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0259 LONG BEACH ROAD
a �� Q 5 e� Commonwealth of Massachusetts �l"ING Mqy ®FpT. Sheet Metal Permit T� ..2 wN Date: 03/24/2020 SCAN�ED Permit# _ O-- sofa® TqB� Estimated Job Cost: .$40,777.00 Permit Fee: $ F Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 801 Applicant License# 4323 Business Information: Property Owner/Job.Location Information: Name: Coastal Mechanical Name: Alvin and Mark Bodzioch Street: 21 L Fruean Ave Street: 259 Long Beach Road City/Town: South Yarmouth, MA 02664 City/Town: Centerville, MA 02632 Telephone: 508-737-8747 Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES V NO LW Staff Initial J-1 /M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family V Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft.V— over 10,000 sq. ft.. Number of Stories: 2 Sheet metal work to be completed: New Work:V Renovation: 1 HVAC V Metal Watershed Roofing Kitchen Exhaust System �— Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: 4 -Zones 2 -York Gas Fired Furnaces 2 -York,Condenisng Units for Central Air Conditioning Venting of(4) Bath Fans, (1) Dryer and Kitchen Hood Exhaust. Supplies and Returns l INSURANCE COVERAGE: I have a current'llabirity insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes J No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter'112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of'the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: By ®Master i Title - = ❑Master-Restricted B.B. cityrrown ❑Joumeyperson Signature of L ensee Permit# ❑Journeyperson-Restricted License Number: 801 Fee:$ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval WGOMMdD1A1O�:TF O�MAS$AIUSE y SNEETI�IE��4'11�UOItfEERS= ISSUES TN FOLLCSWIN l:IbEIS� Y€ ,. � MTER UNRSED AIR PIC � z SGClTIiFkF !(iC�t1TH, 7t b28l2022�ar 1tVT H OF`MEll • o , SHEET 4 Ai_'WORKf�t�'�; .tiQ� x iSsu b jr�y FOLLO►iliiNG LYCNSE ' ?ft: RT D 1NOOD61�iY '� b 1 AST HEATING i { p1 AND LLG f 299 ITIE b h> bra sourH YARM0UTi 'MA '2kb'fi4-1214 ,n k.v3b s.2 C. ` "q k3bk 47". tt y k S01 .4; a..d ;V 03101/20 Client#:764315 2COASTALPL1 MIDDIYY ACORD,. CERTIFICATE OF LIABILITY INSURANCE 01/0 DATE(MMIDDNY9/2020 Y`/) 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: The Hilb Group of N.E.dba PHONE 508 775-1620 5087781218 AIC No Ext: a/C No Dowling&O'Neil Insurance Agy E-MAIL ADDRESS: P.O.BOX 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A:Evanston Insurance Company 35378 INSURED INSURER B:A.I.M.Mutual Insurance Company 33758 Coastal Plumbing&Heating LLC INSURERC:Safety Insurance Company 39454 Dba Coastal Mechanical INSURER D: 299 Whites Path INSURER E South Yarmouth,MA 02664 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD MMIDD A X COMMERCIAL GENERAL LIABILITY MKLV1PBC000737 1/04/2020 01/04/2021 EEACCHq�OECCUR��RENCE $1 000000 CLAIMS-MADE OCCUR PREMISES EaEoNcci�i ence $100 000 X BI/PD Ded:5,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 PRO- POLICY F_X1 ECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ C AUTOMOBILE LIABILITY 5906835 1/04/2020 01/04/2021 COMBINED(Ea NGLEUMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ AUTOS ONLY X SCHEDULED BODILY INJURY(Per accident) $ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident $ A UMBRELLA LIM OCCUR MKLV1EUL102215 1/04/2020 01/04/2021 EACH OCCURRENCE $1 000000 X EXCESS LIAR X CLAIMS-MADE AGGREGATE $1 000 000 DED I I RETENTION$ $ B WORKERS COMPENSATION WMZ80080074082020A 1/04/2020 01/04/2021 X SERTuTE ER OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $1 00O 000 OFFICERIMEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S251631/M251588 LS1 �TNE Town of Barnstable Building Department artment Services * MRNSTABLE, AS&MARS. _ Brian Florence,CBO M i639. ` Building Commissioner FQ MA'1 200 Main Street,Hyanius,MA 02601 www.town.barnstable.ma.us Office: 508-862-403.8 Fax: 508-790-6230 Property Owner Must, Complete and Sign This Section If Using A Builder I, Mr Bodzioch ,as Owner of the subject property hereby authorize Coastal Mechanical to act on my behalf, in all matters relative to work authorized by this building permit application for:. 259 Long Beach Road - Centerville (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. 4n- 44&0-1 Signature of Owner gnature of Applicant lqQrk- James Nolan Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 The C'ominonwealdr of Massachusetts s Department of Ind.ustrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www rnass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE-PERMITTING AUTHORITY, Applicant Information Please Print Legibly Name (Business/Organization/individttal):Coastal Mechanical Address: 21 L Fruean Ave City/State/Zip:South Yarmouth, MA 02664 Phone#: 508-737-8747 Are you an.emptoyer?Check the appropriate box: Type o project(required): I.&d1 am a employer with�_etnployecs(full and/or part•tune).° 7.Type construction 2.Q 1 am a sole proprietor or partnership and have no employees working for the in $, &'Remodeling any capacity.(No workers'comp.hrsurance required.) 9. El Demolition 3,Q 1 am a homeowner doing all work myself.(No workers'comp.insurance required.)t 10❑Building addition 4,Q l am it homeowner and will be hiring contractors to conduct an work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. lectrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions S,Q I am a general contractorand I have hired the sub-contractors listed on the attached sheet, 13. Roof repairs These subcontractors have employees and have workers'comp.insurance) �—,/ b.❑We are a corporation and its officers have exercised their right of exemption per MOL c. 14.5 Other HVAC. 152,§1(4),and we have no employees.(No workers'comp.insurance required.) *Any applicant that checks box#(must also fill out the section below showing their workers'compensation policy information. t Homeownets who submit this affidavit indicating they are doing all work and then hire outside contractors roust submit a new affidavit indicating such, tContractors that check this box trust attached an additional sheet showing the name or the subcontractors and state whether or not those entities have employees. If the sub-contractors hnve employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation Insurance for my employees Below is the policy and job,site ir�orutatiorr. '. Insurance Company Name: AIM Mutual Policy#or self-ins.Lie.#: W MZ80080074082020A.. Expiration Date: 01/04/2021 Job Site Address: 259 Long Beach Road City/State/zip:Centerville,_MA 02632 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under MOL e, 152,§25A is a criminal violation-punishable by a fine tip to$1,500.00 and/or one-year imprisonment,as well as ciyii penalties in the form of a STOP WORK ORDER and a fine of up to$250A0 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify under the palns and pertatlies of per fury that the information provided above is true and correct. Si nature: 44� Date: g 05/15/2020 Phone/l 508-737-8747 a of,j7clal use only. Do not write lit this area,to be corttpleterl by city or town of}7cial. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2,Building Department 3,City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector C Other Phone#: Contact Person:... s g • l I RIGHT-J SHORT FORM Entire House CLIMATROL HVAC DESIGNS Job:CL272 5-8-2020 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM For: COASTAL PHC- BODZIOCH 259 LONG BEACH ROAD, CENTERVILLE, MA ® - e • Htg Cig Infiltration Outside db(°F) 10 88 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (°F) 60 13 Fireplaces 0 Daily range - M Inside humidity (%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make Make Trade Trade Efficiency 96.0AFLIE Efficiency 13.0 EER Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 °F Total cooling 0 Btuh Actual heating fan 2042 cfm Actual cooling fan 2042 cfm Heating air flow factor 0.025 cfm/Btuh Cooling air flow factor 0.036 cfm/Btuh Space thermostat Load sensible heat ratio 88 % ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) ZONE 1 n p 772 26209 19494 650 701 ZONE 2 n p 519 13688 10724 340 385 ZONE 3 n p 462 14626 9390 363 337 ZONE 4 n p 740 20826 15558 517 559 ZONE 5 n p 324 6944 4924 172 177 Entire House d 2817 82293 56824 2042 2042 Ventilation air 3300 715 Equip. @ 0.93 RSM 53511 Latent cooling 7813 TOTALS 2817 85593 61324 2042 2042 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wrjghtsoft Right-Suite Residential—5.0.14 RSR20780 2020-May-08 10:44:40 C:\My Documents\Wdghtsoft HVAC\CLIMCALCS.rsr Page 1 RIGHT J SHORT FORM ZONE 9 CLIMATROL HVAC DESIGNS Job:CL272 5-8-2020 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM For: COASTAL PHC - BODZIOCH 259 LONG BEACH ROAD, CENTERVILLE, MA Htg Clg Infiltration Outside db(°F) 10 88 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (°F) 60 13 Fireplaces 0 Daily range - M Inside humidity (%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 °F Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Clg load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) SUN ROOM 260 13104 10584 325 380 LIVING 512 13104 8910 325 320 ZONE 1 n p 772 26209 19494 650 701 Ventilation air 0 0 Equip. @ 0.93 RSM 18129 Latent cooling 2106 TOTALS 772 26209 20235 650 701 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wrjghtsoft Right-Suite ResidentialTM 5.0.14 RSR20780 2020-May-08 10:44:40 CAMy Documents\Wrightsoft HVAC1CLtMCALCS.rsr Page 2 f - RIGHT-J SHORT FORM ZONE 2 CLIMATROL HVAC DESIGNS Job:CL272 5-8-2020 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM For: COASTAL PHC- BODZIOCH 259 LONG BEACH ROAD, CENTERVILLE, MA Htg Clg Infiltration Outside db('F) 10 88 Method Simplified Inside db('F) 70 75 Construction quality Average Design TD ('F) 60 13 Fireplaces 0 Daily range - M Inside humidity (%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 'F Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Cig load Htg AVF Clg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) FOYER 99 2975 2431 74 87 KITCHEN 216 5501 4920 137 177 DINING 180 4335 2717 1.08 98 1/2 BATH 24 876 656 22 24 ZONE 2 n p 519 13688 10724 340 385 Ventilation air 0 0 Equip. @ 0.93 RSM 9973 Latent cooling 1171 TOTALS 519 13688 11144 340 385 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. k_ wrightsoft Right-Suite Residential-5.0.14 RSR20780 2020-May-08 10:44:40 C:\My Documents\Wrightsoft HVAC\CLIMCALCS.rsr Page 3 I6.- RIGHT-J SHORT FORM ZONE 3 CLIMATROL HVAC DESIGNS Job:CL272 5-8-2020 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM - • • 0 For: COASTAL PHC- BODZIOCH 259 LONG BEACH ROAD, CENTERVILLE, MA ® - • • e Htg Clg Infiltration Outside db(°F) 10 88 Method Simplified Inside db('F) 70 75 Construction quality Average Design TD (°F) 60 13 Fireplaces 0 Daily range - M Inside humidity(%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 °F Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Clg load Htg AVF CIg AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) SIDE ENTRY 98 2792 720 69 26 LAUNDRY 28 1136 2235 28 80 DEN 286 9463 6146 235 221 BATH 1 50 1235 289 31 10 ZONE 3 n p 462 14626 9390 363 337 Ventilation air 0 0 Equip. @ 0.93 RSM 8733 Latent cooling 1053 TOTALS 462 14626 9786 363 337 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wrighltsoft Right-Suite Residential-5.0.14 RSR20780 2020-May-08 10:44:40 C:\My Documents\Wrightsoft HVAC\CLIMCALCS.rsr Page 4 f RIGHT-J SHORT FORM ZONE 4 CLIMATROL HVAC DESIGNS Job:CL272 "-2020 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM For: COASTAL PHC- BODZIOCH 259 LONG BEACH ROAD, CENTERVILLE, MA ® - • • e Htg Clg Infiltration Outside db(°F) 10 88 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (°F) 60 13 Fireplaces 0 Daily range - M Inside humidity(%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 'F Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Clg load Htg AVF Cig AVF (ft2) (Btuh) (Btuh) (cfm) (cfm) MASTER BED 280 9716 6378 241 229 MASTER BATH 81 2017 903 50 32 BED 1 180 3678 3441 91 124 BED 2 154 4181 4109 104 148 BATH 2 45 1235 726 31 26 ZONE 4 n p 740 20826 15558 517 559 Ventilation air 0 0 Equip. @ 0.93 RSM 14469 Latent cooling 1963 TOTALS 740 20826 16431 1 517 1 559 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. wr,ghtsoft Right-Suite Residential' 5.0.14 RSR20780 2020-May-08 10:44:40 CAMy Documents\Wrightsoft HVACICLIMCALCS.rsr Page 5 RIGHT-J SHORT FORM ZONE 5 CLIMATROL HVAC DESIGNS Job:CL272 5-8-2020 3170 MATECUMBE KEY ROAD UNIT 127,PUNTA GORDA,FL 33955 Phone:508-364-5198 Fax 941-575-0013 Email:MILLERHVACDESIGNS@GMAIL.COM For: COASTAL PHC- BODZIOCH 259 LONG BEACH ROAD, CENTERVILLE, MA g ® - • ninegm, - • Htg Clg Infiltration Outside db(°F) 10 88 Method Simplified Inside db(°F) 70 75 Construction quality Average Design TD (°F) 60 13 Fireplaces 0 Daily range - M Inside humidity (%) - 50 Moisture difference(gr/lb) - 28 HEATING EQUIPMENT COOLING EQUIPMENT Make n/a Make n/a Trade n/a Trade n/a n/a n/a n/a Efficiency n/a Efficiency n/a Heating input 0 Btuh Sensible cooling 0 Btuh Heating output 0 Btuh Latent cooling 0 Btuh Heating temperature rise 0 °F Total cooling 0 Btuh Actual heating fan 0 cfm Actual cooling fan 0 cfm Heating air flow factor 0.000 cfm/Btuh Cooling air flow factor 0.000 cfm/Btuh Space thermostat n/a Load sensible heat ratio 0 % ROOM NAME Area Htg load Clg load HtgAVF CIgAVF (ftz) (Btuh) (Btuh) (cfm) (cfm) BED 4 104 2020 1998 50 72 BED 3 136 3393 2344 84 84 BATH 3 84 1531 582 38 21 ZONE 5 n p 324 6944 4924 172 177 Ventilation air 0 0 Equip. @ 0.93 RSM 4579 Latent cooling 583 TOTALS 324 6944 5162 172 177 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. WI"7C,htSOfC Right-Suite Residential^"5.0.14 RSR20780 2020-May-08 10:44:40 C:\My Documents\Wrightsoft HVAC\CLIMCALCS.rsr Page 6 I L Town of Barnstable �§rd Building a h O'T n i Inspection T is 7 *t I �t d n- Fi 3 ti , 'i _ ' ! Permit 'Ce 1� r I re Certificate 0 Permit No. B-19-3100 Applicant Name: RYLEY CONSTRUCTION LLC. Approvals Date Issued: 12/19/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 06/19/2020 Foundation: Location: 259 LONG BEACH ROAD,CENTERVILLE Map/Lot: 185-030 Zoning District: CBDLBSB Sheathing: .......... AS 5 _N n:' YLEY CONSTRUCTION LLC. Framing: I Contractor'. ,;�r�L Owner on Record: BODZIOCH,ALVIN&MARK TIRS Address: PO BOX 63100 Contractor Licerso.182,412 2 Z_ Pr $75,000.00 NEW BEDFORD, MA 02746 Est' Project cost: Chimney: Description: Remodel existing kitchen as drawn b fine lineldes Permit Fee: y $432.50 Insulation: Fee Paid:. .$432.50 Project Review Req: NOT SUBSTANTIAL IMPROVEMENT. 73 Final: Date- 7 12/19/2019 Plumbing/Gas Rough Plumbing: F '.�'\Builcling Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'six rn'onths'after`Issuance. All work authorized by this permit shall conform to the approved application andthe approvedconstruction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and stri.ictur'e's shall-beJ in compliance with the local zoning by-law' s and codes. k — ; ... This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of occupancy will not be issued until all applicable signaturesby the Building and Fire Officials are provided on this,permit. Minimum of Five Call Inspections Required for All Construction Work: y Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before fireM flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame'Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT a t i Application Number......... .. ..... ACLE TOWN OF, UP1 MA88 Permit Fee. Other Fee: ........... .. ........ X9 NOY 26 P1 4: 02 TotalFee Paid............................................................... ...... TOWN OF BARNS ._ ermrt Approval by..... On.. ... .� /9 YJ........... ............... TVISIO �� BUILDING PERMIT 165 036 Map........................................Parcel............................................. APPLICATION Section 1 — Owner's Information and Project Location Project AddressA(SVillage Vi Owners NameAtal� Owners Legal Address UD City P� State zip (J Owners Cell# E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet 0 Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 — Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment El Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other Specify Section 4 - Work Description v f � r eoi�,-A.+.A• 1 1/1 QMM 4 J 3 3 Application Number.................................................... jz , . i Section 5-Detail s. OkiCost of Proposed Construction � 5 Square Footage of Project � � - Age of Structure U Dig Safe Number # Of Bedrooms Existing Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design { Section 6—Project Specifics Wiring ❑ Oil Tank Storage ❑ Smoke Detectors Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑. Municipal [P On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: L () I am using a crane ❑ Yes 13 No � 3 Section 7 Flood Zone Flood Zone Designation i Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposedf t Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last undated: 11/15/2018 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations .. µ , 9 . 600 Washington Street, Boston,MA 02111 wwM.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Avylicant Information Please Print Lezibly Name(Business/Organization/Individ �&MurNvAA Address: t !�S YO) - City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.W I am a employer with' 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-tame).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- _listed on the attached sheet. 7. ❑Remodeling ship and have no employees these subcontractors have S. ❑Demolition working for mein any capacity.acitY• employees and have workers' 9. El Building addition . [No workers'comp.insurance comp.insurance. t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL myself.[No workers comp. 12.❑Roof repairs insurance required,]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Othe r comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. r I am an employer that is providing workers'compensation insurance for my emplo ees. Below is the policy and job site information. . Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: �Ah Job Site Address: City/State/Zip: Attach a copy of the workers'comp sation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requireWder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb under the rdpenaUies of perjury that the information provided ove is tru and correct Si ature: °" Date: Phone#: Official use only. Do not w in is area to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I ' u Information and Instructions -. Massachusetts Geneial Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." ` An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in.the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or arts are not to workers compensation insurance. If an LLC or LLP does have partners, �5' P employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insrred companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: i The Commonwealth of Massachusetts Department of Industrial Accidents OMCC of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877 MASSA.FE Revised 4-24-07 - Fax#617-727-7749 www.maw.gov/dia Client#:766801 2RYLEYCO1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08111/2019 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: The Hilb Group of N.E.dba P IC E. Est:508 775-1620 AN,No): 5087781218 Dowling&O'Neil Insurance Agy E-MAIL ADDRESS: P.O. Box 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis, MA 02601 INSURER A:Penn-America Insurance Company 32859 INSURED INSURER B:Associated Employers Insurance Company 11104 Ryley Construction LLC INSURER C 8 West Bay Road INSURER D Osterville, MA 02655 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY PAV0202867 03/29/2019 03/29/2020 EACH OCCURRENCE $1 00O 000 CLAIMS-MADE a OCCUR PREMISES E.0. ence s50,000 X BI/PD Ded:500 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY I�ECT LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: $ MBINED AUTOMOBILE LIABILITY COINGLE LIMIT Ea accidentS $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC50050205392019A 05I2412019 05/24/202 X SEA T OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1 00O 000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) **Workers Comp Information** Proprietors/Partners/Executive Officers/Members Excluded: John Ryley, President Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S240784/M240783 RPCH1 Commonwealth of Massachusetts • Division of Professional Licensure Board of Building Regulations and Standards (-r Constro6dbri b, rvisor CS-108005 Expires: 11/05/201.9 JOHN S RYLEY 35 QUAIL ROAD41!' 4 OSTERVILLE MAr�02655 io Commissioner tielajoesiapun i SS9Z0 VVV'3llInH31SO •aH-lldno ss A3111:1 NHOr tylk-,_,S 19 ��� �sj J,i ll of n�d1SN00 A31ka 4• =.:, F uol;en x3 tuoiie�ts! as 0-1-1ZEIX � 8010V81NO01N3 W3AO8d WI 3 WOH uoiteln6abl sseuls�nq T s-1184V-iawnsuoo;o 63l40 s ��v�>7/.7?7�'('O//�f/ �✓i/ll'Fl.%77�dY.ULCi� U� O I 4 r,� Details Page 1 of 1 Licensee Details Demo ra _bic Information Full Name: JOHN S RYLEY caner Name: License Address Information ity: Osterville State: MA ipcode: 02655 Country: United States License Information License No: CS-108005 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 10/28/2019 Issue Date: 9/17/2014 Expiration Date: 11/5/2021 License Status: Active Today's Date: 12/18/2019 Secondary License Type: Doing Business As: tatus Change Reason: License Issuance Prerequisite Information No Prerequisite Information No Available Documents https://madpl.mylicense.comNerification/Details.aspx?result=a6fa9fo8-2c22-4ec9-8bd6-... 12/18/2019 Yv w Application Number........................................... r Section 9= Construction Supervisor r Name 10--/*' Telephone Number Address City l State Zip , License Number License Type Expiration Date C� Contractors Email e-- Cell # Y)' I understand my respo ibilities under the rules and regulations for 'c nsed Construction Supervisor in accordance with 780 r CMR the Mass huse State Building Code.'I understand the cons on inspection procedures,specific inspections and I documentation eq ' ed by 780 C d the Town of Barnstable.Attach a copy of your license. 5 Signature Date / �W61 tion 10—Home Improvement Contractor Name 1< Telephone Number - L6 6RZ 5--- Address 3jd'j,,'� City State Zip b) �2 Registration Number S Expiration Date ., I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts Stat uilding Code. I understand the construction inspection procedures,specific inspections and documentati r quired b 0 C and the Town of Barnstable.Attach a copy of your H.I.C... l Signature Date !� ` Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature MDate 7 I Print Name �/I �� Telephone Number l/ 78 E-mail permit to , ' Last undated: 11/15/2018 f Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization b I, ` ��dz as Owner of the subject property hereby authorize to act on my behalf, in all matters relati a to or authorized b s b lding permit application for: hu (Address of job) pp�ture of Owner date Print Name k Last updated: 11/15/2018 d Application number.V. .�`. .. ........... C�IZ?lr� ® Date Issued. ........... ....- I�ST!►>3LE. PREP, Building Inspectors Initials....: VI/..................... T , UN 2 7 2010 Map/Parcel......�,�.��......... O �. A6 OF 8" IVS/AB LE TOWN OF BARNSTABLE -q Part EXPEDITED PERMIT APPLICATION: � ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEA RIZATION PROPERTY INFORMATION Address of Project: (,LQ R ST E VILLAGE Owner's Name: ✓ �10 Phone Number Email Address: Cell Phone Number Sol Project cost $ -0 (�v v Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization Doors (no header change)# Commercial Doors require an inspector's review ED Roof(not applying more than I layer of shingles) Construction Debris will-be going to Red ktffl kad w CONTRACTOR'S INFORMATION Contractor's name JL-� y , Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# V '� `, (attacb CQopy Email of Contractor r�Yem�7*a,,011 Pho n umber 401 - W q—a�1` 7 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER 1 *For Tents Only* Date Tent(s)'will be erected Removed on, number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date AP LICANT'S SIGNATURE U ( Signature Date l All permit ap lications are subject o a buildi g official's approval prior to issuance. i o*IHE r Town of.Barnstable ti Building Department '�''STM' Brian Florence,CBO ��prED�a`�� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This .Section If Using A Builder as Owner of the subject property hereby t\authorize LC to act on ray behalf _ in all matters relative to work authorized by this building permit application for: 55 C i (Ad ess of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accep ed. Sign e Owner Si tore of Appli t �\ o Print Name Pt Name l Dae Q:FORM&OWNERPERMLSSIONPOOLS Rev:10/17 L The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Ryley Construction LLC Address: 8 West Bay Road City/State/Zip: Osterville, MA, 02655 Phone #: 401-484-2315 Are you an employer? Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 1 4. I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Selectrive Insurance Policy#or Self-ins.Lic.M MAARP300349 Expiration Date: 02/20/2019 Job Site Address: 259 Long Beach Road City/State/Zip: Centerville/MA/02601 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to.$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c rti under t ains an 'penalties of perjury that the information provide4 above is true and correct. Si mature: (�/n� Date: cr Phone M Official use only. Do not write n is ar a,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ` 6. Other Contact Person: Phone#• I Commonwealth of Massachusetts 'Z Division of Professional Licensure Board of Building Regulations and Standards Cons#ru.ctibti upervisor CS-108005 c icpires: 11/05/2019 �s JOHN S RYLEY 35 QUAIL ROAD OSTERVILLE IMA.02655'''' x0 Commissioner C, Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC IF Registration Expiration �z 1824:1,2. 06/18/2019 RYLEY CONSTRUCTION,LLC.. JOHN RILEY 35 QUAIL RD. W�' OSTERVILLE,MA 02655 Undersecretary 1 i Client#:78040 RYLEYCON DATE(MMIDD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 6►27►2018 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(les)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: James F Geary Martha's Vineyard Ins Agcy-VH AIC No Ext:508 693-2800 A/C No): 774-487-3145 PO BOX 998 E-MAIL Vineyard.Haven,MA 02568 ADDRESS: jgeary@mvinsurance.com 508 693-2800 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:selective Insurance 11867 INSURED INSURER B:Acadia Ryley Construction,LLC INSURER C: PO Box 1444 INSURER D Duxbury,MA 02332 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L S TYPE OF INSURANCE NSR WVD POLICY NUMBER MM/DDY� MM/DDY/YYYY LIMITS ADDLISUBR A X COMMERCIAL GENERAL LIABILITY S2161576 6/19/2018 06/19/2019 EACH OCCURRENCE $1 000 000 CLAIMS-MADE 51 OCCUR PREMISES EaoccTurtence $100 000 MED EXP(Any one person) $10 000 PERSONAL&ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY 7 JECOT LOC PRODUCTS-COMP/OPAGG $3,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION MAARP300349 5/20/2018 05/20/201 X PER OTH- AND EMPLOYERS'LIABILITYSTAT ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $100 000 OFFICERIMEMBER EXCLUDED? 7 N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Carpentry CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main St ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA,02601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1155941/M963068 OJG �'� • .gl2�l� Town of Barnsta *Permit#�� " / Y Building Departmen efl RI V Sue`�r`e _ Brian Florence,CBO ���� MAM Building Commissioner AA r ( � s639 A1� '0tfp Mpg( 200 Main Street,Hyannis,MA 0' www.town.barnstable.ma.use!! �!�'6HHIu r/� Office: 508-862-4038 a 4790-6230 EXPRESS PERMIT APPLICATION — RESIDENTIAL ONLY + ` 03 Not Valid without Red X-Press Imprint Map/parcel Number I �'f Property Address ❑ Residential Value of Work$ "J 5 �i(/ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1416 5 &C4 Contractor's Name C Telephone Number ) �- Y��- o131 Home Improvement Contractor License#(if applicable_) / Email: Construction Supervisor's License#(if applicable) V �� [,Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# tJ � � Copy of Insurance Compliance.tUrtificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles):All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows 1 #of doors: *Where required: Issuance of.this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of t e Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: M QAWPFILESTORMSTMESS2017 °FIMME rqy Town of.Barnstable °* Building Department v Brian Florence,CBO `b�TE 059. a Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This.Section If Using A Builder M A as Owner of the subject property 4 q. hereby authorize 1, LC to act on my behalf, in all matters relative to work authorized by this building permit application for: (Ad ess of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspectionsare performed and accepted. dtiSign e Owner S' ture of Appli t Print Name Pt Name Dae A Q:FORMS:OWNERPERMISSIONPOOLS Rev: 10/17 Town of Barnstable °FTHE,o� Building Department Brian Florence CBO Building Commissioner EWDISTAMM MASS. $ 200 Main Street, Hyannis,MA 02601 396 - t6 �0 RFD 3g a www.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number _ street village "HOMEOWNER": fame home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-ocgoied.dwgU ngs 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 nerniit. (Seection 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection.procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of supervisor P ( a su see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) Its in se rious problems, articular) when the homeowner hires unlicensed This lack of awareness often results p ,particularly persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed E 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 to amend and adopt such a form/certification for use in your community. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Ryley Construction LLC Address: 8 West Bay Road City/State/Zip: Osterville, MA, 02655 Phone #: 401-484-2315 Are you an employer? Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 1 4. 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. msurance.T required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers 13. Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Selectrive Insurance Policy#or Self-ins. Lic.#: MAARP300349 Expiration Date: 02/20/2019 Job Site Address: 259 Long Beach Road City/State/Zip: Centerville/MA/02601 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone M Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Commonwealth of'Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons,tr,4i-t'16A§b grvisor CS-108005 �, € Spires: 11/05/2019 eel JOHN S RYLEYt` . 35 QUAIL ROAD ; OSTERVILLE MAC 02655 ��' > COmmissioner Cj, " r y C92c- eooivrianozruera�%�� C�/llauzacfur�l Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:LLC Registration Expiration 182412 06/18/2019 RYLEY CONSTRUCTION LLC 1. tt JOHN RILEY lL 35 QUAIL RD. JI c �- OSTERVILLE,MA 02655' Undersecretary 7 tNE '1 Town of Barnstable *Permit# �� S� ires 6 months from issue date Regulatory Services f snxxsTnai.E. "�` . Mesa �, ' Richard V.Scali,Director ' 1639. ® 4 *vs � 00' Building Division FBP`� Paul Roma,Building Commissioner N� 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY gg / Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work$ 11 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1 — 1 a 0.W WAN- 0�ik Contractor's Name o�� =L�Y Telephone Number Home Improvement Contractor License#(if applicable) �11 Email:' Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Che ke one: F am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ (check box). FtRe-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: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: operty Owner must sign Property Owner Letter of Permission. copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: QAWPFILESTORMS\building permit forms\EXPRESS.doc 06/20/16 ` t Depaahnett�r,fludusbid AcdZem& f fI0 a Ofrmws4afiom _ Boston,MA 02111 intin mass gorldsa Wkw1 ers' Campensafrnn Insurmce Affi Sider-JCunhmciursTleaTkianslPhmbers AppUcant Infarmatim Please Pxin city/stair A k 6 )140 Ph0>a,:--.U-- Are an employer?Check gproie b Type of project(required)_ 1.❑ I am a employer with. 4 I am a general contractor and I 6. New construction employees(fall andfor part 6= * 1mve hired the sub-contractors ❑ 2.❑ I am a sale proprietor or partnef- listed can the attached sheet. ?- ❑Rt xnodeligg These sub-contractors have - ship and have no employeesS. ❑Demolition waddng forme in any capacity* employees andl=e worms' 9_.El Budding addition �a W 'cAmp_;�©m„re comp taisutan.�f 1�Q Electrical repairs 17r mans required-] 5. ❑ We are a nozparatim and its ❑ 3_❑ 1 am a homeowner doing all woric officers have exercised their 1 L❑Plumbing repairs or additions mysdf[No worlmrs'comp- right of ememption per M(M§1{ dwe have 12_❑Roofrepairs insinance redlutre&]! s employees_[Noworlrers' 13_�fllhieC `� Comp-insurance required.] HameOWneu Who submit d&affidacitin g&eyydimchin.-slfwa&saddimbkeautsidecontRcimzanst sohmitanewaffidmeit'mdicatino sariz. fCo ' ffiat check this bmc mmt affir-'h m additional sheet shatriag tbename cf the sub-cccamcton and state whmher or notthose entities have emp9ayees.Ifthesnirco-a sbm employers,tfidynnurym a&theit sradmn'comp.palky aumtrer_ I am an Belviv is tha policy and job sde infornzatan. Insurance Company Name: Paficy orSeff-ircLLic ExpiratiaaDale_ Job Mte.t4ddress C41Statel;4p: , Attach a-copy ofthe workers'coanpensationpolicy declaration page(showing the policy*number and expiration date). Failure to secure coverage as required under Section 25A of MM dx 1572 can lead to the imposition of crimiatal penalties of a 5ne up#aI,SI}aOD andror aria-year imprisonment as wagas riial peaakies is the farm of a S P(3P�iTC}R ORDER and ae fln of up to #ir 0-0 y againste violator_ Be a&iced did a copy of this statement maybe hrwarded fn the flf 6ice of Irrvestta#ions for ito o DIAA for coverage ce verifrc atiam._ biro keraby the d psnatf es a er tr}'fhatifia ig formafivrtprati&d abma fs bars and correct Sit�atd:re f � � Date r (� 02Ed i use airily. Do not write in flaw area,€a be cmnpfeted by city artowrn anal City or Town: PermitUcense Issuing A.utharity(circle erne): L Board of Heahhi Bwla2g Department 3.CityMawn.Clerk d.Electrical Inspector S.Plumbing bmpecter' . &other Contact Person Phone#: laformation and bast ractions R��ac- e#ts Ge ral Laws cbapftx I52 rues all may=to Ike WMIM&MMPeasation fir ibea employ=. p ly o Sys �toye�is defined mc` .evaypmsonin the,scavice of�oi�er under airy co�xact afh�, express or implied oral or vxfth! " A employM-is dsfrae d as sIIan Tien ffiA pad imffiip,assocodxon,CMPoration or other legal entity,or any two or more of the foregoing=gaged is aJoint mtm�,and indhudmg the legal rcpresenta_fiyes of a deceased employer,or the receiver or trustee of as indivfdnal,pa t2=Slifp,association or other legal entity,employing effiplopees_ However the owner of a.dweIIng horse having not mare thaw three apartments and who resides therein,or the occupant of the - dw Mug house of anoiner who epkrys P��to do mav2enau ce,camirac t;on or repair work.an such dweIIing homm a¢tenar�thereto sbzHnDtbecanse of such earploymentbe deemedt o be an=plover." or on.the grounds or bmldmg app MGL dupt�a 152,§25C(6).also st&s fiiat¢every stair:err local Ficensmg agency sh R withhoId fhe Zssaance or renewal of a Iicease or permit to operate a business or to construct buildings in the cormmoawealth for any applicanfwho h s notproduced acceptable evidence of cdmphan.ce with the h=rance coverage regair� Additionally.MCrL chapter 152,§25CM states-Neither fhr-r=Tn awrzhh nor a'ny of its political subdivisions shall an ino any co=ftact for the penance ofpubho work u 3tl acceptable evidence of compEgam with fhe insurance. reqaE-ements of this chapter have bedn prese:afed*in the co33fracting anfliO3*t ';' Please fill o-C± f e.worI ='compensation affidavit cdn pleteb%by chedng$.e bo gies that apply to your sifnation and,if necessary,simply sub-contmet=(s)name(s), addresses)and phonenmmber(s)along with their certificate(s) of a►scaHnce_ I,imitedLiabdityCompanies(LLC)orLi=tedLiab> :4,p riness s(LLP)wiihno employees ofherthanthe members or paatners,are not reguaed to cagy warkers' compensation insurance. If an LLC or LLP does have employees,apolicyisr= "ed. BeadYisedthaf this affdayamaybesnbmifindta the Deparfinentof Indnsfrial Accidents for confnmation of m `sm =coverage Also be sure to sign and date the of davit The affidavit should be refrnned to the city or town that the appfica]ion for fhe pemut or license is being rupLst-t,not the Department of n aT Acmd�a_ Should You have any gnestions regardmg the Iaw or ifyo-a ate rcgmledin obtain a worio=as' compensation policy,please call the Depart eat at the number listed below. Self-farmed eo opanies sb oulci ear$heir self-insurance license number on the app operate line. City or Town Of Please be sore that the affidavit is complete and printed legibly. The Department bas provided a space of the bottom DI fiie affidavit for you to fill out in the event the Office ofIuvesli�os has to co�sctycur%arding the applicant Please be sine to fill in the pezmo t cense number which will be used,as a refegnce number_ Imaddition,an applicant that mast submit muht plo p=Micr se appliimtions in any givenYear.need-only submit one affidavit indicafDog can-Mt policy affuraation('if n=ssary)and Tmti "Job Site Address"the applicant should wate"aU locations in (may or town)-"A copy of the•affidavit that has been.officially stamped or maimed by the city cr town maybe provided.in the - • applicant as jxmcfftbat a valid affidavit is on ffie for fatme Permit or licenses_ Anew affidavitmust be fMed out each year.Where a ij�63ne owner or ciiizi is obtaining a license or permit not related tQ any business or commercial 4&atxm (ie-a dog license or perms to bun leaves eta.)said person is NOT rcqqkEd to complete this affidavit The of of TILvestigzdans would Itke to thank you in advace for your coop=-zfi=and should you have any gars ions, please do not hesitate to give us a call. The Depffitmenfs address,telephone and fax number_ ' De ent cif hibstdO Aoc�ident% r �. Bastw.MA 02111 Ted.:#617-727-49W mt 406 4r 1-�RW lvi-A SWE Fax#617` 27 7749 Revised 4-24-07 Mgt f y Fraser Construction, LLC 31 Howdoin Rd. Mashpee, MA 02649 Email: info(Wraserconstructioncapecod.com www.fraserconstructioncapecod.com FAX 1-508-428-0123/ PHONE 1-508-428-2292 HICL#112536 CS#97668 R]E-R(D®FIIIq -PROPOSAL Date 11. 22 2016 Name ¢.': C/O Rob McCarter` Phone 508 420-5753 . Job Address 259 Long Beach Rd, Centerville FRASER CONSTRUCTION hereby proposes to perform the following-services in a neat, professional manner_in,accordance with the manufacturer's specifications and local buiding"code. CertainTeed Shin les ;Shingles Landmark Premium ' - AlVe Resistant f5 years Wind Warran 130 MPH j., We' ht/s care .300lbs "Shin` e des ign Three-Piece ;Color Palate Max Definition VaUevs Closed cut Investment $17 325- * Alt above shingles quoted with.CertainTeed S0 year non prorated 4- warranty Shingle Selection: b'ZOYt iA ' Colors' 'Ul/�gp �A� Initial: Price does not include driveway side small,shed roof or EPDM waterside. Price includes galvanized drip edge not'-vented eves or ridges. — For full warranty onsite inspection is required to accurately determine best course of action- billed on a time ($75 per hour) and materials (mark up 20%) basis. Town of Barnstable Regulatory Services s� Richard V.Scali,D rmtor ► Building Division. . Paul Roma,Building Commissioner . 200 Main street,Hyannis,MA 02601 www.town.barnstable.mans v Office: 508-8624038 =� Fax: 508-790-6230 t • Property Owner Must Complete and Sign This Section If Using A Builder yF, as Ownef of the sub ect P.ro } l PAP hereby authoriz. [ 6' L to act on.my behA . in all inattets relative to work authorized by this building permit application for. (Address of Job) **Pool fences and.alarms are the responsibility of the applicant Pools are not to be filled or utilized.beforo- fence is installed and all final ' inspections are performed and accep of �:. , ,• tote of App t 4 Print Name' , Print Name , Date • , Q:FORMS:oW NERPERMtSSI0NPWLS Town of Barnstable a:. Regulatory Services cIF Richard V.Scali,Director Building Division t BAWMTAMX t Paul Roma,Building Commissioner MAM ab 9. 200 Main Street H MA 02601 3 ♦ t, N11a� Y�� www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number sheet vi1 w "HOhMWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityhown /' zap code The current exemption for"homeowners"was a ded to include o r-oc ied dwellings of six units or less and to allow homeowners to engage an individual for hire who s not possess a cease,provided that the owner acts as supervisor. ON O OMEOWNER Person(s)who owns a parcel of land on which he/she ides or" ids to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures access to fuse and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a ho . Such_"homeownei"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be nsible for all such work Rgrformed under the building t. (Section 109.1.1) The undersigned"homeowner"assumes responsib" ' r co pliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/ tunderstands a Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she mply with said rocedures and requirements. Signature of Homeowner Approval of Building Off vial Note: Three-family dwellin containing 35,000 cubic feet or larger be required to comply with the State Building Code Section 127.0 Construction Contro HOMEOWNER'S EXEMPTIO The Code states that: ny homeowner performing work for which a uilding permit is required shall be exempt from the provisions of this sec n(Section 109.1.1-Licensing of construction Su ervisors);provided that if the homeowner engages a person(s)for hire do such work,that such Homeowner shall-act as su rvisor." Many homeowne fio use this exemption are unaware that they are assumi the responsibilities of a supervisor (see Appendix Q,Rules& egulations for Licensing Construction Supervisors,Section . 5) This lack of awareness often results in serious proble ,particularly when the homeowner hires unlicensed persons. fin his case,our Board cannot proceed against the nnl" nsed person as it would with a licensed Supervisor. The homeown 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFLL.ES\FORMS\buiIding permit forms\EXPRESS.doc 06/20/16 I 41 CU 0 O (n C M N U ram. a N R Office of Consumer Affairs and Business Regulation a 10 Park Plaza- Suite 5170 Boston Massachusetts 02116 v Home Improvement Co' t actor Registration' `� Registration: 177129 ) °c1 �+ � IN j C Type: DBA tr 4 � v d Z,J = V) Expiration: 11/1/2017 Tr# 272823 v o v uj—g °' sm ai ��N E CONSTRUCTION SERVICES ROBERT MCCARTER ; :.-__ _ 20 W W W y YU 15 EVERGREEN DR. =� I := �f 2 m - o o Q MARSTONS MILLS, MA 02648 pdate Address and return card.Mark reason for change. Address Renewal Employment . Lost Card SCA 1 Co 20M-05/11 (-D�7/7-e `pomvnt6quaea4-/z,olgll aadadu de& Office of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR p Registration: 977129 Type: Office of Consumer Affairs and Business Regulation f,7 � y „ 10 Park Plaza-Suite 5170 w Expiration::=._1'1%�:%2017 DBA Boston,MA 02116 - o C y u a) 7 CONSTRUCTION SEi11�G�; c U.!C.m ROBERT MCCARTERT' "' 3.°i. M `o 15 EVERGREEN DR. MARSTONS MILLS,MA Undersecretary Wt v lid wit1tout signature H o 0 a) I` m 0,0 , 1 � O vfA G u m co Co O N'O 0.p0. `i; ,` M, v CQ ` C t± y v C7 V 0 a LLy a o F Y Of z r Town of Barnstable 19*�ermit# Expires 6 fonthsfrom issue date Regulatory Services Fee BARNSYABLE, Thomas F. Geiler, Director .9 MASS. i659. . Building Division Prfo►.w'�a Tom Perry, CBO, Building Commissioner C/ 200 Main Street, Hyannis, MA 02601 www.towri.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY l Not Valid without Red X-Press Imprint [ Map/parcel Number s 036 Property Address hZ4 &c'A A h Residential Value of Work K) C� Minimum fee of$25.00 for work under $6000.00 Owner's Name& Address y, son z l oLh Contractor's Name Telephone Number �O� 7 7- t t Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance x-PRESS PERMIT Check one: d� ❑ I am a sole proprietor AUG ❑ I am the Homeowner I have Worker's Compensation Insurance O OF BARNSTABLE Insurance Company Name Workman's Comp. Policy# f N CD " Copy of Insurance Compliance Certificate must be on file. Permit Request (check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) w l nCQ(�t�� ❑ Re-side � 8 fid Replacement Windows/doors/sliders. U-Value (maximum.44) A tf *Where required: Issuance of this permit does not exempt compliance with other town department regut.ations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: n-\WPFTf 4- The Comtnonwezdth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, AL4 02111 www.tnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant InformationPlease Print Le�ibl� Name(Businessiorganin6on/IndMduaI): �( 'h VI Address: City/State/Zip: Phone.#: � Z/ Z,-� I' Are you an employer? Check the appropriate bwa Type of project(required)- -2❑ I am a employer with �--- 4. [] I am a general contractor and I 6. 0 Ncw construction . employees (frill and/or part-time).* havo hired the mih-contractors 2.❑ I am a'sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, Q Demolition wanking far me in any capacity. cmployees and have workers' 9 Building addition [No workr-rs' GOIIIp.-i asu anCc mrop.insLTr=-C. S. 10.0 Electrical repairs or addition d . [] We arc a corporation and its] officers have exercised their 11.❑Plumbing repairs or addition 3_❑ 1 I a am m a a home nc dwr doing all work myself [No workers' comp. right of exemption per NIGL 12 ❑goof repairs incrirance r P. 152, §1(4), and we have no � ��t employees. [No workers' 13 Other iY1 r L comp, biau-ancc required] *Any applicant that ebnAm box 01 roust also fill out thr section blow showing their wo�'cornpaisa4cn pofieY information t Hom w eoner who submits$this davit indicating Huey an:doing all work and than hire outside conh-aetars must submit anew affidavit indiratmg such tCantractnrs that check this box Hurst attached an additional sheet showing the name of the subtonftadmm and stair whether or not thosd catities have amploycrs. If the sub{oniracinrs have employees,they must provide then workers'=V.Policy number. I am an employer that is provlding workers compensatzorz insurance for my emptayees. Below is the policy and job site inforrnadon d Tncrrarca Company Nam Policy#or Self-ins.Lic.#: �� 77 /P J J y / Expiration Date: j lob Site Address City/State/Zip: Attach a copy of the workers' compe ation policy declaration page(showing the policy number and expiration date; Failure to secure coverage'as requa'cd under Section 25A of MGL c. 152 can lead to the imposition of crimid penalties of er fine tip to S 1,500.00 and/or one-year inalirisonmmen% as wcU as civil penalties in the form of a STOP WORK ORDER and a f ofup to$250.00 a day against the violator. Be advised that a copy of this statcmclit may be forwarded to the Office of Investigations of the DIA'for i surancm coverage verification. - _— I do hereby certify under the pains"and penalties ofperjury that the information provided above is true and correrl Si c: Date: C� _ l © �7 . Pl=tone#- � /, �$ - O fw1al use only. Do not write in this area, to be comped by city or town o ffcciaL let City or Town: Permit[License# Eming Authority(circle one): I.Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other ex °e.VEr � ToWn of Barnstable - °�' Regulatory Services » ELkRNsrest.E, Thomas F. Geiler,Director $Aran;9. 116 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-740-6230 Property Owner Must Complete and Sign This Section Xf Using .A Builder e subject property as Owner of m � p p ty hereby authorize / )I SC/� °� � to act on my behalf, in all.matters.relative to work authorized by this building permit application for: (Address o Job) Sign e of O Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. M : Town of Barnstable mop Y H E Tq�y o Regulatory Services • saxxs-rwscs, Thomas F.Geller,Director g Buildin Division mob'°Eo►A A,� T Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 K-".toyni.barnstabl e.ma'.us i Office: 508-862-4038 1�, —_- - Fax: 5.08-790-6230 -- -7— HOMEOWNER LICENSE EXEMPTION \� Please Print DATE: +( JOB LOCATION: ' number street village "HOMEOWNER name home phone# work phone# CURRENT MAILING ADDRESS: city/town I state zip code " e tended to�include owner-occu ied dwellin s of six units or less and The current exemption for `homeowners was x to allow homeowners to engage an individual for hire who d)js not possess a license,provided that the owner acts as supervisor. . DEFINITION OF HO OWNER Person(s) who owns a parcel of land on which he/she resides or i tends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures a cessory to such use and/or farm structures. A person who constructs more than one home in a two-year peri6d sh not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptab e to the Building Official, that he/she shall be responsible for all such work performed under the building pelrmst. (Sec 'on 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with e 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 1 i Approval of Building Official will be required to comply with the - anvil dwellings containing 35,000 cubic feet or larger vrr q mP Y Note: Three f y g State Building Code Section 127.0 Constriction Control. r HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provision Which that if the homeowner engages a persons)for hire to do s sin of construction Supervisors);p 1-Liccn of this section Section 109.1, g 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 Hith a licensed Supervisor. The homeowner acting as Supervisor is ultimately respons)ble, of his/her responsibilities,many communities require,as part of the permit application, To ensure that the homeowner is fully aware b nilitics of a Supervisor. On the last page of this issue is a form currently used by that the homeowner certify that he/she understands the rcTonst several towns. You may care t amend and adopt such a form/certification for use in your community. i ✓fie iochrvrrwruueczftfi a���acfiuoe � Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR i Registration: 112049 I Expiration 2%19/2{109 Tr# 127259 TYPe DBA• i� SCHULZE BUILDING CO',a LC r WILLIAM SCHI.JLZE PO BOX 288/65 CROCKER ,CENTERVILLE,MA 02632 Administrator fir' LLicense or registration valid for individu I use only before the expiration date. If found return to: IBoard of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 t i it Not alid without sign re n. i i I i ;' � ✓lze -toa�remzo�izuseall�a���Sac�uCaeLzl Board of Building Regulations and Standards .I HOME IMPROVEMENT CONTRACTOR Registration 112049 Exptratio,n ,2/1'9/2009 Tr# 127259 Type DBA` SCHULZE BUILDING CO`,:LLC WILLIAM SCHULZE PO BOX 288/65 CROCKEB.ST ,CENTERVILLE, MA 02632 Administrator License or registration valid for individul use only I before the expiration date. If found return to; Board of Building Regulations and;Standards I One Ashburton Place Rm 1301 I Boston,Ma.0210 �8 I r I I i Not slid without sign re i i i 1 I i , ' 9 } TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map J Parcel �3y Permit# Health Division Date Issued Conservation Division Fee Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address o'1 �O�-9 e�=cl� CJ Village C.P,Jrerty 2 Owner 1.(ii v1/ n d Address �-►� Telephone 996 ^ 3-733 'Permit Request P s,00 w Ll Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost �� 0066 Zoning District Flood Plain Groundwater Overlay Construction Type CEO \ Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family t Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: y Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name__ k_6,evZJ-1AJ;4(5 ' Telephone Number Lf a-O—I� SCE Address k0l. ��Se �a- I-AZ License#_ C)5: 7 (;WAA It-v J1 e . M4 c`ate 3 2 Home Improvement Contractor# 3 y Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7— ,y1✓ /�a�l�• /�'i I SIGNATURE DATE 2d2__0a FOR OFFICIAL USE ONLY PERMIT NO. 1 DATE ISSUED MAP/PARCEL NO. :w ADDRESS VILLAGE OWNER DATE OF INSPECTION: J r FOUNDATION FRAME INSULATION ' r FIREPLACE ` ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL -F - GAS: ROUGH FINAL - FINAL BUILDING r i t r S DATE CLOSED OUT y ASSOCIATION PLAN NO. J The Commonwealth of Massachusetts Department of Industrial Accidents #met811BOStiFSHOSs 600 Washington Street - Boston,Mass 02111 Workers' Com ensation insurance Affidavit n name Q �ar✓�-� �V�Q iS location:city a Lvz� Lea V i� hone# 2-6 �Q FSi ❑ I am a homeowner peffmiiing all work myself ® I am a sole �prietor and have no one workin in capacitv ❑ I am an employer providing IRS workers'compensation for my employees wodcing on this job.: ::::::::::.::::::: .::::.::::::::::: .:::::: i' ii> isi ? asiitis%?'E?����i?2''ii<3iiz 'i iiEisE?i <ii ? i�iii ? i soma my t?<: {:::t:::'::;;:::::{:;::j:::%:YY::::;:jjj::}::j::::.r•:}:j::j : :::......:j:::jj:%Y::Y:j::R;:jj:Y::Y Y:j:YB ... .... ......................,............r•r,.r::r::.v}:::.}}}Y:jjj:?:•}:.;:{::::::}}:.}:.}:.}:{.}:?.}:}}:::;.}:{::{<.}p::::;;<::}`:{•.:{-::{:::...::::?j:;:Y.p:S. ::}:;>.::<:;: h :........................... :::::.:::.::::::.::::::. ..:.... .. ..:..:::........................ WE ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the full worloers' .� �! ?Y4•£j::-:{£:•j:;jy:?jj}ij jj:£:jijijj.'•::::::>:ijij::j$ijjjjij:jjjjj::j;iijnv:j.'jjj:Y:jjj:y;{;:}{:;:::'}}jjjijj::i};:j:::?;::' :iiii::�:j i:.i:{:iii::ji::£:i:v:iJ:£:?jji::::%:i: ......................... .. .........,.r ..:4:.�:.:v:::v- ..........:v::::::...... ......... ......... .........:::v:.v:nw:::J{'i{'4v}}}•:.}•4:4}}•.}.{%:Y w:nv::•.:v::v::::.vvvv}::::::n:::v:: . iry.;•r............v........v:v•::};},.}.;}}............r v.v::.v::::Y:: ..... :•}'nn4w:.vnv:::::r.v::::::::................::::::.v v::.. ,.....,.::...;{::i:Y:j:::{:::::::j::jjjjjjjjj: ::w.}:•}:{{{•}:•:•::::•{}}::::::w:;:4}}:•...... ..........4 :n;....::::.••}}}. ...:..w:.r.•:?:ti}}:a:{4}}}'.}v:::::.}}:{4::::{L'::{v:•}}:•}}}}:{:.:'•}}Y�{h}%:::{•}•a'::{?;•i:{{•}}:{.}•::.};:::::::;.}•:.}}v:: ...........n....................• .::::::::.•rya:..:n........r..........rr...............::•:.•.......:.:v:::v:::{:{{{ry}:w:::.{•}v:4:v:x:.:v:x:}:}.v:}:w:::!v;•}{•}:v.v::::::::;}:4:,{a}i:•}{v:C:•.a:4:......................... 3 'r.'{:i}:isti:i:•ji}:{ti}:ii}'ia`.:jj}`i:>iijijik:isi?:::i}iiii:'fjjjr::j>;jji}}:>:::tijij::ii:::<:iji'ri::z}«:::�::i«::iij:Yi:i:i:{:j:::;:i;:jl;:y,:;:::" {?::t'.'•I:jr:£:%i••^;:: ..�.£j':!'i:?v�:��£:':£jj£,�::;;,.;:Y:<;::;:;:;::j£:;:;:;:v:1{�::-?v�jjj:Y;?:}r,:}y:is;:y:v.::::::::•.::::.:`:?4•:{s{::::.:•:::•:;:;i:}::i•}i:•i+i:jvjjj;;iii}i}?:i;X{;i}}:{;::;+:;:i;i:i(!::�i�::?:t.}iiiii::i:•}:i'::�?:ii;?:;ii:Giii}}}:i?:^ii:v;iii:?:}i}li:v:ij{:^:iii:l`:.r•£':<�}:v::Sr:wv: �aLL� jj:•tY;.:Y:jjjj:�:'Y'{jj:;j.;j:;£;•};}::j j{j•%:j•^t:jY;Sj{j;£r.;j:<i: `•r«+jjjjj::}'`::%.'4 ...........::.::.:•:v... nv. .r.�+i'}::•}}Y .::.',vv;,}.;..;,....v:^4:?:Y:':•'Ov'•.'%4:. .h•v .%':`�?•Y'•:.:jjjj:Y:jjj:{.. .}.....rvv.••.:.r. rW.. -:Ylnnwi.: •::::•.•::•.:.......v }.. ..r..,, :c:.,..>}Y,aY4? 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Yh•• .ka)C:•x'j*;x�`,4,vm`:b.4'.{x:•::d�.x•:::::..... :::::........./... }:4'l.•:•}::v}}::4i:v:,v.• - ... ................w::::%.....4...........................:.::::::•::v.:...{.•:::� r 3Y..n:•::::r..vr}.a:Yv::::•::•:}}.j::yj>4>w.}}j•.w,..;^:::. ...............v�..-.,�,.r%,:,...T,!Cenv w:..r....:.n.......}........................................:.. rr:r: r: FROMM to seems coverage b regoired wider 8eetimr 25A of MQ,IS2 can lead to the impocitian of erhmioal penalties of a lbre np to S1,SOOAO=&or one years'imprisonment as WA as civII pi In the form of a STOP WORK ORDER and a Foe of 5100.00 a day against me. I understood that a for copy of do statement may be warded to the 011lce of InvesHgatlom of the DIA for coverage veri8eation, I do hereby certify the p a pe nakin of penury that the information provided above is trw.and con7 . ed g ` Date y/Z✓�/ZO - Print name &ben,)— .(AA J� h P�# aMdal we only do not write in this area to be completed by city or town oMdal city or town: permit/llceme 0 QBmilding Department a i Bond ❑des idf hnmediste response is required ❑selectmen's Omce E3Hedkh Depar l comad person: plane 0, ❑Other (�esed 9/93 PJ�y 1 l a1 a 1 . a M• •II :. 1 1 �. :1111/ . . • . . - . . 111•a1 •1• •11 . • " aWI . . . �• . ells 11 .11 :. „ r .a•11 w-• • . 1 11 1 - - . 1 . 1 a 011ie 1 Y• :., . 1111• �• • • 11 al • 1 I r • oil • . 0 • 1 • oil1 a - •Y. all• • .11 •'• • //• • / • • • 11 • al • _:.�• 11 • 11 all a • .1/ • 11 • 11 • / - •�% - • �,.all Y.1• :•� • • Y: r• a111• • •1 11 a • ■ • 1 11 • U • /1 a 1 1• •« .1• •11 •1 • 11 a 'J% :IIUI a/11• • 1 • �Illle • e hT1- a 1 •ID 1�• • • • - 1 • 1• 1 11 • 1 • 11 • 11 ,11 11 .11 111 all•. .11 • 1 • :.�V •�. 11 a 11 • 11 • 11• 11 • 1 e • 111 • 1 • • / •/1 a • 1 e a1I • 11 w1 •II k,2/•JL•relb 11 k.1,1 .II Ir- Oil • 1 M• •IIwe • I I dis"'i• 1:49 011 1 1 • • 11 • 1 • • •IIIT I 11 - 'J • 11• • • • 111/) f(a01M• /motile .:e to I / :,111• • 1 • :� - . ell • Y.11.� 11 .1 1' 1 11 11 1 I 11 1 1 JunfmTr1 1 1 11 1 / I 1 1 Ili -1 I II 1 u 1 l 1 1 I r 1 1 1 � 1 1 1 1 1 1 1 1 1 I 1 / 1 1 T. 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"'�.�; The Town of Barnstable E&W VMWAM==MASS De artment of Health Safety and Environmental Services 6 .0 P Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date 4//2-r)2- go 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. of Work: Q Estimated Cost QDro`o 0 Type Address of Work: � g e la GG� I —U/ ire-y I Owner's Name: i Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION.PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date �Contra�ctorNa�me Registration No. OR Date Owner's Name q:forms:Affidav . ,q�r3w "$ s JtOfuI .O��LaddOIYNI,.•/J• MPROVEMENT COORACTOR egistra In 41143 xplr ARBO SIDE` EMO ROERmMMAS a: f � r RYy , �— RTE Vlll MAp2632J. k� Y 7 � 4 Edge of Pave ZONE. Beach Road DCPC LB/SB Long Area (min.) 87,120 SF s86. 30' 00 W Frontage (min) 125' 3.28' Ede of Pave Setbacks: N ' . Front 20' N7T 33' S 4— Nic ' 19' 30"E-cb/dh cb/dh UP 1p 20.0o b2o 15, \ _ Side 15 See §240-131.5 B 51.64' " Rear 15' — 33 55"W; 'I Building Coverage §240-131.6 Lot Coverage §240-131.6 I � Coverage §240-131 6 Lots C2 & 3 J Lawn DCPC LB/SB Lot Area o Building Coverage §240-131.6 21700fsf (to MHW) Flo Allowed 2,300+(0.04x1700)=2368sf N� Existing 2121 sf Proposed 2080sf L "h OCATION MAP: N 6 v Lot Coverage e §240-131.6 ' a,o u� o olrn o 0 9 1 =2,000± Allowed 3,600sf 1 o N. F_.,Iisting o Lawn ICb c 'v"v'v115' 2vsi ASSESSORS REF: Ul I?N Paved Drive Walks/Patios 892sf N(r I N rt Paved Drive 1,634sf Map 185, Parcel 030 BLD 2,121 sf aS o I ° Total 4,667sf OVERLAY Proposed DISTRICT. I Walls 20sf (No Change) AP — Aquifer Protection District w Walks/Patios 933sf I - Paved Drive 1,634sf (No Change) Co -to1 BLD 2,080s f FLOOD ZONE. Ro over °' w Total 4,667sf Zone VE Elev. 15' w w Community Panel No. 0) #250001 C 0563 J N � N ! Q July 16, 2014 N ZN 0 � � Chimney ' I N n s I DIRECTIONS. IFrom Hyannis - Follow Main. Street to the West o cn Patio I End Rotary, Take third exit onto Scudder AveTurn . sb dh Continue right n onto Craigvilleto smith rBeach Road eet at the Land left eop t / ' / Z I onto Long Beach Road. Fence fnd #259 #259 is on the left. 2 S ty w/f Area of I Dwelling I Detail ati Lawn I REFERENCES: Lot C1 Lawn s� I Existing N Deed C136006 I Patio I Plan LCP 16409-8 Patio Lot 3 Deed 219995 / I I Plan LCP 43466-A n all Conc Wall l Proposed 18" Step (Not Calculated as S`83' 44' S1' h BLD Coverage) i i IProposed Roof Overhang sb/dh (Not Calculated as fnd % G BLD Coverage) y/ Meter Beach Grass +o+ 0, Fence / + + I + + I + + N Overall Plan View Beach Grass I Scale 1" _ 20' Pra osed Detail Plan View I �k �� M o Scale 1 N / Zz Beach I I I I IExisting I Overhang-with Step I to be Removed Nantucket Sound 29sf N Existing I I Patio To Remain I Existing Bay Window To be Removed I 12sf I .c:9u.9 R ''� M�Y�Y'i✓. gf II / sb/dh ZtA6F TOWN Of 1ARNSTA fnd ,_ T. y� G W NDVVI Mil eter I b No. 69 4 I c ST NAL „^m I V i S i 0� Existin /Demo Detail Plan View Scale 1 = 5' T1TLE. PREPARED FOR: PREPARED BY.• Site Plan Proposed Improvements Amin & Mark Bodzioch Trustees ' Engineerin & UjVa .� BodZioch .Family Trust At PO Box 63100 C ' p p New Bedford MA 02746 Onsulting, Inc. �'� 259 LoBeach Road (508)428.33"• R.O. Box 659 . 711 Main Street Osterville MA 02655 BamstabTe (osterville) Mass. seci@sullivanengin.com • wwwsullivanengin.com �� 20 0 10 20 40 so Draft: CTR Field WHK/CTR DATE: SCALE: _ , Review: CTR September 9, 2019 1'!_20 Comp CTR Prof• # 390020 Pro j. Bodzioch