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" I ohm - ' F Town of Barnstable *Permit 114E #� p ply Expires 6 months from issue date r�wttrt �A81� : Regulatory Services Fee o1J r MASS. $ Thomas F.Geiler,Director �6 fGd i679• s�0 Building Division I oil-7 Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w �_�RESS PERMIT Y Office: 508-862-4038 Fax:. 5.08-790-6230 Q C T 10 2006 EXPRESS PERMIT APPLICATION Not Valid witlsout Red X-Press Imprint TOWN OF BARNSTABLE Map/parcel Number iQff f 7 Property Address 0�0 L 1/JA)f� Residential OR ❑Commercial Value of Work ,0 0 Owner's Name&Address + L 1 n/ d�f Telephone Number `!�([J y S6 Contractor's Name / Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name — , f' KEL A Workman's Comp. Policy# o C ® � ®6 Permit Request(check box) Re-roof(stripping old shingles) ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44) ❑ Other(specify) ons.i.e.Historic.Conservation.etc. "Where required: Issuance of this permit does not exempt compliance with other town department regulati Sisnature � ""' . expmtrg. , Department oJ'industrial Accidents F Office of Investigations r - ' d 600 Washington Street y Boston, MA 02111 °,M r•J www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plurmbers iplicant Information Please Print Legibly me (Business/Organization/Individual) � �-(,(, R00 f1 WG, [dress: ty/State/Zip:A9AU AlU j2 1d• OZo`gr phone #: -5'OF' �(20. q�r S �o you an employer?Check the-appropriate box:. - Type of project(required):- am a employer with . ❑ I. am a general d I contractor an 4 � 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet.$ 7. ❑ Remodeling ship and have no employees - 'These_sub-c6ntr4etors have 8.....❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance... . 5• ❑ We are a corporation and its required.] . officers have exercised their 10.❑ Electrical repairs or additions i) I am a homeowner doing all work _... -right of-exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'. comp. c. 152, §1(4),and we have no 12:❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other Rf^,,eor�F comp. insurance required.] applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information' N ieowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. actors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infonnhtim. an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site motion. ance Company Name: A-T[_+At'T fC c ff"-)�54 y#or Self-ins.Lic.#: t y(2 D(0- q,_3 OD Expiration Date: Y Co d site Address: %/ 4b FM ./ vg City/State/Zip: CTFdQdfGLt. 04, 0�l03� t:h a copy of the workers' compensation policy declaration page(showing the policy number and.expiration date). re to secure coverage as required under-Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a ip to$1,500,00.and/or one-year imprisonment; as`welI as..civil penalties in the form of STOP WORK-ORDER and a fine to$250.00 a.day against the violator. Be advised that a copy of this statement ruay be forwarded to the Ofi ce of aigations of the DIA for insurance coverage verification. hereby certi �derhe pains and n 'es of perjury that the information provided above is true and correct ature• Date- L4�If a lie#: q,20 -� q q_/ 'Co ffieial use only. Do not write in this area,to be completed by city,or town official. ity or Town: Permit/License# suing Authority(circle one): Board of Health 2.Building Department 3.City/Town,Clerk 4:Electrical Inspector 5.Plumbing Inspector Other .ontact Person: Phone#.: r -c.•. rc�-"x`.i -'' �h^' .sx, " ?e�f�''�z'� ;i^',,:azpxy�!4*^�,�rll�a,aps,��c;^iiz. � SFr "`"`�? .�K,r�. x,� �a x rY'%;, r ?':3 �x+,:.:s w, -.,:. E �''�; ,IiVO�f�KERS';CO vP�NSA7 b �ANb EN�pLC? E�tS`L� B��.�IT§Y�� SURANC��P,QLICY,'�__ - � � t �, rs, `'"� f .z-sx . ���? a��on�P!'�/y(e•��� n��,i ��` r�'= 'j��,���+,F�ioa oo a'.�& Atlantic Charter Insurance Company VDAC Cl Co. No.:29211 Policy Number:, WCV00643001 INSURED: Prior Policy Number: WCV00643000 Robert Tyndall Producer: *30 Jillians Way Fredericks Insurance Agency, Marston Mills, MA 02648 Federal ID Number:174560293 dnc. Risk ID Number:. 1046 Main Street Osterville, MA 02655 Business Type: Individual SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured:See WCE106 Other Work Places: See WCE107 POLICY PERIOD: The Policy Period Is From: 4/6/2006 To. 4/6/2007 12:01 A.M. Standard Time at The Insured Mailing Address COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to.the states, if any, listed here: COVERAGE.REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund States D. This policy includes these endorsements and schedules: See WCE105 COVERAGES: The premium for this policy will be-determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of . Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $516 Interim Adjustment: Annually Estimated Premium (Minimum Premium) $500 Servicing Office: Surcharges) 16 25 New Chardon Street - .. _ Boston, MA 02114-4721 I Total Premium a4 surcharge(s) $516 ;sue Date 03/29/2006 Countersigned By:.___._,_ _ DaWR 2 fight 1987 National Council on Compensation Insurance Form:100m X �� Ur 07IYIYl{YI2GJP,p1�,�/j, O���/��LCltrcLp ' . Board of Building Regclations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found Registr ation; 116064 return to: .Board of Building Regulations and Standards EXpiratron' S11&2008 One Ashburton Place Rm 1301 tType_ LtdtL iability Corporation Bostot:,Ma.02108 \LL ROOFING L1! RT TYNDALL- _ z :IANS WAY`,, -ONS MILLS, MA'-02648 Deputy Administrator — -- - - - - Not valid without signa ure Tow. of Barnstable . vpfK}{E Tpk,�o »� .� eguXaox„y Services Thomas E.Geiler,Director $uildiug Division prF°rN►� TomFery, B ruilding Commissioner . 200 Main Street, Hyannis, . .- �r,ta�n.barnstable,maus --- Fax: 509-790-6230 pffice: 5o&s62-4038 property Ch erMust ..Complete and Sign TMs Section - . If Using A:Builder -CJ l(1� ,as pRrner of the subject property - L� ��r► to act on n�ybehalf, _.. hereby authorize . ' ersrelativeto Workautborize dbythisbuildingpermitapplicationfor. - . m�matt _- tAddxess of fob) - D. Sign tore Owner Print ICI e _ _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Fmap Parcel Permit# 9 Health Division . Pqqq t� y)o 9/70� Date IssuedYJ Conservation Division Application Fee Tax Collector, ri, x. Permit Fee �. Treasurer SEPTIC SYST n n- 4 . 1=i1 �t��T BE Planning Dept.:', INSTALLED `., , NCE Date Definitive,Plan Approved by Planning Board ENVIRONIVI iv s: , r i:- AND Historic-OKH Preservation/Hyannis .TOWN REGULA i- ONS Project Street Address O D' Uv-\C0e Village Ce C'6 \ACC, y+. Owner !<�rNr— G- i-o- �f e�4 ' q\Ar ,J Address Ce ms\fie �1,A Telephone rr®® Permit Re quest New W 1f _W; -p ti 4c i � q 1—� �����.�,��. �r� . /Yew ��e�� (�/Qa Square feet: 1 st floor: existing proposed 2nd floor: existing . proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Woad, IrrGtjme,, Lot Size �� ` Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: 0 Yes )(No Basement Type: ❑Full ❑Crawl 0 Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new .Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil 0 Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size - Other: Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ • Coinmerciah0 Yes:—U No If yes, site plan.review# Current Use Proposed Use- a BUILDER INFORMATION ll 'Name T Telephone Number ,,- Address p o ®: �a,� License# m hol 110 O� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO m s ile Tnv4 r SIGNATURE _/��—��2 "A DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER - T DATE OF INSPECTION: .� FOUNDATION FRAME >Z ; ri2G Dcook ; vEWT rl-b02; I4F,4D6Q INSULATIONq� ' r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH, s FINAL rr GAS: ROUGH= =� C ? FINAL FINAL BUILDING n J ' f ft � � r• DATE CLOSED OUT t ASSOCIATION PLAN NO. u f 'INE . Town of Barnstable Regulatory Services aAWMAat.E, : Thomas F.Geiler,Director MASS. .• Building Division E TfG N1p'l A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: AyP,i\Op— CQ number street village "HOMEOWNER! 5CL^dcG 0"9 �14 R,,\CJ Sb%- �qs - 5��� name home phone# work phone# CURRENT MAILING ADDRESS: 039 C D V n city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a_one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures.'A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official.on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section i09.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. :forms:homeex t . E Town of Barnstable • y�f•r}I ip�� Regulatory Ser,vides 118 , Thomas F.Geller,Director Building Division Tom Ferry,Building Commissioner 200 Main Street, Hyannis,MA 02601 • I Office: 508-862-4038 Fax: 508-790-6230 Permit zoo._ . • Data -��- AFFIDA•Y!T � HOME WROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICAMON MGL 0.142A requires that the"reconstruction,alterations,renovation,repair,modernization,convarsion, -improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied bugding containfi g at least one but not more than four dwelling units or to structures which are adjacent to • such residence or buitdiag b e done by registered contractors,with certain exceptions,along with other requirements, • Type of Work; we-- Ae_e_1L 1 6,A-dti„c am. Lsti=ted Cost Address of Work: l`� �� �[�'� C2� esy\�� Owner's Name; ��'� G--� � QIAC.✓z . Date of Application• 0— ----bH • ' I hereby certify that: Registration is not required for the following reason(s): []Work excluded bylaw ' ❑Tob Under$1,000 ' []Building not owner-occupied R30wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR ANPLIC4,d HOME ZUROYEMENT WORKDO NOT HA.YE ACCESS TO THE ARBITRATION PROGRAM OR,GUARANTY YM UNDER MGL c.142A, SIGNED UNDBRPBNALTMS OF PER]URY ' Ihereby apply foi a' ermit as the agent of the owner: Data Contractor Name RegistrationNo. OR �. Owner's Name 'l no CMR'A¢peodac J Table J5.2.1b(continued) Prescriptive Packages for One and Two-Family Residential Buildings Heated with Fossil Fuels MAXIMUM MINIMUM Olaang Owing Ceiling Wall Floor Basement Slab Heating/Cooling Area'(%) U.value= R-value' R wall Per value' R-value' imeter Equipment Effllcieacy' a Package R-value' R value' 5701 to 6500 Hating Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19, 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13; 25 N/A NIA Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 NIA NIA 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 19% 0.32 38 13 25 NIA NIA Normal Y 19% 0.42 38 #193:::17797—�� 25 NIA NIA Normal Z 19% 0.42 38 10 6 90 AFUE AA 19% 0.50 30 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 01(d ItAM Atoo (�M4erv,J1e, .1%AA 17AAl b r5 ; 14 ;nfo 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 9Y� �t_� x1S��- ah� �,� E OF ALL GLAZING: - IN 3. SQUARE FOOTAGE C x 4. %GLAZING AREA(#3 DIVIDED BY#2): •J w 5. SELECT PACKAGE(Q--AA-see chart above): Q NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING'INSPECTOR APPROVAL: YES: NO: 80303a.S-f9 ,-o rm 9 f 780 CMR Appendix J Footnotes to Table J8.2.1b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. Z After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. 3 The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation.thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall. For example, an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frarime or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 5 The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other'glazing:'Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an-additional R-2 for heated slabs. " If the,building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than'one piece of heating equipment'or more than one piece of cooling equipment, the equipment with the lowest ` efficiency must meet or exceed the efficiency required by the selected package. For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels.Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. have a U-value eater than 0.35). ' requirement i.e.,may � One door may be excluded from this q ( Y c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is.less than or equal to the U-value requirement(0.35 for doors). 43 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50 00 Alterations/Renovations $50.00 Building Permit Amendment $ 0 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0041= •7oL x plus from below(if applicable). GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS , Open Porch x$30.00= (number) . Deck x$30.00= 30,do (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Proicost The Commonwealth of Massachusetts — Department of Industrial Accidents' . � -- — • . Oi��ef�rHrsd�sd�s' . < 660'Washington Street Boston,Mass. 02111'. V ° Workers',• Com ensation.Insurance Affidavit-General Businesses �?a"�+--syi �.. •+` ^.?,uS�a.• .T��ce.:,.rl:y`,r•+•g,,,,.. ,,,,; ` .,r. � �,.�� � I •FL:tc41• ame . . x -- • a,dre Q �,\ P - state h A zip: city ' work site location full address): (] I am'a sole proprietor and have no one Business Type: [l Retail❑Restaurant/Bar/Eating Establishment working in any capacity. 0 ffice Safes(mcluding•Real Estate,Autos etc.) am an err to er with em'to ees(full& art time . [ ther I y I am an Cployer providing workers' compensation form employees worlang on this job.. '.iikafirl;}; :r.. ••:t: {,•gip'• .5�•.;' '`�:,, {",• �;'` 'i'...•i:•:.Yi •i7`f••!r'; •'!. ir• :T-, .,r •�i .ti'. :y..!•.ti •'�' _t.t ., r 1' •i,:..,�.y :'i, ',• _.ti;-i ,Y ;: .ii .?,' ••,i':; cots an •siatne: ;;, . ; ::,:�: ,.r.,;;,;; 'r� ,:. , ':•�,; t r. :},!.•::,. ,�::,i,;: 1 . r; - t •). ,,.•�•t t+,'i„i. •t.,t _ a •.c:. t'}i••t:t5,.'•,ii. •'t. � .;fi�;�'�. '1'+�. ', '!,, - ..'a y ;.•,:';rf'j1,t•. :'jl' +'t.:•: rs,. .r; ,:+.y+.:, .i:•- !.. yt..�'Si:l':• ,•. 4 rq^-r.:...t a sddr'ess' �'}r •„ •t, .•.t:::•�.:,':'tl>•— -1•.1,;: jl,'•�y i�' •t:r•' .!1 % •t,{f�:t :�' -it t,• _ �- �•' f.i•i. ,,.;.. ,r ;;pp ' ,N'•. .�. 'r' '`..1'„r. i :}... 'J::c.':y , r'•'•ii '.. 011C. •tt +�' r'•'�' ' / etor and have hired the ind endeat contractors listed below who have the following workers' am a sole propri eP '• . compensation polices: i .v• ,'eta... ,,.` Ir :,.. '•,,F•:: •�•. L `�•• '�:1: •.:t�� — .\.:,1• ')•,.' ��t.'.. t f y 'Jtv��,:", '.T'r'nt•,�.K Y. co ...n— .ct. :,tt. ,t•is?.^:rt ?{';'�± , 1,:,�;.^•,.; r ... :r'. .:'.'. `!t. :[�i'7.�''.'`:--r .#-i'�"• .. ' "' : r t , , .4 r 1' .1 'i Y _' .t$(� .a„' yi:.i•. iaddre"sS:. c 1 hone'#:. 0%t'j •i - �.r:iii:' ,. !`' J v :,: .} :'t+' ./. �:,•' .iJ •t`` ''}:' .r, y 'l"1t •'u,.5•: •'4�•t' rt ••i'•'i.'r r; `, �t t' -•i'r:'t 'y' '� '' =`r.?4,•Nt�•,' � ii`' -G• r•O�1C stt'':,t.ir.2',•:•.::'8•.7.� ::,',:'•' ti j•'•', •r. '_:y�'.''• • :C"�q�: �e'+':": r'•w'y�:f•C'. v;.4:'.'rw`• k::^:': .l�, S "' insurance,co. ��///�// .,% l•J:t �•�. i•• ,is :•e,.. I('n •' :t:i t i'•.'';.':�.'-r �t •! 'x ','. .:{•; ,, .r ,Y.• ,t.}::•:.. '4•:.J`i' :•'t,: rr,•..�t..�tn;.. •S•. �'n t:`J tt' coin eri rieate:.�.;'+• :r:• .. •,� . . •!.�, :•• .. .t= �,. . , '.�, •;1,, • t l . . + :.,• 1, ' i, OIIE.tf: •i'. .,t �1 L?_S 1 i.4 '•`% :•:: .. r=- i J.. :i:� ,.:u, '.�:'t.•, •r�..n5, �•'' �'i•".L'ly .L y;:�"-l.vT•:`•r.�yl1._t: ::Y,, ...• .,^y i,:•,~^.. ••r ,�:• :54, ,.F;'..y,-. ..t,t`M :,, }'S. 1 r:• ,i�V:^ ,.;. '•.'; i •}.:i.,.ifi�:r` S `.,!i' , t' i 1• '"J•r•'','•' ',�• '�lt `r,i f:'• ••Y.:' %i:�• :s�.:,J '.:•` ''},tom• •.011Cv -i': •r' ,.. in'surance-•so:- Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of eriminalpenalties of a fine up to S1,500.00 and/or one years'Imprisonment as well as civil penalties In the fliim of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that tL ded to the Office of Investigations of the DIA for coverage verification. copy of the statement maybe for-war I do hereby certifY under the pains and penalties ofperjury that the information provided above Is true and corf'ec4 �.L_ to Date ^•�1�_ Signature .. . � � Phone# Sb$ ` �S-`��"�•� Print name Official use only do not write in this area to be completed by city or town official city or fovea: permAlUcense# ❑Building Department . Licensing Board ❑check if immediate response is required ❑Selectmen's Office OHealtliDepartmeni contact person: pbone ; -[]Other _ (,vaed Sept 2003) x3e a Information and Instructions. Massachusetts Gefleral Laws chapter�152 section 25.requires all employers to provide workers' compensation for their. rriployees: As quoted from the law', an employee is.defined as every person in the the another under any contract )f hire, express or implied; oral or written. , association, corporation or other legal entity, or any two or more of kn employer is defined as an individual,partners hip he foregoing engaged in a•joint enterprise, and including the legal representatives of a deceased,employer, or the receiver or association or other legal entity, employing employees. 'However the owner of a �ustee of an individual,partnership,. Swelling house havag'novinore than three apartments and-who resides therein, or the.occupant:of the dwelling house of to _persons to do.maintenance, construction or repair work on such dwelling house or on the grounds or another who emp.b ys.P building appurtenantthereto 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.commonweaIth for any applicant who has not produced acceptable evidence'of�compliance with the insurance coverage required. Additionally,neither the commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements.of this chapter have been presented to the contracting authority. INE Applicants Please .the workers''compensation affidavit completely,by checking the box that applies Please fill in to your situation.:Please Pl company Warne, address and phone numbers along with a certificate of insurance as all affidavits may be submitted supply to the Department•of Industrial Accidents.for confirmation of insurance coverage. Alsa'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 Deparment of Industrial Accidents-. Should you have any questions regard4lhe'"law"or if you are obtain a workers.'.compensation policy,please call the Department at t required to number'listedbelow. ;.. City or Towns . Pleasebe sure that the affidavit is ebmplete.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_pe cens.e number•which will be-used as a reference number. The.affidavits,maybe.retumed to the Departrent VY mA or FAX.unless other arrangements havebeen made. ; The Office of Investigations would liLce to thank you in advance for you cooperation and should you have airy questions, ' please do not hesitate to give us a-call. ' address,telephone and fax number: . • • , . _ _ The Commonwealth Of Massachusetts• Department of Industrial Accidents [fee of West pffens 600 Washington Street Boston,Ma. 02111 fax M. (617)727-7749 phone#: (617) 7274900 ext:406 Q 002 06/17/97 . TUE 12:43 FAX — P. 2 6-17-1997 12! 13PM FROM MORTGAGE INSPECTION PLAN BOSTON 96-09112 SURVIM INC. p.0. Box 220 Charlestown, MA 02129 (617)242-1313 MAIN (617)242-1616 FAX APPLICANT. PAUL 8t SUSAN SOARES DEED/CERT.- 3355/55 LOCATION,• . 20 LINDEN AVENUE PLAN REF: 116169 CITY, STATE: CENTERVILLE, MA 1-A 12180+H S.F. �" L--------- j a7Mo�s •, ,ti • 1.5liTORT ti y .11� LINDEN AVE, r9BQ let B"lor Smrer Wit— PREPARED: 12-12-1996 SCALE; 1 inch=20 feet CERTIFIED TO: GMAC MORTGAGE CORP,OF PA tH OF AlAs� According to Federal Emergency Management Agency The permanent structures are approximately located en the JpHN maps, the major improvements on this propeny fail in an ground as shown.They either conformed to the setback J. Li requirements of the local zoning ordinances in effect at RUSSELL area designated as Zone the time of construction,or are exempt from violation U en- p387t7 Cotttmunity Panct No: rt.t-•vtt f`hentpr QA A- .. V --' '7--—f Z- i P i - k —_ __�_�_ _ -.�.O •_ice.:—t I _�..1� i {_—..-0 f _ _C�� I = E R- iy. s--r tArs i I r , f lfy Xv sz d 4 ILA , i r r •v"N.{{� j. ; 3.-- � i 1 .{ i { ,I 1 --t '-f—.�j 5 --- -. .-.� _ ---.•fit 2t- i it If •; __ ._. _ '-:+tea.-^-ram h —•— v - _ ---III __--•�-- .^^. ii � {, F - --� ---�--.,_,rt=...«-- _ 4 l � � I � F 1 )t � F � � f �; At I { { ..1•__�w��. • ' t � r 4 E I ^� r t t s t , i \ 4 i f� 1 9 t j ' r f - - --- - - - - -- - -- - - —_--a' - — /'� �- n { t S Zs 1 i { ps t t V`� S 1 ' r r • Y t 1 I tt -- - _----- , -F--.-.i--.- _ a- -_.,_L � ' I � fir. I � � a � �•- � L�_ Q-� I i 1130 � I ' - - - - g .Ui f + } r 3 i # Ph— cm— , _s .33 s i • t E , , 3 a 4 1 t 1 r _ _ r i r , F t ` c t ; �C f • t '{{ i I , ♦ i , Y-7 i S , En ineerin De t. 3r oor Ma Parcel Permit# 2- 8 2 0 - - House# d Date Issued — �oard of Health(3rd or)-(8:15 -9:30/1:00-M ) Fee ( �jaj,a P 0/1 nn �•nn) Plannin SEPTIC MMUST`BE INSTAL PLIANCE 19 ENVIRO ODE ARIA TOWN OF BARNSTAELE T0 VAN ' A4� : Building Permit Application Project Street Address -9-0 k ►�ra e� /+y-p—n up Village C e n+,e t_0 Owner P tq U-f 0,&4 d S LL-S q-t-L �' o o,, `ems Address �.0 /,�¢�J�t��., Aim Ct 4d— Telephone 7 Z J to Permit Request ; © e � t First Floor square feet Second Floor square feet Construction Type OL Estimated Project Cost $ —7 So Zoning,District Flood Plain Water Protection Lot Size ` 1 do-® P4,. Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure _57 y-f-s. Historic House ❑Yes LWo On Old King's Highway ❑Yes ❑No Basement Type: Gull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft,) ®2.9 Basement Unfinished Area(sq.ft) _3?L� Number of Baths: Full: Existing—� New Half: Existing 0 New No. of Bedrooms: Existing � New Total Room Count(not including baths): Existing New First Floor Room Count_�.�_ Leae Fuel: UCias ❑Oil ❑Electric ❑Other Yes o Fireplaces: Existing New �� Existing wood/coal stove ❑Yes OToached(size) Other Detached Structures: ❑Pool(size) ached(size) Ge{r- ❑Barn(size) ne ❑Shed(size) " ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name Telephone Number 7 7 l a l b d- Address Za L J" eA A16'2� License# cen-f t-r U 6'l Le, 0 .26 3 a-- Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE i DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) i n Oil r FOR OFFICIAL USE ONLY 9 ri PERMIT NO. DATE ISSUED + _ is r }„ �i 1 ` ,,. _ • r+ = ? � .' .: r �,�".,MAP/PARCEL_ NO. ADDRESS VILLAGE OWNER w F f� DATE OF-INSPECTION: - s FOUNDATION i FRAME �j �.(D (j S INSULATION ' C• ' 'u"� t�f�;�� i FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH,, FINAL. GAS: ROUGH_ FINAL' ` FINAL BUILDING DATE CLOSED OUT. , ASSOCIATION PLAN NO. ' _ �..oy'=^ce'+. r *.tti.-,..,,-i:+y,h-*`a'v.t^:c: �+ t�^^'+'^'"F` - ,'""'r'_`timrv..+a.--.-:.,.'r,...-. ��.'m+°4-•,.^°ey+.''K..,.^.• "' '",-.db"-. ` tHEO� The Town of Barnstable MASS Department of Health Safety and Environmental Services g P �1 'prFDna+a`� Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction'Notice Type of Inspection Location n L 1 (� (,iO ~ Permit Number Z Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: G Vj Please call: 508-790-6227 for re-inspection. Inspected by J;? SN54 (--S s _ -�— Date WE rq� The Town of Barnstable NAM Department of Health Safety and Environmental Services Eon Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. , r Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION { MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work:j .®� Est.Cost 7, 0-0 ,./Address of Work: fl Llc��eta 4 V ell J Owner's Name ��-�I a;4 -Su-s ct.yi So c-re-s Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit 1 r Notice is hereby given that: E OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A� SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name it' Conz,7101,"' ! O aS1ac zu-vc ' "?l' �- •{�' Dcpartlrrcfr!of ladustrial.�ccillclrrs • ,�r - : �� .-�!�• OfIIcP�llmrestlgalloas �' `ji i i •.� 6111111 inkhr-run Street Bunn!! Afasx 92111 Workers' Compensation Insurance ARdavit �lrinlic::nt intnrmati66- Please fR11VT'1e••�jjjv , name �G�CA,1 \�� 0 �rS �Cciftv--C-f-VL+e�-\J-k Z, Xfvhnne 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working_ in any capacity I ,man employer providing workers' compensation for my employees working an this job. commie, mime: atitl rccc� tin•• nhnnc tt• • incnrnncc rn. nnlicv 0 am s sole proprietor. general contractor. or homeowner(circle o're)and have hired the contractors listed below who i:a`, the following workers compensation polices: remnnnv nhnnc• atirlrccc� tin nhnnc l+• incur,inrr rn. Wolin >t cmmnnnv n-itnr- atlrf rrcc• -in•• _- nhnnc�: ncursnre rn Wolin• lttach additional sheet if neeesiary -i•r ��''•�''•'� '' "'"' "}•' --- --_- 'aiiure to sccurr ctn•crace ns required under Secnon 3A of 111GL 152 ea�to the imposition of cnmtnai penalties of a line up t S150U.UU ndiur nr 1 carx' imprisonment as%••ell as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a GM of this statement ma% be forwarded to the Quite of lnvestit ations of the DIA for coverage verification. do l,rrrht crrrif raid• 1ic prrirrs acid peiraltirs of prrjurr Ilia'ME information pros7ded above is' c and cvrrrrt Date 'rint name Phone 0 �res��w official use univ do not write in ibis area to be completed by tits'or town ofrcial cit%.or tn%vn: Mrtnit/license it Mouiidinr Department C3Ucctsin;:hoard �. chrdc if immediate respunse is required Cl5eleetmen's Orricr ► (311eaith Department contact rercnn: phone#: MUther� Information and Instructions Massachuxetts General Laws chapter 152 section 's requires all employers to provide workers' compcttsatian etnpiovces. As yunted from the "taw".an emplgree is defined as ever),person in the service q'l ::»ether undo: contract of hire. express or implied. oral or written. An rmpinrer is defined as an individual. partnership• association. corporation or other legal entity. or any two tits fore�_oim_ end-aged in a joint enterprise,and including the legal representatives of a deceased employer. or rcceil•er or trustee of an individual . pannership. association or other legal entity, employing employees. Ho«, owncr of a dwelling house having not Marc than three apartments and who resides therein. or the occupant.of: d«chin- house of another who employs persons to do mainten ':nce, constriction or repair work on such dwcf or oft the _-rounds or buildingappurtenant thereto shall not because of such employment be deemed to be an e: MGL chapter 152 section =5 also states that eti•er}•state or local Iicensing agency shall withhold the issuanc renewal of a license or permit to operate a business or to construct buildings in the eammom"•ealtlt for s: applicant Who itas not produced acceptable evidence of compliance With the insurance coverage requires Additionally, neither tite commonwealth nor any of its political subdivisions shall enter into any contract for th perforniance of public work until acceptable evidence of compliance with tite insurance requirements of this cf-. been presented to the contracting authority. Applicants Please fill in the workers* compensation affidavit compietely, by checking the box that applies to your situatio, supplying company rtm names. address and phone numbers.as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tl affida%•it should be returned to the city or town that the application for the permit or license is being reques,ed. not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are re to obtain a workers* compensation polic}•. please call the Department at the number listed below. City or •Towns Pie_-se be Sure that the affidavit is complete and printed legibly. The Department has provided a space at the bo: the affidavit for you to fill out in the event the Office of Investigations has to contact you retarding the applican be sure to fill in the permit/license number which will be used as a reference number. 17te affidavits may be ref: the Department by mail or FAX unless other arrangements have been made. The Office of Investi=ations would like to thank you in advance for you cooperation and should you have any qL please do not hesitate to _ive us a =11. The Depanmenrs address. telephone and fax number. . The Commonwealth Of Massachusetts Department of Industrial Accidents _.. Office of I1ves9gations 600 Washington Street Boston,Ma. 02111 rn v m. t rz i on "7_7749 TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. . DATE / JOB_ LOCATION Q �l G�P.�.iIf t% C ��U i .ram / Number. Street address Section of town "HOMEowNER^ Name Home phone Work phone PRESENT MAILING ADDRESS City town State Zip cod: The current exemption for "homeowners" was extended to include owner- occurs-dwellings of six units or less and to allow such homeowners to engage an is dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person (sj who owns a parcel of land on which he/she resides or intends to side, on which there is , or is intended to be, a one or two family dwellinc attached or detached structures accessory to such use and/or farm structurE A person who constructs more than one home in a two-year period shall not h considered a homeowner. Such "homeowner" shall submit to the Building Off_ on a form acceptable to the Building Official, that he/she shall be resnon_ for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requiremen- and that he/she will comply with said procedures and requirements. C HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: .Three family dwellings 35, 000 cubic feet, or larger, will be requires to comply with State Building Code Section 127. 0, Construction Control. 'Iry is 1. R-30 Ft,, �G ra y o, Soft;+�� Z b��'L►.{- � �� RK*& .5;4 p� 1 � q i I10 t�s � � R-ly �In�LceAC - ��jt�.� � t7.G I n _ ,..--•— --- -- - - ---i•-���. . - �16• �� P- I f� �6,.D.G• M SEwn+D Fes_ ax to laor �o�,f3 FrT7 /b"0.C- LIN FJ Ull T-7 -- FIRST FL. L5FT . StDE F-L VATIow p' oPoo5.�v ALE=. •-./.�"•- �=o'• . ALDEN BUICK PONTIAC GMC TRUCK PROGRAM PR470 PAGQ: A DIESEL COUNTER PAD REPORT WORKSTATIONu W1 USFRU of TO TO ........ .................... ........ ........................................ ................................. (31 0 U F:1 MT F*%' MONTHLY SALES HISTOR' -DESCRI-- ` Q LIST -,TRADE _--COST --,LORE tLjj2 K Q-.-1 ............ ........................................ .................................... ............ .... ............................ ............................ ............................ ..................I......... ............ ............ ............ ............ ............ 005 F:, I'll .. . 41020Z5009 007 RETURN 13P A. R 15.24 12.9A, A .00 SPRING AS I R 12.79 10.87 7.66 .66 SPR 1 l`lG I R 15.81 13.44 9.47 1.00 0 111 2 As-- ---woo 004 F:,R.011 4102190002 068 CHANGED TO 41039Z5179 179 FRT LiNY! I F", 8.77 .00 10 CHANGED TO AB4)39Z5210 ooe.5 RIVET I R . 54 . 50 .39 .00 i-:,i � ---4:1. 2 Z,`.'�0 2!.-5 025 CHANGED TO 41042Z5006 500 BRAKE RIV I R .40 .37 .29 .00 3�']:7 DISC PAD 1 R 129.46 119. 10 91 .82 387 CHANGED F:'F,*.0lvl 41060OT38 6 30.', DISC PAD/ I R 45.23 41 .61 32.08 .00 110 ll(.3 1 4.07 3.46 2.44 .00 910 SWING RE 1 R 4.00 3.40 2.40 .00 D2!.*.'- Ukll./CYL R 1 R 10.95 10.07 71,77 .00 32!.'.*-, SEAL KIT I R 3S. 04 M&A 23.OS 000 1 R 9 1. i ki5. 14 5.74 .00 .........................D 0 001. :1. R 9.41 8.00 5.64 0 Ir 000 :1. R 1 . 51 1 .28 .91 227 CYL REPAT I R 15.74 14.48 11 . 17 0 0 F28 CYL REPAT 1 R 23. 50 21 .62 16.67 .00 010 CUP PISTO 1. R 3.92 3.33 2.35 .00 527 Qj/CYL CUF:' I F,, -==----------- 000 EMT WIL I R 2.63 2.24 1 . 58 .00 1 014 BOOT WHEE I R 6.79 5.77 4.07 .00 =7- 00:1. CAP R .95 .81 . 57 UU 002 OIL 1 R...........14,26,, 002 43090Z500:1. Z00 OIL SEAL 1 R 17.27 15. 54 11 .22 IWO Z()0 430909006:1. 0122 OIL SEAL 1 R 17. to i 5.39 11111 .00 017 OIL SEAL I R 39.06 3501 , 25.37 .00 060 0]:L SEAL Ill 17. 14 � 15.4W -Q. 10 "oo, �060 4309090014 27 BOLT KIT 1 R 25.08 21 .32 15.02 .00 427 4321OZ5425 [A] BOLT I R 20;25 1: 429 B 7 DW',i R 104,1113 120. 45 14.48 mo Too F.-I.F.", williDii] :1. R 52.09 46.88 33.83 .00 �427 BOLT KIT I R 22.91 19.47 13.72 00 i 4PT 6IDS ELEVA T( ON - N, ,TING eS �`\ �-- --- NEW LOUVER AT ATTiC. 5Ntt3GLE SIDING AT' S(DES, -TYP. YL 30,�(p op'e-) . ,L :Wl'45) LEII I - a a III i - . ` . ' ' N BUICK PONTIAC GMC TRUCK ` INVENTORY EXTENSION PR43O PAGE � G OC 4 14.94 .00 59.76 .00 59.� G C. 2 14.94 .00 29.88 .00 29.� ET GBPKOC 2 2. 1O .00 4.20 .00 4.� E-R/C C O 1 .29 .00 ING A B 0 17. 55 .0O .00 ING A B O 17. 55 .00 .00 .00 .{ MOSTA G P OC 3 5.09 .00 15.27 .00 15.� KET A BPKOC 0 3.81 .00 .00 .00 .{ ASM- P OC O 24.90 .00 .00 .00 .{ IQUE- B 1 1O.23 .00 10.23 .00 1O.� IQUE- B 0 10.23 .00 .00 .00 .{ FORCE B O 1 .89 .00 .00 ASM-H 0 17. 10 .00 .00 .00 .{ -F/SE BP OC 2 .43 .00 .86 .00 .� ET AS P OC O 6.36 .00 .00 .00 .{ M e C7 � ITI A ji Lij 1 p at f M ]O Lm 2 m v f ; -a .P 79 N a z T m Z - I A I Q`. i � I i