defined as."_.every person in the service of another under any contract of hire, express or implied,oral or written_" An ernpfoyrs is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged ina Joint sntmTrise,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 dweIling house having not more than three apartments and who resides therein,or the occupant of the - dweIlmg house of another who employs persons to do maintenance,construction or repair work on such dwtIling 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 stems 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 buZdings in the commonwealth for any applicant who has notproduced acceptable evidence of compliance with the bnmrance.coverage required." Additionally,MGL cbaptEr 152, §25C(7)states"Neither the commonwealth nor nay of its political subdivisions shall enter mtn any contract for the performance ofpublic work until acceptable evidence of compliance with the inctrrance. re m Patents of this chapter have been presented to the contracting al.3faDzity." Applicants Please El out the workers'compensation affidavit completely,by checlang the boxes that apply to your sitnatiou and,if necessary,supply sub-contractors)name(s), address(es)and phone numbers)along with their certificates) of incr=ce. Limitad Liability Companies(LLC)or Limited Liability-Partnerships(LLP)with no employees other than the members or partners,are not recpmed to carry workers' compensation i Omarce. If an LLC or LLP does have employees, a policy is requited. 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 atTzdavit- The affidavit should be ret=ed to the city or town that the application for the pemhit or license is being requested,not the Department of mar A ccidents. Should you have any questions regarding the law or ifyou are required to obtain a workers'. compensation policy,please call the Department at the n=bcr listed below. Self-insured companies should enter their s elf-fi s*ran ce license number on the appropriate lime. City or Town Officials f _ Please be sure that the affidavit is complete and priated.legrbly. 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 pemlitllicense nwnber which will be used as a reference number. In.addition, an applicant that must submit multiple permit/Ecense applications in any given year,need only submit one affidavit indicate current policy b1f6r oration.Cif necessary)and under"Job Site A ddn_-&'the applicant should Wate"all locations in (city or town)-"A copy of the affidavit that:has been officially stamped or marked by the city or town may b e 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 vent Ure (i.e. a dog license or permit to bum leaves etc;.)said person is NOT required to complete this affidavit The Office of Investigations would at.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. canmlonweala of Massachuszf_tts Dement of ludursfrial A c i-dents Mace of javestigatioa., 6�-�ashingtQn t Bastanz MA 02111 T(-,L 4 617 727-4900 Qxt 4-06 or I-9 -MASSAFF Fax 9 617-727-7M Revised 4-24-07 masg gag/dia Town.-of Barnstable Regulatory Services - dF Richard V.Scali,Director Building Division s.srT,433.E. ` Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 G www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: Please Print (JOB LOCATION: Q_ O number street village "HOMEOWNER": J 1LL I��IAZZ- TO 7YO Wr Qy9 12` I, name home phone# work phone# CURRENT MAILING ADDRESS: Eva ulew 0.atT i �r./lry�/>-ram 1'illl� f➢2.�K� • city/tomrd state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. )- � 2�, Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. , HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is .f .ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that.he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc i Revised 040215 WE Town of Barnstable Regulatory Services MASS. A Richard V.Scali,Director i639. 100 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. . a . .Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:QWNERPERMISSIONPOOLS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � ! )F BARNSTABLE Map �✓D Parcel Application # 01 ^0 5 n Health Division ° ' ' Date Issued Conservation Division Application F 0 -(� Planning Dept. ES Permit Fee Date Definitive Plan Approved by Planning Board M Historic - OKH _ Preservation / Hyannis "Project Street Address �y� Nu ,Village Owner l JA,6 p,,� —12.AA1t-Z- Address Telephone _7 Permit Request '�G�`bu la PAayEGnv �SAPOW yu�;C� AILS 4wo WZff^� :'tom- L,%v,.L. RC S CE'- L) A ` tw D qErs , / ,/� s r V&LV L' _1��.___1- c e /c^- 4AM.,o-t (/• +:ILL 0 4 FtA_ Square feet: 1 st floor: existing proposed 2iid"floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ���a�''' 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 ❑ Nb - 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 `Lem— tTelephone Number Sqo VT Y Address` 70 LA4—, 0'k&e_ License # CagV ,11 1r 1 Y A aw-L Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY Is +APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER d ' r DATE OF INSPECTION: ' FOUNDATION FRAME r 2JI911� 1 r r, INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING t � DATE CLOSED OUT ASSOCIATION PLAN NO. 77re Can inorrivealth of-Massadliusetts Departinerrt of rndrrstrial Accrdeias Uffrce ofIrxr--stigadons 600 Washington Street Baston,41A 07111 xvrvttr rnassgovldiii 'Workers' Compensation Insurance Affidavit Builders/Contractors.EIectricians/Plumbers Applicant Iufaizaf on Please Print LegibIy ` Name(Susmess oiganizationm i zidual). —)VrJAnD Address: u,e-.,3 u11t City/Statel2i0-: NI/}' Phone4 `791 S 0 I Are you an employer?Check t e appropriate bom: Type of project(required)_` 1.❑ I am a employer with -RTI am a general contractor and I 6. ❑New construction employees(full andfor part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. 7. _0 Remodeling shipand have no employees These sub-contractors have g: ❑Demolition wodring for me in any capacity. employers and have u orliers' LNo w orloers' comp_insurance comp_insuranre.l 9. ❑Building addition. required.] 5. ❑ We are a corporation and its 10_❑Electrical repairs�additions officers have-exercised their 3.❑ I am a homeou net doing all'work': 11_❑Plumbing repairs or additions my-self [No workers'comp_ Tight of exemption per MGL 12_❑Roafregairs insurance required,]E c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required-] 'Any applicant:that checks iws 91 must also fill out the section below shouting their wickets'compensation policy infocut2don_ t Homeowners who submit this affidavit indfrating they are doing all waA and dLen hire outside cantractorsnmst submit a new affidavit indicating,sack. '-Contractors ihst rh this box must attached as additional sheet showing the none of the sub-contractors and state whether or not tbnse enutieshave employees. If the subcontractors bare employees,they mustprmdde their arorkexs'ramp.policy number. I ant art eitiplo�,er that is prot.7ding it orkers'conipettsatiati insuraRce for my employ-ees. Below is the policy turd job site informahbn Insurance Company Name: Policy 44 or Self-iris.Lic_4 Expiration Date:: ob Sate Address: 96 CST '✓'q 11 City/State/Zip: 1 d Ll C t I� 0,26 3 2. Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and respiration date). Failure to secure coverage as required under Section 25A of NfGL c 152 can lead to the imposition of criminal penalties of a fine up to S1,500:00 and/or one-year imprisonment,as well as civil peaabies.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 tz the Office of Investigations ofthe DIA for insurance coverage verification. I do hereby ce4Wfi, de�the irs and penalties ofpe ui y that the information pm idtd above.is true and correct Simature: } J'I3ate: Phone Official rue only. Do not wrrtte in this area,to be completed by city ortotrn ofciat City or Town: - PermitUcense Issuing Authority(circle one): 1.Board of Health 3.Building Department 3.City/Town Clerk 4 Electrical Inspector 5.Phambing Inspector 6.Other Contact Person: Phone 9: -- - - 6 Information and Instructions t ; Massachusetts General Laws chapter 152 regrmes all employers to provide workers'compensation for their employees. p tD this statutc,an empkyee is deed as."_.every person in the service of another under any contract of hire, express or implied,oral or wiftea." An ezr,prvyer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged ia 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 gjrotmds or building appurtenant theret o 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 applica.ntwho has notproduced acceptable evidence of compliance with the insurance_coverage regnired_" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter mto any contract for the performance ofpublic work until acceptable evidence of compliance with the ias rran ce. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the woiicers'compensation affidavit completely,by checking the boxes that apply to your sitnation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their certificates)of insmance. Limited LiabBity Companies(LLC)or Limited LiabUity Partnerships(LLP)with no employees other than the members or partners,are not mqumed to cant'workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. B e advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of iasmsnce coverage. Also be sure to sign and date+he affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Deparmmeat of Industrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the number listed below Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials f 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 till out is the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the per is /licrose number which will be used as a reference number. In addition,an applicant that must submit multiple perMWHcense applications in any given year,need only submit one affidavit indicating current policy inforraaton(if necessary)and under"Job Site Address"the applicant should ve to"all locations in ' (may or town)-"A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for fume permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or pmmitnotrelated to any business or commercial veutvre (i-e. a dog license or permit to bum leaves etc)said person is NOT rmFdmd to complete this affidavit The Office of Investigations would like to than 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_ Tht Camaanwe-dth of Massachus(,-tt; Ilegartm"ant cif laid ial Accidents Office of)hVestigatio= FQ4 Wasbi OGIL Sit Boston.,MBA 11�111 Td.4 617-727-49QO ext 406 Or 14M MASSAFF, Fax#617-727-7749 Revised 4-24-07 .magovf dia. r _ Tos Town of Barnstable . Regulatory Services - .p� � a Richard P.Sc4 Director Buf &hg Division T=Perry,Bm gr,Commissioner 200 Maim S reei;Hym is,MA 02601 www.to wnl arnstable_ma_us Office: 50 8-862-403 8 Fax: 50 8-790-623 0 Property Owner Must . Complete and Sign This Sec on If Us in ABuslde� as Owner of the subject property hereby authorize - to act on mp behalf, in all matters relative to worX bythis buiildiag permit application for- 4d;o Addres of Job) 'Pool fences andare the res onsibilityof the applicant Pools are not to be - er i- ized before ence is installed and all finalinspections peormed and accepte Signature of Owner Signature o phr-a„t Print Na mP Print Name Date QXI0R .V T NTEFPER3Y1J.].11o1e00L7 - Tower. of Ramstable Regulatory Services Richard V.ScaA Director F DuUding Division Tom Perry,Biding Commissioner 200 Mato Street; Hyamus,MA 02601 z63g- ti QED► www t own.barnstable_ma.us ' Office: 508-9624038 Fag: 508-790-6230 HOMEO'MUR LICE SON JOB LOCArOK 90 nnmbcr' s�cct � 19 7 YO I LA- `70 SYO FW name - homcphonc# wo6cphonc# • / l qu� �l �i f L 3 CURRENT MAILIDIG ADDRESS: (n r t9 r '`L'J citylbyiu sib up codc 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 hirewho does notpossess a license,provided thatthe owner acts as supervisor_ DFFINMON OR HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two- family dwelling atacbed 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 notbe considered,a hameowner. Such`homeownet'shall sobmitto the Building Official on a form acceptable to the Boding Official,thathchhe shall be responsible for all such workperformed underthe bmZdina permit (Sectioon 109.1.1) The undersigned-horaeowneif'assumes responsibility for compliance withthe State Building Code and ofher applicable codes, bylaws,rules and rega3atinns- - The tmdersigned`homeowner"cm das thathe/she undE=tmds the Town ofBamsfable Building Deparimcntminimum inspection procedures d requir ut s andtbat he/she wM comply with said promdnms and reqa5=enb- sib ofHomcovrncr , Approval ofBnUdingOfcial Note: Three family dwelling's confammg 35,000 cubic fEet or larger will recjatired to comply whir the State Building Code Section 127.0 Canstxnctiou Control HOMMOWNEXIS EXEMMON The Code sbers that: 'Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109-U-Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as sup ervisor." Many homeowners who use this exemption.are unaware that they are assuming the responsibilities of a supervisor (see Appendix(�,Rules&Regulations for Licensing Construction Sipervisors,Section 2J5) 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 mlicensed 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 responsrlir7ities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibrMdes of a Supervisor. On$ie List page of this issue is a forma currently used by.several towns. You may care t amend and'adopt such a form/certification for use in your mmmaum t: - Q 147P1•ZLFS'�ORMSlbm7dmg Pr�it famsl�RESSdoo Revised 0613 I3 rc, � ICSL Wt XI i 370 A5^f d -J pit.J. U � E x �c e,. f � f ` � of ie ' 6 �/ , tti41?ek)r7 f. . i �At4L3V 4 � t f v lie SMOKE DETECTORS REVIEWED ,<,_ � ° K S. ST E BUILDING DEPT. DATE _ FIRE DEPAR TMENT DATE ` BOTH SIGNATURES ARE REQUIRED FOR PERMITTING r a ` i