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0125 LONG POND CIRCLE
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TOE, N 0� �N NS r_,�BL� Date Issued.....:..:... .. ....�. �::. Map/Parcel........ AK.: . ' TOWN OF`BARNSTABLE EXPEDITED,PERMIT APPLICATION: ROOF/SIDING/WINDOWS!DOORS/TENTS/STOVES/WEATHERIZATION* + ,PROPERTY INFORMATION Address of Project_ 0 Laft, po i�� CrN1rry//� NUMBER . TREE VILLAGE t Owner's Name: Plin. e Number 7"�y y8� 7�30 Email Address: Cell Phone Number Project cost$ Check one Residential Commercial ., + , OWNER'S AUTHORIZATION- As owner of the above property I hereby authorize p2fal Zfl��i9i/ or�i9 to make application fo buildin e ' 'n acc Banc with 780 CMR Owner Signature: Date: TYPE OF WORK Siding Windows(no header change)# Q Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's wreview s Roof(not applying more than 1 layer of shingles) Construction Debris will be going to-�/� - - CONTRACTOR'S INFORMATION - - - Contractor's name Home Improvement Contractors Registration(if applicable)# /� ��� (attach copy) Construction Supervisor's License# /D 3 (attach copy) Email of Contractor�f zdl?w. A> ?1em" .carl Phone number 6 eo,�o- 6w/� ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. i APPLICATION NUMBER....................................................../.... *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent liaee'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. \ Purpose of Event 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. Proeide 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 approvab ` . *WOOD/COAL/PELLET STOVES * ' Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side 1 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, specifieinspections andrdocumentation required by 780 CMR and the,Town of Barnstable. Signature Date i - - APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. ' I he commonwealth of massachusetts Department of Industrial Accidents t ' Office of Investigations 60#,Washington Street y Boston,MA 02111 www.massgov/dia. .� Workers' Compensation Insurance'Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information\ .- / ` ' ' ' '' Please Print Legibly Name(Business/organization/Individual). F40 1 Address: �� U.l� Y`�o'1 Eo>'yi f F e.F - t _♦ City/State/Zip: 6414it /J,9 d203s a 'Phone# 5U$ ''YV/,O Are you an employer?Check the appropriate box: Type of project(required)`: 1.El am a employer with i . 4:M I am a'general contractor and I 6. ❑ ew const ruction Eel (full and/or part-time).* 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 sub-contractors have" em olition _ � 8. �D working forme in any capacity. employees and have Workers'-- [No workers'comp.insurance comp.insurance.t 9. ❑Building addition r~ required.] , 115. We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work' ,.;officers have exercised their •11.0:Plumbing repairs or additions= L. . right of exemption per MGL',. myself. [No workers,comp. ,: , . . r 12.❑ f repairs insurance required.]t ti . + , - c. .152,,.§1(4),and we have no employees. [No workers' 13: Other 4vi/lr�or✓ t?ep�/3tra�1� ... 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&providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: ' ' Expiration Date Job Site Address: City/State/Zip: ' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). . Failure to secure coverage as required under,Section 25A of MGL c:152 can lead to the imposition of criminal penalties of a,. fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and r thepains and penalties ofperjury that'the information provided above is true and,correct: Si ature: Date:�/O-1 -/1%_; Phone#: (508) Official use only. Do not write in this area,to be completed by city or town official , City or Town: Permit/Licenie#_ Issuing Authority(circle one): 1.,Board of Health 2.Building Department 3.City/T_own Perk 4.Pectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M - Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." " An employer is defined as"an indiv ual,partnership,association,corporation or other legal entity,or two or more of the foregoing engaged in a joint a erprise,and including the legal representatives of a deceased em oyer,or the receiver or trustee of an individual,p ership;association or other legal entity,employing employee .-However the owner of a dwelling house having not ore than three apartments and who resides therein,or the occ pant of the dwelling house of another who employs ersons to do maintenance,construction or repair work on s ch dwelling house or on the grounds or building appurtenan ereto shall not because of such employment be deemed o be an employer." r MGL chapter 152, §25C(6)also states that' very state or local licensing agency shall withhol the issuance or renewal of a license or permit to operate a usiness or to construct buildings in the commo ealth for any - applicant who has not produced'acceptable idence of compliance with the insurance cov age required." Additionally,MGL chapter 152,§25C(7)states either the commonwealth nor any of its poli cal subdivisions shall enter into any contract for the performance of pub 'c work until acceptable evidence of compl' nce with the insurance requirements of this chapter have been presented to a contracting authority." Applicants . Please fill out the workers'compensation affidavit compl ely,by checking the boxes at apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)an hone number(s)along th'their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Li ility Partnerships(I )with no employees other than the members or partners,are not required to carry workers compen anon insurance. I LLC or LLP does have employees,a policy is required. Be advised that this affidavit ma be submitted t e Department of Industrial Accidents for confirmation of insurance coverage. Also be sure t ign and da the affidavit. The affidavit should be returned to the city or town that the application for the permit or li ense is b g requested,not the Department of Industrial Accidents. Should you have any questions regarding the la r if y u are required to obtain a workers' compensation policy,please call the Department at the number listed be w. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials i Please be sure that the affidavit is complete and printed legibly. The partme t has provided a space at the bottom of the affidavit Ifor you to fill out in the event the Office of Investiga ' ns has to ontact you regarding the applicant. Please be sure to fill in the permit/license number which'will be use as a referen number. In addition,an applicant that must submit multiple permit/license applications in any given ear,need only bmit one affidavit indicating current policy information(if necessary)and under"Job Site Address"th applicant should 'te"all locations in (city or town)."A copy,of the affidavit that has been officially stamped marked by the city town maybe provided to the applicant as proof that a valid affidavit is on file for future pe or licenses. A new a davit must be filled out each year.Where a home owner or citizen is obtaining a license or rmit not related to any bu ' ess or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is OT required to complete thi affidavit. The Office of Investigations would like to thank you in adv ce for your cooperation and sho d you have'any questions, please do not hesitate to give us a call. The Department's address telephone and fax number: P � P i The Commonw lth of Massachusetts Department o Industrial Accidents Office Investigations ' 600 W hington Street a Bos n, MA 02111 Tel.#617-727-49 0 ext 406'or 1-877-MASSAFE Revised 4-24-07 F #617-727-7749 www.mass.gov/dia" F . . � o =fir p D D 4l� C1 -u-u CD � Li mc c :_ 3 �ac. a W 0 -<N N C Co r- y m� x o' =iX N; o of �O O <o DXK M DA3. n co � : l x� 1• 3 ? : cwn (` p n�' ° Z` ;^:; J y T C ice„ _.{ S—`.i �7^C N O Z3m� U Cl o'' AOitil O o.? � cn omaC)m�n �' u, m Q X c 05, \ m m e CD � o D� A; Is -< a i coo n n e w m n O C i N Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition ofthe Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl Registration v `I before the alit for individual use only expiration ion date. If found retu n to: Office of Consumer 10 Park PIaZa< Affairs and Business to: Boston Suite 5170. I MA 02116 Not VW without signature f �n ! t ' JL V 1� JlL l/i Lail 1L4J�.H.RJ iV Building Department Services °FztrE rqk .�.y Brian Florence,CBO Building Commissioner t uxxsrAat�• 200 Main Street,Hyannis,MA 02601 Muss. 9 A 16;9. k�m� www.town.barnstable.ma.us Office: 50 8-862-403 8 Fax: 508-790-6230 Approved: Fee: Permit#: �— ROME OCCUPATION REGISTRATION Name: C �rC�f. Phone Address: l 2 S (� �o�� C�'l�G C e Village: C^P.*i 41-e f Name of Business: Type of Business: ��`�,�� Map/Lot Zo G S -7 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,'subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the, activity shall not be discernible from outside the,dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would snggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. A LDr registration with the Building Inspector,a customary home occupation shall be pe=itted as of right subject to the following conditions: • -The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. •" Such use occupies no more than 400 square feet of space. • There are no external alterations to.the dwelling which are not customary in residential buildings,and there is no-outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess ofnormal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing-the Cuustamary Home Occupation. • . No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall bg employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit, I,3tlie undersigned,Ove re�d and agree tfie above restrictions for my home occupation I am registering. i Applicant: Date: Homeoc.doe,Rev.06/20/16.. ..t.--u:+.'_. .-.::L'.-:vs�.:l.^:uYv.1.T>.:a.S1.WadTLL•.:/L.Lc�r;lrS:i-n:T.LMe4t-axvisxr:.awy�^_i..W]'s.vu.Urtu.tivra...ws.•r^a]•1'hC.G..xsllvL.^.synalraull.vx.r.!t^.:ti.[nCxM L>¢mi4lnfua.v.Fxaxdetruss.'1xu.er�onvx.+aeYa.enarLmn.ax.v.:n.e.n�'namxaNssrcen.n.¢aalnsx.aen�nau--fux.ve �s.atau.au..nw.,u..x.ox.r...—x.. YOU W15H TO OPEN A BUSINESS? For Your Information: Business certificates (cost T340.00 for 4 years). A business cerffi.cate ONLY REGISTERS YOUR NAME in town [which you. must do.by M.G.L.-ltdaes.riot giveyou.permissionto operate.] You must first obtain the.necessary signatures on this form at200 Main St., Hyannis. Take the completed.form to.the Town Clerk's Office,1st FI_; 367 Main St., Hyannis, MvIA 026.01 (Town Hall) and get the Business Certificate that is required by law. DATE: / J Fill in please: !j2 �]:[�!' � APPLICANT'S `YOUR NAME/5: � ar `e5 qh �'c L'r _ �? ! r '•'i'•`�''Mk''' r)' ih:x� BU51N,E55 YOUR HDME-ADDRESS: ���"` �=1 W'1=� TELEPHONE # Home Telephone Number a 16AIi!_FJtyi IK4;��� NAME OF CORPORATION: NAME OF-NEW BUSINESS AI V Ccr -V;v;h Ser�'Ce TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES —NO ' ADDRESS OF BUSINESS- L2��—Poh C,'(r — MAP/PARCEL NUMBER [Assessing) When starting a new business thee.are several things'you must do in order to be In compliance with the rules and regulations of the Town of Barnstable. This form is-intend'od to assist you In obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town, --�-- - - �VIUST COMPLY WITH HOME OCCUPATION �. BUILDING COMM1551DN1=RiS FICE - This individual has b n-;.. r n m• s it m •ts that pertain to this type of business. -RULES AND REGULATIONS. FAILURE TO OMPLY MAY RESULT'IN-FINES. uth6R d Signature C❑ NTS: 1. 2. BOARD OF HEALTH This individusl•has been informed of the permit requirements that pertain to this.type of business_ Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY)This individual has been informed of the licensing requirements that pertain to this type of business. y - Authorized Signature** COMMENTS: T, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel TOWN OF BARNSTABLE Applic4ation0' f ant I Health Division VIMJ� '_ � f l Date Issued Conservation Division Application Fee -16 Planning Dept. Permit Fee D IN I~ 0 f j Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 11;t5 Village ,�}�rWl�� Owner Address Telephone 779 -41Y7- 7(- o Permit Request LJe ►. e11.. -/I) Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 'Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure 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 Roam Count (not including baths):'existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Mike McCarthy Construction Name P0 Box 52 Telephone Number Address west Dennis, MA 02670 License # CSL-58633 HIC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 61MIA l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED -- r MAP/PARCEL NO. - h k r i" S4• ADDRESS VILLAGE _ OWNER . h 4 DATE OF INSPECTION: Y r ' FOUNDATION r FRAME r, INSULATION FIREPLACE 4 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING- DATE CLOSED OUT. ASSOCIATION PLAN NO. 1E The t ommoratwalth of Vassachusefts T Deparhnent of liudtstr al Accidents r Office Of InIleS likafions 600 Washington meet Boston,.MA 02111 wam nass.gov/dia Workers' Compe.nsatiuulnsurance Affidavit:Builders/Contractors/FiectricianslPlumbers Applicant Information ,. ike ,. � c ___ _____t _tawse Print Legibly Flame( sslOrgaaizatiou&&viduaI): PO Box 52 West Dennis, MA 02670 Address-. Cell (508) 290-6964 CSL-58633 HIC-169393 City/Stat&Zip: MOM AVI an employer?�Checkthe appropriate box: T of project r uire 4. I am s contractor and I3L am a employer with 6- ❑New construction employees(fun andlor * liarahired.the sub-conumctors. listed on the attached sheet_ 2- ❑Remodeling I El I am a sole proprietor or partner- These sub-contractors have ship and hate no employees8- ❑Demolition. working for me in any capacity employees and have workers' 9. ❑Building addition [No workers'comp_inu*=e comp.+*,s.uce. required-] 5. We area corporation and its 1t?_.�Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_.❑Plumbing repairs or additions myself. [No workers' - right of eaTmption per MCL 12..[I Roof repaul- insuranre required-]T c.152, §1(4),and we have no �-,` employees_[No workers' 13_�ctther comp-insurance-required-]. *Amy appticxnt that checks box#1 must also fill out the section below showing ihea workers'compeusadion policy infotmatior , T Homeowners vrho submit this Ltadavit indicating they arQ doing alI worik and then hire outside contractors— submit a new affidavit indir tm such- }Gontracturs that check this bcc must attached as additional sheet showing,the name of the sub-cauftactors and state whether ornat those en6 ies have employees. If the sub-contractors have employees,they nmst pmvide thew workers'comp.policy number. lam an employer that is prmidiag workers'comperuation insurance for my employees Belotr is the policy and job site in formation Insurance Company Name: Policy;9 or Self-ins-Lim# V Usk_— LGo —G 67 6 TG- Expiration Date: 712/i Y Job Site Address: ��) 1 Y�r) �lT City/State/Zip— Attach acopy 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 ofrrirninal penalties of a fine up to$1,500.00 andlor one-yearimpHsonment,as well as civil penalties in the form of a STOP WORK ORDIR and a fine of up to$250.00 a day against the violater- Be advised that a copy of this statement maybe forwarded to the Office of Im estigations of the DIA for insurance coverage verification. I do hereby certify re f 'n andpenal tes ofpeijury that the information prinidedaboue is true and correct Sit=_nature: Bate: 6 Phone#: QUW-al use ont . Do not write in this area,to be completed by chi or town ofrciaL City or Town: PermitUcense# Issuing Authority(circle one): , 1.Board of Health 2.Building Department 3.CitylTomt Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone!#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursua itto 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." f 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 le � representatives of a dece ed employer, e . � g g gag ) rp gal p as mp oyer,or th 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"evei Tstate or IocalIcensing agency shall withhold the issuance or renewal of a license or permit to aperafe a business or-to construct buildings in the commonwealth for auy applicant who has not produced acceptable'evidefice`6f co6ipliance with the insurance.coverage required.'" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their c:erbEcate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no erployees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required_ Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. Tire affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 4 Please lie 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 bye sure to fill in the permit/license number which will be used as a reference number. In add lion,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 il-r (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 idled 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 lice to thank you in advance for your cooperation and should you have any questions, Please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of hidustrlal Accidents Office of lavestiptians 600 Washington Street Boston,MA 02111 Tel.#617-727-49 00 ext 406 or 1-9 7`-MASWE Revised 4-24-07 Fax# 617-727-7749 - Www.mas&gov/dia r Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633�,, MICHAEL J MCgAR PO BOX 52 ' W DENNIS MA 6267 a' 92— )t j1 0 Expiration Commissioner 04/10/2016 d��e t�rn�zc�u�et CiGsac�u��e Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. SCA 1 ej 20M-05/11 El Address Renewal Employment Lost Card r DATE(MMIDDIYYYY) � ®[Jr,� CERTIFICATE OF LIABILITY INSURANCE 10116/2013 �. THIS CERTIFICATE IS ISSUED A MATTER OR NEGATIVELYON ONLY AND CONFERS NO AMEND, EXTEND, OR ALTERRTHETS UPON THE CERTIFICATE HOLDER.COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ect to IMPORTANT: If the certificate of the o an ADDain ITIONAL L INmaySURED, an endoirsement A statement on this certifmust be endorsed. if icate does noOGATION ISt conferDrightslto the the terms and conditionspolicy, certificate holder in lieu of such endorsement(s). C�NTACT PRODUCER 01962-001 LN ME: . �__.-------...._-----------... AHi��fo Ext (508)398-6060 �AIC,No_ (508)394 2267- Bryden&Sullivan Ins Agcy of Dennis Inc �� - - —— EMAIL --� FO BOX 1497 . I AooREss: So Dennis,MA 02660 I _NAIc a I�SURERL$)AFFORDING COVERAGE-_. - - - 33758 A.I.M.Mutual Insurance Company INSURED Michael McCarthy Construction Inc - - L(NSUREiiC P O Box 52 `' --------- -- -• - , West Dennis,MA 02670 a -- -—-- I COVERAGES CERTIFICATE NUMBER: � REVISION NUMBER: - BOV FOR THE ED NAMED A THIS IS TO CERTIFY THAT THE POLICIES IREQUIREMENT,NTERMSORDCONDI ON BELOW AOF ANY CONTRACVE BEEN ISSUED TOR OTHER THE RDOCUMENT WITH ERESPECT O POLICY WHICH THIS INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED—HEREIN-IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF SUCH POLIC�ES LIMITS SI.OINN MAY HAVE BEEN'REDUCED BY PAID CL*11S -_T POLICE EF POLIO LIMITS ADDL UBR114101 -- g POLICY NUMBER --) ML MIDI —)-1------ ILTR' TYPE OF INSURANCE INSR I WVD I D - - -- -_� __-_--. -- ---w- - i EACH OCCURRENCE --L$. _ _ GENERAL LIABILITY I DAMAGE TO RENTED — _(Ea occurrence), $-..-- ------- COMMERCIAL GENERAL LIABILITY I MED EXP(Any oneperson) $ I CLAIMS-MADE I OCCUR I LPE _- -..-I , RSONAL&ADV INJURY j GENERAL AGGREGATE $ --- _. PRODUCTS.COMP/OP AGG .,$ PER: GEN'L AGGREGATE LIMIT APPLIES I j POLICY PRO- LOC _ I -- - _ COMBINED SINGLE LIMIT - — _. L -.. _ AUTOMOBILE LIABILITY _ (E_a accidentl_ _. DILY INJURY(Per person) $ I e0 _- ANY AUTO I BODILY INJURY(Per accident) $ I ALL OWNED I SCHEDULED j PROPERT Y DAMAGE $ AUTOS OS i AUT NON-OWNED F_(Per accident HIRED AUTOS !AUTOS ------ I $ I EACH---- --- - -- --.--- AGGREGATE ---- - a ' L- ----- - $ OCCURRENCE UMBRELLA LIAB j !OCCUR 6 I EXCESS LIAR CLAIMS MADE I AGG �$ --- - — DED RETENTION $ - - �- ---- X LTORY LABS' -_R �- - - -- 7�p ------ --- ..._.__.,_ I I E.L. ACH ACCIDENT $ 500,000.00 WppRKE�RS C�EjNR3€LIABILITY _._..._ ._._.-.-- ANDE P O YIN I A PRR�ETB�R/PA TNEf/EXECUTIVEr--I j E.L.DISEASE EA EMPLOYEE$ 500,000.00 Ny R VWC 100-6017656-2013A 17117/2013 17/17/2014 r- — OFFICE M M R EXCLUD D? I Y I I N/A A (Mandatory In NH) I j E.L.DISEASE POLICY LIMIT $ - 500,000_00 ID � � �bb d - SsCRIP�[ONOF9PERATIONS below... --- - L ----_.- Is required) DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,"d more space CANCELLATION' a CERTIFICATE HOLDER 'i TOWN OF SANDWICH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES E CANCELLED BEFORE t' Attention:BLDG DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN HALL ANNEX ACCORDANCE WITH THE POLICY PROVISIONS. Sandwich,MA 02563 — • AUTHORIZED REPRESENTATIVE 7G3a OWN EIRAUTHORIZATIONFOR -(Owner's Name) ' owner of the property located at L d (Property Address) V ' (Props y Address) ' hereby authorize' (Subcontractor) an authorized subcontractor for RISE Engineering, to on my behalf to obtain a building permit and to perform work on my property. Signature: Mne _ Menu H Rowland thlav 31.20141, Owner's Signature Date 'L I r � �, � Y r s isi `tial and Commercial Builder 7 _I�Z�ATION SPECL4LIST .' '^R MCCARTFIYc 1 -- i"E6' WWW. C ti October 21, 2014 Town of Barnstable ' Thomas,Perry CBO110 Building Commissioner 200 Main Stret Hyannis, MA 02601 IUV RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application W at 125 LONG POND CIRCLE has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o Parcel 0!Q Application # 1 V Health Division Date Issued / S/ Conservation Division lJ 'CO - Application Fee S v Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board J Historic - OKH _ Preservation/ Hyannis •► Project Street Address Village Cenreow+ Owner pnyt w_ pjn�/�Nd Address /2 S- Lary OQ nwc If- Telephone Permit Request I,Qe�•� �as - � '° t�%N``� "�� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size >y? nc R e Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family O� Two Family ❑ Multi-Family (# units) Age of Existing Structure !VS'7+ti Historic House: ❑Yes YKo On Old King's Highway: ❑Yes dl�o Basement Type: O'1!5ull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) J2% Number of Baths: Full: existing new Half: existing 1 new Number of Bedrooms: existing _new Total Room Count (not including baths): existing G new First Floor Room Count Heat Type and Fuel: r3 Gas ❑ Oil ❑ Electric ❑ Other W � ,Central Air: ❑Yes 3lo Fireplaces: Existing INew Existing wood e al stove:❑Y1ee e"N"o Detached garage: 0 existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: L1,01fisting O5mew' size_ 'Attached garage: Cr existing ❑ new siz Sghed: ❑ existing ❑ new size _ Other: �: a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 171 y ' Commercial ❑Yes U oo If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name a ��%�1� C 570 /7Z Telephone Number Address AY A/Wikw ".A,- License # 'CS.0'I7,0 y3 Home Improvement Contractor# 10 A, o26 Sys! Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ram,.. flo�eur C411A z/ir, SIGNATURE DATE 1.2? �>3 4 r FOR OFFICIAL USE ONLY - z APUPLICATION# DATE ISSUED MAP/PARCEL NO. ` ADDRESS VILLAGE OWNER i t DATE OF INSPECTION: µx it FOUNDATION t fUN4 JA JWUY MUM' i - FRAME -10 112343 - 1014 t r+:INSULATION o 1.� lu FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r . GAS: ROUGH FINAL � FINALBUILDING �� L DATE CLOSED OUT ASSOCIATION PLAN NO. a The Commonwealth of Massachusetts Department of Industrial Accidents VOffice 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 .r Name(Business/Organization/Individual): W r A-4-W, h( Address: 2� N ��,� BI.Q'` �a, u,F 82,' City/State/Zip: s' Phone#: 91 Are you an employer?Check the appropriate box: 1.ElI am a employer with 4. �"am a general contractor and I Type of project(required): 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.r C 1temodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity, employees and have workers' . [No workers'comp. insurance comp. insurance.$ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 1011 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o work ' right of exemption per MGL y � workers'comp. 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[:1 Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1 Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year.imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ins and penalties ofperjury that the information provided above Jis true and correct. Signature: Date: 4912� r`5 Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk, 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant-to this statute,an employee is defined as"...every person in the service of another under any contract of hire, ess or implied,oral or written." I An enT 'er is defined as"an individual,partnership,association,corporation or o er legal entity,or any two or more of the fore ing engaged in a joint enterprise,and including the legal representativ s of a deceased employer,or the receiver or tee of an individual,partnership,association or other legal entity, ploying employees. However the owner of a dwe g house having not more than three apartments and who resi s therein,or the occupant of the dwelling house o other who employs persons to do maintenance,constructs or repair work on such dwelling house or on the grounds o uilding appurtenant thereto shall not because of such a loyment be deemed to be an employer." MGL chapter 152, §25 6)also states that"every state or local licensing a ency shall withhold the issuance or renewal of a license or p mit to operate a business or to construct buil ngs in the commonwealth for any applicant who has not pro ced acceptable evidence of compliance wit the insurance.coverage required." Additionally,MGL chapter 1 §25C(7)states"Neither the commonweal nor any of it's political subdivisions shall enter into any contract for the p ormance of public work until acceptabl evidence of compliance with the insurance requiremefits of this chapter have en presented to the contracting autho ty." Applicant's i Please fill out the workers' compensation ffidavit completely,by chec ing the boxes that apply to your situation and,if necessary,'supply sub-contractors)name(s), ddress(es)and phone n er(s)along with their certificate(s)of insurance. Limited Liability Companies(I L or Limited Liability P erships(LLP)with no employees other than the members or partners,are not required to cant'w kers' compensation surance. If an LLC or LLP does have employees;a policy is required. Be advised that th affidavit may be .ubmitted to the Department of Industrial Accidents for confirmation of insurance coverage. so be sure to s and date the affidavit. The affidavit should be returned to the city or town that the application for permit or li ense is being requested,not the Department of Industrial Accidents. Should you have any questions reg ing the 1 w or if you are required to obtain a workers' compensation policy,please call the Department at the num r liste below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. e D artment has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inves gations to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be sed as a re ence number. In addition,an applicant that must submit multiple permit/license applications in any giv year,need o submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" a applicant shou d write"all locations in (city or town)."A copy of the affidavit that has been officially stamped r marked by the ci or town may be provided to the applicant as proof that a valid affidavit is on file for future perm or licenses. A new davit must be filled out each year.Where a home owner or citizen is obtaining a license or pt rmit not related to any b Mess or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is N T required to complete th affidavit. i The Office of Investigations would like to thank you in advance for your cooperation and shoal• you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth f Massachusetts Department of Ind. trial Accidents offee of Inv stigations 600 Washix on Street Boston, 02111 Tel. #617-727-4900 e 406 or 1-877-MASSAFE Revised 4-247-07 Fax# 617-727-7749 www.mass.gov/dia ACGO CERTIFICATE OF LIABILITY INSURANCE DATE(kM1DDIYYYY) �..�� 1 6/25/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements). PRODUCER NAME: Colleen Crowley Risk strategies Company PHONE_,,,. (781)986-4400 (FAX No):(781)963-4920 15 Pacella Park DriveE-MAIL Suite 240 INSURE S AFFORDING COVERAGE NAIC 0 Randolph MA 02368 INSURER AWuard` 42390 INSURED INSURER B:Technology Insurance William C Stoltz, DBA: Stoltz Building INsuRERc: P.O. Box 1325 INSURERD: INSURER E: Harwich MA 02645 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1362563673,t REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY AM IS TOR NT PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE a OCCUR nBP402777 /24/2013 /24/2014- MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ Include GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY JECT El LOC e; $ AUTOMOBILE LIABILITY - - C GUE LIMIT 4 Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED " BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED'' PROPERTY DAMAGE HIRED AUTOS AUTOS Per a. dent) ent $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION I AY OTH- AND EMPLOYERS'LIABILITY YIN Y LI ITS ER ANY PROPRIETOR/PARTNERIEXECUTIVE s E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) �3j57105 /23/2013 /23/2014 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(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Evidence of Insurance , CERTIFICATE HOLDER CANCELLATION (,. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable AUTHORIZED REPRESENTATIVE ` chael Christian/CLCr <� ' �`�_ ACORD 25(2010105) O 198872010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD f r g " THE A Town of Barnstable °+ Regulatory Services y� Mnss. Thomas F.Geiler,Director .i6gq 'OrEn 391. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder P as Owner of the subject property hereby authorize ! to act on ray behalf in all matters relative to work authorized by this building permit. / 110. (Ad e s of Job) ®-;4 3�a **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. signaLue pf Owner Signature of Applicant AV lU Print Name Print Name Da Q:FORM&OWNERPERMISSIONPOOLS 62012 f �'THE Town of Barnstable Regulatory Services ' " Thomas F.Geiler,Director 'den Building Division r Tom Perry,Building Commissioner j 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4�38 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: � JOB LOCATION: number �� street village "HOMEOWNER": ' name home phone# work phone# r CURRENT MAILING ADDRESS: city/town to zip code The current exemption for"homeowners"was,extended�extended to include own -occupied dwellings of six units or less and to allow homeowners to engage an individual for hire wdoes not possess a lic use,provided that the owner acts as supervisor. DEFINITION OF H OWNER Person(s)who owns a parcel of land on which he/slee resides or inten to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accResponsible to such us and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered aowner. Su h"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall r all such work performed under the buildin ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for c pli ce with the State Building Code and other applicable codes, bylaws,rules'and regulations. The undersigned"homeowner"certifies that he/she understan a Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with ai rocedures and requirements. Signature of Homeowner 1 Approval of Building Official / Note: Three-family dwellings containing 35,0 cubic feet or large will be required to comply with the State Building Code Section 127.0 Construction Control. y H?MEOWNER'S EXENT The Code states that: "Any homeowner rforming work for which building permit is required shall be exempt from the provisions of this section(Section 109.17 Licensing of construction upervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as pervisor." Many homeowners who use this exemption are unaware that they are assu ing the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Sect►t n 2.15) This lack of awareness often results in Serious problems,particularly when the homeowner hires unlicensed person . In this case,our Board cannot proceed a ainst the unlicensed person as it would with a licensed Supervisor. The hom owner acting as Supervisor is ultimatel .3'x'esP onsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOudook\QRE6ZUBN\EXPRESS.doc Revised 053012 -- . . -- 5 -- Vhe 1panrmza7�u�elGLGfia�VVGaa9ac�tc0eG�4>� y . - frice of Consumer Affairs&Business Regulation , Massachusetts-Department of Public Safety ME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards gistration *6562 Type: Construction Super%isor piration 5/22/2 DBA License: CS-077013 _ +;I 1 STOLTZ BUILDING _ WILL1<AM C STOb`TZ •.', 28 NTHN WALKER RD/POB1325 WILLIAM STOLTZ HARWICH MA 62645 gi 28 NATHAN WALKER HARW ICH,MA 02645 Undersecretary Expiration Commissioner 06/29/2015 -. - x :. R •r"gyp«. .. r' . play . ♦ r ,«. . - r. . PQ 13=1325 t ,taA asses Pb 508&5&0M F=MMV—UW Stoltz Building Email Fm T« �A�...;;��/z. i�v.l��>, . �7�1✓r A'°o'� Gv>�l.a� C_ Sim trZ D Urwat 0 Fotr R- I O Memo Commun t 0 Plme Rq* O Phase v/ze tCanznearzrue¢ll� Ki:uaclrraeCGr , . 1Tice of Consumer Affairs&Business Regulation License or registration valid for iadividul use only ME IMPROVEMENT CONTRACTOR i before the expiration date. If found return to: - 9istralion: 175562 Type: Office of Consumer Affairs and Business Regulation Plradon: 5/2212015.; DBA 10 Park Plaza-Suite 5170 STOLTZ`BUILDING I Boston,MA 02116 WILLIAM STOLTZ 28 NATHAN WALKER RD HARWICH,AAA 02645Undersecretary Not valid without signature !i k ►-w 0' t.n.! ft i; II i q � i (t(eL' C4. Vr�Yeti,` I { �t e fc . f L s i C7eor e)essopArchitect@yervon,net July 30,20.13 r Chris Stoltz Re: Ann Rowland Residence Stoltz Building Co. 1.25,Long(pond Circle P.O. Box 1325 Centerville,MA 02632 . -Harwich,MA 02645: Header Beam Design Dear Chris;. A Design of.HaadarbeamA to supplant the existing wall at the first floor;between the Dining Room and the Kitchen/,BreakfI.ast Area comprised of two or more IN41 x 7'/" 1,9E Microllam LVL beams to span an opening of unknown width is as follows. .. The roof loading of the Dining Room wing was originally intended as a 2x(o framed roof over unused apace with bearing at the wall plates.The rafters connected by collar ties in the top third of .the height would support the earlier.traditional snow load of,25 psf.The new code.required snow loading and additional.wind loading values have increased the total load analysis remarkedly. The support of the rafters at the intersection of the collar ties to frame a storage.closet over the Dining Room and Kitchen has shifted the bearing from the exterior walls to the interior wall centered front to back.The loading is centered equally and wholly over the:wall.and thence the beam replacement required.As a rule of,thumb,the center loading is slightly,more than one half the.floor span loading:actually about 5/6'h of the total load with the;remainder, shared equally by the outer walls at,3/1,6 each.- ;,ri My calculations suggesta 3-ply,1 3/-"x 7'/ " 1.9E.Microllam LVL will span V-0"from center to center of the post supports.The net clear opening is about 7'-611. If this opening is centered on the wall area,the first floor framing beneath will require strengthening to support the second floor span and-the increased loading of the roof.The present design is inadequate for the:existing loading imposed. The posts required on either side of the opening under the proposed beam must support 8800# each with solid blocking to transfer the load or posts continuing to the girder below the first floor. -,Built-up 5PF columns of 2x6 requires 5 ply p:2100#/each or 2x4 g (O ply C9 1 G50#/each. Ao single 4x6 Hem-Fir post will meet loading conditions g MON. Y The existing 3-ply 2x 10 girder is inadequate,failing in shear and moment under the proposed loading. To transf6r the point loading of the span above directly.to_:the footings, two additional columns from the girder to the slab are r squired.The spacing of the additional columns into match the spacing of the arch above as shown in the accompanying sketches. `. .. r e , The footings are proposed at less than the code minimum as the loading is calculated as a special point loading and not a part of the general structure.The soil bearing pressure is assumed to be 1,500 psf for the purpose of sizing a footing. The loading ranges from 10,604#to 10,630* say 11,000$/1500 psf= 7.3333 sf. 30"x30" = 6,25 sf 7.3333 x 144 = 1,056 si V 1056 = 32.5 say 33" x 33" footing size minimum. Code minimum is 3' x73611 for isolated"footings: existing footing size is unknown,continuation of existing footings to.required size is expected. Deflection of 1/240='/4" to%" is a problem_ for exposed beam(s)but not for encased beams. Spar:choices based upon fixed beam depth and 'variable span and end wing wall depth are: 2-ply 13/4"x 71/" 1.9E Microllam LVL x'12' w/opening of V-0" centered w/3' wing walls equal 3-ply 1-1/4" x 71/4 I AE Microllam LVIL x:f 2' w/opening of 7'-0" cente.red,,w/2'=(P" wing walls equal 3-ply 13/4"x 71/4". 1 AE Microllam`LVL x,12' w/opening of 7' W centered w/2'-3"wing,walls equal NOTES:_. -beam is 12' in length to support the roof load directly to foundations,without increasing.the 4 first floor loading on'the inadequate girder below and allowing for cabinets or opening on either side of support posts.The cantilevered design reduces deflection at mid span, I calculated a single span beam from post to post with resultant excessive deflection for maximum span as shown above. 2. Openings are clear span face of post to face of post exclusive of finish. 3. 5u `ort osts are included in.the wing walls.or,openspace ,.- _ PP_ P 4, 5upport posts are supporting all anticipated second floor loading as before and renewed. 5. Wing walls vary in thickness to match beam width over as a design-element only. 6. Footing placement will vary depending on choice of span above. 7, Simpson Column Cap for 3-ply LVL.to post 51/2" x 71/2" =55T-CCG5-85D52.5 Call,me with any questions. Sincerely, George A/ mbar Qf the Am�< n Irntutr Qf Archlt4ct4 �Qn�gpYty Rf Arch�tyc �jftQq�ls�shuse�ts ���the(��u�nal T �t fRr I�istQrjs Pre��n! pn r ,_ p ,, _: F r r ~ as Lct,2,. f "ram'1.a $►L.+t�C ..� 1 }-Ve 4 OA �C� � XsSAP AP(HITNT DAIS � .? scAle !� mions PO box 12 7 7,(entem k IAA 02652 Ide/fax 5o8.4 2.8.895.2 geoQseopsoporchiteatom. DRAW 67 :rV&Nt DP mna po.jSIL f 07 Lqr 1.9 tit 1 ' 1f2�J6r+2•. 4 36 x3Gk ' ol r.oplt XSSOP AP(HiTr(T DATE . (ALE QISIOns PO box 1.2`77,Centemllr,f'1;4o265'2Tek/Pais 5.08.428.8952 sgeo@ eopsoperchiterttom DPAWn by DRArflWnQ PO; t f �� 6I113 �TIN Town of Barnstable *Permit# E xpires 6 f is ue e yT Regulatory Services Fee * iARNSTABLE, a >039. Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us , Office: 508-862-4038 r` Fax: 508-790-6230 EXPRESS PERMIT APPLICATION -' RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number )OV /o,7 = Property Address 1,, <- 41,3 �5r c•�Q. . Ce vIVI-11,"�it� v° ~ [V]Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address hti41t 1?9u/1,Faef ' Contractor's Name Iv, G'Iw1> S1101 1& 171104 Sy0/2 F V,j,iWAJ Te16phone Nu nber Home Improvement Contractor License'#(if applicable) M Email: 5PItl�c�srYi�S 19 ys+/6'ewh Construction Supervisor's License#(if applicable) orkman's Compensation Insurance X-PRESSr E R10VIII Check one: 4: ❑ I am a sole proprietor t ❑ I!tn the Homeowner OCT 2 3 2013 [/have Worker's Compensatiominsurance Insurance Company Name j e��arr���y jNSvae►n-ems'• MII/AI ('1a D n U. RNSTABLE' Workman's Comp.Policy# rl✓G '3 5-r w s' Copy of Insurance Compliance Certificate must accompany each permit. . Permit Request(check box) , ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over. existing layers of roof) ' r?O'Re-side [Replacement Windows/doors/sliders.U-Value -'0 (maximum.35)#of windows 6 #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: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: ` C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 the Conimolnsveallh of Massachusetts, - DeTorttnetst of Industraal Accidents Orke ofInvesdgations 600 Washington Stmet Boston,K4 02111 ►vt v.mass.gvv1disc Workers' Compensation Insurance Affidavit: Builders/Contractors EIectticians/Plumbers Apiplicaut Information Please Print I,exibly Na=(Busiuewxrg&uinf on%dMdw0,: S lb/fc Address: ;ZZ Armi,-rm 1,44 - a nv, l�iak 132j--- City/Stat&7;p: t},gat-,-c4 Phone# 5-;�1;-9S-6 -a)25 Y Are you an employer?Check the appropriate bos: T of project(required): 4. I am a general contractor and I 3'Pe p J ( �= 1.[]'I am a employer with�— ❑ employees(full and/or part-time}.* have hued the snub-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' '[No workers'comp.insurance comp.mmxauce.l 9 ❑Building addition required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner do' all wank officers have exercised their. � 11.El Plumbing repairs or additions myself[No workers'comp- right of exemption per MGL insurance required.]i c. 152,§1(4),and we have no 12°❑Roof repairs employees-[No workers' 13.(1Other_ eu,-,.L 1-e/l k9 cc,••z comp.insurance required.] ;Any apphc=that thetas bm#1 must else fill our te.secdon below sbuwing th&waakers'cemperasadoa policy inforWtioa k,H ., omeowners who submit this affidavit indicating they are doing all wank and d=Lime outd&contmctors must subma a new affidavit indX&tiog stuck. ZCGAtmcrors that check this box must attached an addiriand sheet shorting the name of the sub-cemtrxmors and,stare whether or not those entities haee ' - employees. If the sub-conC;actots:hwe employees,they m est pmvide tb-ir workers'romp.policy number. t 4m an ernnp r that csp► gding workers'congw asadion iresaarance for atw eragdOymm Be iv is thegalky ash'job sate infor ruation. Insurance Company Name: 'Fe c.4"`61.1 .1^5 u4tke� Policy i#or Self ins.Lic.#: 7vL f 'Expiration Date: .912 f Jay Job Site Address- 12 r- lu,, Cam- City/State/zip: Ce4,t4,,,,A 074 02f--S:Z Attach a copy of the workers'compensation policy declaration page(showing the policy number and eaparatiou 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the fb m 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 D1A for insurance coverage verification. I do hereby certify under thepains,andpwnalties of pedwy that the inforinadomproWded a bove h tnw and correct S ienature: a. Date' Phone#: 9 S s —07 s y O,f a"al case only. Do not write in this area,to be completed by city or tosm officiaaL ' City or Town: PermitUcense# Issuing Authority(cu-cle one): 3 1.Board of Health 2.Building Department 3.City/rown Clerk 4..Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person phone# ACa DATEQMWDmrn i..- d CERTIFICATE OF LIAP,1 ITY INSURANCE 10/8/2013 THIS CERTIFICATE IS ISSUED AS A MATIT R OF INFORMAim ONLY AND.CONFERS NO RiGH'i5 UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NO*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(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the Certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. ff SUBROGATION IS WAIVED,subject to the terms and conditlonsof 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 endorse en s. P� f COK[ACT Colleen Crowley NAME Risk Strategies PHONEY _ (781)986-4400 Fax N,.t791a963-4420 15 Pacella Park Drive ADDRM- Suite 240 INSURER(S)AFFOI M COVHtAGE NAIc# Randolph Na 02368 ,NsuRERA ARIGua*A 42390 INSURED ; wtwmta a4whnology Insurance williamn C Stoltz, jDBA: Stoltz Building INsuRetC: P.O. Box 1325 Imo. I 1"SUPakF Harwich I!&Il 02645 INSLIRERF- COVERAGES j CERTIFICATE NUMBER:CL1362563673 REVISION NUMBER: THIS IS TO CERTIFY THAT HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOrJVMiSTANDING 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 CONDMONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. OTR PE OF INSURANCE POLICY NiNBHt POLICY EFF POLICY EXP L TY LIMnB O9iBtALLtABILnY i EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LLABILITY PREMISES $ 50,000 17-1 A C AMISMADE X j I OCCUR RIBP402777- /24/2013 /24/2014 MED pI,(AWN ore Personl $ 5,000 PERSONAL&ADV INJURY $ Inclu k k e GENERAL AGGREGATE S 2,000,000 GENLAGGREGATELWIRAPP[IESPER- PRODUCES-COMPIOPAGG $ 2,000,000 7X POLICY PRO-SECT in LOC coMeNEDOMM, IT AUTOMOBILE LIABILITY acdde ANYAUTO I BODILY INJURY O erpmw) $ ALL �114N® S6HMID TOSS BODILY IN AIRY(Per awkImt) $ AUTHUtEDAUTOS NON-OV ED PRO DAMAGE $ AUTOS � $ t LA LIAR 'I OCCUR EACH OCCURRENCE $ EXCESS Luke _' CLAIMSMADE AGGREGATE 1 1 $ DID I I RETENTION" r $ B WOmam I2IMPem-nON .j VIA STATU OTH AND EMPLOYERS'LIABO RY I Y/N ANY PROFRIETORIPARTNERIF QITIVE E.L EACH ACCIDEIYT $ 100,000 OFRCEPJMEM3EREwaUDEtyt a NIA oftndatuyff��s5le ;{ 357105 / /� /zi/2014 ' EL DISEASE-EA EMPLOYEE $ 100,000 . IDESCROP62ATIOIVS below ' EL DISEASE-POLICY LIMIT $ 500,000 1 t DESCRIPTIONOFOPERATIONSILOGAnOWiVEHICLES tAffadlACOFM1M,Addl(mw1Remwtm$dmU%ffmoreopeoebregld" LSvidAme of TnsuranO® s' ,j t CERTIFICATE HOLDER ! CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CUCELIM BEFORE f THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Harastable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Mai- Street Hyannis, MIL 02601 AUTHORIZI DR13RESEWATWE 'I chael Christian/CLC ACORD 25(2010/05) j O 1988-2010 ACORD CORPORATION. All rights reserved. INS025(2woos)oi The ACORD name and logo are registered•marks of ACORD Massachusetts-Department of Public Safety ee ofCoun=erAffdm&BasInasRegalafion Bondi of Building Regulations and Standards ME MMPROVEMENT CONTRACTOR = Construction Supervisor: '. n: 175_562 Type: License:CS4)770 i3 ration: :�_ _ DBWILLM Y. STOLTZ BtJH D1NIG 2$NUINVALKBR l O1' s 28 NATHAN WALKER HARWICH,MA 02645 0�Qcgpt�rayti�OR 11FA 15 ConmMssioner License or registration valid for individuf use only before the expiration date. If founa-setum to: Office of Consumer Affairs and Business Regulation ' 10 Park Plana-Suite 5170 Boston,MA 02116 3 ' Not valid without signature INE sntuvsrnB�, # , MA W Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO 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 ILEJL� lV 1� as Owner of the subjectproperty,- ' l / hereby authorize CA rTS St6 Cf-,- F T to act on my be�fl in'all matters relative to work authorized by this building permit application for: (A r s of Job) 4. Sign tore of Owner Date 1V C cr>L. ND Print Name - If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. r C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRFSS.doc Revised 061313 k TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel {,,Application Health Division Date Issued LS� Conservation Division _Application'Fee 03 Tax Collector µ Permit Fee 66 _ Treasurer 211°7 Planning Dept. Y Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address l-9.5' /_ 0i2�1 Village rester L1,11 Owner fight) &6olamd Address �'�r►�� /-s asou� Telephone JOE� Permit Request 8 ti Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#,units) - Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: ! �, Zoning_Board of Appeals Authorization ❑ Appeal# Recorded❑ ,` _:n _ Commercial ❑Yes ❑No If yes,site plan review# - Current Use Proposed Use ' BUILDER INFORMATION f . Name `SArnes 2• Meje.ivrr, 13 u lA�- Telephone Number Address L962 P1001-C (D 4 License# 6S (k(o5B yknoph paw - Home Improvement Contractor# /4/)i! 2 Worker's Compensation# tvlb ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � �, SIGNATURE DATE cue, /10Z*17 . £ . { . FOR OFFICIAL USE ONLY sAPPLICATION# DATE ISSUED . . / MAP/PARCELNO. " ADDRESS VILLAGE \ OWNER DATE OF INSPECTION: . . f � } FOUNDATION \ FRAME . . INSULATION FIREPLACE $ . \ ELECTRICAL: ROUGH FINAL ' ƒ ' PLUMBING: ROUGH FINAL - : . . ( GAS: ROUGH FINAL FINAL BUILDING . \ . DATE CLOSED OUT ASSOCIATION PLAN NO. � . . � . i ,per The Commonwealth of Massachusetts \ Department of Industrial Accidents Office of Investigations ' a 600 Washington Street Boston,MA 02111' wyOmmass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information .Please Print Ledbly Name(Business/Organization/Individual): 102n0 'Q MeAIL/n •Address: _ (9�16 Route City/State/Zip: yf��/►'bu�l� �o>� Phonet 5t' Are you an employer?Check the appropriate box: ;Type of project(required):, 1.❑ I am a employer with 4. [] I am a general contractor and I 6 New construction . loyees(full and/or part-time).* have hired the sub-contractors [{]'remodeling . 2;�a'sole pro listed on the-attached sheet. 7.prietor or partner- e ha t t ub-conracors v ship and have no employees These s 8. ❑Demolition employee's and have workers' working for me in any capacity. 9, []Building addition o workers' conp insurance comp.insurance.comp, ' 5 [] We are a corporation and its 10.❑•Blectrical repairs or additions . required.] officers have exercised their 11.[]Plumbing repairs or additions ' 3.❑ I am a homeowner doing illwork . myself.[No workers'comp. right bf exemption per MGL 12.Fj Roof repairs insurance.required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No' workers comp,insurance required.] 'Any applicant that checks box#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 anew affidavit indicating such. . tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must providb 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 information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date. r Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a.fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investi ations of the DIA for incur ce coverage verification, Ido hereby certify under thepains•andpenalties ofperjury that the information provided above is true and correct. Si afore: Date: Phone#: 3W U Official use only. Do not write in this area, to be completed hy.city or town off ciaL City or Town: ' ' Termit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone Contact Person: #: I E'Oyti Town-of Barnstable Regulatory Services � $ Thomas F.Geiler,Director, Bundling Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax; 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVElYIENT 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. n*� Type of Work: /./ Estimated Cost 9 kddress of Work: l Owner's Name:_..Oe %ur4, Date of Application: 9LO4 6, nWOI I hereby certify that: Registration is not required for the following reas on(s): ❑Work excluded by law ❑Jab 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 MROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER.MGL c.142A. SIGNF)UNDER PENALTIES.OF PERJURY I hereby apply for a permit as the agent of the owner. 1`t 7" JPQAu4) 14015-7 6arxr Date' Contractor Name Registration No. OR Date Owner's Name �oF�Her�,y Town of Barnstable Regulatory Services $ LE'$ Thomas P.Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 w•er w.town.b arnstable.ma.us Office: 508-862-403 8 Fax: 5OB-790-6230 Property Owner Must Complete and Sign' This Section If Using ABuilder as Owner of the subject property herebyauthorize �Rmab (Z&A—ekauS 16u to act on m. �'Laor Y behalf, alf, in all matters relative to.work authorized by this building permit application for: . 125 6A Cep (Address of Job) 2® Aignat=ure of Owner Date ✓d i/!�1 '44 /® fir/ Print Name QTORMS:OWNERPERMIS S ION C ` oo B boardot`n6j'idRegulations --.`�i��caacQek o ` = g Re ulations and Standards - 9 co - o U HOME IMPROVEMENT - - I .� CONTRgCTOR License or registration valid for individul use onl e�'o o$ G( � rYpe Individual f One Ashburton Place Rm 1301 Standards .; cu JAMES R .- ' .` Boston,Ma.02108 MEDEIROS JAMES MEDEIROS O� m c ,:. ' H 696 ROUTE 6A —m U f _ W 0 HPORT YARMOUT , 4 ,ty w a. r C-G w .: ... MA 02675 AdministCo rator w Not valid without signature Qom } y I �VEA�, The Town of Barnstable Department of Health, Safety and Environmental Services MUMAMA = Building Division MAM r ,0�' 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration g Date: /"�' 6 Name: NAAL l 17C Phone • J��'—7!# Address: �•�.� GUC� «/� Village: CC T�N of C L Type of Business: raapyf�Gs MCyt i ap/Loot: --20cP OS7 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residenuai volumes. • The use does not involve the production of offensive noise.vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat.¢arc,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such ttse shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pickup truck not to exceed one ton capacity,:tnd one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned,have read and agree with the ve restri Eris for home occupation I am registering 61�� Applicant: . Date: y IL Homeoc.doc Engineering Dept.(3rd floor) Map a n A, Parcel������ Permit# House# M./ � Date Issue Board of Health(3rd floor)(8:15 - 9:30/1:00-4:3 ��o �'"" `� "� Fee Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) ,THE Definitive Plan Approved by Planning Board 19 • BARNSTABLE. F TOWN OF BARNSTABLE 'FD �°`� _ Building Permi+A *W n Project Street Address_ � Ct�� rd C i�Rc�C u�e �" A., Village G�-`.L.i� 2h'Cf._ ,.� / Owner- �a�..�vt �.,� Address Telephone "Permit Request Two 16,L-� _1 ;,p . 0 A kt4e Sty, 0 I4GL4'� First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ S'O®p , Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure ] Historic House ❑Yes 17g"� On Old King's Highway ❑Yes No Basement Type: ❑Full ❑Crawl Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) — c Number of Baths: Full: Existing New Half: Existing New No.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 )dNo Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) JWAttached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan'review# Current Use Proposed Use Builder Information Name 4d9 P%j j Telephone Number 'q Y-3 Y lf! Address L3/ License# c) j g 9 A,4A. Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ►n �'7� SIGNATUR DATE "� BUILDI -T ERMIT 4ATED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY 4 PERMIT NO. DATE ISSUED i MAP/PARCEL NO. ! w ADDRESS VILLAGE ' OWNER ' I L'D TE OF INSPECTION: r FOUNDATION f FRAME r' - 'INSULATION +A ,l t FIREPLACE ELECTRICAL: ROUGH 1 Gi FINAL PLUMBING: ROUGH {I �7� FINAL . GAS: . ROUGH `f FINAL FINAL- BUILDING a DATE CLOSED OUT ; 1 ASSOCIATION PLAN NO. F ' , a t •_ 1 A ' .v. The CU) iitilOtiii,calth•of Alassac•husctts _ : Department of Inrlusirial Accidents liw _ �,; Office ol/nvestigat/ons ti00 {1'ashhtrtun Street, BON101t, Ma.v.v. 02111 Workers' Compensation Insurance Affidavit '�' Applicant information: ��Plcase PR(NT leb�j� ._,_. _. .... •.'•� name R laY e le-a C C4.- A location: r city phone I am d homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity .: ...+..• . —,y...._._".... �......_.- a ur.r-z•...�r�r--'Q+►4+r-••yyg'?.*?. ..�e!r—.rea.o.yR�S..•.r;.... •�+.q.�w,-s-,.. ,.«..*.-.a...� n .. ,w..�...�_„r,,._�... I am an employe r r vidinc, i rkers' compensation for my employees working on this job. r1 cone tan• name: 4. - I address: city: �1� 12hone# insurance co. pofiev# I am a sole proprietor, general contractor, or homeowner(circle otte) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: `` U°X 131 cif': Ose,l VAVAW® n �F'h- �2GG � phone c� ! �"���7 � ` r insurance co. policy# r - .. •�0.r1'B:.�L,.-71`r^.'�......� '_�'•PY...,.,.r, ..__ .f r'^^cti.�- n;L�T;^S*.'9wwy r - zl,.. _........pr.,.a:--t..L - _-...__._... ....-__.�...—._...._- ._ILL:.u.`Y.yr:._.aw_.w�1�.ry.r'.:14'.�.r.1a�•..a�r.✓�.. ,- •. .,1• ". .: .�•Y• ii - L.._i.OridL_ —_..L company name: address: city: a Phone#: insurance co. policy# -•--- —.._:Attach additional addiUonafshcet if necessary� -< ,r' °� -„�;,4:t..x ••• , •.:,F ''�-..'''•"w�'°�;:,�"�^�.�'"�"„'�x� _:::, u:..��t�• ._._._...,�na�.:L,.Yr....�..-�•mac-�:.r::i,�r.._..:."ra. F:iilurc to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 andiur one years'imprisonment as%%ell as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do bereft certif•un r lie pains d pe cs of perjury that the information provided above is truelancorrect. Sienature Date � Print name R ��t2.�'©�/ Phone# 22 `t—3 if Y3 T _ official use only do not ss rite in this area to be compacted by city or town official k.. city or town: permit/liccnse# rIBuilding Department Licensing[bard I]check if immediate response is required [3Sclectmen's Office : C3I1calth Department contact person: phone iJ; MOther Ire%ised 3.'o;I)J,\r i Information and Instructions E - Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers compensation for their emplo\•ees�l-'As quoted from the "lacy", an enipinree is defined as every person in the service of another under an_v contract of hire. express or implied. oral or written. An emplorer is dcfned as an individual, partnership, association. corporation or other 1 ,al entity, or any two or more of the foregoingenLaued in a joint enterprise, and including the le-al representatives of a d _cased emplover, or the receiver or,trustee of an,111dividual , partnership, association or other legal entity, emp/loy ng employees. However the owner of a'dwelling house having not more than three apartments and who resides there's, or the occupant of the dwellin�L house of another\who employs persons to do maintenance , construction or repair work on such dwelling house or on the �scounds or building ppurtenant thereto shall not because of such emplo/neat be deemed to be an emplover. MGL chapicr 152 section 25 al o states that every state or local licensing agency hall withhulJ thr issuance or reneiyal of a license or permit operate a business or to co truct buildin sio the commonwealth for am• applicant *%•ho has not produced cceptable evidence of com Hance with flic fnsueance coverage required. Additionally. neither the commonwe lth nor any of its political subdivision �sli 'I enter into any contract for the performance of public work until acce table evidence of compl ance with ,i i surance requirements of this chapter have been presented to the contracting authority.. .y 1 � _ .-.:.-.-.� .........-..•war-..-�.-:..-.. ...-.w-+•.- .. .- Applicants- Please fill in the workers' compensation affidavit completely, bjr c ecki g the box that applies to your situation and supplying company names. address and phone numbers as alhaff avits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Al o be sure to sign and date the affidavit. The affidavit shbuld be returned to the city or town that the applicati n for the permit or license is being requested, not the Department of Industrial Accidents. Sliould you have a v,questions regarding the "law'or if you are required to obtain a workers' compensation polio, please call the Depa dent at the number listed below. �, r City or Towns Please be sure that the affidavit is complete and printed1egi ly. Till Department h s provided a space at the bottom of the affidavit for you to fill out in the event the Office/of Inv stigatio s lias to contact ou regarding the applicant. Please be sure to fill in the permit/license number which ill be u ed as a re erence number. lie affidavits may be returned to the Department by mail or FAX unless other arran=ement have been ade. { The Office of Investigations would like to than'l Vou in a vance for you`cooP eration and should you 1lave any questions, please do not hesitate to Live us a call. Y•-'SV v.t..-... . -•� .r-t..r..::+r�.�. -:..•!�wr.. ........+Tw'tT?-w+-�.awM+.q.V�+.: Tile Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street { Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 � oFTNE T� • ,�� • The Town of Barnstable ' � ,e�' Department of Health Safety and Environmental Services Eon' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissior. For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL,c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other /requirements. IType of Work: � ;u� Est. Cost r� (40 Address of Work: 117 cr7 Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. _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 t o t o the o er. Date Cont r ame Registration No. OR