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0015 LAKEVIEW DRIVE
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"1.r.,�:-.-� „�":., ..M�r;: � m:, e-3'i{C��..rd .;'w krw.. �+.; �µ �rt�+-��-_. � ., - `rµ"�fi' _- `. _ •.,e-;•^�.�."^'•�:�-�-�t _. .,.-s`.r• . .ram.., ""�. ,..�'.;"""'+' .�,.'c`rr„'�r'v-fiU" ^"vw^.^Ew-"�-%lE. -s ^-�'t- i'' �*e� .. . �;' ;; G _ ,. �. �� 1 nr r .. - � J' ;. - - .. .. _ � � .� � '2 .. �, a * ° _ x 2 r k o " X placation number .... .. Ap �.� 1� r ` Date Issued .... l.1;.:. �. .. . } s! - BuildFng Inspectors initials.l �., ..t: .... ....... a�/Parcel �.��. .... 03; /r. �. aw f TO" OF B ►RNS�'ABLE f fEXPEWTED PERM T APPLICATION: �,; ' .. ROOF/SIDING/W EiD.OWS/DOORS/TENT.S/STOVES/WEATHERIZATION PROPERTY INFORMATION x Y < x Address of Project:-ect. fLai P_iV r - . C C �rr NUMBER '� STREET viI,IAGE Owner's Name: Ct!l�.c Phone Number 7 `- 7�`CJ-` Email Address:t_Uef1 � L4 - Gtl1i1 (.,. Cell Phone Number J. Project cost$ W K3•� Check one Residential ✓' min Ci . . Co er al ,� I O'R?NER',S AUTHORIZATION ' - As owner of the above property,I hereby authorize to make apphcahon for a builduig permi IVIR-� t m accordanc e with'78 Owner Signature: a/z"G!�cw Date: F. . TYPE OF woxx f "'3 F Z ia'... .Z qt.rr. ..r J'n ` jr? F'`.•- .v. _ e � Sidi g i W ndows',(no header change)°A Insulation;Weathertzat 0 Doors no header change)# Commercial Doors re ,rure.dn a• ( g ) g nspector's�frevaew"` . Roof(not applying more than 1 layer of shingles) rr Construction Debns will be:going to CONTRACTOR S INFORMATION' Contractor's name T /yyd Home Improvement Contractors Registration(if applicable)# / �3 (attach copy) `. tj :n�3-r h: -::.k ; ti ' s t °> S' o r15'.�w a+ '•^- j y Construction Super�sor's License#' (attach copy) Email G of=Contractor �' ` Phone nuanb r 7 . ..of D ,.e�hafr ALL PROPERTIES THAT HAVE,•STRUC?URES OVER75 YEARS OLD ORIF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFO,RE A PERMIT CAN BE ISSUED.; ' APPLICATION NUMBER............................................................ *For Tents Only* t Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES* Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APP IC 'S SIGNATURE Signature Date &I6 , All permit applications are subject to a building official's approval prior to issuance. DocuSign Envelo a ID:C6E36D98-40CD-48B4-A31B-454076D366D9 Permit authorization . ry. ass 11 Ove Form I Site ID: 3852823 Customer: Benjamin Anthony _. 4 1, ;owner of the property located at: (Owner's Name,printed) 15 Lakeview Drive Centerville, MA 02632 (Property Street Address] (City) hereby authorize the'Mass Save Home Energy Services Program assigned Participatin'g'Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. E�.,, 3304AMF425... ocusigned bOwner's Signature; 8/13/2019 1 8:30 AM EDT Date: " i i r 0t i of :1 0iie i i 9ip✓, 0/00 i vo, i a O6,9 Gi.b/ti�Oi,�Do��-�/4i.�b!G Q�'//G�/Do'///off�//i.��/9a-�P�i.°/Oir 3!li'�''/,/'ir���ir'�'O�i 2 �q/li.�Ob'���/D/r�pk�!a�/Oi.�%ii�G�'�6F��41 Y'Oic"//��� �!O'/" FOR,OFFICE USE ONLY We have assigned the following'Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: RISE Engineering Phone: 401-184-3110 Email: Page 1 of 1 Pear mice use bnty The Commonwealth of Massachusetts Department of IndustrialAccidents a 1 Congress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Ap0cant Information Please Print Legibly Name(Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC.' Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.�✓ I am a employer with 16 employees(full and/or part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. O Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3. -1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]! 4.�I am a homeowner and will be hiring.contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14.[D Other INSULATION 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:LIBERTY MUTUAL INSURANCE Policy#or Self-ins./Lic.#:XW05�88867158 Expiration Date:06/07/2020 / 4 Job Site Address: / �c,�fr�,�%P,�u _ City/State/Zip: � .//e , Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under e' ` s and alti s>of e uty that the information provided above is tr7417 and correct Signature: Date: Phone#:508-567-4240 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# - Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: # ^ , Commonwealth of PAass.achusett§ Division of Professional Licensure. Board of Building Regulations and staridards Constru-di$n'StSpgrvisor CS-105454 Eknires; 05/08/2021 Ay TIMOTHY CABRAL - 58.DICKINSON STREE�f � a FALLRIVER MA 02721 ' r Commissioner .. r i PJf2G C�GLfj?/�2�tf2CCGCIGG/2 G� r %l'�iCG1CGCfZGGsP � Office of Consumer:Affairs and.Bus:i:ness Regulation: 1000 Washington Street = Suite.710. .. . Boston. Massachusetts 02118. Home lmDrovement Contractor Registration T.vpe: Corporation Re isi at on- 17H83 AL T ER11.4ATIVE WE:ATHEREAT10N WC: x e,ion: ... 05r28/202 i 2 LARK ST �, :,. rFALL:RiVER, VA 0272:1::.:::: 6. :Update Address and Return Card. SCA 1-fi.:201VI-05117 ... .. ... :.. .. ... ... .. ... :.. .. .. :.. :: /�- �nriiinini�.rr///r�._•��iiiiriifir;!//: Office of Consumer Affairs.8 Business Regulation HOME IMPROVEMENT CONTRACTOR: Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 75683 05r2812021 1000 Washington Streit-Suite 710 ALT RNATiVE-VEATHERIZATION.INC.' 3oston;MA 02118 : .} 1 I t. r ; J f TIMOTHY CAER4L t/ 2[RK C l ��:. rALL RIV=R,AAA. 0272^ is IOt Valid wittioujsignature UndersecreiGry. f DATE MIDD/YYYY) r CERTIFICATE OF LIABILITY INSURANCE 05/24/19 THIS CERTIFICATE IS ISS{JED 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Anthony F.Cordeiro Insurance Agency PAHONNo.Et: 508-677-0407 FAIC,No): 508-677-0409 Fall Pleasant Street ADDRE Fall River,MA 02721 SS: HSouza Cordeirolnsurance,com INSURER(S)AFFORDING COVERAGE -NAIC p INSURERA: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURER C: Ohio Casualty Y 2 Lark St INSURER D f Fall River,MA 02721 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE OCCUR PREMISES�Ea oocc rrence) $ 300,000 MED EXP Any one person' $ 15,000 A Y Y BKS58867158 06/07/19 06/07/20 1 PERSONAL a ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,000 Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED N y BAS58867158 06/07/19 06/07/20 BODILY INJURY(Per accident) $ AUTOS ONLYAUTOSXHIRED NON-OWNED PROPERTY DAMAGEAUTOS ONLYAUTOS ONLY .Per accideni $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 f A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/07/19 06/07/20 AGGREGATE $ 1,000,000 DEO RETENTION S $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY C OFFICER/MEMBERPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 a NIA XW058867158 06/07/19 06/07/20 (Mandatory in NH) It yes describe under E.LDISEASE-EAEMPLOYEE $ 500,000 , DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA,its direct and indirect parents,subsidiaries and affiliatesshall be named as Additional Insured on commercial General Liability and Automobile Liability polcies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road i Waltham,MA 02451 AUTHORIZED REPRESENT I 2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 0. ALTERNATIVE� .: W•EAT;H E'RR;AT`i,;O.IV:' b Imo)�t p Q�p . Date*,' f z- Town of Barnstable " 3' =::;. :,�w • 100 Main St Hyannis,MA 02601 �'r.; c 'fir)'},::r•rr^� `'•ii` r!:.J','n 1 1/� /KQ.s Re-Permit# �— °� � r.�� = :? .r . Village, '•%:Y�w", "�`�-F 1,l,,:+`:;2j%r�'%'v •a•.i:,i. 'jtk?,:,,4. •.�•yk:r,: ^:?�. r:JCc,• _ r; ..{c,.A�i�x,., r�•;Ba t: �; T�..,.,r r:r, L•::;•' .,;R.;. 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Re %';%i✓J;, ,.a��i?8i):'^.'. ���':�=•.h'�,!•eY,•• `r,. .e. "G,1,rqi. ,/�,a�`4j,;;�,.�'j,:<.�":� , ,pry:; ;'• •' ' •,.,,;' ,��.".,,. 3::' . . A "i, ,�< cam, ' c<,ir< .<r.`•r�• %i?v,'" :.: "c`•,,Ka�;a`', a;; r .. .}.cwh`�;yr„ .. .M' s ac` �<.,r '..�.<rr.'y A'�i>�, -.:r::.: L:S• :,;'�=,.i;F4^:,�,r 'f3,.,�.. •!�..}:..�.,,:r}a :t�, �ra ;k4; c,%r ,,,`�` ".,yv.•'. '=�,.^':•a: Jfinwr�k 's�i�'�i.y� ,• .. • ��''7a„_,�'3�rro. ra ",Q��r' .,t'•r�'�a7:;:<r":'•s:T'r�: 2,..v'�"r'�.. Timothy Cabral, President CSL-105454 58 DIOKINSON.STREET I .FALL RIVER„fMA 02721 1 .(508).567 4240 �., XLTE-RNATaV.EWEATHgRILATtON*@CCti1AIL:C©M' r + TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel ®_ Y �o A lication # p — Pp ' l Health Division 1.00.I�'- Z 7S Date Issued 1141AM a-3 � Conservation Division r7/� _` Application Fee Planning Dept. dyl� _ ±5. Permit Fee Date Definitive Plan Approved by Planning Board Historic.- OKH Preservation/Hyannis Project Street Address ,"LA Ac G✓ Village OwnerG-', ����Ct Address C Telephone / Permit Request e�i�c� CZ / eC d� � Ajyy dlr D /' ovspl-am-r 6af�4 Onto el C'P T Square feet: 1 st floor: existing �3 y proposed 0 2nd floor: existingvrff proposed Total new Zoning District C Flood Plain ,�tiL, Groundwater Overlay. a6-AC Project Valuation ne Construction Typed r Lot SizeT Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure V -J Historic House: ❑Yes 'fQo On Old King's Highway: ❑Yes KO4 Basement Type: XFull ❑ Crawl ❑Walkout ❑Other Pry 10o s eG �v � �- � Q fs��-e Basement Finished Area (sq.ft.) �f�CS Basement Unfinished Area (sq.ft) / Y Number of Baths: Full: existing 71 new Q�) Half: existing 4!� new Number of Bedrooms: existing G riew Total Room Count (not including baths): existing ` new - First Floor Room Count_ Heat Type and Fuel: ` Gas ❑ Oil ❑ Electric ❑ Other_ eqSC,7--q"` A?er '-arim Central Air: es ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes MO Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage xisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ,N o Commercial 0 Yes o If yes, site plan review# Current Use 'q A Proposed Use -« APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Z�",�Iz ! e Telephone Number Address �(� � �Ca>e � C� � License# �J Ac, Home Improvement Contractor# Worker's Compensation # A// ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOGi!'/l,j � SIGNATURE ®ATE r is FOR OFFICIAL USE ONLY Ao_�LICATION# ` ~DATE ISSUED MAP/PARCEL NO. ADDRESS ` —VILLAGE' ' OWNER DATE OF INSPECTION: FOUNDATION j FRAME m o S�I� J ` INSULATION mksjl� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH - FINAL ,FINAL BUILDING : 3 r , ' DATE CLOSED OUT g ASSOCIATION PLAN NO. ' 5 - • �. The Commonwealth ofh'fassachusetts s j f Department of Industrial Accidents O_ff ce of Investigations E '; I ju 600 Washington Street \,-/ Boston, MA 0.2111 =` www:mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Le 'bl Name{BusiDI ness/0 an ization/Individual): Address: C� City/State/Zip: /IS Phone #: � 71ami'l ployer?Check the appropriate box: F7. E] oject(required): ployer with 4. am ageneral contractor and I constructions(full and/or part-time).* �� ��have hired the sub-contractorse proprietor or partner- listed on the attached sheet $. odeling ship and have no employees These sub-contractors have olition working for me in any capacity._ workers' comp, insurance, ding addition_ [No workers' comp. insurance 5. ❑ We'are acorporation and itsrequired.] officers have exercised their- rical repairs or additions 3.❑ 1 am a homeowner doing,all work 'right of exemption per MGL bing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.[:j Roof repairs insurance required.] t. employees. [No workers' comp. insurance required.] 13:❑ Other *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 their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: i�� �Pi City/State/Zip: F 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 certo�urider t pains and pen Ides of p rjury hat the information provided above is true a correct Si afore: 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#: t � f . f , 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,eatity, employing employees. However the owner of a dwelling house having not more"than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that•"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable.evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractors)name(s),address(es)and phone numbers along with their certificate( ) g (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 youxegarding 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 proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Deapartm-ent of Industrial Accidents Office of Investigations 600 Washington Street Bo.SRton,MA 02111 Tel. # 617-727-4900 ext 406 or 1-$77.-,MASSAFE Revised 5-26-05 Fax # 617-727-7749 wvtw.m,ass..gov/dia T �If _- _ - -- _ - 9 - coo -- - - /G ' !©G 2�� c5/Zcrrr _ I .40 • Q Y j �� ,� ---- _ _, _T .�'_ ._.� _-- - - - L- - _--- �x _ A11C ce 1 6 - I# I f G-��t!1..... _ _.. _�.-c, Gs�'�i Cam_��!IJ.G� /,���61'cT. �-�✓f'. .._ . . . . ` 4 1 a n r i M<t s,tchusett - Dejturtment of Public SafetN AM Board of Building Regulations and Standards Construction Supervisor License License: CS 2265 Restricted;to 00 w LARRY D'''NICKULAS �rtaf dry` ` PO BOX 507 W BARN.STABLE,,MA 02668 Expiration: 1/18/2012 Commissioner Tr#. 14331 - �1ie �ooavnwozcueca/,�i � � Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation I Registration:,.�A;1r00496 Type: g Expiration: 6/18/2012 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 j LA RY NICKULAS;_ - 04 Q f , Larry Nickulas 20 CEDAR ST. W. BARNSTABLE MA:02668)' Undersecretary Not valid without signature I 3 �THE r � Town of'Barnstable Regulatory Services sAxrrsus[.� : _ uAas_ Thomas F. Geiter,Director 'Building Divis1011 Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towmb arnstable.ma.us Office: S08-862-4038 Fax: S08-790-6230 Property Owner Must Complete and Sign This Section Ifs A Builder as Owner of the subject ptnperty hereby authorize r� /�!/C !'C c�/C'/' to act on my bebalf, in all matters relative to work authorized by this building permit application for.- dress of Job) C�1011 7t Signature of Owner G ate Print Name If Prope Owner is apply ng forpermit please com lete the Homeowners License Exemption Form on the reverse-side. Q:FO RMS:o WMERPERMISSION Town of Barnstable � y Re alator g y Services } r uxxsrAsr e, Thomas F. Geiler,Director • MAE& �. �bss� �� k Building Division F o Tom Perry, Building Commissioner 200 Main-Street;_Hyannis,MA_02601 ,A,wvy town.barnstable.ma_us Office: 508-962-4038 Fax: 508-790-6230 HOIrMOWNER LICENSE EXEMPTION Pleare Print DATE: JOB LOCATION: number street • village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/to.wn state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellinn of six units or less and to a110w 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 strictures accessory to such use and/or farm structures. A person who constrgcts more than brie 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 responsib)e for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. i The undersigned"homeowner'certifies that:he/she understands the Town of Barnstable Building Departrpeat minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner a . 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, HOMOWhIER'S EXEMPTION •The Code states that "Any homeowner perfoiming work for which a building permit is required shall be exempt from the provisions of this section.(Seetion 1D9.1.1 Licensing of construction Supervisors);provided that if the homeowner rngages a persons)for hire to do such work~that such Homeowner shall act as supervisor."- 4-any homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Comsiruetion Supervisors,Section 2.15) This lack of awaren ros ess bftcn ults in serious problems,particularly er when the homeown hires unlicensed persons. In.this Case,our Board cannot proceed against the unlicensed person as it would with i licensed Supervisor. The homeowner acting as Supervisor is ultimately responsrb)a, To ensures that the homeowner is fully aware of his/hQnrsponmbilities,many communities require,as part of the permit application, that the homeowner certify that hedshe understands the responsibilities of a Supervisor. On the last page of this issue is a farm currently used by several towns. You may care t amend and adopt such a form/rcrtification for use in your community. Q:fomzs:homeexcmpt �T"E' ti Town of Barnstable Building Department 200 Main Street &&-RNSzABLE. * Hyannis, MA 02601 9 MASS. (508 i639. ) 862-4038 ArFD MA'S A Certificate of Occupancy Application Number: 85566 CO Number: 20060058 Parcel ID: 000000329 CO Issue Date: 06/23106 Location: 15 LAKEVIEW DRIVE Zoning Classification: Owner: CONVERSION CUSTOMER Proposed Use: HYANNIS, MA 02601 Village: CENTERVILLE Gen Contractor: NICKULAS BUILDING CO. Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: 612-3�o6 Vuildinog Oepa ment Signature Date Signed TOW `OF BA,RNSTA.BLE BUILDING PERMIT _. - 1 z tf� PARCEL 1D 000 000 , 329.. GEOBASE ID , ADDk2SS' t 1:5 ''LAKEVIEW DRIVE PHONE CENTERVILLE ZIP LOT LOT 1 BLOCK LOT. SIZE DBA DEVELOPMENT DISTRICT. PERMIT 85566 DESCRIPTION :4:BDRM/SIN FAM/Al-r GA:R/ZBA 2005--026 P.ERMI.T TYPE BUILD TITLE NEW RESIDENTIAL BLDG PMT CONTRACTORS'. �NICKULAS BUILDING CO. Department of ARCHITECTS:' Regulatory Services TOTAL FEES: 1,670.46 BOND $.00 piF CONSTRUCTION COSTS $361,088,06 r .101 SINGLE FAM HOME DETACHED 1 PRIVATE 01 + BARNEMABLE, # •� MASS. , ,� Cf 039. A, BUILDING DIVISION By ' DATE ISSUED 07/21/2005 EXPIRATION DATE THIS PERMIT.CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART.THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN' CROACHMENTS ON PUBLIC`PROPERTY,NOT SPECIFICALLY PERMITTED.UVDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE.OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS'THE ISSUANCE OFTHIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS ,; THIS CARD KE'T.POSTED UNTIL FINAL INSPECTION 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU PERMITS ARE REQUIRED FOR (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN,MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS .p�v`'� 1 r F 3j G 3 F K 6 Z3 v� A_PJ 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2�.,-. BOARD OF HEALTH'tl/ OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. ' BUILDING ��� . PE RMIT �� f W t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel 3 4? ermit# _ �S .5 (a Lo Health Division `oW cJ a7 �` �'�/�'S - �,,, ate Issued �/R Conservation Division J! �f�/ ®���tj Application Fee Tax Collector �iJ!. �� Permit Fee e d7� .1:�' L ' Treasurer n I — SEPTIC SYSTEM MUST BE ' Planning Dept. �•� oS o�f INSTALLED IN COMPUANCE WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE Historic-OKH �q Preservation/Hyannis , . TOWN REGULATIONS Project Street Address c - Village v. Tef2S� i Owner Address /6 Oeye�X �, a Telephone �'t l/�rvp 2 d_ Sid Cs C) 74 01 Permit Request 3 -C.- C.. 't-- r � `�v� ✓C�/d U diyfAP � 3�rrd Square feet: 1st floor: isting 7 U Z proposed 2nd floor:existing proposed Total new Zoning District Flood Plain /✓/q Groundwater Overlay Project Valuation Construction Type tf(r Lot Size S Grandfathered: ❑Yes ❑ No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#•units) \ Age of Existing Structure Historic House: ❑Yes On Old King's Highway: ❑ p Yes Vo Basement Type: II ❑Crawl alkout Cl Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Z 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 w cv Heat Type a Fug` Gas 0 Oil Cl Electric ❑Other Central Air: 'e Ei O No Fireplaces: Existing New l Existing wood/coal stove: O Yes 0 No CD Detached Detached gage:4existing Zl new size Pool:O existing ❑new size Barn:0 existing 0 new size Attached garage:CLtexisting Q new size�K'_Z- Shed:❑existing ❑new size�Z Other: 2 aK Zoning Boayd of A�als Aut orization ❑ Appeal# O O Z G Recorded / ��� ` Commercial O Yes 0 No If yes, site pla 'eview# : Current Use /I Proposed_Use_ B ILDER INFORMATION Z G Name s-� / . �i� CL `� Telephone Number J-ZI 2 U Address VSc" License#- f t' Home Improvement Contractor# IC-) 0 l 9 V� o u r �aC,� Worker's Compensation# _Se L-a ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ci /"v' SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. ' DATE ISSUED MAP/PARCEL NO. t , ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATIONS c� 6 0 l !tJ U -- FRAME%' r. INSULATION FIREPLACE l ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH) ` FINAL rl .� Ccr ' GAS: ROUGIj FINAL BUILDING O R (,0/?-31®L DATE CLOSED OUT ' i fr. + ASSOCIATION PLAN"NO. O ` RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE ; New Bguildin s $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 �' l Building Permit Amendment $25.00 S FEE VALUE WORKSHEET , NEW LIVING SPACE 3 �� V square feet x$96/sq.foot= 3 fr`' x.0041= C� plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= plus frombelow(if applicable) GARAGES(attached&detached) s uare feet x$32/sq.ft.=2 5 U t j x.0041= 14 PiQT-�' / C ACCESSORY STRUCTURE>120.sq.ft. S `j f✓( . n sf 500 sf $35.00 >500 sf-750 sf 50.00 _ >750 sf-1000 sf 75.00- >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: x,0041= square feet x$96/sq.foot= STAND ALONE PERIMTS Open Porch x$30.00= (number) o sv-- . Deck _x$30.00= (number) :b Fireplace/Chimney x$25.0'0= (number) Inground'Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) permit Fee Prolcost Rev:063004 I — J , ` Affidavit of Substantial Financial Interest I, /'r— �G���J of �... l3 a i►., c�G , on oath depose and state as follows: y 1. I am an applicant for a building permit for the property located at Map Z , Parcel The address of the property is .z `tc 'r" fC-/ 2. 1 have U % legal or equitable interest in the real property which is the subject of the building permit application which is identified in paragraph 1 above. 3. Within in the last twelve.months from today s date, which is , the following individuals or entities have had a 1% or greater legal or equitable interest in the real property which is the subject of the building permit application which is E identified in paragraph 1 above: Name Address ecl lJ� �n t1 100# 6 v /i WX 4. Within the last twelve months, from today's date, which is /Z— I have had a 1% or greater legal or equitable interest in the following properties which have been . the subject of a building permit application: Map/Parcel Address ,-7 � 5. .Within this calendar year, I have submitted building permit applications for. property in which I have a 1% or greater legal or equitable interest. 6. Within the last ten days, I have submitted building permit applications for property in which I have a 1%o or greater legal.or equitable interest. 7. Within this month, I have submitted building permit applications for propertyin which I have a 1% legal or equitable interest. AJ Within this month, I have received building permits for property in which I have a 1% legal or equitable interest. ' • � a�y L Signed under the pains and penalties of perjury, this—day of !!l��� , 200 `7 2001-00501affin 1 Q/LOTTERY/AFFIDAVIT ` - F _ — The Commonwealth of Massachusetts :- -- Department of Industrial Accidents = ONIGd BJA1rYri'Sd��' , . • 600 Washington Street Vas Boston,Mass. 02111 Y workers' Cum ensation Insurance Affidavit-General Businesses / r/rr r r ar r ti name: - address: %x— OZ(O � city�.✓• /J G� N S�r^ ✓ ` state one# Z work site location full address ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑RestaurantBar/Eating Establishment working in any capacity. ❑Office❑ Sales(including Real Estate,Autos etc.) ❑I am an emplo rer with ein I es(full&part time).//// � ❑Other/ ///1�//r% I am an employer providing-workers'compensation for my employees working oa this j b; coin 9 hone#• .instirence.cb:•:•, ..G.�•:. - '�',:'.`.7.:;`•�••�'�� olic.'•#:,; I-=-a-sole-proprieter and have hired the independent contractors listed below who have the following workers' compensation polices: ; coin"'an name:' .,'" : . •. , tiddress� fl • insurance co. - // f 4 M11111111011111011111 //�/�////////10 com•eii. .usiiiie •1�` •'��''��• • . • address - �i✓'77— hone N. 4. •iiisui•arice=co:-:• •. ::. .:.:' :: •.• : :. .'•:- /:.. '�'�� '` ` A WA N VA WA WIN 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 eivilpenaities in the form of it STOP WORK ORDER and a fine of$100.00 a day against me. I understand that ii copy of this statement maybe forwarde to the Office of Investigatio f the DIA for coverage verification. Ida hereby certify-under the s and p alties perju at th formation provided above is true an orre / Signature Data r % �C ✓Print name Phone# . official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office i (]health Department contact person: phone#; ❑Other (revised Sept 20M) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service'of another under any contract A 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 perfoi-mance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority., ii Fill Applicants Please fill in the workers' compensation affidavit completely,.by checking.the box that applies to your situation. Please supply company name, address and pbone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for con irmation of insurance coverage: Also be sure to sign and date the ep ation for the ermit or License is.b affidavit. The affidavit should be returned to the city or town that the apphc ,, ,p � requested, not the Department,of Industrial Accidents. Should you have any questions regarding the"lave' or if you are required to obtain a workers compensationpolicy,please call the Departrnent.at the number listed below. ////%///////��//f////��///1/////l�///////y///� i.,�����/ �i.�G, %�������itii,% i:ih /% �i % �%/,yam City or Towns Please be sure.that the.affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill.out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will b'e used as a reference number. The affidavits may b e returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank ybu in advance for you coop eration 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 Me of Imsngetigns 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)7274900 ext.406 FEnfotcementAgenclr . 780 CMR Appcn J Trade-Off Works heet PemUt# i A < Date Builder Name BuilderAddress tJ Cx- / Z I Checked By I S� l-4 ���� 'r• Zone#�--_ Building Address �� G Z $� Submitted By L 12,01 y v' ���' Phone Number G �— L _ Date Ceilings, Skylights, and Floors Over Outside Air Required Insulation U-Value x Area s UA Description R-Value U-Value " x Area UA p 633 2/.s m Ceiling �p 2 Floor Over Outside Air r fn f tt2 Skylight — ft2 tt2 Ceilings:Total Area tt2 Walls,Windows, and Doors Required Insulation U-Value x Area UA R-Value• U-Value x Area = A ` r Description ��� t 17 -L V ft2 L EEg= r Wall �� ' � G 1 AL Window -- . v , Door _ Sliding Glass Door tt2 ft2 m Walls:Total Area `��/ ,tt2 Floors and Foundations Required U-Value or Area or Insulation Insulation U-Value or Area or F-Value x Perimeter UA F-Value x Perimeter UA 34 m Description Depth R-Value � � Q .J A Floor Over Unconditioned ft2 ft2 tt2 Basement Wall ft Unheated Slab in. ft ft ft Heated Slab in. n2 Total Required UA Total Proposed UA L� T— Total Proposed UA must be leis than or equal to the Total Required UA. d building design represented In these documents is consistent with the building plans,specifications, Statement of Compliance: The propose emi to lication. Z/ and other calculations bmitted e P PP _ CY Da Company Name Builder/Designer 53 L.D. NICKULAS.CO. P.O.BOX 507•WEST BARNSTABLE,MA 02668 OFFICE:508-362-6295•FAX:508-362-5578 t ✓lze�an �ealClc a' / oacaclzueeka j, x BOARD"OF BUILDING,REGULATIONS' x License CONSTRUCTIOWSUPERV.ISOR Number a�S� 002265' Birth 1118/1,95.$ Expires 01/=18/20, Tr.no: 1.2952 Restricted LARRY D NICKULAS y PO BOX 570 l W BARNS: BLE, MA 02668 Administrator. �,. ---- ,,pp�------- ✓lie -�arrvaw�euea/,t�i`o�✓�aaaacluiaet7a � �\ Board of Balding Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrat ot-�100496 Expii'attan 18/2006 YP Ctliidual LARRY NICKULAS, Larry Nickulasa � 125 LAKEVIEW DR ,� CENTERVILLE,MA 02fi32-' Administrator W—T C Temp'Mapparcel 000 000 329 ! ;;` Date 06/15/2005 r 'f Street W 15 e� '� �� RE s >' 4 ,Road Narre LAKEVIEW DRIVE , r� iks x ` - 7........,.� '1 �la 't�'� �� ,� z g �� Village CENTERVILLE ' � � � � � � " � ;�.:.fi M'9.4.�+-,.. ,H6tl�PXT �'h:`�.n � s� '£ ��:i � 3- �� ,Part of M/P � (LOT 1)MAP 214 PARCELS 038.W00 Plan Ref (6 2 W 2 C)PLBK 600/18 Ig e v + �k" # �": n z 1Y. *14 F ,, Final'Map Parcel ' w o� nlap y tpcl1 ° ti Pc2-. ,dc °. AN 4 �a "M OF BARNSTAMS MOMENT Of PUBLIC WO 60GINEERING DIVISION 367 MAIN STREEt GYANNIS.L%OM I Bk 19677 F•!3322 209C1i i '34-01-2005 c`bi 04 X 34 ca Quitclaim Deed , Property address: 300 Shootflying Hill Road West Barnstable and 35 Lakeview Drive, Centerville, MA I, Gerald Ramin, of Brookline, Norfolk County, Commonwealth of Massachusetts, for consideration of Seven Hundred Fifty Thousand ($750,000.00) Dollars paid, grant to Larry D. Nickulas, of P.O. Box 507, West Barnstable, Massachusetts 02668, WITH QUITCLAIM COVENANTS,the land and any buildings thereon at Centerville,Barnstable County,Massachusetts, bounded and described as follows: PARCEL A: Those certain parcels/lots marked as N and O being shown on a plan entitled "Plan Number 4 of Property in Barnstable Mass. Owned by Howard Marston, Scale I"=100', surveyed Nov. 21-24, 1914 by Vaughan D. Bacon-Barnstable, Mass." recorded in Plan Book 3, Page 81, which lots are bounded and described as follows: NORTHWESTERLY by Seth Hinckley Road (now called Shoot Flying Hill Road); EASTERLY by Lots P and R shown'on said plan; and SOUTHERLY by an unnamed way having a width of thirty (30) feet,sometimes called Lakeview Avenue. Excepting therefrom the land included in a Taking made by the Town of Barnstable for highway purposes and duly recorded with the Barnstable County Registry of Deeds in Book 519, Page 45. PARCEL B: Those certain parcels/Lots shown as P and R as shown on a plan entitled "Key Plan of Property in Barnstable,Mass.owned by Howard Marston,complied Step. 1 st., 1915,by Vaughan D. Bacon,Surveyor,Barnstable,Mass."recorded in Plan Book No. 1,Page 53,which lots are bounded and described as follows: z NORTHERLY by Seth Hinckley Road (now called Shoot Flying Hill Road); EASTERLY by land now or formerly of Marion P. Bond; SOUTHERLY by an unnamed way having a width of thirty (30) feet, sometimes called Lakeview Avenue; and WESTERLY by other land shown as Lot O on said plan. Excepting therefrom the land included in a Taking made by the Town of Barnstable for highway purposes and duly recorded with the Barnstable County Registry of Deeds in Book 519, Page 4.5. Subject to conditions, restrictions and reservations of record. Meaning and intending to convey the premises conveyed to me by two deeds of Beatrice Ramin,individually and as Trustee dated March 10, 1993,and recorded with said Barnstable County Registry of Deeds in Book 8489,Pages 306 and 308. IN WITNESS WHEREOF, the said Gerald Ramin has hereunto set his hand and seal this 3 J day of March,2005. „ Gerald Ramin COMMONWEALTH OF NIASSACHUSETTS Norfolk,ss. t; p March 3 i , 2005 Then personally appeared before me,the undersigned notary public,the above-nai-ned Gerald Ramin,who is known by me,and to me known to be the person whose name is signed on the preceding document, and he acknowledged to me that he signed it voluntarily for its stated purpose. Notary Public Print Name: , Richard B. Aronson My commission expires: • 613I05 The Town of Barnstable Department of Health Safety and Environmental Services MAM 16 -0 g Buildin Division - Eo�• i 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 u Fax: 508-790-6230 PLAN REVIEW Owner: Map/Parcel:- 2 14 U .3 Project Address: 5 I 0 ey Builder: c v- The following items were noted on reviewing: r �� C-��e h�Q�Vv►� rn - � ors 1 s . \�3. 0.V 32Y lr0. Es Reviewed by: Date: oFTMETpy� The Town of Barnstable BARNSTABLE, MASS. g Department of Health Safety and Environmental Services 1639. N0 pTfO MAC a. Building Division - 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection F;AC, Location La k6i,e w Permit Number t Owner Builder One notice to remain on job site,one notice on file in Building Department. /The following items need correcting: �✓ @rnOlerIJ W AAdw)S AfAP-3 lAU-c f'er,UIrc� k7U CO 4e (_Ji ' vI SL kk A n4 0 �al�� SPr\1>n ct� eNC�65(A -t 4" - J 2- TYt�C�+W0.c-� ��SSih4 TCa �•� �X�Cr.oc- �aor kY�u�A r 1' 1G1< .5�� �w� �yu5� �76 CaCt(Z.r,-C e �J J zme �aY\ A,0 6c coVVA ! ALA(3ks f'V�- 5 1 ` (' U MIN V t p�&—C " V lr A 00 r G ct ra q e- Kul, J JG W. � . Please call: 508-862-419M-for re-inspection. Inspected by Date SNOW 25 pot FLOOR 40 p9f ZN✓l� ,� / DL 15 pl:f Noe v�;4 x38 L.4-4 f3 01.7 Gjti 2 to O57 42V.. /FT � or j 12 4 s • s wo W b )L2b fi . 00 BeamChek v2004 licensed to.Jim Egan Reg#8111-1975 15 LAKEVIEW DR., CENTERVILLE GARAGE BEAM G1 Prepared by:jee Date: 7/27/05 Selection W 14x 38 50 ksi Wide Flange Steel Lateral Support at: Lc=6.1 ft max. Conditions Actual Size is 6-3/4 x 14-1/8 in., Min Bearing Length R1=1.1 in. R2=1.1 in. Data Beam Span 28.0 ft Beam Wt per ft 38.0# Reaction 1 TL 11732# Reaction 2 TL 11732# Bm Wt Included 1064# Maximum V 11732# Max Moment 82124 # Max V(Reduced) N/A TL Max Defl L/240 TL Actual Defl L/324 Attributes Section in' Shear inz TL Defl(in) . Actual 54.60 4.37 1.04 Critical 29.86 0.59 1.40 Status OK OK OK Ratio 55% 13% 74% Fb(psi) Fv(psi) E(psi x mil Values Base Value Fy 50000 50000 29.0 Base Adiusted 33000 20000 29.0 Adiustments YP Factor, Lc. 0.66 0.40 Loads Uniform TL: 800 A Uniform Load A 0 R1 = 11732 R2=11732 SPAN=28 FT Uniform and partial uniform loads are Ibs per lineal ft. Notes PAGE 1 i rti BeamChek v2004 licensed to:Jim Egan Reg#8111-1975 15 LAKEVIEW DR., CENTERVILLE KITCHEN BEAM K1 Prepared by:jee Date: 7/27/05 Selection W 8x 28 50 ksi Wide Flange Steel Lateral Support at: Lc=5.9 ft max. Conditions Actual Size is 6-1/2 x 8 in., Min Bearing Length R1=0.9 in. R2=0.9 in. Data Beam Span 16.0 ft Beam Wt per ft 28.0# Reaction 1 TL 6624# Reaction 2 TL 6624# Bm Wt Included 448# Maximum V 6624# Max Moment 26496'# Max V(Reduced) N/A TL Max Defl L/240 TL Actual Defl L/448 Attributes Section in3 Shear(in 2) TL Defl in Actual 24.30 2.30 0.43 Critical 9.63 0.33 0.80 Status OK OK OK Ratio 40% 14% 54% Fb(psi) Fv(psi) E(psi x mil Values Base Value Fy 50000 50000 29.0 Base Adiusted 33000 20000 29.0 I Adjustments YP Factor, Lc 0.66 0.40 Loads Uniform TL: 800 =A Uniform Load A 0 R1 =6624 R2=6624. SPAN= 16 FT Uniform and partial uniform loads are Ibs per lineal ft. Notes PAGE 2 f BeamChek v2004 licensed to:Jim Egan Reg#8111-1975 15 LAKEVIEW DR., CENTERVILLE BEDROOM BEAM B1 Prepared by:jee Date: 7/27/05 Selection W 8x 28 50 ksi Wide Flange Steel Lateral Support at: Lc=5.9 ft max. Conditions Actual Size is 6-1/2 x 8 in., Min Bearing Length R1=0.9 in. R2=0.9 in. Data Beam Span 18.0 ft Beam Wt per ft 28.0# Reaction 1 TL 4752# Reaction 2 TL 4752# Bm Wt Included 504# Maximum V 4752# Max Moment 21384'# Max V(Reduced) N/A TL Max Defl L/240 TL Actual Defl L/493 Attributes Section in' Shear(in') TL Defl in Actual 24.30 2.30 0.44 Critical 7.78 0.24 0.90 Status OK OK OK Ratio 32% 10% 49% Fb(psi) Fv(psi) E(psi x mil Values Base Value Fy 50000 50000 29.0 Base Ad'usted 33000 20000 29.0 Adjustments YP Factor, Lc 0.66 0.40 Loads Uniform TL: 500 =A Uniform Load A 0 R1 =4752 R2=4752 SPAN = 18 FT Uniform and partial uniform loads are Ibs per lineal ft. Notes PAGE 3 r! r o OR+ SMOKE PETECTORS EIIEWED BA Tkld,901LDIN6btff. 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' ✓Dr-�iv � �r�y��� Pc s /70 `�o�s ,P,�/E�Ia did E f' LNIOUTy f. A complete TJ-Xpert framing plan requires the Trus Joist Framer's Pocket Guide _ See This Joist Framer's Pocket Guide for Product Trademark information Cnxpqrt. .2110. ��81' PRELll��N�RY DR41V1NG - _ , • . - - JOB COMMENTS CREATED BY Mid-Cape Home Centers �LARRY NICRULAS ' ' - PO BOX 1418 - CUSTOM COLONIAL 465 ROUTE 136 15'LAREVIEN DR ' - SOUTH_ DENNIS, MA 02660 CENTSRVILLS MA 5083986071 f FAX: 5083984559 Joists By Others - - Rm2 Rjm� " O !• _ - - - SYMBOL LEGEND —H9 M10 _ M8 O Point Load 2 - 88 - Line Load III H1 H2 Bkl III Area Load " III Detail Callout Label III A6 Al III O (See Framer's Pocket Guide) III � Required Bearing Length in inches A4� (Adequate bearing has been provided if III Ega A2 A3 ,12" O.C. III bearing length is not indicated.) M6 III III I _ f H2 A1�111" rx "° •+ £Inca 4 1/d" d 3/16" J.4 III III M8 A, H3 1 III AB a Ha _E6 a" III LEVEL NOTES III 6 1/2" �. 4 3/16" III. File Name: NICxULAS CUSTOM COLONIAL.JOB _ _H2 Level Name: SECOND FLOOR 3 .2 Plotted: 7/20/2005 08:25 III Design Status: III Rml i•+ z I"' S 5/8" FIRST FLOOR....7/20/2005 08:23 Am2 III A5 _ SECOND FLOOR...7/20/2005 08:23 ATTIC LOADS....7/19/2005 16:00 c ROOF LOADS.....7/19/2005 16:00 .. A3 A7 I NOTE: Level design times indicated above provide _ 2_. H2- assurance for proper level stacking. Design Methodology: ASD H2. Floor Area Loads Vary: l A 25 to 60psf Live Load and 10 to 12psf Dead Load A3 1 Maximum al/80 Live Load Joist Deflection: l L/260 Total Load TJ-Pro Rating Information: weighted Average: 50 Lowest Rating: 35 • Highest Rating: 71 27' 8 1/2" [1*-8' 3 1/2°- _ 34, f 11' ► Glued a Nailed Decking is Required Direct Applied Ceiling of 1/2" Gypsum is Required 1 x 4 Strapping is Required Floor Decking: 23/32" Panels (24" Span Rating) Normal O.C. Spacing - 16"* - JOIST AND BEAN LIST _ ;} - *Unless noted otherwise Plot ID Length Product Plies Qty HANGER LIST - Simpson Strong-Tie C - Layout Scale: 1/8" 1' . omyany, Inc.® ± Al 18' 11 7/8" TJI 230 joist 1 18 y ACCESSORIES LIST A2 14' 11 7/8" TJI 230 joist 1 28 Plot ID Qty Product Label Top Nails Face Nails Member Nails Notes 1 A3 16' 11 7/8" TJI 230 joist 2 6 Plot ID Length Product Plies Qty A4 12' 11 7/8" TJI 230 joist 1 8 E1 5 MIU416 20-N10 2-N10 f A5 10, 11 7/8" TJI 230 joist 1 10 E2 60 IUT3512 10-N10 2-N10 Rml 16' 1 1/4" x 11 7/8" 1.3E TimberStrand LSL 1 9 A6 8' 11 7/8" TJI 230 joist 1 3 B3 3 U3512-2 16-N10 6-N10 (2) Bbl 1' 1" net Backer Blocks 1 6 A7 d' 11 7/8" TJI 230 joist 1 d H6 d IUT3512 10-10d 2-N10 Ski• 2 1/2" 11 7/8" TJI 230 Blocking Panels 1 1 AB 28, 16" TJI 560 joist 1 17 HS 3 IUT3512 10-10d 2-N10 (5) Nb1 8 7/8" 7/8" x 2 5/16" web Stiffeners 2 12 A9 26' 16" TJI 560 joist 1 5 E6 1 HUS612 10-10d 10-10d Rm2 16' 1 1/4" x 16" 1.38 TimberStraad LSL 1 4 M1 is, 1 3/d" x 11 7/8" 1.98 Microllam LVL 3 3 H7 1 Not Found Shl 4' x 8' 23/32" Panels (24" Span Rating) 1 68 142 16' 1 3/6" x 11 7/8" 1.9E Microllam LVL 2 2 H8 2 IUT9 8-N10`. 2-N10 Bk*, Random length blocking panel cuts M3 16' 1 3/4" x 11 7/8" 1.9E Microllam LVL . 1 2 H9 1 HU414 18-10d 8-10d Rm, Aim Board Page 2 of 4 M4 14, 1 3/4" x 11 7/8" 1.9E Microllam LVL 3 3 M5 12' 1 3/4" x 11 7/8" 1.9E Microllam LVL 1 1 Hanger Notes: 210' 1 3/d" x 11 7/8" 1.9E Microllam LVL 1 1 (2) web-Stiffeners Required FOR THE TJ-XP E RT WARRANTY N7 6' 1 3/4" x 11 7/8" 1.9E Microllam LVL 1 1 (5) Backer Blocks Required MB 4' 1 3/4" x 11 7/8" 1.9E Microllam LVL 1 2 SEE FRAMER'S POCKET GUIDE M9 28, 1 3/4" x 16" 1.9E Hicrollam LVL 2 a TJ-Xpert 6.40 #6 H10 8' 1 3/d" x 16^ 1.9E Hicrollam LVL 2 2 ( 91)C6.40 D6.40 S6.40 P6.40 BOOK PAGE 10 c CA � RECEI?FO AND RECORDED A/oi�i�o✓AL (/N•aER T,�E S/JP1D/V/s/pN CONT.FOL L.. 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