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Home My WebLink About0030 LAKEVIEW AVENUE o : , > , F THE T Town of Bax stable Permit# Regulatory Fee 6monthsfrom issue date yMASS. '$ Richard V.Scali,Director '� D 16.39. ;Nw�,� MAY 10 20,l y Building >< Paul Roma,Building Commis ioN-O 200 Main Street,Hyannis,MA 02601 STABLE www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PExNUr APPLICATION RESIDENTIAL ONLY 0 ` Not Valid without Red X-Press Imprint Map/parcel Number Property Address �°�CC «� �y � �►y.3t ` C ��. [Residential Value of Work$ o ' Minimum fee of$35.00 for work under,$6000.00 Owner's Name&Address 1 �C� C Contractor's Name ItA3 �,�Cwz Telephone Number. ^©S Home Improvement Contractor License#(if applicable)(S-•C-4GS'&2 . Email:"�Wwex:sp�\kx RiCCC� y ao"j Q a Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Ch ck one: 91 am a sole proprietor ; ❑ I 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) Ej Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to -+2� Z '�� L ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof). Re-side Replacement'Windows/doors/sliders.U-Value :2 (maximum.32)#of windows #of doors: *Where required:•Issuance Uthis 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. yofuirre . he Home rovement Contractors License&Construction Supervisors License is SIGNATURE: QAWPFILESTORMSUilding permit formsTY PRESS.doc 01/25/17 27w Commompeakh of-Wassadtrtseas Depaahneut of rudzusb at AcddeFaft - Offl-ce of gafions. 600 WashfizLdm Slreet Bosun,MA 02111 kvrvto�cugo�Iilra... , Warke& Ce Affidavit Bbflders1Cunftmciurs/E1 ers - Applicant Tnfwmation Please Prim Nm= Addre �1�� l,�VAt.�Cam—' c��kc-�-z=- Are you an anployer?:Check the appropriate box: Typc of project(reclnirea): - I.❑ I am a employer uitfi 4 ❑I am a general confoctor and I ' 6.•❑New oonstmc is= employeasfall andfor pa-fime).* have hired#fie sub-con acfom 2. I am a sole proprietor arpar aer- listed on the attached sheet 7. ❑Remodeligg b These sn -contractars have - s9p and have no employees 8_ ❑Demnlitsaa ¢�xandhavewodwre tivo�ag forme in �to any capacity- . � $ 9..El Suil�addition [N4 worlcers'comp.insurance COMP-ma+2n+ required_] a' '. ;5. ❑ We are a corporatim and its la El Electrical repairs or adcwons 3_El I am a homeowner doing all work officers have e=rim t 11-ElPlu nbingrepaim or ad4&tions myself.[No wodmrs7 ooaip- right of esempfi4m per MGI.. a❑Roof repairs i�+cnras�re re uked_]I C. , g 1{4 )6 andwe have no employees [ltiTowoz rs■ 13.❑other comp-msm me required_] 'AnyzWEcmtfttcbecUboaftlmastalsoSIlo the sectioabeiowsi�rniag�eawo�ces'campensahc�peyeyia�nrmsuo�. #�aa�eoamersvaaho sabugt this�a in> g t3Ley axn doing a1F vrc¢ic and daen]nFxe outsidetoat�samst submit a aem affida�iCmditsthp sadi . ZCo 6 that cth—I Its boat must s<tiarhe d addid-A sheet d miag tHemmne of the s¢b-�a amd stye vchether or not ihme entities} employees.7fthesuh c�tr>t<rtflesZuve emPIaS�rs,d2e}'amstpm�ide theme srndmn'iMmp.pali y am ibm I am an emplayer that is pruuiduy�torkets'cotfl peresaffirn irrszirartcs�or aria etrrp£ayees $eiory is iihe policy arm job s>�s ircformatintl< Itssmaace Comp3nY.1PTame:' . Paficy�or pelf-isa€Lio_� •'Esgit�ioaBate: .. . Job ate Addiess: CiiylStawzJ p: , . - Aftach aropy of the workers`Compensationpolicy declaration page(showing the policy,mrmber and expiration date. Faiinm to sec=coverage as required under Sec ion 25A of MGL m 15 can lead to the imposition of criminal pennit%es of a fine up to$L,54a 00 im dray oao-�!earimpfism=umd;as well as;ci penalties in the farm of a STOP WORK ORDERand a fine of ups -00 a day against the violator. Be advised'that a copy of this statement ttsay be fxvvarded to the office of IIIvesttations ofthe DIA for insurance covemSe veri$c�on_ Ida[Tw6yc us Id tal�sa�Ferj�ry'thattheinformatfmiprot�r�da �ii �iaidCorrect -` Sure: Daft- 1r' Phone � P �Gi L►,f CiaL arrrTy Do iwt orate in ffib area,frr be cmnp&dd by chp artoteu afjSrcrat ' City or'faWu: Plerm eeme kn3ing Auffit}rrtg(Carle one): ; L.Board of mr BW-Mmg DgMtnM& 3.CAYf rown.Clerk 4.Elechr fuspictor S.Fhumbi ng l aspector 6.Other , Com#act Person: J%OW#: - 1haformation and Instructions, M cac7 s�CT=uc l haws chapter 152 rmq==all�ploy�s'�prime W°J"�'� for fbeg employees. PMTC[M3t-m fbia fie,an MMPIoyee is dafined m=every person in fhe SmnCc of another under auy contrast ofhurl express or implied,oral or wtiit=U-" An a zV&Yer is defined as"an inEyjamh,per,assoniaiic corpm-.dm or ofb ar legal e�y,or any tavo or more of the foregoing=gag�,m aJoat ,and j=bEmg the legal�esembdi=of a deceased eorployer,or$ m receiver or trustee of an mcT vidaal,parresbip,associafinn or other legal entity,emploYMg=3pI0Y=_`- However the owner of a,dwelling horse having not more tbm t=apartments and who resides f=eni,or the occupmmt of fi>e- dweIImg house of mo$er who employs persons to do mabbman x,cansf uccti on or repair wo&on such dwelling house or on the grounds or bmlcrmg appm-[ananf Thereto shan not because of such employmmit be deemed to be an employer" MM chapter I52,§25C(6)also stains fit"every s aim or local Iicensmg ageicy shall wifhhold the issuance or renewal of a license or permit to operate a business or to constracE buMfitgs is the commonwealth for auy applicautw•ho has notproduced acceptable evidence of cnmpL-mc:e wn tTze hmurahce covexage repaired-" .Add�Dm]2y,MM chapter l52,§25C(7)states-Tedhmtie nor a'ay ofitspolift I snbcr7Ld-ns shall enter into any contract for the peafmmance ofpublic Wmk u3jI acaeptabk evidence of compliance wi-ih I ie insurance._ rcqciir=euts of this chapterhave beenpresent�dto the mutt- ting a[dhO3 ity." A.pplicanb ' Please fal oil fie worl='compensation affidavit completely,by ch=jjng file boxes that apply to your situation and,if s)name{;), addresses)adph=e,n= ez(s) alongw-Ahthezcmtifeate(s)of necessary,supply s wiEno Io ees other than fb e insurance Lmmitedi-iabz�itY CrnnP�.es(fit=)or Li�itrdI.iabflitp-Paztne�sbiP (LLP) �p Y members or parta=s,are not rupirt4 to cany workers'compensation nasm-arm If an IZC or I.T P does have employees,apolicyisregontd- Be advisedthatthisaffrdayhmaybemflx ittedtotheDepaitmeatof Industrial Accidents for conflonatim of msar m=mvmzge_ Also be sore to sign and data the affidavit: The affidavit should be retied to ,the city or town that the application for the permit or license is b6ngreqamtcd.not the Department of ; TnrT,�ct,ial 1�=d=tL Sbouldyou have any questions regardmg the L or ifyon are recp d obtain a mots' cmp=saticmpo�iey,please call tbdDepartmeotatthmmumibetlisf�dbelow. Self-msuedcorVaniasbovlden rti�eit self-msar. ce Hcrose number on the appropriate Ime. City or Town Officials _ f Please be sane that the affidavit is complete andprmic;dlegRb y_ The Departmevthas provided a space at tha botb3n of the ent affidavit for you f)Ell out in the ev the Office oflnvesdgatinas has to cozGactyou regarding the applicant Pleasebe sm-oto fllinthopennitllicensexmmberwhichwMbeusedas amfez-eacem=be. I•-addition,an applicant fiat mast submit multiple pe,,,M;crose appht:ations in any given year,need mly submit one affidavit indicating cu=mut policy iofornation(if neoessary)and under-Job Site Addrcss-tie applicant should write"all locations in (cftY Oz_ town).'A copy of the affidavit fiat has been.officially stamped or marked by Ae city ar town may be provided in the applicant as proo-fthat a valid affidavit is on file far f ore peanits or licenses_ Anew affidavit must be filled oirt each year.Where a home owner or cit�a is obtaining a license or permitnot related to any business or roman m ial v�(i.e.a dug license orpe�ittn bunlleaves etc_)said.persern is 110Trequircdtn complete this affidavit : TheOffcoOfln wou->fir_toffl nkyoukadvaamforyourcooperatzonandshDOAyamhav'e-any questions, please do not hesitato to give us a call. 'lie Department's address,telephone and fax number_ - D:qmmnent ofIud �A�ci�l ants �4 man Fax 617'27 7749 Revised4-24-Q7 - -g ToWn of Barnstable - Regulatory Services . a MABEL Richard V.Scaly Director - 1639. �� Building Division. ` Paul Roma,Building Commissioner 2< 200 Main Street,Hyannis,MA 02601 www.town.barnstable=ma=ns Office: 509-862-4038 Fax:.508-790-6230 ' - r - � - `:.�♦ � yr ' �Y ►r_ ` r Property tOwner Must J_ Complete and Sign This Section If Using A Builder 4 vZA(A I� t , as Owner of the subject property 1 . 111 hereby authorize o a VS V� 'c!t� to act on my behalf in all matters relative to work authorized by this building pemzit'application for: (Address of Job) 'k'kPool fences and alarms are the responsibility of the_applicant Pools e: are not t d or utilized before fence is installed-and all final insp ns p ormed and accepted. S• a-of Owner . S• tore o Applicant ��a1c� �lCce,lS Print Name Print Dame r . Date . • - WORMS:OWNERPERMISSIONPOOLS Town of Barnstable u Regulatory Services f plFt Richard V.Scali,Director Building Division S swarta AJ= t Paul Roma Building Commissioner NAM 039. 200 Main Street, Hyannis,MA 02601 �,� O�Ep www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION d—//4 Please Print DATE: ..JOB LOCATION: age "HOMEOWNER": �1� lGl��; c �tGADDRE%: . home one#R rk p e# CURRENT MAIL � �.�`G 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 hermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." Many homeowners who use.this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing.Constivction 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 per application, permit a lication that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currentlyused b 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 06/20/16 ._.�e�mn �Ia,3a�ic>�e6ta 3 -Office of Consumer Affairs&Business Regulation 1f�E 1MPROVEMENT.CONTRAC.T_OR.. gistration77283 TYPeT . piration:-._714 _2-- LLC--- THOMAS C.WHITE WQ£1)��t/f}j3TfER'LLC. ;;THOMAS WHITE 144 TAIN-ST CENTERVILLE,MA 02632 Undersecretary j h Massachusetts -Department of Public Safety.., . Board of Building Regulations and'Standards �.I/ll�ll lllill/ll Jll�/C1 YI111� License: CS-066582 �j.TTS THOMAS C WHIJ* c\ '/, 415A MAIN ST ; IIF . • Centerville MA 02632 Expiration Commissioner 03P14/2017. _ I • I 3 use group which _ Unrestricted-Buildings of any 991tn)of main less than 35,000 cubic feet co e-;',osed space. etts he hilass3chus Failure to possess a current edition pit o of thi license. '— State Building Code is cause for rev �ov�DPs / 'For DPS li¢ens'ing information visit: wv+W Mass TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 'a Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board QG�- Historic- OKH _ Preservation/ Hyannis Project.Street Address ?)0 L.WCr\1 kC W Air-- Village �AKA Owner nkAArQ� cs L\S Address Telephone Permit Request '�� Ci 'i( U Q tlJO VkF5Ag3 C-(\ C- - �'R �L►� c� T=kIS\�wc 4,X ,S'�� /wk"VowS -(09V OAS Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District- Rb '" 1 Flood Plain Groundwater Overlay Project Valuation (Q WO-Pt, 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 _ Barns❑existing.'❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:-,I 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<T'o r , �0�'a'W�C�'C-' Telephone Number �� Address [S-A Ak'oli ` License # "��` 0� a- l64; Home Improvement Contractor# Email+\Pjwgalgorke.h'ca vemo" AE'l Worker's Compensation #-- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO —caw U1_) e5t_ 3L tLL SIGNATURE - DATE 1,4Z l 8� FOR OFFICIAL USE ONLY APPLICATION # r DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE a OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 17M COZZzwomweaM ofMa"adr=etts Department of rud=h ial Accida7ds -- Office aOM.Ttigadom. 600 W'asltu-- rgtm Street , Baswn,M4 02111 . : t6�v��massg�w�dia . Workers' Campensai anInsurance avit S.gilders/CantractarsMectrician-vPhj�nhers licant InfQrm dGu . Please FFint "bl Are you an employer?Checkthe apprapriate bay , Type of project(regtm<ed)c I_❑ I am a employer with 4. 0 I atn a general con�ciZsr and I emglapees(full anlbr pat-time)* Isave hired Me suit-coafact=' 6- 0 New c onsaucEim 2. I am a sole pmptietar orpartler listed ou the attached sheet. 7. 54 RemodeHag s*and have no emplc5ees These sob-cantractom hava & Demolifiag Wn—ch6- Rx me.in any.Capacity employeas audlmre wo&em- [No lt+'dt mm'comp.rrasm=t-- comp_fimranml 9. ❑B.ulldiag adEtion reclnired] 5.'El We are a coipmafifla and ifs 16❑Electrical repairs cWidQions 3.0 I am a hzmeoumw Gluing ail work ofiicerrs fi"a�X c ed their 1 L Q Plumbmgrepairs ar�dctitians myself[No workem'comp- right of esempf lon per MCI. 17 0 Foofrepairs i�+� a required-]i } c_152,§1(4�and we have no employees.[No wozT=, " 13.D-Other canxp. ��j - *Any WBuatfbat cbecU bas-,I,— O.,.SIlo tht sechoabeiows3rasEiug i5eswat3ces'campeasa5aupaycgi e� 11�a�eowaerS Who SII�t rltis�d3[`3]fig limy sae dcd�ag wa¢t sad then lade auLside r,,,,+,,,-e,,,zamst suhmita nem afad�ert indicate rnr� • fCaafrsde6*zIeb—Irt}us box mastxmwbedsaadrlitirm 5heashmcdagdmn2meoEthesat�c rr�:mdstate�r �mtthnseenritiQshs� empk,32es.Iftbe-6731 cantaCti=j reemployers,they33M Srp=Mide&ek vwkas'tam . P PQHCY=nbm lam all erripr fliQt is prutreg tvarkets'camperesran urszirartt a jvr irr enrpTuf�ees SeTaav is ii�spaficy aru�jata�it� Frzformair'ntL ' Insurance company Name: Poficp�or pelf-jr.M Lie. F�gifai slDate: Job Rte Address_' c . Attach a copy of the warps'compensationpolicy decIara4iou page(showing the policy irmEber and expiration(Iate}. Failure to secure coverage as required under Section 2 5A of MGL c.157 cg n lead to tie imposition of rrimh,aI penak es of a flue up m$L50 D-OQ andlor one-yearimi f onm,,t:as well as ciO peuaNes,in the foaa of a ST(]P WORIK ORDIa and a fie Of up to ZTOG a day 26aiust tf►e violator- Be ad-used gmt a copy of this shatemenr=y be forwavded to the Office of lmvestigadcm oftie DIA for insmmuce cavemge vedficatioM_ Fdo hemby CM#j! prar1 an F s afvmf ly&a Ills iafurwtat rrprm rigid abor ig true u�id correct Itate Phone ik S 08,"- 3 — �� Ufficitd use anly. ,Da swt writs in this area,to be crrmpkted by CRY artown oo`rcrat City or Tomi: Perm ffucense# Fssn�g Afitarity(car.Ie One): L Bbard of Health 3.Bviffirmg Depute eat 3.City1Town Clerk 4L El 6.Other ectrical Inspector S.Plumbing i or Coact Person: Phone#: information and Tnstmefions { . I52 all�glopeas to Provide waste compensation for ibex earplayees. ��***setEs GeaalLawg ersonm$�e seayice of anotherrmder aaY contract Cfhrze, pursua�to.this sib,an�IayeP is defined as.¢.�rY P emprcsg or implied,oral ar wratffi-" • asso fiisn,cozporafion or other Legal eaiitY, 13't�vo or more AnFay�is defned as an mdrvidBal,p � �faiives of a deceased employer,or the of she foregoing®gaged M a joint e�prJse,andmcbidmg die Legal sepses �°g�IDY�- IIowever the recei4M or trastee of an indivi�p ��O or other legal entity, not mcQe than three apartments and Who r=deg therein,Cr the,ocr,¢p of foe - owner of a.dv►elling house having ,than or repay w�.on such dweIfmg house awmiling house of SII�er who.PI°Yg P��iD do , or on the grounds or b�di appmten.amtheretn cball nntbecanse of M.h empl be deemedtn be an employees" `� state or local a�cY shall withhold fie issuance or 1�GL chapter ISZ,§25C(�also sfaip that every m the cD=nO Wealf3i for any renewal of a ficease or permit to operate a baseness or�construct bmT[I>ngsmcffraace coYexage r " applicant who has not produced acceptable,Y., , t 6 cOA cn With aa��y ofifs political gnbdivisians shall Wr Ad�onalb,MGZ chapter 152,§25CM states-Ieifhex ` . f o hc'4Pa&Mtj acceptable evidence of campli�cewife the mstuance•. eni�r into c;a any ntmct for the performan Pub arrETio fy.' ' rtqa�:=Mts of this chapter have be®presea�ed to the contras ng '. . ensation affidavit compl�ly,by g�e boxes that apply to yc�boa�if Please fi]l Cyst file-WD3asg'comp es and e nnmber(s)along their cesfifir�E(s)of necessary,supply��actor(s)name(s), address( ) phon Io ee$other than the Liability Compames(LLC)or LiabgityP Ps.�)wtlhno eanp y fiance. Leif i �m once If an.L'T_.0 or LLP does hate nlad 2s orpartn s are not to conyv�caL c kmaybm . to ees a. olicy is regII.i Be aLIVisedtbatthis affida-Yitma3'be snhmiiir3 in the Depa�-finent of In I ovld �- y P Also be sure to sign and dafehe affidavit. The affidavit Accidents for confnmation ofinsm'ance coverages stA not theDep�neat of be returned to the city or town that the applicafion far the penIIit or license is being r$gae Ti&.fti.l A-c dam_ Sbovldyon have any gees ions reg g the Iaty ar ifyon are requhea to obtain a wow' comp=sationpDlicT.PLease caIl the Deparfm.e�at the nzsnbez listEd below pelf-msvred ca�a�es should enter their self-i Haan=License number On the apprapriaie Tine. Gift'or Town Ofccials - leteand Ieg�Iy. 'IlieDeper�.enthas provided a space at thebotfnm. Please be sore that f3ie ff&vit is cCmp P has is cord youregardmgihe applicant of the�davitfor youin fill out inthe event the Office oflnvm Please be sine in fi11 in the pennit/Ii cease rossber whichwM be used as a refere n ce bin t: affidavit indicating a'addit'014 an applicant "t that innA submit mu�Ie p e�lIicease appliba ions in�y gw�yam.need only snbmTt and "lob e Address"fhe aPPlica2t should v;fife"aIl locaizcns in (city or policy infvznation(if neY) ed or madced by the�y or tnvm may be provided to the town)='A copy of the-affidavittbathas been officially stamp applicant as proof that a valid affidavit is on file for f�.p�=�or hcoses A ncW a$idav$must be— o e ash year.-Where a homeowner or citizen is obtaining a.Iicense or permit not reZatad any bps or coulmeazial vie - is rPe ties affidavit (ie_a clog license or pert to bran Leaves -)snot person is regrmed to coIet r�fn thankyaum advance foryour coopeaaiicn and sbouldyouhave any 4�t0�. The O$me of Investigations w v dl please do not hesifadz to give us a call. i Zhe 1?epffiime�t's ad&mss,tElephcne and fax rMber: 1 C=MMWMM OfIChMlr Depaitnent Oflu lAocilen� • f�� tio� BQstto- MA(P-11I -`r 14' 61 1-- 49OG i�Et 406 Qz 1-977-MASSkFE Revised 4-24-07 gd�d T©wn of Barnstable a R;,egalatory Se�c� Bwidmg Division zoo Main sftwk Hyana*MA OMI .uarnstsble.�M Offices 50"62-4038 Fsg: _508-790-6 Property Owner Must Complete and Sign This Seethm . If Using A Builder �C +ACto as owner of the subject property authonze l T - -� m act on m behA y .an m2tten relative to cos$ this,bmIding P=33it 2 catim f= LA►c(-I vktw Avy, C' o (Address of ob **Pool fences and alarm. are the responsibility of the applicant Pools are not to be fined or Utilized.befort fence is instilled end a}I final inspections are rmed and accepted. / S*aitaxeof06er of APP w Print Name - , Print Name Q.FOR)M. June 2,2016 y �q Mr.Thomas Perry I\1GI GI NEERI Building Commissioner NG ONSULTANTS Town of Barnstable taurd a�fl m.Ro,mentai 200 Main Street Hyannis MA 02601 s` RE: Beam Design for Bearing Wall Removal, 30 Lakeview Avenue Centerville r: �t��X;.aL` •� R}ice�etJ \ - fk. F t Dear Mr. Perry, _ t 9 k r � McKenzie Engineering Consultants,Inc was retained-by Tom White;contractor,to r complete structural design for a flush framed beam to be installed in order to remove a bearing wall between the living room and the bar area at the house located at 30 x Lakeview Avenue in Centerville. 3 We completed a site visit to review existing conditions,make measurements, and to evaluate load pathways. Based on this information we completed design for steel beam to support the loads currently on a wood beam supported by posts. The beam length was determined to be 18.5 feet long and will span the entire length of the room. Based on the loads on the beam which include the second floor load and roof load,the required beam necessary to support the design loads is a W 8 x 40 steel beam that will be installed flush to the ceiling. The beam can be supported by 4x6 PSLs down to the concrete foundation wail that is present on both ends of the beam. The posts need to be continuous to the foundation or solid blocked with like material below to the concrete. In order to flush frame the steel beam,the web will be packed out with 2x lumber and through bolted. The bolt pattern needs to be for 1/2"bolts spaced 18" on center alternating top and bottom 1 3/4"off the top and bottom of the web. This will allow the floor joist to be rehung with flush framed joist hangers. If there are any questions on this matter,feel free to contact me at any time. Sincere nzse, Pr .,M Al g Consultants,Inc. cc. Tom White 79 Millstone Road awster,MA 02631 74.3531144 74.353.2142 w.mckengineers.com F - �--�' f :b W III , ! I y OfficcoEConsumerAffairs&Business-Regulation ME IMPB01[EMENT-CONTRACTOR-... gistration. 3 Type 1 pirat bn. 2Oi ..--- LLC - -- ;_ THOMAS C.WHITE 1NQQ�WQRLfER LLC. I r,THOMAS WHITE r 415A MAIN-ST. - CENTERVILLE,MA 02632 - Undersecretary j • - f 1 • Massachusetts -De - - -- --- p wbich partment of Public Safety ` Buildings of any use grow I . Board of Building g Regulations and Standards ed- 35,000 cubic feet(991m)of : Su-C� llnrestrict , contain less t1>� License: CS-066582 Ztic', osed space. THOMAS C W" . 415A MAIN ST Centerville MA 0'2632 � , r e usetts e Ma ssach :y , f the •, edition o se. . e n �.t . n ice s current this _ c Failure to possess a J� � ��i�a,� . Code is cause for revocation o '� Commissioner . Expiration State Building Mau COv/BPS 03/14/201 information visit: www. Z_ For f)P5U Fens.. j' 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a - Map Parcel ' ( Z ( Application # 06Ck Health Division Date Issued Conservation Division "ApplicationJ Feb-,.:) Planning Dept. Permit Fee. 1 6 Date Definitive Plan Approved by Planning Board Historic = OKH Preservation/Hyannis Project Street Address Village �t�� Owner t� �hc kc� I Addresses t&k0/1et,3 Av- .OeAA-cvtIV Y4 -.LG32 Telephones ) Permit Request on (C .2 c) Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuatiN!'-, `XCCQ Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ,3 Two Family ❑ Multi-Family ;# units) Age of Existing Structure 191? Historic House: ❑Yes B<o 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: cl/Gas ❑ Oil ❑ Electric ❑ Other t=� o Central Air: M-Yes ❑ No Fireplaces: Existing New Existing wood/coal stove ❑yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: 0 existing newer size_ it •:� Attached garage: ❑existing ❑ new size _Shed: ❑existing ❑ new size _ Other: - Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ,, to Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Pcw I �. Qazexl� �S trnG Telephone Number 5_ J a �.I�� Address t-03 1 min yy rem License# CZ 'o a 63 W�_ (�)31-e-rV+ e CIA ©2CS5 Home Improvement Contractor# lo;9 I Ll Worker's #Compensation N `77iS ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 'IcmrMtAn bd(�11 SIGNATURE _P DATE —7 —Zc> 12-- FOR OFFICIAL USE ONLY `? .APPLICATION# S DATE ISSUED MAP/PARCEL N0. _ �i } ADDRESS VILLAGE 7 OWNER ' r f DATE OF INSPECTION: 'FOUNDATION:': E FRAME r.4 2 INSULATION , `r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL F -•.GAS: ROUGH FINAL x . ' DATE CLOSED OUT ASSOCIATION PLAN-NO. f 5 The Commonwealth of Massachusetts Page 10 of 10 Department of Industrial Accidents Office of Investigations, 600 Washington Street vwu Ux` Boston,MA 02111 z• www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 17n Name(Business/Organization/individual): Address: to 2,1 C'b-,rl City/State/Zip:Ct>W V'(1e MA 026.s Phone#: Are y u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance S. ❑ We are a corporation and its required.] ' officers have exercised their ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152, §1(4),and we have no .12.❑Roof repairs insurance required.]t 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 their workers'comp,policy information. I am an employer tliat is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:�Li l ''`o�yc-k n2wR.t. c-c' Policy#or Self-ins.Lic.#: '3 t Expiration Date: 0_0 Lbl s Job Site Address:2r-> LaL<z-V JeO AVV—, City/State/Zip:GAk (A 11-( t PIA c)X3 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 I do hereby certify under the pains andpenahies of perjury that the information provided above is true and correct Si ature: 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#: I 8/,2�/2012 5.59:10 AM PST (GMT-8) FROM: 100005-TO: 15087781218 Page: 2 of 3 ACC CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 123/2012 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 Fti€fEate-holder4n lieu of such endtwsem Q. PRODUCER Dowling&O'Neil Insurance envyy. CONTACT NAME: 973 IYANNOUGH ROAD 2N�FLOOR PHONE N9.E t A/C No: 778-12 Hyannis, MA 026011990 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAICIJ INSURER A: INSURED INSURERS: PAUL J CAZEAULT&SONS ROOFING INC 1031 MAIN STREET INSURER OSTERV I LLE MA 02655 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 13922010 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.LIMMS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL SUER POLICYEFF POLICY EXPt.I.S LTR 1 5 WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYW GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(RENTED awErence) S CLAIMS-MADE DOCCUR ME EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE IS GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRD- JFCT LOG $ AUTOMOBILE LIABILITY C�pp (Ea acBlcitlEerOii)IN LE LIMIT $ ANY AUTO BODILYINJURY(Perperson) $ ALLOWN AUTOS EDS R AUTOS SCHEDULED BODILY INJURY(Per accident)NON-OWNED PROPERTY AMAGE tilR£DAUTO AUTOS Peracadent S $ $ UMBRELLALJAB CCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ -` $ I A WORKERS COMPENSATION YIN WC5-31S-386670-012 8/10/2012 8/10/2013 ,/ oRY MIT LIS AND EMPLOYERS'LIABILITY OFFKERIME BEANY R�OCCUDED?ECUTNEa NlA ` E.LEACHACCIDENT $ 1000000 (Mandatory in NH) ` E.L.DISEASE.EA EMPLOYEE $ 1000000 If yes,desorbe under DESCRIPTION OP OPERATIONS below ..._.-.. E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedufe,if more space Is required) _ I Workers Compensation insurance coverage applies only to the workers Compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED. IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ' J � Jeff Eldrid e `J ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD CEF.T CIO.: 13922010 CLLCNT CODE: 1614132 Maria Anderson 8/23/2OL2 5:56:24 AM Page 1 of 1 This certlf1Cate cancels and supersedes ALL rre`jious Ly issued Certificates. '.. I Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - Registration: 103714 Type: Private Corporation Expiration: 7/9/2014 Tr# 228652 PAUL J. CAZEAULT & SONS, INC:,. Paul Cazeault 1031 MAIN ST OSTERVILLE,;MA 02658 ~ Update Address and return card.Mark reason for change. Address ❑ Renewal Employment R Lost Card DPS-CA1 0 50M-04/04-G101216p ✓fie -VOnirr�oycurealc�a o�yl'�tikfc�clztcae�a••. Office of Consumer ffairs-&11 Business Regulation License or registration valid,for individul use only _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - Registrati r . •103714 Type: Office of Consumer Affairs and Business Regulation Expiraho 7/9/20.14{ Private Corporation 10 Park Plaza-Suite 5170 j• Boston,MA 02116 PAUL J.CAZEAU'LTONS INC.: Paul Cazeault I n 1031 MAIN ST � (Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Superiisor License: CS-026325 PAUL J CAZEAULT n�'r 1031 MAIN S OSURVILIA MA 02655==- �� Expiration ' Commissioner 10/20/2013 Property Owner Must Complete & Sign This Form if Using a-Roofer I Builder. 1 (Print-) f."h".AQ . C hG , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all'matters relative to work authorized by this building permit application for: 1 Address of Job Signature of Owner. Mailing Address of Owner 3ov t 0'�-63ox- Tele hone# • .` P _ Date �-- - t x (Please return this form to Cazeault roofing along with your signed contract;.It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you) fax#508-420-4555 i M 4 , ' Bright Thinking in Solar r �g - a oa^ � � _- ,�. a ram. �' �`• ,�' �`•, �O `e k. . 1W M Ai , Aw Ar AV ter' rp* Component Specifications Code Compliant 6o6i-T6 and 6o63-T5 The SolarMount°system is PE certified. •SolarMount ballast frame Call Unirac for documentation applicable 6105-T5 aluminum extrusion to your building code SolarMount®rails Warranty Mounting clips and clamps Tilt legs and L-feet SolarMount° is covered by a io-year limited Two-piece standoffs product warranty and a 5-year limited finish Severe Condition 4(very severe) warranty. zinc-plated welded steel For complete warranties,download any •one-piece standoffs SolarMount® installation manual from 18-8 stainless steel our web site. • Fasteners CRC NNUNIRAC Bright Thinking in Solar Visit us online at www.unirac.com I KYOCERaMyGenT'Systems 10 YEAR LIMITED PRODUCT WARRANTY, 5 YEAR LIMITED FINISH WARRANTY Unirac, Inc.,warrants to the original purchaser("Purchaser")of product(s)that it manufactures ("Product")at the original installation site that the Product shall be free from defects in material and workmanship for a period of ten (10)years,except for the anodized finish,which fi nish shall be free from visible peeling,or cracking or chalking under normal atmospheric conditions for a period of five (5) years,from the earlier of 1)the date the installation of the Product is completed, or 2) 30 days after the purchase of the Product by the original Purchaser("Finish Warranty"). The Finish Warranty does not apply to any foreign residue deposited on the finish.All installations in corrosive atmospheric conditions are excluded.The Finish Warranty is VOID if the practices specifi ed by AAMA 609&610-02—"Cleaning and Maintenance for Architecturally Finished Aluminum" (www.aamanet.org) are not followed by Purchaser.This Warranty does not cover damage to the Product that occurs during its shipment,storage,or installation. This Warranty shall be VOID if installation of the Product is not performed in accordance with Unirac's written installation instructions,or if the Product has been modifi ed, repaired,or reworked in a .; manner not previously authorized by Unirac IN WRITING,or if the Product is installed in an environment for which it was not designed. Unirac shall not be liable for consequential,contingent or incidental damages arising out of the use of the Product by Purchaser under any circumstances. If within the specifi ed Warranty periods the Product shall be reasonably proven to be defective,then Unirac shall repair or replace the defective Product,or any part thereof, in Unirac's sole discretion. Such .repair or replacement shall completely satisfy and discharge all of Unirac's liability with respect to this limited Warranty. Under no circumstances shall Unirac be liable for special, indirect or consequential damages arising out of or related to use by Purchaser of the Product. Manufacturers of related items,such as PV modules and flashings, may provide written warranties of their own. Unirac's limited Warranty covers only its Product,and not any related items. 16C peyen_ n , . So^ \rM | K8n~ T*^~U�8�^��U ��=��Un^ — � ' . ` ' ^ Pub 11om»-l»uvn.0 Auuustum1 , SmlarMmumt Module Connection Hardware............................................................^...... I Bottom Up K8Odu|8 [1ip-----��---� ----- ................ ��—' MidClamp ------.--�_. ...................................................................... EndClamp...............— ..................................................... ---_--...........:......—'2 SolarMoumt Beam Connection Hardware........................................................................3 ' � L-FOOt...................... .................................. — ....... .---.........-------..........3 � Solar0�oumt Bemms-----.----_--.r--_.'--.~--------_—...-----..--------4 ' ' ^ . . . _ . . SoUarMount ModK�U«� ��ec��K� ��rdwmare SolarMomnt Bottom Up Module Clip Pert No.3O2B0OC ^ Bottom Up Clip material: One of the following extruded aluminum Bottom (hidden..see ' alloys: 8UO5'T5.O1U5'T5. 0O01-T6 ~ UP C/lp Nut no ^ Ultimate �tenoks� 38� .Yie|d:35h� F��h: C�arAnod�ed, - - � Bottom Up Clip " � /w|owoU|oand uoa�nloads are valid when components om ~~~^ ' assembled with SoladNount series beams according toauthorized , UNIRACdnoumonto _ Assemble with one'/4''2OASTMF5A3 bolt,one'/4''2OASTMF5O4 . serrated flange nut, and bne1/4'flat washer Use anti-seize and tighten to1O#+ibaoftorque ^ Resistance factors and safety factors are determined according 0u part 1 section 9of the 2OO5 Aluminum Design Manual and third- party test results from on |AS accredited laboratory ~ / ^ Module edge must be fully supported by the beam NOTE 0N WASHER: Install washer on bolt head side ofassembly. � `OC;NOT install washer under serrated flange nutApplied Load Average Allowable Safety Design Resistance ' Direction Ultimate Load Factor, Load Factor, ' | � tj ` . ^ ' ' L- p=�� ' � ` �X' � ' � / _�_ . ` ` . . ' � ^ Dimensions specified m inches unless noted ^ ! | . � k "� | m no OLARMouNT - D. . - - A HILTI GROUP COMPANY SolarMount Mid Clamp.' Part No.302101C,302101D,302103C,302104D, 302105D,302106D • Mid clamp material:One of the following extruded aluminum j rra Bolt alloys: 6005-T5, 6105-T59 6061-T6 Ml0 1 la e N Clamp � � _ Ultimate tensile: 38ksi,Yield:35 ksi • Finish: Clear or Dark Anodized �. Mid clamp weight:0.050 Ibs(23g) Allowable and design loads are valid when components are assembled according to authorized UNIRAC documents Values represent the allowable and design load capacity of a single j mid clamp assembly when used with a SolarMount series beam to �. retain a module in the direction indicated ` { Assemble mid clamp with one Unirac /"-20 T-bolt and one'/"-20 f ASTM F594 serrated flange nut • Use anti-seize and tighten to 10 ft-Ibs of torque Beam I Resistance factors and safety factors are determined according to `` part 1 section 9 of the 2005 Aluminum Design Manual and third- party test results from an IAS accredited laboratory Applied Load Average Allowable Safety Design Resistance t 3 oa6CgMa -- Direction Ultimate Load Factor, Load Factor, BMWEt ENHOO"`tS _. R Ibs(N) Ibs(N) FS Ibs(N) M Tension,Y+ 2020(8987) 891 (3963) 2.27 1348(5994) 0.667 Transverse,Z± 520(2313) 229(1017) 2.27 346(1539) 0.665 e Sliding,X± 1194(5312) 1 490(2179) 1 2.44 741 (3295) 0.620 1 —►X Dimensions specified in inches unless noted SolarMount End Clamp Part No.302001C,302002C,302002D,302003C, 302003D,302004C,302004D,302005C,302005D, _ 302006C,302006D,302007D 302008C,302008D, 302009C,302009D,302010C,302011C,302012C End clamp material: One of the following extruded aluminum alloys:6005-T5,6105-T5,6061-T6 oltt Ultimate tensile:38ksi,Yield:35 ks'i • _,�•-� • Finish: Clear or Dark Anodized End clamp weight:varies based on height: --0.058 Ibs(26g) nd` Clamp Allowable and design loads are valid when components are Serrated assembled according to authorized UNIRAC documents i Flange Nut Values represent the allowable and design load capacity of a single end clamp assembly when used with a SolarMount series beam to retain a module in the direction indicated Assemble with one Unirac'/<"-20 T-bolt and one'/"-20 ASTM F594 Bea serrated flange nut • Use anti-seize and tighten to 10 ft-Ibs of torque • Resistance factors and safety factors are determined according to part 1 section 9 of the 2005 Aluminum Design Manual and third- party test results from an IAS accredited laboratory Modules must be installed at least 1.5 in from either end of a beam Applied Load Average Allowable Safety Design Resistance . Direction Ultimate Load Factor, Loads Factor, rarasr Ibs(N) Ibs(N) FS Ibs(N) ' Tension,Y+ 1321 (5876) .529(2352)- 2.50 800(3557) 0.605 f" Y�I Transverse,Z±' 63(279) 14(61) 4.58 - 21 (92) 0.330 Sliding,X± 142(630) 52(231) 2.72 79(349) 0.555 Dimensions specified=in=inches-unless=noted 1313 A HILTI GROUP COMPANY SolarMount Beam Connection Hardware f SolarMount L-Foot Part No. 304000C,304000D L-Foot material:One of the following extruded aluminum alloys:6005- T5,6105-T5,6061-T6 • Ultimate tensile: 38ksi,Yield:35 ksi • Finish: Clear or Dark Anodized L-Foot weight:varies based on height:•-0.215 Ibs(98g) • Allowable and design loads are valid when components are Bea assembled with SolarMount series beams according to authorized Bolt UNIRAC documents L-Foot For the beam to L-Foot connection: •Assemble with one ASTM F593 W-16 hex'head screw and one errated - ASTM F594 W serrated flange nut Flange N •Use anti-seize and tighten to 30 ft-Ibs of torque Resistance factors and safety factors are determined according to part . 1 section 9 of the 2005 Aluminum Design Manual and third-party test Y results from an]AS accredited laboratory NOTE: Loads are given for the L-Foot to beam connection only; be �"X -sure to check load limits for standoff,lag screw,or other attachment method Applied Load Average Safety Design Resistance A SLOT FOR, Direction Ultimate Allowable Load Factor, Load Factor, Ibs(N) Ibs(N) FS Ibs(N) m Sliding,Z± 1766(7856) 755(3356) 2.34 1141 (5077) 0.646 Tension,Y+ 1859(8269) 707(3144) 2.63 1069(4755) 0.575 Dimensions specified in inches unless noted Compression,Y= 3258(14492) 1325(5893) 2.461 2004(8913) 0.615 Traverse,X± 486(2162) 213(949) 2.28 323(1436) 0.664 • a r UNIRAC . - D. . - - A HILTI GROUP COMPANY SolarMount Beams �^a Part No. 310132C, 310132C-B, 310168C, 310168C-B, 310168D 310208C, 310208C-B, 310240C, 310240C-B, 310240D; ` 410144M,410168M,410204M,410240M 4 Properties Units SolarMount SolarMount HD Beam Height in 2.5 3.0 Approximate Weight(per linear ft) plf 0.811 1.271 - Total Cross Sectional Area .. in 0.676 1.059 Section Modulus(X-Axis) in 0.353 0.898 Section Modulus(Y Axis) in 0.113 0.221. Moment of Inertia(X-Axis)' in 0.464 1.450 Moment of Inertia(Y Axis) in 0.044 0.267 Radius of Gyration(X-Axis) in 0.289 1.170 Radius of Gyration(Y-Axis)' in 0.254 0.502 SLOT FOR T-BOLT OR s SLOT FOR T-BOLT OR 1°728 --1 14"HEX HEAD SCREW 1/"HEX HEAD SCREW • T 2X SLOT FOR SLOT FOR BOTTOM CLIP 2.500' BOTTOM CLIP - , 3.000 1.316 SLOT FOR 38"HEX BOLT U - SLOT FOR 1.385 • 3�" HEX BOLT a .387 .750 1.207 Y Y 1.875 A .FX L►,X SolarMount Beam SolarMount HD Beam Dimensions specified in inches unless noted 4 3116 4'r v e n, % .-BY 'KYOCE 06v 04 A4 _g Features and Benefits Easy Iristallation, likie iis4llalss Ar- I 1W _�W E y C h S� d"I "in a(s oicE� a ra""e 6 d:'ai f":I i,2,,,15-',,� �6'QNatt�' 16alran ST At eas ,W 5_e�I if 0 e 6 ue lKyocera Solar has developed the pre-engineered 111.9f"MoT:�o\Ai6f-thr ot I'A TU- a- z5' ",re"T,'T ffi�LLaW 211 1 arrE A E MyGeni,�Syst'e m to"p�ovicle-6verything you need to generate your, 40-install _,qwn electricity.These easy systems,are compatible with a wide variety of roof '--�Naclein the U.S.A.:�,I- I% 6 Opes and materials.WyGen Systerns are dEsighed A, ali i'nv'e,,ir t 1� ke i �pnne s. for use on either Residential and Lite Commercial a Di� ,,n egr -I _�k I� ,IK _j4A b�uilclings andIre icleA'l forg'6th new coin""struc6 o I 0 yeaFwarraqty retrofit applicitions.Ahen you install aMyGenrSystem;�k V- on your home or building,�ou will be playing a majoi A Afkequir6g�jess�� _�rts th�n-.,qt Ae in preserving precious natural'resources. NIRAC-Rac in is t leading'rac in choice in ih'96.S.'F �CAW d W ess�N 0 ,,groun,ing�..�L Pow�`ered PVAM 10'10 card��a st;h(4ard fe�ture "FOG K" W&W" hif6ring�tfi 9 n ervice� r _on-lineffionit66g s 0erj iendly W_ _Provicles�.eas �tofolloW�I 0-byste str' on's y, , _qe,,,t tARA -ai t I�ook Y_Y, AN qf� able, 1A jP 'Ye 6e4 Designed by experience �ra eng r_,,,(6y ars 7 led _"ide) byl 4 ng"a c;e- 6'r3do s i9f I i A C6 0 ag�n i -*Combiner box,-.labels, 'holder,66jo !use5j,yse per,vWi for dibund',*MC4 4 r dririecticin,cabl -te b A!r�:(401 11 ricani- Specifications Residential (240V) Lite Commercial (208V) ro 56326 5 4 W- 0 6VI -,v,�, Izj,l %SMSV !Wp 0 ;1' 41-� 7; 6 4 4 ,.Y 4,30' 5 2 D L,�,,0215 k. 1� -6 424 1_�A&I 20 ' 3 gg.j X 2 X 1-0 X12 3 X`12 112`�'g_'j _`412'�_ 6x 1 W PV P-2�0 0 460( 4600) `446000 NOW PVP_ ',wP4�8 , I 4 2 ��VP-35'00 PVP-4800 C7 77 SolarMount° PV's most versatile mounting system F ' r w_ __- t. Ground Mounted---Roof Mounted"IIII10pen Structure G ogle Campus, Cal omia Solution Solult n " � Solution ©�2007�_-CO�Lrtesy ofjELSolutions lnc. SolarMount is the most versatile PV mounting rail system on the market today. We've engineered installer-friendly components for maximum flexibility, allowing you to solve virtually any PV mounting challenge. The universal SolarMount rail system has three options which can be assembled into a wide variety of PV mounting structures to accommodate anyjob site. Unirac provides a technical support system complete with installation and code compliance documentation, an on-line estimator and design assistance to help you solve the toughest challenges. : � RIIRAC Bright Minking in Solar Visit us online at www.unirac.com SOLARMOUNT° RAIL OPTIONS PV's most versatile mounting system SolarMount®HD HD(heavy duty)rail adds the SolarMount advantage to PV PoleTops',U-LAs(see separate data sheets), and custom applications that require long spans. Standard SolarMount® Standard rail gives you ultimate flexibility,including MODULE MOUNTING bottom mounting and tilt-up options. Assembly Sequence Is Your Choice Top Mounting Clamps Bottom Mounting Clips Ideal for flush mount applications, Use bottom mounting clips such as residential rooftops,where (standard and HD rail only) it is most convenient to secure whenever you prefer to footings and rails before installing preassemble the array using modules to mounting clams p g p - module mounting holes. securely grip any point of the Simply fit the clip into its rail module r odu e frame,freeing you from slot over the mounting bolt for the constraints of module a secure connection.Adjust the mounting holes. clip position anywhere along the rail slot. ATTACHMENT OPTIONS KEY BENEFITS Flexible Components Speed Installation of SolarMount® Rail Standoffs Maximum flexibility Use standoffs whenever flashed installations are required,on tile roofs,for example.Two-piece Flush, high-profile or aluminum standoff allow precise placement of low-profile configurations a flashing over a secured base prior to the installation of the standoff itself. Roof or ground mount All standoff types come in four standard Pitched or flat roof heights:3,4,6,and 7 inches.Appropriate flashings are available. Serrated L-feet Ease of installation - Standard for ground mount installations on Installer-friendly components residential and commercial rooftops,use L-feet alone above asphalt composition shingles or in Minimized penetration with conjunction with flat top standoffs.Mount longer attachment spans than standard or light rails.Configure to either of two competitive products rail heights,one promoting air flow for cooling, the other offering close-to-the-roof aesthetics Designed with customer input Strut-in-Tube Style Legs Grounding and wire Quickly set the precise tilt angle required.Styles management options are available for high profile(i or z legs per rail) and low profile installations. R Each series offers three leg lengths so that you Complete technical support can adjust to exactly the tilt angle you want—up Installation and code V to a maximum of 6o degrees—without cutting and drilling at the job site. compliance documentation • Online estimator FastFoot'" ,41 The FastFoot'"attachment features Eco-Fasten Person-to-person technology by the Alpine Snow Guard Company, customer service allowing attachments to metal,concrete and wood decks without compromising the integrity of the roof. Core component for Unirac S-5 mounting solutions S-5 captures the PV potential of standing-seam Three rail options to metal roofs at the lowest possible installed cost. accommodate any job site Clamps don't penetrate the roof.With only two basic components,S-5 clamp sets are easy to Incorporated into other install and align,saving time on the job site. major product lines T-Bolt RS Quickly top mount your modules to any rail using the T-bolt RS.The modification to Unirac's s - original T-bolt allows placement and hands-free attachment using top mounting hardware. mm No UNIRAC Bright chinking in Solar ill o �Via Town of Barnstable *Permit# O F-spires 6 months f n ,s d' Regulatory Services Fee ` snaxsrntate. Thomas F.Geiler, Director QED MId► CORE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us_ Office: 508-862-4038 Fax: 508-790-67130 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1:a�a Property Address 190D Residential, Value of Work- y/_7 Minimum fee of$35.00 for work under$6000.00 Owner's Name& Address ri f�(rr � h Qba/1s S . ------------------ Contractor's _.T'elephoneN Lim ber Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) orkman's Compensation Insurance 2011 Check one: ❑ P I am a sole proprietor ^_'` . h ❑ I am the Homeowner AB UZ have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# G!/LIQ cf�(7 5�0/_0-114 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)(trot stripping. Going over existing layers of roof) Re-side of doors ❑ Replacement Windows/doors/sliders. U-Value _ (maximum .35)#of windows *When:required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.!li,turic,Conscn;dion.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: t� C.ifi ers\deallik'+Appl)atal(neat\Microsuli\Windo��s1T tporary Internet files\Content.(hdlook\DDV87AA7\IiX(TINS doe Revised 0721110 �Izrssaihusctts- Ucirtrtmint .rf 1'uhlic�ti;rlct� AM Board of Buildim.: Re-i tatimm. and Standards Construction Supervisor License License: CS 9714 Restricted to: 00 RICHARD P GARNEAU JR f4 251 WOODSIDE RD W BARNSTABLE, MA 02668 Expiration: 414/2012 (",,mmissuner Tr#t: 25310 �l,r..,r 'hn,r;l� Ilclr.rrinrcnl !'ullr �,rtrr: tinar t! ,,( }tuil�lirr Ilc�ul;rtirr, nrl �I.urri.rrr!• , JJ Construction Supervisor License t.u.ense: CS 9714 Restricted to: 00 RICHARD P GARNEAU J R 251 WOODSIDE RD W BARNSTABLE, MA 02668 Expiratton 4412012 �r ) � 1r ��ljl j/11�11�GC�l:'�+r �`� c�,f � " ' r,�,it'rt'» ,; Office of Consumer A fairs end Business Re rulmil}rl 10 Park Plaza - Suite 5170 Boston, Massachusetts 021 16. Home. Improvement Contractor Registration, Registration 162600 lvpe Supplernent call BAKER & ASSOCIATES INC. expiration. 3/26l201:3' RICHARD GARNEAU 521 SHOOTFLYING HILL RD - CENTERVILLE, MA 02632 Update Address and return card. Mark reason Im chant; Address Renewal Emplovou+nt 1.410 r l,)fticr oft owumer Affairs'& Business Regulation License or registration valid for individul use only '. OME IMPROVEMENT CONTRACTOR before the expiration date. If found return fir: .r Office of Consumer Affairs and Business Rekulation ---.Registration: 162600 Type: 10 Park Plaza-Suite 5170 Expiration:P 3/26i2013 Supplement Card Boston,MA 02116 At;SOCIATES INC. -'1C1 WQ..D GARNEAU MA 02632 +: - t ndersecroary Not valid without signature I� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ,-www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business[Orgariizahon/lndividuai): .'BQ L r d A ssae w4s "Ae Address: S D City/State/Zip: Cahrgl Phone#: 1��10 G� ?w Are you-an,employer?Check the appropriate box:' Type orproject(required: mil. I am=a l t t general conracor=ahnd i<- 1.`[j�am a employer with - / • fl g � 6. �New construction # have hired the sub-contractors employees(full and/or part-time). _ 2.❑ I am a sole proprietor or partner listed on the attached sheei. 7. ❑,Remodeling _ ship and have no employees k _ These sub-contractors have 8.;❑Demolition . • working for me in any capacity. employees and have workers' [No workers`comp.insurance comp.insurance: 9. �]Building addition required.] 5.`0 We ama'corpomtion and'its - X 10r0 Electrical repairs,or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right f exem n o exemption per MGL myself. [No workers comp. p p 12.❑.Roof repairs " insurance required.]• c. 152, §1(4),and we have no employees. [No workers' 13.®Other t comp.insarancerequired.] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information: f 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 thai 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/4,,So a c&key�f Policy#or Self-ins.Lic.#: jr r�'_ �,�D� �S/d/ D �l Expiration Date: Job Site Address: �D ✓Q/S�o_��1Z°� QUA - City/State/Zip: ivi / e' Attack acopy of thewo;rkera'compensation petky dectarexi page(showing the'policy number,and expiration date): -Failure zto secure,cover-age as=requiredwnder Section 25A of-lvlGrL,c.452,can leadLathe=impmition,ofcriminal penalties-of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine ' of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town officiai City or Town: -Permit/License# Issuing Authority-(cirde'one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector .6.Other Contact Person: Phone#: ! Client#- 9742 2BAKERAS COR® 05i12t011 CERTIFICATE OF LIABILITY INSURANCE UA1E(MM2011 Y, �4 I 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 INSURFR(S),ALITHOR17ED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must he endorsed.H Sl1BROGATi!3PS IS WAIVED,subject io the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confr>r rights to the certificate holder in lieu of such endorsement(s)- CON IACI NAME: Dowling h O'NeilsQfi 7r.# Neil Insurance PHONE !!AY A'C No,Enli: "^1Qi2Q Fv C.�'d `J0�§//111211t Agency -- - ;ADDRESS: ------- - r 973 lyannough Rd, PO Box 1990 INSURER(S)AFFORDIN,cOtfERAGE _ NAIC ti Hyannis,MA 02601 INsuREH A:National Grant3e Mutual Insltranc INSUNLU 1 IN3URERB:As50ciated Employers lnsuranCe- Baker&Associates,lnc. P O Box 923 i wSUItEH c: Q IN3URER 1): Centerville, MA 02632-0071 -- -�— - ---� INSURER 1, IN3U RERF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS Ic TO CERTIFY THAT THE POLICIES. OF INSURANCE LISTED BELOIN HAVE BEEN ISS'JEL, Tf"T E %NSURED NAMED Ar,OVE FOR I HE L'CdJi Jul NCICATE NOTVITHSTANDING ANY' REQUIREMENT, TERNI OR CONDITION OF ANY F'I NTP T'R N!=NT 01TTH R .PFGT 0 VVHICH THIS CERTIF'(--"T_ 114A Y BE I551!ED !)R MAY PERTAIN, THE INSURANCE AFFORDED BY T-l: P()LICIES D I'.,'J I 31 iEJ�KT TI= AL_ 1 -L T=4N13. EXCL:!SI",ff; AND CCNUITION S OF SUCH POLICIES. LIMIT sHOVvN MAY HAVE B_..t! G" YI i'1_Altt.: IN3RI IADDL UBR POLICY EFF POLICY EXP 9 INR IyFV OF INSUHANCE IINSH WVU POLICY NUMUEH UMII°i MMiDD'YYYY- MIV_40Di_YYYJ A GENERAL LIA6ILRY MPJ7223M /1 9120i1;IJ4119(201 EA:_.H:=;rc.I_II1f,Era'-e 1,000000--I 'sarutFF'C:AI L;F1v Hal I ,u ! 1r �' nNi;t '_LAINt-MACE X c_un I� rE F.11,1 ,10 000 1,000,000 I tro rt L I I R LrAre 2,000,000 L-NI AhGHFi;AIt 1111;1 AFFI F'-,1-F�:: I i .,�.n.! ! : ,�,1 ., ,a•:,Fs :2,QOQ,QOQ JECT I I L1�1'- — — AU:UMvHILEUPUILIIY -- i if A A.T_ .ILL r - -- — —�--'----�111 L r`+raD SGHEDV LEC IF AUTIDS I I ru:N<tvrro-u • � ��.c ! !.I1 ral�isF, I t UMBRELLA LIAR EXCESS uAB CLAIMS MACE ---- iul-I1 rF;Frvanrm14 I 'NJKKEKS COWL NSA I ICN LSsLT�. E B WCC5002454012011 2312011104123t201 _ X R H. — p AND EINPI OYERS LIABILITY "'--'---- FI rn rRET 7R.rARTIlERrE�F=JT!•;E Y!N F! ,.:, F1 L-;,-I1 `51}Q 000 r F4.FI.I01-n.wF r.t-",('IIni F1!;- N IN,A .: -- —L---- - 1 M In tl�to T In NHj i E L UI:EP,_E EA EMPl_ LrESCR FT'1 H•JF Ir•ERAT:INS Uoi—, I I �;'F:�-:!-_F'in c !;1:q:.1 s500,000 UESCKIP IUtJ dF UPEHA I TUNS I LOCA I IONS/VEHICLES(Attach ACUKU'104,Addltlonat KAMIrkc S1Zh.0,J1a,If-- Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of 3 insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. } CERTIFICATE HOLDER CANCELLATIONY. • \ . l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANGELLED BEFORE Town 0f Barnstable. THE EXPIRATION DATE THERrOr. NOTICE WILL Fir DELIVERED IN ( Thomas Perry ACCORDANCE WITH THE POLICY PROVI,ION5. _ 1 200 Main Street Hyannis, MA 02601 AUTHORIZED REPREMNTATME - - t?1988-2010 ACORU CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S807221M80721 LS! 1r1A`r'-1E-cI_111 i.=ia:^c,iih1 Ea . Id:BAKER =, O'-'OrIATi Paae:t_,I;t` Aufffurization Fo • as myner of the ,, + i i ■ fo u n muu � 1Sblmy V,64t& lu aut uu illy beliall, m all matters relative to work authorized by this building permit application.for. : Address of property: 30 Lakeview Ave. i lle, 1V A Signature of owner: Print Name: - Date: LyUy!UNS•U1 UL UULJUUIJS 6 iuiN- tU =1 I Ilfl AN=U!WUJU 6aU-6U-nUN i of r T oWn of Barnstable � �.� G � "it# � Y Expires 6 months an issue date Regulatory.Services a�aivsr�za, : Fee �� Thomas F. Geiler,.Director I rso Mt►t° - Building.Division !►Ii o�«/ Tom Perry, CBo, Building Commissioner V 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Officer 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Paud without Red X--Press Imprint Map/parcel NumberpZ f p2 Property Address 30. Lt4�C vWk.L'" L�'Residential Value of Work dpp co Hnimum fee of$35.00 for work under$6000.00 Owner's Name&Address - Contractor's Nazmn7e Telephone Num ben- C>.-� Home Improvement Contractor License'#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑R I am a sole proprietor ❑ I am the Homeowner �` ' ❑ S ,PERMIT ' I have Worker's Compensation Insurance ., 'Insurance Company Name N O V 2011. Workman's Comp. Policy# �opy of Insurance Compliance Certificate must accompany each permit. 'ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side W"IEVVE J3' 'n [� Replacement Windows/doors/sliders. U-Value 40 #of doors — ; (maximum .44)#of windows *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. 0 of t Home Im vement Contractors License& Construction Supervisors License is re ire 7NATURE: E PFMESIFORMS1but7ding permit forms02RESS.doc ,ised 070110 The Commonwealth ofAfassachusetts Department of Industrial Accidents Office of Invesligadons 600 Washington Street Boston,MA 02111 www.mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Le2ibly Name (Business/Organization/lndividaal : �� C W(Alm Address: �5 1�! WkAlw S1 City/State/Zip:, ..hy�eZ� 3 Phone#: '50 0 --63C�c,'� Are you an employer? Check the appropriate bog: .I am a employer with 4. I am a geneJhedh tractor and I Type of project(required): 2.&employees (full and/or part-time).* have hired t -contractors 6. ❑New construction am a sole proprietor or partner-. listed on thehed sheet. 7. ❑Remodeling ship and.have no employees These sub-ctors have working for me in any capacity. employees ave workers' 8' ❑Demolition [No workers' comp.,insurance comp,insura 9. []Building addition required.] 5. [� We are a coron and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers havecised their11.❑Plumbing repairs or additions myself [No workers' comp. right of exem per MGLinsurance required.]t c. 152, §1(4) we have no 12.0 Roofrepairs employees.[ orkers' 13.[] Othei l��`. "As-,T comp.insuraquired.] l.A.A wpm S *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 insu information. rance for.my employees Below is the policy and job site Insurance Company Name: Policy#or Self-ins, Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi n r the ins d pe lies of perjury that the information provided abo e" true and correct: Si fore: p p - Date: l C Phone#: dC� 'CS �� 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[[2ContactPPerson: Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ther Phone#• 'THE a OF ' Town-of Barnstable Regulatory, S LE.MASS } g ry ervices Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street Hyannis,MA 02601 � www.town.barnstable.ma.ns Office: 508-862-403 8 f Fax: 508-790-6230 Property Owner Must` Complete and Sign This Section If Us` ' A.Builder z, lC ono as Ownet of the subject prgpertp hereby authorizeHTi to act on my behalf in all matters relative to work authorized by this buildv g permit 3� UAL <1a (Address of Job) Pool fences and alarms-are the responsibility P ty ofthe•applicant. Pools are not to be filled before fence is installed and pools are not to b.e Utilized until all final i�nspectibns are performe • d accepted. i XA, Signature of Owner " S tutu.of A plicant Print Name l . Ptiat Name Date Q:FORMS:O WNERPERIvILSSIONPOOLS v, THE Town of Barnstable °* .Regulatory Services Thomas F. Geiler,Director MASS. sb�g9. a � Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HO OWNER LICENSE EXEMP ON Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name ho a phone# work phone# CURRENT MAILING ADDRESS: city/town state t_ zip code' . The current exemption for"homeowners"was extended to includ weer-occ ied dwellings of six units or less and to allow homeowners to engage an individual for hire who does f ps'ssess.'a license,provided'that`the owner acts as supervisor. DEFINITION OF HO OWNE Person(s)who owns a parcel of land on which he/she resides.or tends to side, on which there is, or is intended to be, a one or two-family dwelling, attached or detached struct r s accessory such use and/or farm structures. A person who constructs more than one home in a two-year peri d shall not.be c ' idered a homeowner. Such" "homeowner"shall submit to the Building,Official on•a form cceptable to the uilding Official, that he/she shall be responsible for all such work performed under the buildin t. (Section 109. .1) The undersigned"homeowner"assumes responsibility for c mpliance with the Stat Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she unders ds the Town of Barnsta a Building Department minimum inspection procedures and requirements and that a/she will comply with s procedures and requirements, Signature of Homeowner i f Approval of Building Official F \ Note: Three-family dwellings containing 35,000 bic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. -•- HOMEOWNER EXEMPTION- I The Code states that: "Any homeowt er performing work for ich4 a building permit is required shall be exempt from the provisions of this section(Section 109.1.1.-Licensing of construction supervisors);p ovided 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 the are assumingthe responsibilities Rules&Regulations for Licensing Construction Supervisors,Section Z.1 This lack of awarenessoRenresults in serious probie problems,parpendix ticularly , � i when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed ` Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue-is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Worms:homeexempt I. W,lall llUTl U1 — VC 10,11111MIII VI X UI/IM , all U(I B�►ard of Buil(lin�� Rc��ulatiuns :uid Standards Construction Supervisor License License: CS 66582 THOMAS C WHITE 415A MAIN ST . CENTERVILLE, MA 02632x;'� !� Expiration: 3/14/2013 ('ununissinncr Tr#: 536 a Office of Consumer Affairs&B mess Regula�ti o s HOMEI MPR O.V_EMEN T CONT... .RACTOR.. , a Registration: :1,23702 - Type: Expiration: -3/28l2013 DBA Thomas C.White,WOOgWbRKE14LC F 11 Thomas White Y c F 415A Main St. ':Cep.terville MA 02632 Undersecretary 17 i License or registration valid for individul use only" before the expiration date If found return'to Office of Consumer Affairs and Business Ri<gUlatrarr� = �' 0;1Park Plaza-Suite 5170 ti,i2oston,MA 02116 "Ntitrvalid without signature- ?'r-� ' 109013 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel w Application # / Health Division Date Issued 1 b Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic _ OKH Preservation / Hyannis , Project Street Address 30 Lakeview Av Village Centerville Owner Richard Shakal i s Address same as above Telephone 508-744-7943 Permit Request ;;ir sealing, duct sealing, add insulation to atti as, install 5 soffit vents add 19sa ft of R-19 to basement ceiling perimeter. Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2821 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 ❑ '_ 72 Commercial ❑Yes ❑ No If yes, site plan review# °R Current Use Proposed Use =M C APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name RTSF Rngi nPPri ng Telephone Number 401-784-3700 Address 1341 Elmwood Ave Cranston, RI 02910 License # 100459 Home Improvement Contractor# 12go Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Af SIGNATURE DATE Erik Nerstheimer for RISE Eng. FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 1. o DATE CLOSED OUT 1 ASSOCIATION PLAN NO. The Commonwealth of Massachusetts qM Department of Industrial Accidents Office of Investigations' - 600 Washington:street Boston,Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/C6ntractors/Electric ans/Plumbers Applicant Information Please Print Legibly Marne(Business/OrganizatiorAndividual): RISE Engineering a division 'or Thiel ch Engineering Address: 1341 Elmwood Avenue City/State/Zip: Cranston, RI 02910 Phone#: (401)784-3700 or 1-800-422-5365 Are you an employer?Check the appropriate box: Type of project(required): 1. 0 I am an employer with 4, 0 I am a general contractor and I 6. ❑New construction employees(full and/or part time):* have hired the sub-contractors ❑Remodeling 2. 0 I am a sole proprietor or partner- listed on the attached sheet. , ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers'comp.insurance c comp.insurance.1 g required] 5.0 We are a corporation and its 10. 0 Electrical repairs or additions 3. 0 I am a homeowner doing all work 'officers have exercised_their 11. ❑Plumbing repairs or additions myself [No workers' comp. - right of exemption perm MGL insurance required] t c. 152, § 1(4),and we have no 12. 0 Roof repairs employees. [no workers' 13. N Other Insulate comp.insurance required.], *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. (Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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 isproviding workers'compensation insurance for my employees.Below is thepolicy and job site information. Insurance Company Name: The Preston Agency Policy#or Self-ins.Liicc..#: 3730961-00 Expiration Date: .l/l/11 ' Job Site Address:OD V 4L "/u)j fWw� 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 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 $250.00 a-day against violator. Be advised that a copy of this statement maybe forwarded'to the Office of Investigations of the DIA for coverage verification. " I do herby certi and fhe in enalties ofperjury that the information provided above is true and.correct. Si nature: Date: Print Name: Erik Nerstheimer Phone#:(401)784-3700*or J-800-422-5365 extl �3 Official use only, Do not write in this area to be completed by city or town official City or Town:' Permit/license#: Issuing Authority(circle one): 1.11oard of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: r AC CERTIFICATE OF LIABILITY II URANCE COP lb- 47 �ATEWWDONyy) THIEL-1 04/13/10 PRooucER THIS The ton DivERTIFICATE i$ISSUED AS A:MATTER Of INFORMATION P Agency, Inc.IeC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1350 Division Rd Suite 303 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 8'10 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW East Greenwich RI 02818-0810 Phone: 401-886-8000 Fax:401-8.85717'00 INSURERS AFFORDING COVERAGE _ NAIC INSURED - INSURERA: Zurich—American Ins Co, 1 Thielsch Engineering, Inc � INSURER 8:. twaz.ic CW—et.. r, 1.1,b11"ity Thielsch 6alty Inc. INSURER North American Capacity Hi Tech Realty Inc. --- Cranston19S Frances Avenue INSURERD: Hartford Insurance Company RI' 0291.0 INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWI IHSTAtlDING ANY RECUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER OOCLOENT`NITN.RESPECTTO WFIICH 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - IF75F�0 LTR INSR 'TYPE OF INSURANCE POLICY NUMBER DATE(MMlODM') GATE(MM p/YYa LIMITS - _ GENERAL LIABILITY. EACH OCCURRENCE 2 1,0 0 0,0 0 0 , - .� X COMMERCIAL GENERAL LIABILITY.- 3730962=00, 04/01/10 01/01/11 �— PREMISES(Ea occurenca) S 30 0;0 0 0 CLAIMS MADE OCCUR MED EXP(Any,one person) S 10,0 00 PERSONA:&A.DV IN,;URY $1 O00,000 GENERALAGGREGAIE S 2,000,000' GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,0 0 0,0 0 0 POLICY X. PRO-' - - - JECT Lqc Emp Ben. 1,000',000 AUTOMOBILE LIABILRY i1 X ANY AUTO 37309*63-00 04 (Ea./01/10 O1/O1/11 CaaccccididD SINGLE LII�IITeni) g2,000,000 ALL OWNED AUTOS 80DILY INJURY SCHEDULED AUTOS - - - (Per person) HIRED AUTOS - - — BODILY INJURY y. NON-OWNED AUTOS - .. (Per accld@rd)_ - - PROPERTY DAMAGE $ --- ?Per eccidenl) . GARAGE LIA8ILIN _ , AUTO ONLY-EA ACCIDENT $ ANY AUTO - - - . . OTHER TITAN .EAACC $ AUTO ONLY: AGG. $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 1Q,000,000 ' B X OCCUR CLAIMS MADE LIMB 9 2 6 3 6 3 7-0 0 0 4/O 1/10 0 T O 1 11 AGGREGATE / 510,000,000 DEDUCTIBLE 3 X RETENTION 410,0 0 0 y WORKERS COMPENSATION AND ' - - X TORY LIMITS FP EMPLOYERS'LIARIUTY A AN}'PROP RIETOR/PARTNERIEX.ECUTIVE '- 3730961-00 _ 04/01/10 01./O1/11. E.L.EACH ACCIDENT S 11000,000 OFFICER/MEMBEREXCLUOED9 - - E.L.DISEASE-EA EMPLOYEE 5 1,000,000 It yes.0e5c6be under , SPECIAL PROVISIONS below, - - w _ - F.L:DISEA.SE.-:PdLICYLIMIT :f.1,000,000 OTHER -- - _ CiProfessional Liab DVL000026.800 04/01/16 04/01/11 Prof Liab 2,000-,000 D Leased/Rented Eqp 02ULNTDS679 04/01/10 04/01/11 Equipment 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I—SPECIAL PROVISIONS - CERTIFICATE HOLDER CANCELLATION' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION y DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN - ' NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR . - REPRESENTATIVES." .. - AUTHORIZED REPRESE v ACORD 25(2001108) L2)ACORD CORPORATION 1988 "r rlS for Engineering, a division -of Thielsch Engineering,. nc. ll Associates,; a division of Thielsch Engineering;. Inc. BAL Labo.ratory;..a division of Thielsch Engineering-, Inc., ESS Laboratory, a division -of, Thielsch Engineering,., Inc. ALCO Engineering, a division ,. of Thielsch Engineering ,Inc. Water Management Services, .a :division of Thielech Engineering, Inc. , 1 r r age 10I 1 The Official Website of the Executive Office of Public Safety and Security (EOPS) Mass.Gov Home " Public Safety Department of Public Safety License Complaints License Type Construction Supervisor. License#I 100459 ' a Restriction WS,IC Name Erik Nerstheimer City, State, Zip North Scituate, RI,'02857 Expiration Date 3/28/2012 Status Current No complaints found for this Licensee. Back To Search \ ✓>lie.-Va72nz�nxuecz/.(/ �a6,zc,�iccl,� _ - . : .... . .. f Board of B,Iilding Regulations and Standnri.Ps" ' Li.eenseor reEistration val,d'for individW use onl}� HOME IMPROVEMEfNT CONTRACTOR I t 1 r before the expiration date. ,If found return to: Registration,:, 120979 Board of Building Regulations and Standards Ezpirafion 3%25/2010 1' One Ashburton Place Rm 1301 — 1 PP' meet Card >r�c'str131 �Ia. 021-08 le ELSCH ENGINEERING';- K NERSTHEiMER- -. =- 1 ELMWOOD.AUEL ! . \NSTON, R1 02910 i sir ai --- Admmisti.:to Not valid without sign titre http://db.state.ma.us/dps/llcdetalls.asD?t)(tSe,gr(,hr N=CU 1 nnAcn 91te Of��iceo nSumerKillialn'��u�sS a Onog 10 Park Plaza - Suite 5170 Y Boston, T ssachusetts 02116 Home Improve • ontractor Registration Registration: 120979 Type: Supplement Card THIELSCH ENGINEERING � w y Expiration: 3/25/2012 �, r ERIK NERSTHEIMER .4 w 1341 ELMWOOD AVE. CRANSTON, RI 02910 Update Address and return card.Mark reason for change. Address 0 Renewal Employment 0 Lost Card DPS•CA1 0 50M-04104-G101216 fie �omvnwvuuea/l`i o�/�aaaac«usaeC�d - Office of Consumer Affairs&Bu iness Regulation '' License or registration valid for individul use only ' OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registrati6nQ79 TYPe: 10 Park Plaza-Suite 5170 Expira = ="12 Supplement Card Boston'MA 02116 THIELSCH ENG ��F 7, • ERIK NERSTHE�' 1341 ELMWOOD CRANSTON, RI 029Pi Undersecretary Not valid without signature r RISE ENGINEERING Federal ID u 05-0406629 RI Contractor Registration No 8186 A division of Thielsch Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,RI 02910(401)784-3700 FAX(401)784-3710' 'CONTRACT R I S Page 1t THIS CONTRACT 18 ENTERED INTO BETWEEN RISE � ` ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER _ ,. . PHONE DATE Ch"tS Richard R Shakalis (508)744-7943 03/17/2010 109013 SERVICE STREET - - BILLING 'BILLING STREET 30 Lakeview Avenue - 30 Lakeview;Av ----- --.. ........... ..-- . _ — - SERVICE CITY,STATE,LP - - BILLING CITY,STATE,LP Centerville,MA 02632 Centervil,MA 02632 JOB DESCRIPTION RISE Engineering will provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of,air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements and other unheated areas(windows are not generally addressed.) This work will be performed at the rate of$66 per man per hour,which includes materials and testing. 14 man hours.This measure is available for 100% rebate from the Cape Light Compact. $924.00 RISE Engineering will provide labor and materials to seal heating ducts within designated unheated attic area. This work will be performed at . the rate of$75 per man per hour,which includes materials. 2 man hours.This measure is available for 100%rebate from the Cape Light Compact. $150.00 RISE Engineering will provide labor and materials to install a—8,5"layer of R-30 Class I Cellulose added to 80 square feet of Floored attic rear kneewali band,loist space.Client to temporarily remove storage items. $96.00 RISE Engineering will provide labor and materials to install 2.25"R-10 semi-rigid fiberglass board insulation to 105 square feet of front kneewall area. $283.50 RISE Engineering will provide labor and materials to install a I 1"layer of R-38 Class 1 Cellulose added to 565 square feet of open attic space. $678.00,,,, RISE Engineering will provide labor and materials to install FSK foil faced rigid insulation board across the.face of the rafters,behind the rear" kneewall. Seams will be sealed with FSK foil tape. 209 square feet of area.Client to temporarily remove storage items. $561.60 RISE Engineering will provide labor and materials to install insulation and weatherstripping to the overhead attic-access hatch. $25.00 RISE Engineering will provide labor and materials to install 514" X 16"rectangular aluminum soffit vents to increase ventilation in attic areas. RISE ENGINEERING Federal ID#06-0405629 RI Contractor Registration No 8188 A division of Thlelsch Engineering MA Contractor Registration No 120979 a- CT Contractor Registration No 620120 1341 Elmwood Avenue,Cranston,Rl 02.010 • (401)784-3700 FAX(401)784-3710 CONTRACT �11 F Page 2 R R+ THIS CONTRACT 18 ENTERED INTO BETWEEN Rise " ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRISEO BELOW _.�__.... ----._.........._._.. -- ... -.:.__... ...-_.._.__........ ...._:_._._.. - --.........._ ...._..-... ............I ..._.._.--.... ._.......... ........_-...;. . CUSTOMER - PHONE DATE Client b Richard R Shakalis (508)744-7943 03/17/2010 109013 SERVICE STREET BILLING STREET _ - 30 Lakeview Avenue 30 Lakeview Av SERVICE CITY,STATE,LP ` - BILLING CITY,STATE,LP Centerville,MA 02632 Centervil,MA 02632 JOB DESCRIPTION $85.00 RISE Engineering will provide labor and materials to install 16 square feet of missing R-19 faced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $17.60 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,-not to exceed$2,000 per calander year. $2,394.03 WE AGREE HEREBY TO FURNISH SERVICES,COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Thirty-Six&67/100 Dollars $436.67 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY _ UNPAID BALANCE AFTER 30 DAYS.BEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. ............____.....__.___......__._ :.__-.... .............................._.._....._... DO NOT SIGN THIS-CONTRACT IF THERE ARE ANY BLANK SPACES r ---...-- ...._.-- - - AUTHORIZED S -RISE ENGINEERING - CUSTOME AC A - NOTE:.THIS ..- CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 0 � � D____... ___.... _ _........ ............ ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 3 SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK ----.-_._-_.- DAYS. . AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE °' oF�►,t r Town of Barnstable *Permit# 0 D b�zz Expires 6 months from issue date Regulatory Services Fee • BARNSTABLE, 9�A 639 ,�� Thomas F. Geiler, Director r® S PERMIT rf0 MP't A �" Building Division Tom Perry,CBO, Building Commissioner MAR 1 3 2009 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us �� ®F BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X=Press Imprint �b� ' ! 0 Map/parcel Number Property Address _ZC:> LAQ\a y LEt0 AUE 0a G 3 c � U'Residential Value of Wort. 00 0, Ob Minimum fee of$25.00 for work under$6000.00 Owncr's Name & Address AA OoCI:� Contractor's Name � Telephone Number L�b0 ---!Ionic lmprovement_Contractor_License#_gip lip cab-I_e)___ Construction Supervisor's License# (if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner ❑ ,I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy # XN Copy of Insurance Compliance Certificate must be on file. Permit Request (check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value 0 (maximum .44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owaer must sign Property Owner Lofer of Permission. A cop th ome Im ement Cont r ors License is required. SIGNATURE: i t.'\a l'1-11.1:5%.I:ORMS\building pemiit forms\EXPRESS.doc Revised 100608 f The Commonwealth of Massachusetts TJDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual) Qlkk As r Address: ,� 1 w �=� T Phone City/State/Zip: `� G v Are you an employer? Check the appropriate box: Type of project(required): L❑ 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.MI am a sole proprietor or partner listed on the attached sheet. 7.. ❑Remodeling ship and have no employees 'These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' y p �'• # 9. ❑Building addition [No workers'comp. insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ p 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers'comp_ right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no 13. Other 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: I Y Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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. Be advised that a copy of this statement may be forwarded to the Office of Investi ations of the DIA for insurance covera a verification. I do hereby certify er, a pai Vnadafti perjury that the information provided ab ve is true and correct. Signafore: / Date: _ Phone#: Official use only. Do not write in this area, to be completed by city or town offwf lal City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,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-contiactor(s)name(s),address(es)and.phone number(s) along with their certificate(s)of insurance. Limited Liability Companies*(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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 io any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia IHME Town of Barnstable Regulatory Services • uxxsrwsr.E, v MA89. $, Thomas F.Geiler,Director Ep aim Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 ' . www.town.barnstableana.us Office: 508-862-403 8 Fax: 508-790-6230 r . r Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize tb _ to act on my behalf, in all matters relative to work authorized by this building permit application for: !20 LP60W tISL 6AkVI'Ll VIA Ad ss of Job) 0� Signature of. r Date Print Name ; i If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RMS:OANERPERMISSION Town of Barnstable 'THE Regulatory Services Thomas F. Geiler,Director MAIM Building Division PrE° To Perry,Building Commissioner _..... .- 200 ai '.Street;Hyaimis,MA 02601 _ ..._.._.... _.._. . . _.__.... .. .town.b arnstable-ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOl\ OWNER LICENSE EXEMPTION Please Print DATE.: JOB LOCATION: number street village "HOMEOWNER": name hone phone N work phone# CURRENT MAILING ADDRESS: cityhown state zip code The current exemption for"homeowners"was extend d to elude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire does not possess a license,provided that the owner acts as supervisor. DEFINTTIO OF HOMEOWNER Person(s)who owns a parcel of land on which he/she ides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detach s ctures accessory to such use and/or farm structures. A person who constructs more than one home in a tw a period shall not be considered a homeowner. Such "homeowner"shall submit to the Building O�cia] n a f rm acceptable to the Building Official,that he/she shall be re onsible for all such work erformed under the uildin permit. (Section 109.1.1) ., Tine undersigned `homeowner assumes respons ;lity for ompliance with the State Building Code and other applicable codes,bylaws,rules and regulations The undersigned.."homeowner"certifies that. she enders ds the Town of Barnstable.Builliipg Depattrnent minimum inspection procedures and require tuts and that h she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings ntaining 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Co truction Control. HOMEOWNER'S MMON The Code states that: "Any homeo er performing work for which building permit is required shall be exempt from the provisions of this section(Section 1 D9.1.1 -Licensing of struction Supervisors).provid that if the homeowner engages a person(s)for hire to do such work,that such Homeovmcr shall ad as or." Many homeowners who use this exemption are unaware that they assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) Th lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board carmot coed against the unlicensed person'as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the borneowner is fully aware of his/her responsibil 'cs,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a =visor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt aucb a fomi/certification. use in your community. Q:forms:homccxcmpt {� l�dtegot�ttorrs- ndStnn HOME IMPROVEMENT CONTRACTOR -Registratioq' 23702 \} Ex iration / - P. 3/28/2009 I Tr# 127366 : ' � Ype DBA • Thomas C, White WOODWORKE- C Thomas White ' 4T5A Main St. Centrville, MA-02632__1.-'`.:.: Administrator I 1 t+ ti Brd o . u�ding egalat�ofis an tan ar s ;a I ' I i Construction Supervisor License s z License: CS 66582 ' Expiration 3/14/2009 Tr# 9163 - �.`Restnntion yi00� � THOMAS C WHITE 415A MAIN ST CENT RVILLE,MA 02632 ' Commissioner '. i , . f s G ' .,.... - �• license or registration valid for indvidul use only Y = - before the expiration date. If found return to: Board of Buildrfrig-Regulatiens and Standards One Ashburton Place IRm 1301 Boston,Ma.02108 r :- — Not valid withoutsignaturef - i 1 {I PRES5 g Town of Barnstable permit# cX!gQ 7 PERMIT Expires 6 months from issue date Regulatory Services Fee DEC 12 2007 dfl �Q � Thomas F.Geiler,Director p� .,� / I OF SAR'VSTABLE Building Division `'tly!� 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 Not Valid without Red X-Press Imprint Map/parcel Number Property Address :30 bAQ 0t�tw ©'Residential Value of Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name �.kA-"-,5 V 3 (A c F Telephone Number Home Improvement Contractor License#(if,applicable) Construction Supervisor's License#(if applicable) C•,� v ❑Workman's Compensation Insurance Check one I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name QA Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping.•Going over, existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value ..5 (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope er must sign Prop ty Owner Letter of Permission. A c y o e H ve nt Contractors License is required. SIGNATURE: Q:Fonns:exprntrg Revise06-1306 ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' wtdw.mass.gov/dia ' Workers'Compensation Insurance Affidavit: Builders/Contractors/Eleetridans/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual) jc�l.1 Address: City/State/Zip A- Phone.#: , ��'-C-) 7d Are you an employer?Check the appropriate box: :Type of project(required):, 1.❑ I am a employer with 4. 0 I am a general contractor and I 6. ❑New construction . 'employees(full and/or part-time).* have hiredthe stab-contractors 2.0I am a'sole proprietor or partner- listed on the-attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, Demolition �vorkin for me in an capacity. employees and have workers' g Y P tY 9. 0 Building addition [NO WOrkeIB' comp,insurance comp,insurance,$ required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions '3-❑ I am a homeowner doing ill-work . officers have exercised their 11.0 Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance.required.]t c. 152, §1(4),and we have no employees,[Na workers' 13.0 Other , camp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infanT atim t Homeownera.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating hidL xContractors that check this box mutt attached an additional sheet showing the name of the Subcontractors and state whether or not those entities have employees, If the sub-contractors have employees,they must providh their workers'comp.poficp number. I4M 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: lob Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number..and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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. Be advised that a copy of this statement maybe forwarded to the.Office of Investigations of the CIA for insurance coverage verification. ' I do hereby certify el a pain�d penalties perjury that the information provided above,is true an'd correct, Si afore Date 1, Phone#• !�128 Official use only. Do not write in this area, tb be completed by,city or towmoffcctai 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#: °F�► l�ti Town of Barnstable Regulatory Services , yBA BLK KASS, $' Thomas F.Geiler,Director rFo rnA'�" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.tow n:b a rns tab l e.ma.u s Office: 508-862-4038 Fax: 508-790-6230 < 4 S 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 perinit,application for. (Address of Job) Z I 'Q� Signature o Date Print If Property Owner is applying for permit please complete the Homeowners License Exemption Form\on the reverse side: Q:FORM&O W N E RP E RM IS S ION Town of Barnstable OF THE Tp� Regulatory Services + Thomas F.Geiler,Director BARNSTABLE, 9 MASS. �A 1639. �. Building Division rEn �s Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable. Office: 508-862-4038 Fax: 508-790-6230 HOMEOWN LICENSE EXEMPTI lease Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home p ne# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was exte ded to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for ' e who does not possess a license,provided that the owner acts as supervisor. DEF ION OF HOMEOWNER Person(s)who owns a parcel of land on which / he resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or eta hed structures accessory to such use and/or farm structures. A person who constructs more than one home . a o-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building g ci on a form acceptable to the Building Official, that he/she shall be responsible for all such work `erformed,under the buildin ermit.' (Section 109.1.1) The undersigned"homeowner"assumes esponsi ility for compliance with the State Building Code and other applicable codes, bylaws,rules and re ations. The undersigned"homeowner"certifi s that he/sh understands the Town of Barnstable Building Department minimum inspection procedures and equirements d that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family wellings containing 3 ,000 cubic feet or larger will be required to comply with the State Building Code Section 27.0 Construction Con ol. HOMEO ER'S EXEMPTION The Code states that: "Any homeowner performing w k for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supe 'sors);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 unaw a that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,S tion 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case, r Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forrms:homeexempt tdrn9 Rt Ong a ns and Stlndardsr -7-HOME IMPROVEMENT CONTRACTOR Re g i strati do:`,123702 Expiration 3/28/2009 Tr# 127366 . Type Thomas C.White WOODrNOR CER_LC Thomas White - _ 415A Main St. Centrville; MA;02632 Administrator r `l f, l i. icense or registratiod for individul use only before the.expiration date. If found return to: Board of Building Regulations aiid.Stardards One Ashburton.Place 1Rm 1301 !� '.Boston,Ma.02108 4�� 1.._ II ✓ t i I Not valid without signature I _ 1 r +` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a Map o Parcel �o`t Permit# Health Division q• — i 1 a-9 tO q Date Issued Conservation Division I i[m Application Fee Tax Collector !Y/D y�d Permit Fee . Treasurer SEPTIC SY Planning Dept. INSTALLED ISTEM CO MUST BE WITH TITLE 5 IA Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AN Historic-OKH Preservation/Hyannis TOWN REGULATIONS f Project Street Address ?�O L�'KAE�1 w A\\I Z Village C12s' z^&v"`e �"`�► Oal�3� Owner \�kck ►ARO ��+AI�iA�`� Address 5-AM(r Telephone S'bS ' 1 -4 1 — 7 2<-/3 Permit Request Square feet: 1st floor: existing aZ'�- proposed 2nd floor: existing I v`Z`(3 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 3a :r g g Historic House: ❑Yes GQ No On Old King s Highway: ❑Yes l�No Basement Type: 29 Full ❑Crawl ❑Walkout ❑Other z.' Basement Finished Area(sq.ft.) =35 �;C)C: Basement Unfinished Area(sq.ft) Number of Baths: .Full: existing new Half:existing • new Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing new First Floor Room Count 3 Heat Type and Fuel: 21 Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes 54 No Fireplaces: Existing ( New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size 350. Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:24 existing ❑new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name—TI1A0Uk0<S C . ��CZ" Telephone Number Address t.t 15' �A%A% STYL ' License# 0�.'i:�S82 e VAIN Home Improvement Contractor# A3 itD;� , Worker's Compensation# Sfp`.cy ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE % t/ DATE fie/ FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ' MAP/PARCEL NO. ADDRESS. _° VILLAGE OWNER DATE OE.INSPECTION: f" FOUNDATION i FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL rn GAS: ROUGIffi FINAL rT r` m 0 FINAL BUILDING 0 zir r ' .. DATE CLOSED OUT 5 M 0 ty' .0 0 ASSOCIATION PLAN NO.. M in a I The Commonwealth'of Massachusetts u —�04 Department of Industrial Accidents 600 R'ashineton Street r� Boston,Mass. 02111 Workers' COMMensation Insurance Affidavit-General Businesses �/ address: city state: zi : hone# work site location full address ❑ I am a sole proprietor and have no one Business Type: []Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑Office❑Sales(including Real Estate,Autos etc.) ❑I am an em loyer with em 1 ees(full& art time). ❑Other I am an employer providing viorkers' compensation foamy employees working on this job` com anv eddr'e:ssi ••• 'C1ty: .. Boni#.. insurance cb::'.:. I am a sole proprietor and hove hired the independent contractors listed below who have the following workers' compensation polices: com an name: < - . oddress' city big* phone#' J +GS .. 4• � Cyc 0 3 :# insurance on. 1 v MM / //// /%/////////// comp any neriYe address c .. phone ity # ... :•: ,:.:: ,:.; ?.: r,:, Folic*#..,, insurance co.� •:.• : •,•..: :...•'.. .' / Failure to secure coverage as required under Section 25A-of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or. one years'imprisonment as well as civil penalties in the form of it STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be f ded to the O;j;F of the DIA for coverage verification. I do hereby certify d ihepains and t the information provided above is true nd�ccor et, ; Signature Date Print names W �— Phone#Mi official use only do not write in this area to be completed by city or town official city or town: permA(license# []Building Department ❑Licensing Board [I check if immediate response is required ❑Selectmen's Office ' ❑13ealth Department contact person phone#; ❑Other e (revered Sept 2003) ' �rnr• arm---- Information and Instructions �I 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. ME Applicants l F . Please fill in the workers' compensation affidavit completely,by checking the-box that applies to your situation.,.Plp'ase supply company name, 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 retuined'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 they"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 perinitthcense number which will b'e used as a reference number. The affidavits.may be returned to 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 niiaiber: The Commonwealth Of Massachusetts Department of Industrial Accidents Offfca of Imsffgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext.406 Town of Barnstable ti y` °^ Regulatory Services ' BAMSrABLE. ' Thomas F.Geiler,Director Mass. � i639, `bA,Eo 39.E p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. / Type of Work: qM?LA< leXkSZk 4 C. Estimated Cost • Oo Address of Work: 30 l tJ�\C�1�lT'� � C- �� "'L A Owner's Name: \\\C�►�K� �� QS�fS Date of Application: 1 �� I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 FBuilding 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 UN) R PENALTIES OF PE Y I hereby appl for a permit as the agen owner: Date Contractor Name Registration No. Date 'WAOwn 's ame Q:fomis:homeaffidav i �,► .�,, Town of Barnstable ti Regulatory Services ' Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Iiyannis,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. --/WZM ivS to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) t d�-63L i Signature of Owne r Date r Print Name :F0RMS:07a,TMERMISSI0N 1 77 t 1 LOT 80 " 1 79 dp. 30 I i } ! � 1C1 »01 MORTO LOAN I EC11 11LI245 SAGAMORESURVEY` ASSOCIATES 5CALC; i IN.= 40 F i � , P.Q. BOX Lg DATE., NOVEMBER 2Z, 2004 SAGAMORE REACH, MA, 02562 506) RSB 5667 I CERTIFY T0._.w_ Y�hp�tAT SHE LOCA I0N OF THE BUILO�.Nrj SHOWN HEREON CO�NI"ORMS THIr ZONING OF THE TOWN OF _._.. '-�>._IE WITHIN THE FLOOD 'YHAZARI� I I CERTIFY THAT LOCUS DOES NO ZONE A5 DE.LINIATCb ON MAP 0005C COMMUNITY ..NO. '250001 pLpiv REt'RENCE' �ARNSfA 1_L RE >;�`iRY OF DPI I; 1 R> C4STnY ��'NER: BOOK PAGE-, LC NO 20'239-C, SH 6 LOT NO.1 CO., 1vC 1.2 , 1 BUYER, PLAN BY: GERALD a. MERCER & DATED: FEBRUARY 1958 �. 7,() ENUS N9A E E ROM N 1!v � SURVEY AND �SNOT D i 0R aENC S, NE GF� Ta6lIV L.OII�IES. FOR u�E OF IRANK 7 c ift !ran7yiT �1�25 A-cea S3`G --jo`G ,r 1AAAGS 00 Q r, ` 'y v It�EtiJ 'C��'L� --Ctstva� L+��vc`t�1 Px `P T A 7 1 r a act , . +ALj� 3xiQ Q%_Lw�,gC`4w1� �ns �Fvo � a 3o.__� Kcv�cw..�U� Ci s-\�nv��_.... ...� Ix S:'t�bts - aen s gO+ARD OF BU�ILD1!NG;R�GUTATI®NiS G License ,GQNSTRU'CTI'®N SUFERUISO'R �N�umbe�€ G 066582 ' Itpir 0 / 4/ b05 Tr.no: 12852 X � THOMAS 415,A IvIAJ�N ST a Admmistrator CENTER;UaILLE, MA 02E3�2" , li 71. Po nma�ziuea o�✓ �. Board of Building Regulate ns and Standards HOME IMPROVEMENT CONTRACTOR RegisOahi�on; 123702 M F�xp�ra$Jdtx 3128I2005 i Iype Individual Thomas C.White WOQ?pVURKt LLC Thomas White G�- 415A Main St � Centrville,MA 02632 . ..... Administrator e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Map : � � l Parcel Ly'T 9'® 10t-:Pj OF BARti-TA.BLE Permit# Health Division 9S- lIr,cld,T�74/3 Date Issued �� Conservation Division Fee 110 S c 6-6 Tax Collector ADD f �---Dk �—/ , /(1L . � B;EIEd� a firA, ,� ` _.�' � ®o Treasurer ALLED U4 COMPLIANCE I SL1111TH TITLE 5 Planning Dept. ENTAL C01)E A.t.r rd Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 5 0 L'eyf,� V I- to 4-y "� Village G FXJ _1 _91 j L._L.E Owner 5Wd <-�L/ 57 Address 36) Telephone '7 � Y-3 Permit Request EX/9 Z�- A9Yf Square feet: 1st floor: existing �6ft9 /� proposed S 2nd floor: existing / �� proposed S�'� Total new w Valuationb" Zoning District _Flood Plain Groundwater Overlay Construction Type 449d c7 t—XAtL,t , Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 3 Historic House: ❑Yes Ul;�o On Old King's Highway: ❑Yes 2rX o "Basement Type: XFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) -!P-49� Basement Unfinished Area(sq.ft) Acvy Number of Baths: Full: existing ;2— new 0 Half:existing ` new Number of Bedrooms: existing new Total Room Count(not including baths): existing 17 new 0 First Floor Room Count Heat Type and Fuel: IN Gas ❑Oil ❑ Electric ❑Other Central Air: , Yes ❑ No Fireplaces: Existing New 61, Existing wood/coal stove: ❑Yes YNo Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:xexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes )(No If yes, site plan review# Current Use � �/ G,� Proposed Use T ,Ve� E BUILDER INFORMATION Name fs 6.61 Iv- T Telephone Number Address License# G-4�2 —6:'014- -P I 20,2— Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i FOR OFFICIAL USE ONLY i • Y 1 P PERMIT NO. + 1 s. DATE ISSUED MAP/PARCEL NO. y , � w ' .ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ti _ r FINAL BUILDING ' DATE CLOSED.OUT ' ASSOCIATION PLAN NO. s 1 11 1 1 ■ 11 1 t 1/�t ' 1 �1 t�1■ t 11 1 ' • 1, 11 ' SI II 1 I t 1 • 1 I t 1 1 1 t l - I •,� 1 1 1 ✓.It. ■ 11 1 :111 t t'-1 t IN'I 1 ., M �t Ills.11 `/:11 0 1 . 11 ' -1111t 1 t •,� 1 t 1 1 t 1 vl , 1 11 ------------ , 1 `\ 11 1 1 t 1 • - 1 JI 1 1 1 1 t 1 1 111641 " 1 / 1 1 1 1 �1 1 - •/ I t 1 �t t- 1 •'1 1 1. 1 , 1n 1 , 1 '•11 1 11 � �` '1 111 - official li - s „l . 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MASI Regulatory Services i639' �m ArEp,�,t• Thomas F. Geiler, Director Building Division Peter F. DillMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601, Office: 508-862-4038 Fax: 508-790-6230 Permit no. - Date AFFIDAVIT. HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair.modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. . Type of Work: LA,® /D �/ Estimated cost - U U Address of Work: Z) � � ao t� Owner's Name: � '� 7U Date of Application: I hereby certify that: Registration is not required for the following reason(s): FlWork excluded by law QJob Under$1,000 []Building not owner-occupied []Owner pulling own permit j Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED. CONTRACTOR OR ARBITRPLICABLE HOME ATION PROGRAM OR GUARANTY WORK D�E M 1�142A. ACCESS TO SIGNED UNDER PENALTIES F Y I hereby apply for a permit as the of the owner. Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidar.rev-070601 • �I ♦ Ei } �t N rCli 4%*\\ E a � N`� �: �� J �a, � � I f . a x' � r nG � � � f -� � .� ` � ' � 1 r _ - - �. ��,� � �� . Q 0 a -- �r anvnw 71®NS I - " BOARp O;F BUILpING REGULA CONSTRUCTION SUPERVISOR I License. 1. i 066582 Bhd-a A�� irt 1954 Tr.no: 11690 - CI\ = `HOMAS 415A MAIN ST � I, Administrator I cENTERVILLE, • i pFfME 1py, Town of Barnstable *Permit# Expires 6 months from issue date BARNSTABM Regulatory Services Fee 0;�25•C 0 9cb 16�39,' 10�' Thomas F.Geiler,Director ArED1A0`A Building Division X-PRESS PERMIT Peter F.DiMatteo, Building Commissioner JAN 15 2002 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 'TOWN OF BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ? Property Address L/ V Residential Value of Work Xep Owner's Name&Address 57 Contractor's Name �19i�'I2P.1�J� �G� /�i Telephone Number 7 Home Improvement Contractor License#(if applicable) C� Construction Supervisor's License#(if applicable) o � S B of ❑Workman's Compensation Insurance Check one: I am.a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof)" ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ .Other(specify) *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature !` I Q:Forms:expmtrg Revised121901 ..f_.y � o?moo? /d, , Assessors map-and lot number .. ....... , SEPTIC SYSTEM MUST BE CFTHE T� ................................. . r Dk INSTALLED IANC ' LLED IN COCO�JP o Sewage Permit number .......:: . 7. ........ ...................... WITH TITLE 5 b ENVIRO • BAHB3T11DLE, i House number ...ZQ.... ...... . ENVIRONMENTAL CODE A M�a L ..........................:.... TOWN REGULATIONS °°.�2639.a\0� • ! 0 YpY TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO u lq X Zg_ aex�` �,p,.1 g r 4T.................. ......' .. ......... TYPE OF CONSTRUCTION .... .....:............................................................................. v. 1. .....2.z'.=.................19... TO THE INSPECTOR OF BUILDINGS: 'The undersigned hereby applies. for a permit according to the following information: Location ..3 .........L!oKEv..}. .....Ayg................. ......M.!N............................................................. Proposed Use ... €�/?q,/'1. "97I'7 t&Y /LOOM /✓� 2cio? 11 ... P..l .:.................................................... /.....................................................Fire District �.. T Zoning District ......Fi.c�..�/. .......T?. ...�...OST............................................. Name of Owner ..... . .....Address ......�H.MC................................................ Name of Builder Ga.4!.! ....SIT.Z.-.. j014-P..................Address ... ...ShFo2 ....o ,.......E.oPC'......Mh.................... Name of Architect .......SAME ..........................................Address ;n,".C............... ............ ................ .......................................... Number of Rooms / ....�...........................................................Foundation ..Fv..44...... Exterior :..G`W!P d?....1...5H�Nt, .......................Roofin .........Anf.tf�4 .................................Interior ........ .4AF ;T.iCR Floors ��.✓d..F.�.s?.0%�.../.�e4Rp .T. .... ........................................................ Heating ..... 1 ....AQQ .... ............................Plumbing ...G0A/v.4`r...!OA ...-7D... ..._........... Fireplace ..../.90? .e..................................................................Approximate. Cost ... "©7p .40 ............ Definitive Plan Approved by Planning Board ________________________________19________. Area ... .pp ........... Diagram of Lot and Building with Dimensions Fee ........... .... ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Namjl........ . .. . ... ........................... _ Construction Supervisor's License ............. SHAKALIS, RICHARD 28231 ADDiTION No ................. Permit for .................................... Single' Family Dwelling ............................................................................... 30 Lakeview Avenue Location ................................................................ 'Centerville ..................... ......................................................... Richard Shakalis Owner .......4.......................................................... r Type of, Conitruction* ..Frame.............................. .......... ............. ............ ..................................................... Plot ........................ Lot ................................ July 22 85 Permit Granted .........................................19 Date-of Inspection-..- ........................ .........19 4A I .............. ...... Date Completed M Cr M 5;. P Ca M ar ro 03 n �1 1, 1 l l l'1 II 1 1 1 Q ` 1 to ` to � ISoo cv a x L � IYPaINT' UPTIC SYSTEM MUST BE . Assessor's map and lot number ....... ..,..... L....:: .� ra INSTALLED IN COMPLIANCE z 6•KYk�/< `7 2 �' 7 ,� ' WITH ARTICLE 'II STATE s-: V SANITARY CODE Sewage, Persnit number ......................................... ...... yypp�y�t''11ff nny� ryry ��++ AND TOU1l t' r } RGG-ULAI IONS. } yOTMETO �- .� TOWN OF�`BARNSTABLE f -. � BAHH9T11DLS • : t owava�e� �. UUI'LDIHG INSPECTOR ;K tS Gt C APPLICATION'. FOR .PERMIT, TO .. ............................................... ............................... TYPE OF CONSTRUCTION ......................... ... .. ............................................. �i t C , 4 � k.- ...................?d.. .... .......19.77. TO ,THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .................. 4-77., .............. ................:..................................................... ProposedUse ....�.W 5. l4al .....................................................................................................:................... Zoning District ............z..M.-.1...........................................Fire District Name of Owner ........ .&464o %/....:D.4.4/ .... .Address ......... �.........4�..t�r Name of Builder ......�Q.4� `...Address ..............................................................,/.................. Name of Architect 1C......-� dress e.�4 9 ............. Number of Rooms .................... .........................................Foundation .................. ...I! 1IF............................ Exterior ...............:....................��".. ...................................Roofing ......... 12�PAA.W!44�r............................................... Floors .........................Ci.. ! ...................................Interior ............: y�rd/✓9;Z.e�. ................................. Heating .................. ...F..44�..4......................................Plumbing ............. ��''....., ' ' w+.�i�............................... . Fireplace .Approximate Cost ........................© '....................................... Definitive Plan Approved by Planning Board ___________, =--� ----- Area ............ �... Diagram of Lot and Building with Dimensions Fee 3' ! SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ...... . ...... u4.d. 4 ........... - ~ ' Holly Development Corp. 19508 two story No.�- -.-_— Permit for ----.---.----. ' single f '--�^`'r^~—,`''`'—'-^'-�—=—`--^—'—'—`' u/ ~ ` ^ "oMLakeview ,Avenue Location_ ~_—.-.—�.----.—..—.~—_—.----.Center ^ . r ~------.��...��=,�----------.. ' Owner - ^-----~''~---~'''"^`-;----^ D frame X, Type of Construction .......................................... ^ '~~.—.--^^~^^'°'—^---^^—'--`—^^.—'--' � ' �� ' . p�� —.—.. Lot ................................ '-----' — � ~ /a ' J�x�o�� l� 77 �~'o^* �ron�a6 ~ , lV ` --. — ` Date of . 'Inspection � Date Completed-.' ' � ' ^ � -�/��J�-------.]� ' . _ / � -PERMIT REFUSED ' ^ ' l� .._.--..�,~.,-.-.. ..---�]'— ^ .........................^.'------�--'-'''*--'~^^'^—' . . '^_ /~ ` —.~-....^..^....~...,........,.`.—...---.' . ' � . �� , ,....,.--,..,.-_....-.�,�....--.,.�...�.-.��.' � . --..~`�—....~.�^^.,...._.,.,~...,..,......—..�/~ ^ . ---------------.. lA . Approved ^ � / ---._-------.—.--..-�—'�~.,�...—. , ' `'\�--��-------'--'—^—^~^~'--~'^^.�^ ' ° ~ ' | ^ ' Assessor's map and lot number ... TOWN " OF BARNSTABLE BUILDING INSPECTOR TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 40, Definitive Plan Approved by Planning Board Area -4.:�; 7.2,67)- A Diagram of Lot and Building with Dimensions I? SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of 8ornuhz6le regarding the above mome--�. ---' - ' | _r Holly DevelopmeTY-,V Corp. A=252-121 19508 two story No Permit It'r single family dwelling ............................................................................... Location ..'A* ..Lakeview Ave............. .............. Centerville ............................................................................... Owner Ho.11y. . Devel. op.....ment. ...Corp.® ........ . . ...... .......... .... . ........ . Type of Construction frame ................................................................................ Plot ............................ Lot ................................��80 August 17 77 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED / ................................................................ 19 .............. .p�.. .. ......................... ..... .......... 4 L.../......... ............................. ...... .......fF / ... ................ ....... ... ........ ... ..f. , .' ^..... .............. Approved ................................................ 19 ............................................................................... ............................................................................... � f TOWN OF BARNSTABLE permit No. ----------_----------------- 1 3AILISTM ; Building Inspector Cash ------- aVAI OCCUPANCY PERMIT Bond ----__ ------------ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to -lolly Developraent Corp. Address WiringIns Inspector p P' _ �f .��,lf��.,�.�,� Inspection date �r Plumbing Inspector Inspection date Gas Inspector ( Inspection date Engineering Department 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. ..............................................1 19...... ..................................................................._..._....._... .. _._...._.�. Building Inspector „�''”` • TOWN OF BARNSTABLE Permit No.l!S _8/17/77 1 s�n.d Building Inspector Cash OCCUPANCY PERMIT Bond __ N/A No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Holly Development Corp. Address Box 395 East Falmouth, MA lot #80 Lakeview Avenue, Centerville Wiring Inspector j �� ' Inspection date 4 Plumbing Inspector L Inspection date • f' Gas Inspector t - Inspection date 9 �\1.a.}pfn .—�2' R .PiY-i{�H'IV�.• r� � d`J Engineering Department 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. r �. ....................... _, 19 . Building�Inspector ._...._ ....» ._ `4. -c a f 4a 8/ � i 0zz � 1 v a.4R. c 7 � ldsSR`� t•. y ' .S TIA16: iav�S AT/4 iV 40'121 0 / 1 IOf u ' SGRGE= ! =3a floes fc f77 } ,Vae/L1AN 4;�U,SSMA1Ff P e d r Assessor's map and lot number ............................................ CF THE TO Sewage Perrxut• number .............. ...............-?.....................�i Z EARNSTULE, i House. number ...��aC�... .y ........rH�................................... V rasa L r, 1639.�\0� 0 ypY TOWN OF BARNST•ABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .!. -.A...............................................� �............r2...b' �.y TYPE OF CONSTRUCTION .... .................................................................................... �.�. ..... . :..................19.J�47 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: f, Location ...3.4�........tr .....AA 4 . :�I . ....M.! .................. Proposed Use .... .....!G!`?'^>��Yoo,� �.f1........................................................ Zoning District ......A.Q.:71....................................................Fire District ....4. ?�?T..� OS"[" Name of Owner .. 1• ......* AAW_c> Address S ....... ...................... ..... . .f .ml` .. ........................................................... Name of Builder .Co��.!!....:G.1T.z.-.A!1;A0 P.........:.........Address ... ...SHorz ....P..C?......... ......MA..:................. Name of Architect .......s!?.M£.................................................Address ...:............: ........................................................ Number of Rooms ...: ... .......................... ..F.v 4n................... ........... .......Foundation Exterior ...5;:�!_f! �W .......................Roofing ........ Floors Fk P.o%4....`. tR© .7..................................Interior ....... LA57 te......................................................... Heating .....6.2. r_0Q....,q.c-7.....te .14..459...........................Plumbing ... .4W. .......................... Fireplace ....A ..i................................................................Approximate Cost .....57P .......................................... Definitive Plan Approved by Planning Board -------------------------------19-------- - Area ...r .n-�..��............ Diagram of Lot and Building with Dimensions Fee ..........�. -""�'� . . ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nami5!.. �jl... ......................... .Construction Supervisor's License .0.5!.��lo..��.............. J tom{ SHAKALIS, RICHARD f. A=252-121 No .2.823.1..... Permit for .... DITION ................ Single Family Dwelling Location D .... ... 30 Lakev. iew..Avenue........................... . ............... ........... Centerville ........ .. ...................................................... Owner Ri.chard. ...Shakalis. . . ........................... . ........ . ...... . ...... i Type of Construction Frame ................................................................................ V rr Plot ............................ Lot ................................ Permit Granted .......July 22,................19 85 Date of Inspection ....................................19 Date Completed ......................................19 r , � _ v