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0027 LIETRIM CIRCLE
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'd :ef �{ti�.. i '�t; ry y � ,� "� .t •� ��; 8� � } .ski ypy �i� h! ,r. 'v M tt c ypG� I'I f i i rl !p{ .�:�9'{ ]rA fli, � .6:f •, � 9 !1�{ �. Ii 'Ii '. I ,,, fi rp '1 Ilr � v+ F •ll 'e ," f F't' f' '�, {' nndi •�T r H 3 . PX ' 4 ( �..a ,tq t k� • 'ir �t � ti`('' �. �:, 'f i�1,, ,, � tip; 't, , .i°; t•'� � , ! 1 R , Y 1 1 . � t d inF I 7 r , ,r 6,.�t'+, '': � e;,_�.., t•y y '! n{'+ ,��,` IWIt$ k• ;� �! r,'n'?f��+ar ,a � ..,° `6�-��. ,,,1,:�.r#�1�.9 ,i..tl! ...._ -.r. ';t �.... _...,'��1,�:. 1.. �.., � r8lk.`• --, ,k,..'F1.{.- I��. ..:.._ i'7 �J= 1 �„ Town of Barnstable Permit# i �T " Regulatory Serviceg,,p fee 6monthsfromissuedate • t►tnes. �, Richard V.Scali,Director au. Building Division 2017 Paul Roma,Building Commiss ��/n ' 200 Main Street,Hyannis,MA 012 �"i 14 t l 'HA H J'j www.town.barnstable.ma.us !A BL Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY -Map/parcel Number �!J I /„q Not Valid without Red X Press Imprint Property Address Lr,--r-� � C�t t t C_Utl L U—�-- [Residential Value of Work Minimum fee of$35.00 for work under$'6000.00 Owner's Name&Address 1 a-q Ck0"D-E,—k--. Contractor's Name Telephone Number 5o g IF q 6 9 0 Home Improvement Contractor License#(if applicable) Email:A Gt- `1 O-94-tZ-(2 l e-vc'o. � Construction Supervisor's License#(if applicable)_D 9 cl- l 67 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor �❑,�am the Homeowner Lid I have Worker's Compensation Insurance Insurance Company Name itc i(,r�iv Workman's Comp.Policy# 5(�-s0 Copy of Insurance Compliance Certificate must accompany each permit. Permit Re que t(check box) [Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers-of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. t � ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home ImproveTefftsontractors License&Construction Supervisors License is required. SIGNA Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc , 01/25/17 i Tlm Comm ompeaWk of- assr diusetts D parairut ofrahurzidAccidmdr � f�,f,�c�of�iit? gafirt�rs ' 600 Washington&treet Baaston,CIA 02111 }nvimmamgorldlia Walters' Caffipensaffi n Tmmn a>ace Affidavit BwldeimICantmetars/Flectdcians/Plm:Lbers ' Applic-3pt Infwm,afign II Please Print Na={BusinessfCig _ �j i t,4 V10 G lk)C- Adiress: J eityts�:t : �� � � . � ��• �o� � 6 Flo - - Are7U an emplarr?f hegt!e appropriate bo= ' Type of project(respired}: L I am a emplace ui.& 'L 4. ❑I am a general contractor and I emfrlay.ees(Tall.an&or part#ime * lie hired.the sub-comtrat� 6- ❑New oansftucfibn 2-❑I am a sale proprietor orpartner- listed oathe attached sheet. '?. El Remodeling sUp and lmve:no employees Thew sab-con�ractars have ,❑Demolition wasiaag fornP in any capacity. employees andhave wo6mrs' 9. ❑Building addition INp vvpdg' comp-insurance Comp.iasuranc, 5. ❑ We are a cotpozafien.and its ME]Elecfncal repairs or adcritiom Officers have:exErdsed fhEtr 3_❑ I am a bnmeaumer doing all work 1 L❑P3umbmgrepaiss or additions, mys-ef[No wo6mrs' - rdEX of ememption per MGL L[� afrepairs c.15Z§I aadwehaveno tslciitanre reG�II1L•Ed�i (� l3r_❑Other �1�w-[Na ' conxp:insnzanCe regirired.j ;A apg&a��st cbecksbcx#1 x�st also ffio�the secBoabeIaar�ra►dag�earvo$ce��ompeasaSaupcycyiu��aiaoa ff�evavasswbasnbngtduss�da<<ui gtheyaretiaingaifwcaicawdtbmhaEoutsidecaatmchRszmastsnhauraneweMdaeit' iCUk. acs- rCa�xactps�utcbe&tb ibaxmostattarhedsasddifinnslsheetdwvd=gtbe=neofftsob-c�mindstgawbegmarnatlhoseeaffdeshare amp Impes.Iftbesol-caa+tactneshave emplgv s;they l pmtadethek war]Ems'c=p•ply zLmnbes I arrt art elxpin;�sr flerrf;isprmtiriuzg n�nrke-rs'cattipetisrr��rt i�iraace�or m}*�rplo}�er. Seloty is t7t�paLicy'a�jah seta. €nformatbiL Elsumce Com.panyName: (Xi 'Policy-4orSelf--in.Lie.4 J W O(00- V FxpimobnMde: 5 ' (O 18 n C. s Jab Site Address:Z2 1T I l� LC eity/scate .Lp. Tt`�J (.1. °� 0�6�Z: Attach a copy of the workere comppewationpoherdechwation page•((showing the policy number and ezpi�tion date). Failure to secure coverage as required under Section 25A of MGL c-1572 can lead to the imposition of rdmimal penalties of a fine up to$1,5a0:OD andfar one-year imprisonment,as well as civil peaalties Jn the fa=of a STOP WORK ORDER and a floe of up to$250-0!0 a dap ag-ainst the violator. Be adidsed firaf a cape of this shkaient.snay be fowarded fn the Office of Investigations o€the DIA for ffisuramce coverage-mrifrcatian- Idah Aycerg ff � ' tlts artdr afp � �}'ihattrio infbrmagmprm dedabmchbarsandc�rrect simmat k—A-2-C:2 Date: Phone 0,0kf d am wily. Do nat wrcta in fids area, 5e cmnpkad by cftp or tan-71 offiC QL L"dy or Town: PermitrUcense# Issuing Anwar *(cacieone : VZ ; L Board of ealth Bufldmg Dep=ta ent 3.Ciyl£owa Clerk 4..Electrical hmpector S.PhEmbing fnspector b.Other Coact Person: Phone#: - — --- 6 t 'arxiation aax( Tas ct- i-Onas GeSreaalL[n ffiaplmr 152 req=es all=3PIOY='to pravidevzorke&comp ensafionfarf]eiremploy pis-¢ O this staiUEL-,,M MVPLayee is&fined as.,—.e-, ,ypersonin.lha sea'vice of aaothm ffides auy conftaA oflibe E empress or implies,,oral orb." • M-In associ aticsn,corporation or oilier legal Y, aaY tFvo or mrne ¢ An Ivy r is defined as an m ideal,p � I er,or tlae of,, f faze foregoing m&Joint use,a admclndmg legal represer�iives of a deceased emp oY reiver or truster of an inffd,7ual:par� ass biP, oc7ai or ofherlegal e�fity,euzploymg=P]Dy= ec - However Elie owner of a dweTrmg boase I�&gig nflt more f�tbree aparfraenis End resides f3 em,or fhe ocr�f offiie- dweIIing house of a X&M who employs pMS=to da maiz ce, ^„ch art;rsn or repair Wow on such d�eII>ng hoIIse or on_the grounds or bn11dmg appu�fhemeb shannotbecanse of such=Tloymedbe deemedto be an employm7 MGL chapter 152,§25g6)also states that¢every sfdL-or local licensing agency shaff wil3ihoId ffie issuance or renewal of a Bcense ar permitto operate a business onto construct bffdiags in he commonwealth for any applicantwlLo has notproduced acceptable evidence of cdmplianMwith tbr-msQranc �yeragere " Additionally.Md chapter 152,§25C(7)states fiTeifber the=TTTn_aweala nor a'uy of its political subdivisions shall enter fnffi any fi7rfbeperformance ofpublio wDikuninl acceptable evidence of compliancewitli the insurMce. req er of Bois chapfes bave Been presez>ted in flee co�racfrng.a�Tioly." Applicants ' Please fiQ o;ct Elie wu J=s'compensation affidavit completely,by chmidag the boxes'dLA applY to your sifnaiion and,if nemszq,supply=ia-�or(s)n=(--(s), addre sss�es)andpho Me;number(s)aIong With.their=ifrCH t*)of Dance. Lir f Liability Campa�es(TLC)or LimifiEdLiability Partneahips(LIP}wrthnn employees other than th e members or pa=fners,are not rimed to cagy wo13ce2s'compensation insox�ce_ If an LLC or LLP does hate empIoyees,apolicyisregaitD(L Beadvisedthatthisaffi aYitmaybe dinfheDepa-finentofrn&Otial Accidents for confmmafion of insurance mverage: Also be sure to sign and date [e affidavit: The affidavit should berefjed to ffie city or town that the application foi Elie peaait or license is being requested,notfhe Department of �,4 r�-�rT�,fs ST�Tdyon bare auy gaestions regardmg the Jaw or ifyon are required to obtain a workers' compensation pofiey,please call flee Dep artmerrt at file number lfs�i below: Self- cages should= Z their Se, Iioerlse�bPa an file aPpmp�aiE Ime• City or Town Officials - Please be sure that Elie affidavit is complete andpriatt-,dlegIly. The Department has provided a space at the bottom Of the affidavit for youto fIl out iath,event tine Office oflnvm%n& ns has to co�ctyour%7rdmg�applicant. Please be stn e to fM in the pemit]Hc=r-mzabes w ch.w7I be used as a reference nBmbeu Tn won,as aFPv-Cm1t fhat must submi`Dzultiple pence* ?N �e applications many�}venyear,nd.e only submit one affidavit indicating dent p oh v infomation (if necessary)and under-Tob 5Re Q ddr "the applicant should v;rife-all locations in (may or town)"A copy of the affidavitfhat has been.officially sfn3ped or madred by tine city or town may be provided to faze a ic.It as prooftizat a valid affidavit is on file for fntme'pemufs or Ifs=w, Anew aff davkimrs�t be:fiIled out Chrh year.Vhere ahome ovfnea or citizen.is obfiammg&license or permitnotrelatedin anybn�1eSs or Commercial veofrin� a dog license or pmmit to bum Ieaym etc-)said Peron fir NOT in complete tins affidavit hD Office ofln;,e gafi=wovldliketo:thankyouaadvance for your coopmafianand should,you hzve nayqaeVdu=. please do notheoate to give us a call The Depffifm=Lfs address,telephone and tax mmiLbex- '11 CaMMInM S*of • .. �ref a�Acfs • . fuse d14:�tiw� �.4 man BaStM MA 0�11I -Ta 4 61 7-7274M cxt 406 or 14M IAA 99AFE Fax#617-727 7M Keyised�-24-47 �-��d� I, Payment schedule;500/6 due at project start, balance upon completion. Respectfully Submitted, Oliver Kelly. ,( Proposal accepted by; �"""' Date ) / 31 /2017 If acceptable please sign and remit one copy to the address above, keeping a copy for your records, this proposal is valid for 45 days from date above, please call to verify thereafter. Massachusetts Department of Public,Safety Board of Building Regulations and Standards License: CSSL-099167 Construction Supervisor Specialty . 4< M KELLY OLIVER 8 RHINE ROAD t`=, YARMOUTH PORT MA 02' t: L / • f i _ Expiration: Commissioner 09/28t2097 Office of Consumer Affairs and Business Regulation ' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 128957 Type: Individual Expiration: 6/14/2017 Tr# 28693E Oliver Kelly Oliver Kelly 8 Rhine Rd - Yannouthport, MA 02675 - = Update Address and return cant.Mark reason for ch scky zunnosn, _ Address ❑ Renewal C Employment [j- Los v. r/71r. `�cv�r�ar.•rrctnr���n -lliJs�ir-�ruefl.: �"-------�___._`.�.�___�.... _.__..._ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only T SOME IMPROVE1.MENT CONTRACTOR before the expiration date. If found return to: egistration: _128957 - ._ Type: Office of Consumer Affairs and Business Regulation Expiration: :6/-1.4/201_7: Individual 10 Fark Plaza-Suite 5170 - _ Boston,MA 02116 Oliver Kelly Oliver Kelly 8 Rhine Rd. Yermouthport,MA 02675 Undersecretary Not valid without signature 0 A� CERTIFICATE OF LIABILITY INSURANCE 05T15-2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: DOWLING&O'NEIL INS PHONE FAX 973 IYANNOUGH RD (AIC,No EXt: ac No); HYANNIS,MA 02601 E-MAIL INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:ACE AMERICAN INSURANCE CO INSURED INSURER B: KELLY ROOFING INC INSURER C: 8 RHINE RD YARMOUTHPORT,MA 02675 INSURER D: INSURER E: INSURER F: COVERAGES ERTIFICATE 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 TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM�Y EFF POLICY EXP LIMITS LTR INSR WVD ( oNYYY) MM/D GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS-MADE❑ OCCUR PREMISES Ea occurrence MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY jRa LOC $ AUTOMOBILE LIABILITY EOa a�deD SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) .$ HIRED AUTOS NON-OWNED pOPERTY AMAGE $ AUTOS Per accdent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH_ AND EMPLOYERS'LIABILITY Y/N X TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTIVF�NIA A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? td UB 05-10 2017 05 10 2018 (Mandatory in NH) 8H085809 E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER NCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 200 MAIN ST CANCELLED BEFORE THE EXPIRATION DATE THEREOF, HYANNIS,MA 02601 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE JOHN J.LUPICA,President ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. .F Map q6Y Parcel Application # 'k J Health"Division !9 - So S Date Issued Conservation Division t r` Application Fee Planning Dept. t Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH Preservation/Hyannis Project Street Address ze,! Village ��,� �f�2ZZZ! � �� Addressy 7 1f . Telephonet/UG�� � � g!2 ; Permit Request o� Square feet: 1 st floor: existinq*�proposed/ �4 2nd floor: existing proposed Total new ' Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type�a_ Lot Size f 14"®12. 7 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 Gp new O Number of Bedrooms: e)o - existing Qnew Total Room Count (not including baths): existing _new First Floor Room Count Heat Type and Fuel: �s ❑Oil ❑ Electric ❑Other Central Air: es ❑ No Fireplaces: Existing New Existing wood/c)gal stove' ❑Yes J&<oo Detached garage: ❑existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑, isting news size_ Attached37- garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: �4 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Telephone Number Address Z ,/ License #(:fS 6 ;!/gf Home Improvement Contractor# Worker's Compensation #ly� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �AT 3 i ' FOR OFFICIAL USE ONLY j APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE 4 OWNER DATE OF INSPECTION: ' ' FOUNDATION FRAME g 9 14f us s�1 I also /o�l6�a� 'INSULATION { FIREPLACE n ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL -FINAL BUILDING DATE CLOSED'OUT ASSOCIATION PLAN NO. e The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations q 600 Washington Street Boston, AM 02111 • www.mass.gov/diu , Workers' Compensation Insurance Affidavit: Builders/Contractors(Electri�cians/Plumbers Applicant Information Please Print Le 'bl Name (Busincss/OrgmizaEbnllna;viduai): 7p Address: City/Statdzip: Are you an employer? Clteck the appropriate box: Type of project(required). L❑ I a employes with' 4• ❑ I am a general contractor and I 6 ❑Kew construction ployecs(full and/or part-time).* have hired the Sub-contractors em 2. I am a sole proprietor or pariner- listed on the attached sheet 7. ❑Rodeling ship and have no employees These sub-contractors have 9. ❑ Demolition. employees and have workers' working for me in any capacity. 9. E]Building addition [No workers' =p.•mmnaancc comp-mcrrrance. 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions rcgtured] officers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a homc;own z doing all work uryscl£'[No workers' comp. right of exemption per MGL 12.0 Roof repairs incurancc re t c. 152 §1(4), and we havt no d j employees. [No workers' 13.❑ Other cautp.insurance required j *Any applicant that chmkr box#1 must also'fifl out the=t on blow sbowing tbcu workus'coropcusalion))obey information. t Homeowners who subiniY this affidavit indicating they arc doing all work and thcri hirL outside evnh ee tnrS mast subrmt a n�cv affidavit indicating such_ $Contractors that ebcck this box must attacbcd an additional&beet showing the name of the sub eantraLiurs and stain wbrther or not those entities bavc employees. if the sub-mnhaetors bavc mTTloycrt,they nnut pruvidb their workers'comp.poBey number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and jab size information J s Lmu-ancc Company Names Policy#or Sclf-ins. Lic. #:I,e'-Z Job Sitc Address: /'' //' City/State/Zi Attach a copy of the workers' compensation policy declaration page(showi.ng 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 rrimb al penalties of a fine Yip to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP.WORK ORDER and a fim Of up to$250,00 a day against the violator. Be advised that a copy-of this statrmtrit may bo forwardad to the Office of Iuvcsti ations of the DIA for insurance novas e verification. I do hereby c u der the pains-arid penalties of perjury'that the information provided above is true and correct. Si at�c I?al Phone Official use only. Do not write in this area, tb be completed by city or town off cuiL City or Town: Permit/Liceme# Issuing Authority (circle one): 1'. Board of Health 2'.Building Department 3, City/Towu Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: ^ Massachusetts General Laws chapter 152-requires all employers to provide workers'compensation for their employees: pursuant to this statute, an empLcyee is defined as "...every person in the service of another under any contract ofhirc, ' express or implied, oral or Wlittcn_" L j An er,%PLoyer 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 cecciver or trusted of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not morel than three apartments and who resides therein, or the occupant of the iwclling house of another who employs persons to do maintenance,construction or repair work an such dwelling house )r on tha grounds of building appurtenant thereto shall not because of such employment be dcamed to be an employer." 4GL chapter 152, §25C(6) also states that"every state or Iocal licensing agency shall withhold the issuance or. •eneWal of a license or permit to operate a business or to construct buildings in the commonwealth for any Lppiirant who has not pro duced.acceptable evidence of compliance with the insurance coverage required." Vdditionally,MGL ohaptcr 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall nter into any contract for the performance of public work until acceptable evidence of compl.ance Rriith the insurance: cquircmcnts of this chapter have been presented to the contracting authority.. Lpplicauts ` lease Ell out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if ,�ssaiy,supply subc�ontrar;tor(s)name(s), address(cs) and phone number(s) along with their certificates)of isuuance. Liruitrd Liability Companies(LLC) or Limited Liability Partnerships(LLl')with no employees other than the ,ambers or partncis, are not required to carry workers' compensation insurance. If an LLC or LI does have nployccs, a policy is requircd. Bc advised that this affidavit may be submitted to the Dcparhncnt of Industrial ccidents for confirmation of.imnrawc coverage. Also be &ure to sign and date the affidavit. The affidavit should returned to the city or town that the application for the pcmnt or license is being rcquestrA not the Department of idustrial Accidents. should you have any questions regarding the law or if you are required to obtain a workers' impensation policy,please call the Department at the nurgber listed below. Self-insured companies should enter their If inerrant.0 license number on the appropriate line. ity or Towp Officials ease be sure that the affidavit is complete and printed legibly. The D cpartrncnt has provided a space at the bottom 'tbc affidavit for you to Ell out in the event the Office-of Investigations has to coatact,you regarding the applicant case be sure to Ell in the permit(license number which will be used as a refcrcncc number_ In'addition, m applicant A must submit multiple permit/liccnsc applications in any given year,nccd only submit one-affidavit indicating current licy information(if necessary) and tinder,"Job Site Address" the applicant should write"all locations in (city or wn)."A copy of the a$davit that has been officially stamped or marked by the city or townmaybe provided to the, , plitant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit rnust bc'fllcd out each ar.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture ;. a dog license or permit to brim leaves etc.) said person is NOT required to complctc this affidavit c Office of Investigations would 15m to thank you in advanec for your cooperation and should you have any questions, :ase do not hcsita-tc to give us a calL Department's address, tcicphone•and fax number. Tha Cammbnv�c9th of Ma.s (GhusetMs ' Depa ant of lndustrial Arcictc-,nts Office of luvestiptz4ns 600 washingt= Street Boston, MA 0211.1 Tei. # 617-727-490.0 cxt 4-06 ar l-V7-MASSAFE Fax# (517-727-774-4 ( 11-22-06 www.maS,3.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR'ENERGY EFFICICIENCY FOR ONi- AND TWO-FAMILY.' DETACHED RESIDENTIAL,'CONSTRUCTION (780 CMR 61.00) Applicant Narne: � � Site Address: T print . Town: Applicant Phone: t-le;7e 6-,r,-e 8�1-,f vo?oxf— Applicant Signature: ��—��� Date of Application: � s NEW CONSTRUCTION: (choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR - NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM' MINIMUM Ceiling or Basement Slab Option 1: Fenestration exposed Wall Floor Perimeter U-factor floors. R-Value R-Value Wall R-Value AFUE ISPF SE ER- R R-Value R-Value and Depth National Appliancc Energy 3 5 R-3 8 R-19 R-19 R-1 D R-10, Conservation Act(NAECA) of 4 ft. 1987 as amcndcd,minimums or realer as a licablc Note: This form is not required if you choose either of the-two versions of REScheck.as.listed below. Option 2: PREScheck—Web ck Version 4.1.2 or later variant software analysis must-be. completed MR_6107.3.2 which can be accessed at http://www,tncrg cY odes.€oy/reschecld DDITIONS=M '.4TERA TIONS'TO':EXIST- IN G.BTJ AX,NI G9::O:-VER-5:t.A.RS 0LD* Wildings under 5 years old must use option#1 or#2 in New Construction section above: . Dmplete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b- a) . .-SF 100 x Q % of glazing --39�_ ' (b) Glazing area equals. SF b Q 7lazing is ,40%o usd,tht-chart bclo.w. If,glaziri is:>:40°Q/o proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING 'LOW-RISE RESIDENTIAL Bl'JILDINGS MAXIMUM MINIMUM Ceiling and Wall Floor Basement Wall Slab Perimeter Fenestration Exposed floors R-Value R-Val U-factor ue•' R-Value R-value R-Value and De th .39 R737 a R-13 1 R-19 R-10* R-10, 4 feet R-30 ceiling insulation'may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e. not compressed over exterior A ails, and includingan access o enin s).- ❑ SUNROOM-An addition or alteration to an existing building/dwelling unit where-the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition, Note:. Owner to fill out Cons um erfnfo rmatio n Form (found in Appendix 120.P) AWC Gicide t0 jVood Conso-16ctiou in HiJh .)-Yind Areas: I10 inplr 1Virr�l.Lo»e MassachusettS CieckliSt ft01- C0111pliance (78o C11.1R 5301.2.1.1)' Check Compliance 1.1 SCOPE WindSpeed.(3-sec. gust).................................................................. ................................................. 110 mph Wind Exposure Category....:................................:.....' .............. B Wind Exposure Category................Engineering Required For Entire Project .................:.....................0 !/ 1.2 APPLICABILITY Number of Stories (a roof which exceeds 8 in 12 slope shall be considered a story) stories <_2 stories Roof Pitch ..............................:............................................(Fig 2 s 12.12 MeanRoof Height .................................................... ........(Fig 2)................................................. ft 5 33' BuildingWidtH,,W ......................:.............................._......,..(Fig 3)................................................. -ft s 80' !/ BuildingLength, L ..............................................................(Fig.3)............................. ....._..........::. 4j�ft <_ 80' G Building Aspect Ratio (L/W) ..... ...:......................................(Fig 4)................'.........1,..G' .........� FY `3:1 Nominpl Height of Tallest Openingz ..... ............................(Fig 4)................................................ Pp _<6'8" -Z 1.3 FRAMING CONNECTIONS General compliance with framing connections.:..................(Table 2)..................................... ' ..... h S.. 2.1 FOUNDATION,. A Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete....~......................:........................................................................,._........................ �G ConcreteMasonry .................................................................... .................................:............................. 2-2 ANCHORAGE TO FOUNDATION1j3_ 5/8"Anchor Bolts:imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only .+ Bolt Spacing-general ....... ......................I...........(Table 4).............................................. in. v Bolt Spacing from end/joint,of plate .............................(Fig 5).........I........................... 6"—12" !i Bolt Embedment—concrete.........................................(Fig 5)...................,............................:7 in. >_ 7" Bolt Embedment— masonry..—....................................(Fig 5)..........._i............................... in >-15" PlateWasher.........:......................................................(Fig 5)..............................................> 3"x 3"x'/." 3.1 FLOORS Floor framing member spans checked ..........................:.:..(per 780 CMR Chapter 55)................................... Maximum Floor Opening Dimension.-.*P 9 . . . . . . (Fig 6)..................................................._ft_ 12' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall (Fig 6)...........................I............. Maximum Floor Joist Setbacks Supporting Loadbearing Wails or Shearwall ................(Fig 7)........................I............................_ft 5 d Maximum Cantilevered Floor Joists, Supporting Loadbearing Wallsor Shearwall.............. (Fig 8).................... < d FloorBracing at Endwalls...............w .'................................ (Fig 9).......................................,.... ........................ Floor Sheathing,Type .........:.........:....................................(per 780 CMR Chapter 55)................................ ... Floor Sheathing Thickness ...........................................:.....(per 780 CMR Chapter 55)....................... in. Floor Sheathing Fastening..................................................(Table 2).._d nails at in edge/_in field :.1 WALLS Wall Height p Loadbearing walls. ....:............:.............:.......:..........(Fig 10 and Table 5)............ .......... ft s 10' Non-Loadbearing walls ................................................(Fig 10 and Table 5)................ . �1_'�'ft.<20' Wall Stud Spacing . ..............I.............:..............................(Fig 10.and Table 5).....I........ 24'o.c. Wall Story Offsets .......................................'.........`...(Figs Te.8)............................................_ft"_< d ; .2 EXTERIOR WALLS' Wood Studs Loadbearing walls.. .......(Table 5)...... ............... - ft in. Non-Loadbearing walls ............:...................................('fable 5)..............................2x - ft O in. Gable End Wall Bracing Full Height-Endwall Studs.. ......(Fig 10)...................:........:................................. r.:. ft>W/3 WSP-Attic.Floor Length...:.. : ....... :....:.. ..:::.(Fig 11).::...:..... 'Gypsum Ceiling Length if WSP not used ............... Fi 11 ft>_.0.9W and 2.x 4 Continuous Lateral Brace @ 6.ft. o.c. .. (Fig 11)............................:............:..... .........:.:. or 1 x 3 ceiling,furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft..spacing in end joist.or truss bays/ Double Top Plate Splice Length ..................................:..................(Fig 13 and Table 6).......................,........... ft Splice Connection (no. of 16d common nails}...............(Table 6)..:.....:.:.....,......_..:.......,.._................. --� AWC Guide to IVood Cofistructio" if Higfi !Wind Areas: 110 j1zplr hVi»d Zolie Massachusetts Ct1eCJj1Sf f01- Con1pli.2I1Ce (780 01,111 5301.2.1.1)t Loadbearing Wall Connections Lateral,(no. of 16d common nails) ...............................(Tables 7)........................................... Non-Loadbeanng Wall Connections /y Lateral (no. of 16d common nails).............. .................(Table 8)........................:.-....... -.......... .......... Load Bearing Wall Openings (record.largest opening but check all openings for compliance to Table 9) Header Spans ...................(Table 9).................................J_ft in._< 11' Sill Plate Spans (Table 9)................................... ft in.511' . Full Height Studs (no. ofstuds).. �t...............................(Table 9)............................,................... :.._... Non-Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................I.................................(Table 9)......................:........: _ft_in._< 12' /y' Sill Plate Spans............ (Table 9).................................._ft—in.5 12" Full Height Studs (no. of studs) �............ . . . ....(Table 9)....................................................... Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension, WAl Nominal Height of Tallest Openin z ..... :....:...................................._5 6'8" / Z note 4 ....:............ -�i ........ .. . SheathingT e......t�/.-.-�••. ......... Edge Nail Spacing................:._........I.............(Table 10 or note 4 if less)......................... in. G Field Nail Spacing Table 10).,........ ...................... ............./,2- in. Shear Connection (no. of 16d common nails)(Table 10)......................:...............................3 Percent Full-Height Sheathing Table 10 ....... ... .........:............................. 5%Additional Sheathing for W,allwith Opening> 6'8"(Design Concepts).................... Maximum Building Dimension, L i Nominal Height of Tallest Opening .......................................................I............... 6'8" !� Sheathing Type/. ,,r ............................(note 4)............_......:.............................._.. -� Edge Nail Spacing:... ...................... ..............(Table 11 or note 4 if less)....................... in. Field Nail Spacing...........................................(Table 11).........:......................................./,?- in. Shear Connection (no:of 16d common nails)(Table 11)...................................................... � Percent Full-Height Sheathing.......................(Table 11).......:.........................._................. 3 % 5%Additional Sheathing for Wall with Opening > 6'8"(Design Concepts).................... Wall Cladding Ratedfor Wind Speed?....................................................... ............................................•.................. ROOFS. Roof framing'mernber spans checked?........................(For Rafters use.AWC Span Tool, see BBRS Website Roof Overhang ...................................................(Figure 19) ............. ff s smaller of 2' or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12)......:.....................................U PIf Lateral ........................................_... (Table 12).............................................L=/'?Z' plf Shear...............................................(Table 12)............................................S=--;2-;7plf !/ Ridge Sfrap Connections, if collar ties not used per page 21... (Table 13).................. = Fi _ Gable Rake Outlooker..........................................(Figure 20) ••••••••••••• ft 5 smaller of 2' or L12 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors //11 Uplift................................................(Table 14)._..........................................U= T . Lateral (no. of 16d common nails)---(Table 14).......................................L 5��b. _/Z Roof Sheathing Type........./ 3y...:`..1/ld..............(per 780 CMR Chapters 58 and 59) ............ ess..... .Roof Sheathing Thickn � ........:..... .. in. >7/16" WSP Roof Sheathing Fastening able 2 .... ..G. K �• •<� •_ l� This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of, 780 CMR.5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 !� b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a and Figure 18b xception: Opening heights of up to 8 ft. shall be permitted when 5% is added to th'e percent full-height sheathing -equirerr ents shown in Tables 10 and.11. the bottom sill plate in exterior walls shall be'a minimum 2 in. nominal thickness pressure treated#2-grade. I J Er�'L `lC'oWn of Barnstable r r Regulatory Services r ZALt•ISI'ABI.� M ss $ Thomas F. Geiler,Director. �AItin) - Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable_ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section ff Using .A_ Builder 7 as Owner of the'subject property hereby authorize to act on ray behalf, in all matters relative to work authorized by this building permit application for: e: c;L 7 �.t -etri/l Ciro e, Ce.11e�v►cle �/n� 4 �32 (Address of Job) R-Lz — 3 Signature of Owner Date (r 6 (At P- Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on th'e reverse side. Town of Barnstable �*► Thy01 Regulatory Services Thomas F. Geiler,Director L BAitNsrwat> - MA-S Building Division FQPT fD������ i7 Tom Perry,Building Commissioner . 200 Main Street; Hyannis, MA 02601 Yrw-w.town.b arnsta bl e_ma.us ice: 508-862 4038 Fax: 508-790-6230 HOMEOWNER 'LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number Street "HOMEOWNER": home phone# work phone# name CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINrrION 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 f�vo-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 helshe shall be es onsible for all such work performed under the building permit. (Section 109.1.1) [he undersigned"homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. 'he undersigned "homeowner"certifies that belsbe understands the Town of Barnstable Building Department ninimurn inspection procedures and requirements and that be/she'will comply with'said procedures and f�quirements. ignaturc of Homeowner oproval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the ate 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 shal be ex s for hom ire prov1�doisions h this section (Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engagesp () rk,that such Homeowner shall act as supervisor•" Many homeowners who use this exemption ire unaware that they arc assuming the responsibilities of a supmisor(sec Appendix Q. Ics&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly cn the homeowner hires unlicemcd persons. In this ease,our Board cannot proceed against the unlicensed person as it wou)d with a licensed >crvisor. 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, :the homeowner certify that he/she tmdcrstands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by oral towns. You may care t amend and adopt such a fonn/ccrtification for use in your community. • t t GRANITE STATE INSURANCE COMPANY 78154-0000 WC 826-69-33 13102 ________________�----------------------- 013-66-0408-00 CAPE ABILITY CONSTRUCTION LLC Member Companies 13 FORT HILL RD per'►ids of EAST SANDWICH, MA 02537-0000 American international Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK. N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D# MA UI#& •. LOVEQUIST-MURRAY INSURANCE AGENCY INC WORKERS COMPENSATION AND EMPLOYERS PO BOX 38 LIABILITY POLICY INFORMATION PAGE WEST DENNIS, MA 02670-0038 INSURED IS PREVIOUS POLICY NUMB LIMITED LIABILITY COMPANY I NEW OTHER WORKPLACES NOT SHOWN ABOVE: SEE NAME AND ADDRESS SCHEDULE - w9go610 ITEN12 POLICY PElgoc IM AAL standard the at the bostffeft nmuing address FROM 04/09/08 To 04/09/09 ITEM 3 A. Workers Compensation Insurances Part One of the policy applies to the Workers Compensation Law of the StataS listed here: MA S. Employers Liability Insurance: Part Two of the policy applies to the work in am* listed in item 3.A. The limits of our liability under Part Two are: Bdly Injury by Accident$ 100,000 each accident Bodily Injury by Disease $ 900,000 Policy limit Bodily Injury by Disease $ 1 QO.000 each employes C Other States Insurance: Pert Three of the policy applies to the stater, If any, bated hem SEE ENDORSEMENT - WC200306A MEM 4 The preenitun for this po Ncy vAN be determined by our Mang of Ruffs, qasifioetions. Rates and Rating Plans. AN information required below Is subject to verification and chwoe by aunt. Estimated Total Raft Per Estimated classificallons Cade Namber Rmummati°n $100 OF R1► Premium alAnnual❑3 Year min1M1 Annual ❑3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $45' MWBW 00110rAW MOM WIMM APPLICABLE av STATEi 18 MA MINUUM PR®nuv S SOO MA TOTAL EIRIU M PREURINS 1.138 If Indicated below,Interim a*u sbnents of lammiurn etaiI be auaMoG ❑ Seal-Annually ❑ a-ia lY ❑ mww DEPOWPI3111101 SEE ATTACHED FORM SCHEDULE - WC990612 04/08/08 ASSIGNED RISK 66 ' issue cats issubg Otftce AUtherlaWmitivosontAive WC 00 00 01 z . Massachusetts-B Rim t°or°;And Standards ublic Saftty Board of Building" ~Supervisor License Construction License: CS 69188 Restricted.to: 00... � •: DAVID J *IJERSON \\ 13 FORT HILL RD . . E SANDWICH,MA 02537 Expiration: 65=0 - ('onunicQioaer Tr#: 25M 71.4mmawmiA�. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR _ Reglstrt}tori:; 124091 Expiraffon, f1,?,�2009 TrB 262108 CAPE ABILITY David Anderson 13 FORT HILL E.Sandwkh,MA 02M Administrator j . 43 `,o 13 L , 1 ' 0 � I i 'I � I, •i _ lIIII),I• I I I f� - ,_ .//�Ly` I f- ri_H; f � ' � I, 1 11 IIIRII Rg ' `I I ( F 0.I \ _ r L\ l= _� :, ) 'i`' III it EL 7 R '!!IIICIUII -kill - r— .I 1 1-� �� 0! I �III,I I to `? .►> ;I:� f il-lll! i i' Ef rt�� I< i' I f M f_I I h Ilr V - .. wG too OVA 1v Mgt W. ! r y 4 , J : L / '.0o \ EY tt; PPi G)P05�p✓�COrnahi \ .. 77 a.•: la An A NMI 5"#`�47 x�y � O i•JI1C;��)/ / .. - /' - • 17 �GouUy :`I x I 5/4"Su r`_bcF UIL F _, _ \ Z;�.I ]� �k y���'` TO ham} .:: O L...[:iT.l .. `•I' '() I �i 1 2.''.:s.r_5'l �•I F F P:>: \.t'A j. SS 4 '•I _'l7 111 �.' I' 0p �'_!II:Cc'I�(� - 1 1- �' FOI,f •� � :: � :; ,' -� :: .:.. D "'-Its Jc�d�' '.5�1-: :=>1 oPi_:;o P•u , rt pqr .. ri ::.1 �H,'Sv F�. ''1�FS r5 1�h1GHOP> • •p's`t I { ,: ^µ - t .. 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' �- WIK)00111 rj GHE.(M ULE -- - --- - - "�•L �� �11 Tm � cot�t: Ql1Ar1. ,C�U1hybYZf -.0sq•'•1 ppaq CA-r^.L-.0qMTV Q 1 �I° Ilisll� 3, y ,`• ,�,, GP�a�IkLl �C�/QCwIc� 3 Cl C0 c at l' i:TtylM cl�C�6 '�G;r. ) X .;_ >.:--1 23.' .Ill51r�. -'�-.(_r'/0a ?�•3��5 "�h6p - f9 -- -_ 9Iv .'' -%'rLv1��c rnnr)4ncFtu zooai`; �Moo:SePileS ' 3. PpVLt /J�Tli(•)').. _tl�cPT 1 , 10 l...A}_)- _i.:n4 r3:� - - - d° .., •2• /EP�9P w1'C1EL� y SAI» •" , r`N Est, r�w� !.la• x}• ;; _. .., - - �.:TA..fJ11 Gt-Jr1r_vl v...7_ - ' o' 7 lk r w !� T OWN OF 8ARNSTABLE Town of Barnstable AIJG 26 PM 4: OS �'WHE Apt Regulatory Services sAaN Thomas R Geiler,Director}------..,..,._—__ M"S& Building Division Tom s63g. ,0� AlFD �� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 0 PERNIIT# 3 FEE: $ � SHED REGISTRATION D Q �- 120 square feet or less v Location of shed(address) Village Ee�e J e Property owner's name Telephone number Size of Shed Map/Pareel# CR Signature Date74 Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? d Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN a LOT 44 f S 4 ? �Q LOT 42 `oSw LOT 41to M. 42 CD u7 LOT 43 co HOUSE-27 N CI` N �. 26$ 23 0 19 �4 N • d' E- CIR CL E-' RES. ZONE: RC FLOOD ZONE:. C , THIS MC)RT'GAG-E= T NSFPEC'T ION PLAN IS FOR BAN • S TOWN: CENTERVILLE REGISTRY OWNER: CARLI. WOLSIEFFER DEED REF: 2532/324 BUYER: PETER L & BRENDA G CROWELL DATE: 5/24/89 PLAN REF: 2?3/139' SCALE: I -= 30' ere y.• certify that the ui ing OF "', shown on this plan is located on ��tN YAI�IKEE SURVEY the ground as shown and it �� cy� position does conr.orm to the PN-A r^ CONSULTANTSzoni''ns law setback requirement of 8 lTH�W BARNSTABLE No. and does not lie within the special FESS� A� PHONE: 428-0055 flood hazard area as ' shown on IR�� SURV� �Q 143 ROUTE .*149 ( P.O. BOX 265 ) t h u . d . • f 1 o o d map dated MARSTONS MILLS, MA, 02648 is p an not made from an instrume'tit rjIeJB . Paul A . Herithew, RPLS surve , not to be used for fe,necs. et 1 rr Assessors office(1st Floor): Assessor's map and lot number /U/ % THE T � 4 ;�:. Pao Conservation(4th Floor): Board of:Health(3rd floor): t I ` • Sewage Permit number `' `- 1 sARXITA c Engineering Department(3rd floor):'. House number } f Ito ear Definitive'Plan: pproved by Planning Board t 19 I APPLICATIONS PROCESSED.8:30-9:30 A.M.'and 1:00-2:00 P.M.only , TOWN s OF BARNSTABLE SUILUNG INSPECTOR t APPLICATION FOR PERMIT TO I ti TYPE OF CONSTRUCTION t 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 2 z �� f 0,. 4 ' Proposed Use Zoning District Fire District. Name of Owner / Address' o2)7 oe?Ge2/26 L�G� ✓L�=�XQ Name of Builder Address 67 It'll Name of Architect Address Number of Rooms Foundation Exterior Roofing Ae6l Se"44 Floors Interior r Heating Plumbing Fireplace Approximate Cost Area c © C��' ' Diagram of Lot and Building with Dimensions Fee � 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. Name Construction Supervisor's License �o s- CROWELL, PETER u, No 36097 Permit For RE-ROOF Single Family Dwelling Location 27 Lietrim .Circle �. y • �r Owner Peter Crowell f" Type of Construction Frame Plot Lot ` Permit Granted August 13 , 1 g 9 3 Date of Inspection: Frame 19 + r Insulation 19 .,. 4 Fireplace 19 Date Completed t2 19 C 1. . . '.., •, `- r-� { � n t COMMONWEALTH DEPARTMENT � -- -__._---_-,.-- .-- -'--- - OF PUBLIC SAFETY OF ONE ASHBORTON PLACE ' F861t!letOppgEoasaserrent MASSACHUSETTS "BOSTON,MA 02108 i %' SSr�cu`wsa¢I Mt,��®BY)/?dip EXPIRATION DATE LICENSE o9thfsUae�sp. CONSTR. SUPERVISOR CAUTION 04/05/1996 � � RESTRICTIONS EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST NONE THEFT, PUT RIGHT THUMB 8 0 b 13 d/1 93 006156 PRINT IN APPROPRIATE o OA NI EL S 1J A BOX ON LICENSE. 60 PINYON WAY zi > E EALNiOUTH MA 02536 BLASTING OPERATORS m PHOTO(BLASTING OPR MUST INCLUDE PHOTO. ONLY) FEE: I 100. NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY .1 HEIGHT: STAMPED-OR-SIGNATURE OF THE COMMISSIONER { ,,: a THIS DOCUMENT MUST BE CARRIEDON THE PERSON OF �''v THE HOLDER WHEN EN- ` GNATURE OF LICENSEE t SIGN NAME iN FULL ABOVE SIGNATURE LINE OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION. IONER ✓lee PomvnwiuuealDi o�/ eoae�ivavlr HOME IMPROVEMENT CONTRACTOR Registration 108865 Type - DBA Expiration 08/26/94 Daniel S. Oja \ Daniel S. Oja 60 Pinyon Way ADMINISTRATOR East Falmouth MA 02536 I yo*THE r TOWN OF BlzRNSTABLE • B8BB9TABLE, am i � "6 9 BUILDING INSPECTOR 9 a• APPLICATION FOR PERMIT TO . . .... .... .......... .... ... ........... .................................................... TYPE OF CONSTRUCTION .... .... ... . ... ... . !'�& o .......... .. ...... ............... .......19... � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .. . ... -...... .1.. T.r .. ..... ..t. .. . .....................C...g�.T '. .u.�.. 1.. `.............. Location ... _... ProposedUse ... ..t6... ......... .. ... .. . ........................................................... ZoningDistrict ....................... ................................................Fire District-....(f.—.. ....:....................................................... Name of Owner .... '-s_. .... �if.. ....Address .. .... ..Q.....tl..........:�.(:� .. /6''�. 77 Nameof Builder ...................... ...:.......................................Address .................................................................................... st Nameof Architect ..................................................................Address .................................................................................... ek Number of Rooms ..............fJ.... .......................................Foundation ........./i ..�(................................:...... Exterior ..........Z......P-47-.601 .............................Roofing ............. . ...... ......! �/..................... Floors ..... . ..... . ...... ...........................................................Interior .....:`.L ....... Heating ......... ...G .......... ..t�.A..........................Plumbing ........./........................................................................ Fireplace ....... ..........................................................................Approximate Cost .........,... 1,..., v. ................................ Difinitive Plan Approved by Planning Board _______________________________19________ . I)S-7 SIC/ Diagram of Lot and Building with Dimensions O = CU ' m � � O cn 11 z y. w F-- a- U-J 7% U LL _ z y Ate., Cca 3 < Jib to Q a /0- P. I KN I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �- Name ., ... . ................................ .................... Dacey, William E. Jr. DEC 31 1970 137... Permit for one Story, ,single family dwelling ... .................................................. a 7 Lietrim Circle Location ................................................................ Center,&le .............................................. ............................... Owner .............William E,. Dacey, Jr. ............................................... Type of Construction frame ................................................................................ Plot ............ Lot ............442............. Permit Granted ........October 22 19 70 Date of Inspection .... ..........19 70 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................... 19 ............................................................................... ............................................................................... LOT 43Y a yizg f k� 3 AS/LOT 169=60 f , 'V O - S0 , 5 LOCUS . LOT 44 J� d 43 - eet R AS/LOT 169-61 SRO, LOCUS MAP 70.2ft ` PLAN REF - 223-139 O DEED REF 6775-038 '5 DRI Y VEWA � LOT 42 , . ASSESSOR'S MAP.' 189-059 ZONING. "RC SETBACKS.- 20�10'-10' AS/LOT 169-59 FLOOD ZONE: 16012.7 SQ. FT. /%�� G��� PANEL NUMBER 250001 0015 C DATED.• 0 81-1 911 9 8 5 0.4 .AC R-ES PLOT PLAN OF LAND LOCATED AT ,;;;;'.#27;;;;;;'' , 27 LIETRIM CIRCLE o• CENTERVILLE, MA s s PREPARED FOR.• 60 Sol PETER & BRENDA CRO WELL 16.7ft , LOT 4 1 40.9ft JUL Y 24, 2008 AS/LOT 169-5B 7Qs AD �� REV REV REV GRAPHIC SCALE �� YANKEE LAND SURVEY ♦ c P� �m 20 p 10 ° 20 40 ♦ o sTFJ�=,J �. CO., INC. ' LOT 36 40 INDUSTRY ROAD = 20 �� == �� AS/LOT 169-53 MARSTONS MILLS, MA 02648 1 inch ft _ � �� ` TEL 508 428-0055 FAX 508 420-5553 SHEET 1 OF 1 .TOB # 54418 SH,