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0260 NOTTINGHAM DRIVE
P 5` r ; e w ° o a , e r c Y a � a , n n 3F o „ Town of Barnstable Building fpposted st This CardSoThat it is VisibleFrom the Street-Approved Plans Mustbe Retained on Job-and this Card Must be Kept b ` Until Final Inspection Has Been Made. Permit $Where a Certificate of Occupancy isAequired,such Building shall Not be Occupied-until a Final Inspection has been made Permit No. B-19-762 Applicant Name: William Callahan Approvals Date Issued: 03/12/2019 Current Use: Structure Permit Type: Building- Insulation-Residential Expiration Date: 09/12/2019 Foundation: Location: 260 NOTTINGHAM'DRIVE,CENTERVILLE -.Map/Lot 171-038 Zoning District: RC Sheathing: Owner on Record: BUCKLEY, DANICA A Contractor Name: ,WILLIAM CALLAHAN Framing: 1 Address: 260 NOTTINGHAM DRIVE Contractor License: CS-095581 2 CENTERVILLE, MA 02632 Est. Project Cost: $ 3 :,700.00 Chimne Y Description: Insulation/Air Sealing i Permit Fee: $85.00 Insulation: s Fee Paid:' $85.00 Project Review Req: I Date. N 3/12/2019 Final: s ' - Plumbing/Gas Rough Plumbing: g g ? - - :Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after'Issuance. All work authorized by this permit shall conform to the approved application and the`approved construction documents;for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. F Final Gas: 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 work until the completion of the same. I ,r i - Electrical ;The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials'are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection Y 3.All Fireplaces must be inspected at the throat level before firest 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 11— � � Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 0 �� lz�z3lly n �,►+E Town of Barnstable -pelt#4 Ob9 33 Expires 6 months from issue dat Regulatory Services Fee RAMSrABIA Mom'1639. Richard V.Scali,Interim Director �� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (i 1 Iy�Qj Property Address ZtgO N 6-m N GAV" D 9.\U E- [Residential Value of Work$1 4,c0bMinimum fee of$35.00 for work under$6000.00 Owner's Name&Address Mw cA 6l/L _y t_F ti Contractor's Name C>�1 f Ii1} ( fArF P/7i1 S S Telephone Number ✓ J 7-7 Home Improvement Contractor License#(if applicable) J Email: 1F� Construction Supervisor's License#(if applicable) cis — l) 2 ��,_ pEnMI 19Workman's Compensation Insurance DECCheck one: EC 2 `t�O�I. ❑ I am a sole proprietor❑ p' C I am the Homeowner TOWN OF BARNSTABLE VI have Worker's Compensation Insurance Insurance Company Name lto(a1 12s G vl Workman's Comp.Policy# 9/zpmo�t }- 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) ❑ Re-side [V]�Replacement Windows/doors/sliders.U-Value o 2 (maximum.35)#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: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: TAKEVIN Muilding Changes\EXPRESS P ITTXPRESS.doc Revised 061313 �I The Commonwealth of Massachusetts s - Dep-drtntent of Industrial Accidents Office of Investigations 600 Washington Street y UT Boston,MA 02111 www.mass.gov/dla ers . /Eleet n Insurance Afftdayit:Builders/ContractorseaseaPrint Le ibl UstPlumb Workers' compensation PI A licant Information x /�Y f1v Name(Business/organization/i ndividuaQ: / lS1 Gd Address: �'�'`l•l' � '� Phone#: City/State/Zip: Type of project(required): Are ou an employer?Check the appropriate box: 4, ❑ I am a general contractor and I 6 [�New construction l,�I am a employer with « ' have hired the sub-contractors ?: Remodeling ; employees(full and/or pert-time)• listed on,the attached sheet._ 8 [�Demolition 2,❑ I am a.sole propridtor or partner- Those sub-contractors have addition ship and have nq employees workers'comp•insurance. 9, ❑Building working for mein any capacity. 5. 0 We are it!corporation and its IO Electrical repairs or additions [No workers' comp.insurance offcers.l ave exercised their 11.❑plumbing repairs or additions required.] right of exemption per MOL Pairs 3,❑ I am a homeowner doing all work c,152,§'i(4),•and we have no 12.❑Roof re S myself. [No workers' comp. ' Other W 1 employees.[No workers 13.( insurance required.]t comp.Insurance required.] compensation Policy information. such. Any applicant that checks box#1 must also fill out the section below show ing their workers'comp P oil information. st submit a t Homeowne rs who submit this affidavit Indicating they are doing all Winkle theno outside contractorsa atheir workers`coup il�'di��ng ;Contractors that chock this box must attached an additional sheet showing . e to ees. Below is the policy and lob site I ant an employer that is providing workerlr'compensation.insurance for my mp y lrtformatlon. WC71 �5 Insurance Company Name: l: Expiration Date: i + Policy#or Self-ins..Lic.#: `� Mom Iration date)., Job Site Address: 21Sp 1.�6"CCl1�U � - -City/State/Zip: (,41/i LSE of the workers' compensation policy declaration page(showing the policy number and exp criminal penalties of a Attach a copy ositto Failure to secure coverage as.required under Section 25A of�MOL c. 152 can lead to the imp e u to$1 500.00 and/or one-year imprisonment,as well is civil penalties ethe t a be forwarded ttoo theof a STOP Rfffic Of d a fine fin p , of up to$250.00 a day against the violator. Be advised that a copy of this statement Investigations of the DIA for insurance coverage verification. . ert! under the pains and penalties of perJury that the information provided above is true and correct. I do hereby c if i'� i 8 i, Date: Si nature Phone#: Official use only. Do not write ln'this ared,to be completed by city or town official I City or Town: Permitliacense _r_\E�2 Issuing Authority(circle one): 1. Boa rd of Health 2.Building Deportment 3.City own`Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#• Contact Person: DATE(M ,ac R CERTIFICATE OF LIABILITY INSURANCE 2212.0MIDDIYYYY) 4/22l2014 MIS 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 pollcy(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 endoreemen s. PRODUCER NAMEstano Rogers&Gray Ins.-Kingston Branch ENE FAX No - 63 Smith Lane E-MAL Kingston MA 02364 AD° INSURERS)AFFORDING COVERAGE NAIC tt INSURER A;Arbefla-indemnity Insurance INSURED CAPEENT-01 INSURER B: Capewide Enterprises LLC INSURERC: J.P.Macomber&Sons INSURBRD: 153 Commercial Street Mashpee MA 02649 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER:1865828735 11 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 ADM SUBR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MPO�LIDCY EXP LIMITS LTR A GENERAL LIABILITY 8500050813 30/2014 30/2015 EACH OCCURRENCE $1,000 000 DAMAGE TO RENTE X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $250,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000000 GENERAL AGGREGATE_ $2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,0D0,000 POLICY fil PRO- LOC $ A AUTOMOBILE LIABILITY 1020017539 20/2014 0/2015 UMMMO SINGLE LIMIT a 1 000 000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS ! BODILY INJURY(Per acident) S NON OWNED PPR�OPPEERd mDAMAGE X HIRED AUTOS X AUTOS $ A X UMBRELLA LIAB OCCUR 4600050814 1 4130/2014 30/20115 EACH OCCURRENCE $5,000,000 EXCESS UABH CLAIMS-MADE AGGREGATE $5,000,000 I DED X I RETENTION$10 000 It A WORKERS COMPENSATION AND EMPLOYERS LIABILITY 120510414 /14/2014 14/2015 X WC STATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE YIN j EL EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) EL DISEASE-EA EMPLOYE $1 000 000 If yyes describe under DESG�RIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $1,000 000 Leased Rented Equip LR Limit $50,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,itmom space is required) I i i 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. AUTHORIZED REPRESENTATIVE f ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I I. Cjjie License or registration valid for individul use only Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 1.43358 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 xpIration 7/dh dt6. Ltd Liability Corpor Boston,MA 02116 CAPEWIDE ENTERP�WL( C RICHARD CAPEN �? 4507 R RTE 28 COTUIT,MA 02635 Undersecretary JEot valid witho ignature • r Massachusetts -Department of Rubiic Safety. . Board of Building Regulations and Standards which construction Supervisor Unrestricted-Buildings of any use group License' CS�.089273 contain less than 35;000 cubic fed(991M )of n, << enclosed apace. tts RICHARn M cA1*x ' r� r 122 WHITMAIt 1 Cotuit MA 02635 ' failure to possess a current edition of the Massachusetts: t�`` Expiration � Sty Building Code is catue for rewcation of this license. 1112713015 Commissioner For Dps ucensln6 Information visit: www.tNs»,Gov/DPS vvn arnstable- - ' Regulatory Sen-aces 4 DAMNSTA- MASS, Thom-as F.Geiler,Director c 3 pg Division Ton_Perry, Building.Com issioner 20O Main Stree- Hyannis,MA 02601 t'�4S'�i`yflll'i^..l?£YI3St3tl:e.?I:�.li5 Office: 508-862-4038 Fax: 50&.790-6230 Property:Owner Mist Complete and Sign T Ins,Section If Using A Bider n i/1 as Owner of,ti?e S&j• ea popexgr hereby autszori7e LGl �ep T to act on my behalf, �12.dLt�' Siii.a.V- .t{.r,v�t3r 2 i'�is`'' CJ"f'��iJ 1�,..1` ..�Pm, 'LrMIT app C n all :ctl.Cn ldtr; . h,? Ad&-esS of 34b) Signature of Owner Date ern +tire Li(' -� 1 ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel_ M3 Application # Health Division Date Issued L 5 l Conservation Division . '' Application Fee Planning Dept. Permit Fee Date Definitive Plan•Approved by Planning Board OS/1 3 HistoricOKH- _Preservation/Hyannis Project Street Address 2�¢ t") D `n hQ'M v Village I �/{ l.� Owner v_dI--t C-n ICIA,- Address nalffu-� Telephone Permit Request E'4 ;d t Square feet: 1 st floor: existing 1229`t proposed _2nd floor: existing N' proposed Total new _0— Zoning District Flood Plain Groundwater Overlay Project Valuation $5-t 600 Construction Type ® -> Lot Size ` 3-1 Grandfathered: ❑Yes ❑ No If yes, attache porting:,aocumntation. < C> L Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure I -7 2 Historic House: ❑Yes ❑ No On ighwarg 0 Yg ❑ No fal Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other w Tt.! Basement Finished Area(sq.ft.) Basement Unfinished Area(sq. ) 10 n Number of Baths: Full: existing 2. new Half: existing new Number of Bedrooms: existing Onew Total Room Count (not including baths): existing 4 newer_First Floor Room Count Heat Type and Fuel: LYGas - ❑ Oil ❑ Electric ❑Other Central Air: U4es ❑ 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: Yxisting ❑ 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) Name 8jCif a /WtW)d' 1P_ Telephone Number - 7 7-7 Address �5� GomM���� License # C� 9 ZI J VlS�1 L r' i I I men Home Improvement Contractor# �`�J'nJJ--P) Worker's Compensation # 112 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 5 &05 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. r } ADDRESS r VILLAGE r r OWNER -; DATE OF INSPECTION: FOUNDATION FRAME 3 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING -- DATE CLOSED OUT } rx i F11i. t ASSOCIATION PLAN NO. r a i 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): o) e (// Address: CQ j'��Ci1 SJ City/State/Zip: II lQr MA 021af9Phone#: Are,you an employer?Check the appropriate box: Type of project(required): 1.[ I am a employer with Z Jc— 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time),* have hired the sub-contractors ,g/ 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet._ �• L�Kemodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑Other *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 their workers'comp.policy information. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy and job site information. �_ ,, ' Insurance Company Name: Policy#or Self-ins.Liic__.,�#: ! Expiration Date: t�r Job Site Address: -1�(� I�6% rf Vf_- City/State/Zip: Attach a copy of the workers' compensalion 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 certyy under the pains and penalties of perjury that the Information provided above is true and correct Signature: Date: 1. 2 Phone#: � l C�)� 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 i Contact Person: Phone#: Assessing As-Built Cards Page 2 of 2 CAPEENT-01 DCOSTELLO DATE(MMIDD/YYYY) �CORoR CERTIFICATE OF LIABILITY INSURANCE 4►2212013 NFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS THISCERTIFICATE IS ISSUED AS A MATTER OR F INFO ELIY AMEND,ATION LEXTENDY AND OOR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY BELOW. THIS CERTIFICATE,OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). *0W_ PRODUCERRogers 8 Gray Insurance Agency,Inc. Fn c No : 434 Rte 134 South Dennis,MA 02660 INSURERS)AFFORDING COVERAGENAIC# INSURER :Arbella Indemnity Insurance INSURED INSURER B Capewide Enterprises LLC INSURER C J.P.Macomber&Sons INSURER D: PO Box 763 INSURER E Centerville,MA 02632 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. ADUESUOR POLICY EFF POLICY EXP LIMITS - INSR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD (MMIDDIYYYYI 1,000,000 LTR EACH OCCURRENCE GENERAL LIABILITY 250,000 8500050813 4130/2013 4I3012014 PREMISES Ea occurrence $ A X COMMERCIAL GENERAL LIABILITY 5,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000-000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ POLICY PEOT LOC COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY Ea accident $ A ANY AUTO 58944400004 4/2012013 4/20/2014 BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ ALL OWNED X SCHEDULED AUTOS AUTOSNON-OWNED PROPERTY DAMAGE $ PER ACCIDENT X HIRED AUTOS X AUTOS $ EACH OCCURRENCE $ 6,000,000 X UMBRELLA LIAR X OCCUR 6,000,000 A EXCESS LIAB CLAIMS-MADE 4600050814 4/30/2013 4130/2014 AGGREGATE $ DED X RETENTION$ 10,000 VJC STATU- OTH- WORKERS COMPENSATION X TORY LIMITS ER AND EMPLOYERS'LIABILITY 9120510412 411412013 4114/2014 E.L.EACH ACCIDENT $ 500, 000 A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N NIA 500,000 OFFICER/MEMBER EXCLUDED? FN E.L.DISEASE-EA EMPLOYE $ (Mandatory In NH) 500,000 It yes,desu-be under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Addltlonal Remarks Schedule,if more space Is required) With regard to general liability,blanket additional insured and blanket waiver of subrogation apply if required by executed signed contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD, http://www.town.barnstable.ma.us/assessing/IjMdisplay.asp?mappar=088001&seq=1 4/22/2013 'Tow. -of-Barnstable7 ^� eg aata Sees 'Y :t$A"r'N BLE, " Thomas F.Geller,Director BuRdinguDivislon Tom Perry, Building Cownissiorer F�� .iown.barns�a�le�rr�.us - Property-Owner Must. } gee anet:Srgn 'Is Section If Us.. Ts ng A 3u ld-er As der of tl e_su'ect proper-y hnEry��''m t�'iOrize J" to act 0I1:-my beh?f, kwor zuhrz' ecl Dl t a II? tt2xS aa2Q; en- t apgcatioZ fori (Adoess of job) Sigriat-am 6f 4.Owngr D2�� O .' ;..z_;oy-nERY zls:o1 License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: , egistration: 143358 Type: Office of Consumer Affairs and Business Regulation xpiration: 7/872014 Ltd Liability Corpc: 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPEWIDE ENTERP,�4 a L;L C;. RICHARD CAPEN 4507 R RTE 28 a= COTUIT, MA 02635 Undersecretary Not valid withou 'gnature r , Massachusetts Department of Public Safety Boam of Building Regulations a¢,ct Stan.djrds Unrestricted-Buildings of any use group which (unoructinn Supvn i%ur contain less than 35,000 cubic feet(991m3)Of License: CS-M273 m enclosed space. 13.I01ARiD'ib1 G~,lPP i • 12 W1iilI'.M.Itr.�t�' �. J,. Failure to possess a current edition of the Massachusetts Expiration State Building Code is cause for revocation of this Ncense. Commissioner 1112712013 For DPS Licensing ir+formation vish: www:h4ass.Gor/DPS C 1,e5�f Avg �yNOW i C�vs�t' �EsJfa��vcE oz( o A/oTr1&M4W,4 M 2 e M cy-, Town of Barnstable *Permit# o ' T date S A$Tgulatory Services �e 6 `ue + RIANI AMZ, # - 9 KAn s639. AUG -O p 20�2 Thomas F. Geiler,DirectorOV �A �� TOWN Division OWN OF SARNST rry, CBO, Building Commissioner Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT!'APPLICATION - RESIDENTIAL ONLY i i Not.Valid without Red X-Press Imprint Map/parcel Number ( 6� Property Address__ 2 t 0 lyodwe C�en� �d ren•>•C/y,'!f It / r D esidential . Value of Work 5�_ atJ _ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Dn t r n. 9UC k It c/ Contractor's Name 36 e m7-L1-E�-- Telephone Number_C P lf` �(?- �^S 24 . Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) CS . <q C) 7 ❑Workman's Compensation Insurance Check one: �( I am a sole proprietor ❑ I am the Homeowner . , ❑ I have Worker's Compensation Insurance :Insurance Company Name rLS, .Workman's Comp.Policy# W C ow '`�,� Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check.box) Re-roof(stripping old shingles) All construction debris will be taken to k/ L � � ❑ Re-roof(not stripping..Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/shders. U-Value (maxiinum .44)#of windows h *Where required: Issuance of this.permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. .f ***Note Property Owner,must sign Property Owner Letter of Permission. A'-Copy of the Home.Improvement Contractors License& Construction Supervisors License is required: IGNATUR.E: . 1WPFILESIF0RMSIbu ing permit formslEXPRESS.doc ;vised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + a 600,Washingto"n Street f Boston, 02111 "' •�• �� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): [JdG Al ' CL6� Address: 26? O2f3b �-c; u, - City/State/Zip:5A re.° <Z51; Plione.#: C"O/l Z� Are you an employer?Check the appropriate box: Type of project(required):; 1.0 I am a employer with 4..D,I am a general contractor and I employees(full and/or part-time);* have hired the sub-contractors 6 .E]New constructi1 . on,. 2: I am a'sole proprietor or partner listed on the attached sheet: 7 0 Remodeling ship.and,have no employees" These sub-contractors have g,..0"Demolition workingfor me m:an ca aci employees.and,have workers' ."" Y P tY ; 9. ❑Building addition [No workers',comp:insurance` comp insurance. required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions self. o workers'. comp. f"right of exemption per MGL triY ` 12 Roof repairs R insurance required.]t c.152, §1(4),and we have no p t'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. a t Homeowners who submit this affidavit indicating they are doing all wo:k 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: �OQ?� h2QcQ Policy#or Self-ins:Lic.#. WC '����5�� Expiration Date %l�•,:.3/� zo(L Job Site.Address:Z60 �dggiyl� City/State/Zip: Ce w,lAp wca:;> 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 25AFof MGL c. 152 can lead to`the imposition of criminal penalties of a fine yip 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 Investigations of the DIA for insurance coverage verification: Ido hereby certify under the pains andpenalties ofperjury that the'informationprovded above is true and correct. Si attire: Date: -7' .Za 17 _. .E:. (4 "Phone#: /7 $L 8 5�24 6 Official use only. Do not write in this area,to be completed;bycity, or town offzciaL' City-or Town: Permit/License# Issuing Authority(circle one): y • 1.Board of Health 2.Building Department-3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: * Y .- �• ._ ' � it . h �r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person.in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association,or other,legal 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 partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured_companies should enter their self-insurance license number on the appropriate line. City or Town Officials r � t { Ail 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,heed only subAt 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 burn leaves etc.)said person is NOT.required to complete this affidavit. The.Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonweal of Massachuse4tts � �� � � f Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. ##617-727-4900 ext.406 or 1-977-MAS.SAFE Revised 11-22-06 Fax#617-727_7749 www.mas5.gov/dia A tom , Town of Barnstable t Regulatory Services MASS. g, Thomas F.Geiler,Director En Building Division Tom Perry,Building Commissioner {; 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us c Office: 508-862-403.8 e0 Fax: 508-790-6230 Property Owner Must y Complete and Sign This Section If Using A Builder R h n C w as Owner of�the subject property hereby authorize O 5��11 ` N( 1 e,✓' , �— to act on my behalf, in all matters relative to work authorized by this building ermit . gP (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and-,pools are not to be utilized until all final inspections are performe'd',and accepted. Signature of Owner #ature of Applicant " Print Name / Print Name Dad ? . n E Q:FORMS:OWNERPERMISSIONPOOLS t P. �r THE Tp Town of-Barnstable � � � .. r Regulatory Services 3A>ZNSTABLE; : ,.. Thomas F:Geiler,Director ' ' 9: A.�� Building Division . , ' Tom Perry,Building Commissioner t) 200 Main Street, Hyannis,MA 02601. www.town.barnstable.ma.us o Office: 508-'862=4038 Fax:. 508-790-6230 : }. HOMEOWNER LICENSE EXE PTION Please Pririt DATE: JOB LOCATION: number street village , "HOMEOWNER": name home pho # work phone`# 'CURRENT MAILING ADDRESS:, city/town state zip code 4 The current exemption for"homeowners"was exten ed t include owner-occupied dwellings of six units or less and to allow homeowners to engage an indipidual for hire does`not possess a license,.provided that the owner acts as t supervisor. DEFINITION F HOMEOWNER Person(s)who owns a parcel of land on which he/she r i s or intends'to reside,on which there is, or is intended to be,a one or two-family dwelling, attached or detached truc es acckisory to such use and/or farm structures. A person who constructs more than one home in a two-y ar per d shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on form a ceptable to the Building Official,that he/she shall be responsible for all such work. erformed under the b • dinLy De t. (Section 109.1.1) The undersigned"homeowner"assumes responsibili for compha e with the State Building Code and other applicable codes,bylaws,rules and regulations. " The undersigned"homeowner"certifies that he/she derstands the.To of Barnstable Building Department minimum inspection procedures and requirements o d that he/she will co ply with said procedures and requirements. Signature of Homeowner , • s y Approval of Building Official Note: Three-family dwellings conta• • g 35,000 cubic feet or larger will be. equired to comply with the State Building Code Section 127:0 Constructio Control. HO EOWNER'S EXEMPTION The Code states that: "Any homeowner peifo ing work for which a building permit is required s 11 be exempt from the provisions of this section(Section 109.1.1 -Licensing of constructio Supervisors);provided that if the homeowner engag a person(s)for hire to do such' work,that such Homeowner shall aci'as supervisor." r Many homeowners who use this exemption are inaware that they are assuming the responsibilities of supervisor(see Appendix Q, 4 Rules&Regulations for Licensing Construction Supervis s,Section 2.15) This lack of awareness often results i serious problems,particularly when the homeowner hires unlicensed persons. In this cast,our Board cannot proceed against the unlicensed pers as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultim ely responsible. To ensure that the homeowner is fully aware of is/her responsibilities,many communities require,as part of the permit application, r _.that the homeowner certify that he/she understands the resp nsibilities 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 fo certification;for use in your community. Q:fonns:homeexempt' I r U/ze c(>oarrir�aarzcaeaCCL a�C�/�/l��aacLcateC� - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: ,1,52083 Type: Office of Consumer Affairs and Business Regulation xpiration r 7/2812014s Individual 10 Park Plaza-Suite 5170 *— Boston,MA 02116 JOSEPH MILLER '` F ai JOSEPH MILLER +ate 26 POPPLE BOTTOM ROAQ SANDWICH, MA 02563 Jy-t Undersecretary Not valid without signature r+ f Nlassochusetts - Department of Public Siifel� 7 Board of Buildin., Re�-,ulations and Sturt ards ' >>• Construction Supervisor Licenses' License: CS 79074 "7 JOSEPH MILLER. 26 POPPLE BOTTOM RD SANDWICH, MA 02563 \ Expiration: 9/11/?G12 commissior•,,r Tr#: 2338 Town of Barnstable o� 12IJ2/1l Regulatory ServicesTO��N OF B a�� M L Thomas F.Geiler,Director MASS. Building Division "IN OCT --4 PH 4: 02 1659. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us _:.. --- IVISIOI Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $ / SHED REGISTRATION 2000 square feet or less Location of shed(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# Signature Date Hyannis Main Street Waterfront Historic District? �y Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) !'" Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN REV:042911 A r i f r LOT 18 ti LOT 19 Oxj •,,,,,,/,///,,,,r0• , s oe ,/ yy opt LOT 20 Plan is RES. ZONE. "RC" This MORTGAGE INSPECTION Bank Use only FLOOD ZONE' 'C" THE DISTANCES AND MEASUREMENTS ON THIS PLAN SHOULD BE.VERIFIED BY AN INSTRUMENT SURVEY. TOWN: _ REGISTRY OWNER: ELEANOR_U KEIRSTEAD DEED REF: _L1459,1212-------- BUYER: _JOHAT-R EFAY_______________________ DATE: _04105102_____-_-__ PLAN REF:-- - - ___-SCALE:l"= . 30---FT. I HEREBY CERTIFY TO _M_9 CxELL ____ ____ YANKEE SURVEY ___--THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS PAM CONSULTANTS SHOWN AND THAT ITS POSITION DOES ____ CONFORM 9' 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE , INDUSTRY ROAD TOWN OF __ BARNSTABLE ___AND THAT IT DOES_NOT_ LIE WITHIN THE SPECIAL FLOOD HAZARD ' MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED 0 TEL 428-0055 Co unit -Pan 1 _250001_0015 C - FAX 420-5553 THIS PLAN NOT MADE- FROM AN INSTRUMENT SURVEY 32984 JF P UL A. MERITHEW_P- NOT TO BE USED FOR FENCES BUILDING PERMITS ETC. Town of Barnstable Regulatory Services �FIKE � Thomas F.Geiler,Director Building Division BMM9rABM Tom Perry,Building Commissioner MAM! ; ��� 200 Main Street,Hyannis,MA 02601 �AjFG MA'S A Office: 508-862-4038 Fax: 508-790-6230 March 24, 2009 Steven Sweeney 108 Ralph Talbot St. Weymouth, MA 02190 RE: 260 Nottingham Dr. Centerville, Map: 171 Parcel: 038 Dear Mr. Sweeney: This letter is to notify you that a final inspection was conducted at the above referenced address for permit application number 200806947 and the following deficiencies were found: 1) Shower does not meet requirement of 780 CMR 5305.1 2) Stairs to l st floor not in accordance with 780 CMR 5311.5 3) Ventilation not observed in accordance"with 780 CMR 5303.1 You must correct the above deficiencies and arrange for a reinspection by April 23, 2009 or this office may file a complaint with the Building Board of Regulations and Standards. Penalties for non compliance may include; but are not limited to, suspension or revocation of your construction supervisor license and home improvement registration. Thank you for your immediate attention in this matter. I may be reached at (508) 862- 4034 with any questions. By Order, Wre 'o'�. Local Inspector Q:zoning5 1TV� VJ� 0 Z 0 rF �.1 V I CD D rU 0 z 0 cQ V 1 � P i �1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application c QZ6 Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application F e Planning Dept. + Permit Fee `' 3 Date Definitive Plan Approved by Planning Board OOK (C116V Historic-OKH Preservation/Hyannis Project Street Address Village L'e vat 'NA-a Owner _ %R C- %OC L�Address P►-rr� Telephone C? Permit Request 7 6o 6% "See—, Of r Rsu—Q e9(-Xr� arc I-AN i� ybg- pr r Corn rA i C Square feet: 1 st floor:existing Ja&o _ proposed_ nd floor:existing C:2 _ proposed go Total new Q { Zoning District k)o Flood Plain Groundwater Overlay r\Ty Project Valuation 240CC%-00 Construction Type �it s Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Y" Two Family ❑ Multi-Family(#units) , r- Age of Existing Structure 36 $04vc, Historic House: ❑Yes [mo On Old King's Highway: 0 Yes 4-IVo Basement Type: �ull ❑Crawl ❑Walkout ❑Otherj►,�1(4�c . Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) @00 Number of Baths: Full:existing new i Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: CRGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes t2(No Fireplaces: Existing i New Existing wood/coal stove: ❑Yes Colo Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded(3 Commercial ❑Yes Q No If yes, site plan review# Current Use Proposed Use "�'BWLDER INFORMATION Name ,l Telephone Number- Address 10S q`AA = License#09t Ee 3 eW � Home Improvement Contractor# Worker's Compensation# i ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ll")6 'IzP cc A . 0 5 SIGNATURE DATE d+ i t r. FOR OFFICIAL USE ONLY •s r N PERMIT NO. DATE ISSUED M i t MAP/PARCEL NO. ' ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION k FRAME INSULATION llo t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING .� s9 { Y�li k ' t i DATE CLOSED OUT ASSOCIATION PLAN NO. ail CUSTOMER ' C � � SYsiENl�s ADDRESS ITY STATE c�a T ZIP & .. HOME PHONE I - 4 CELL PHONE _ I �l ' \ _ �i (� �J _T_ _—_ _. , t • { ,—` % , I i t r • _ S- f EL- ji LC qI s a t w 1 • �1.� i , r , _w . - __-_ _r S , { i y -• �N�6e�A� • 3 f , r % , f t S + t 4 t S WALLS APPROX LN FT _ COLOR ' V���~C[ � TRIM COLOR PREFINISHED WHITE OAK J 2nd SIDE APPROX LN FT FSK FRP OUTLETS 3 ADD BREAKERS �T STANDARD DOORS 30" 32" 36" SWITCHES ADD SUB PANEL WBIFOLD DOORS 31V 36" 48" 60" 72" CAN LIGHTS _ ELECTRIC MOVES o� CEILING APPROX SQ FT /(�j' 2 x 4 LIGHTS #OF POLE WRAPS Q CEILING TILE SIZE ' " .G(R2 CEILING DROP LN FT� APPROX SO FT CARPET STAIRS PAD CEILING STYLE #OF HEAT VENTS �_ CARPET STYLE U REMARKS � .,c � l 4 A r,x �� _=2 r �n Ja-�e,.t'•F 111 7�0 0.cock I AM / �:s s t `�.,�=��- STscl r btQ: �nc7E Wl�s�C' . 3 C 11 Fae , I e�PL REPRESENTATIVE SIGNATURE HOME OWNER SIGNATURE HOME OWNER SIGNATURE ` ,dfIK�E Town'of Barnstable . Regulatory Services BARNsTABm ` Thomas F. Geiler,Director MASS. 9 %6 9. �p�fn► ° Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-79076230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize Sto act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job A -16 -oF. Signature of Owner Date !c l v � Lam` Print Name Q:FORMS:OWNERPERMISSION - one tasnnuron dace tcvom I -Jv t Al Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration_ 155551 TVpe: Ltd Liability Corporation Expiration: 4/2312009 Tr# 255104 ELITE HOME IMPROVEMENT SERVICES L h STEVEN SWEENEY 108 RALPH TALBOT WEYMOUTH, MA 02190 Update Address and return card.Mark reason for change. Address Renewal Employment Lott Card �s�a� v soti+osc�-Ft;au�z Board of Building Regulations and Standards License or registration valid for individut use only HOME IMPROVEMENT CONTRACTO€Z before the expiration date. If found return to: Registration: t55551 V'�kr Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 4/23/2009 Tr# 255104 Boston,Ma.02tOS Type: Ltd Liability Corporation ELITE HOME IMPROVEMENT SERVICES LLC esignat're STEVEN SWEENEY108 RALPH TALBOT`NEYMOUTH,MA 02190 Administrator. 1` SYi BOARD OF BUIU3111443 REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 094632 Birdulate: 10AW1970 Expires: 10/040109 Tr.no: 94632 kbo Restrktedc 1 G STEVE A SWEENEY 108 RALPH TALBOT ST WEYMOUTH, MA 02190 commissioner. . ,^. . Department of Industrial Accidents t Office of Investigations 600 Washington Street Boston, MA 02111 t www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eledtricians/Plumbers Applicant Information + Please Print Legibly Name (Business/Organization/Individual): Address: (llAlfl�-I City/State/Zip: • 1 n, Phone#:_ a 3 kre you an employer? Check the appropriate box: v Type of project(required):. ❑ I am a employer with 4: ❑ I am a general contractor and I loyees(full and/ partrthe).*- have hiredthe'sub-contractors 6: El New construction I am a sole proprietor or partner- listed on the attached sheet t 1. ❑Remodeling ship and have no employees These sub-contractors Have 8. ❑Demolition working for me in any capacity, workers' comp;insurance. g, ❑Building addition [No workers' comp,insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL. 11.❑Plumbing repairs or additions myself, [No workers' romp. c. 152, §1(4),and we have no" 12.❑Roof repairs insurance required.]t employees,.[No workers' 1 comp.insurance required.] 13.❑ Other my applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, ontractors that check this box must attached an additional sheet showing the name of the sub-contractor;and their workers'comp,policy information. im an employer that is providing workers'compensation insurance foamy emplayees formation. . Betow is the pplicy and job site f surance Company Name: -licy#or Self-ins.Lie.#: l Expiration Date: b Site Address: J ` City/State/Zip: tach a copy of the workers' compensation po cy declaration page(showing the policy number and expiration date). ilure to secure coverage as required under Section 25A of MGL e, 152 can lead to the imposition of criminal penalties of a .;e 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 up-to$250.00 a day against the violator, Be advised that a copy of this statement maybe forwarded to the Office of vestigations of the DIA for insurance coverage verification. !o hereby certify under ins and penalti f perjury that the information provided above is true and correc4 afore: t Date: d one Official use only, Do.not write in this area,to be completed by city or town of t r City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4,Electrical Ins 6, Other pector 5,Plumbing Inspector j 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, express or implied,oral or written." An employer is defined as"an individual,parin rship,association,corporation or er legal entity,or any two or more of the foregoing engaged in a joint enterprise, including the legal represents es of a deceased employer,or the receiver or trustee of an individual;partnership,as .ciation or other legal enti ,employing employees.•However the owner of a dwelling house having not more then thr a apartments and who r ides therein,or the occupant of the dwelling house of another who employs persons to d maintenance,con on or repair work on such dwelling house or on the grounds or building appurtenant thereto shall of because of suc .employment be deemed to bean employer." .MGL chapter 152; §25C(6)also states that"every state o local licens' g agency shall withhold the issuance or renewal of a license or permit to operate.a business or to onstruc buildings in the commonwealth for any applicant who has not produced acceptable evidence,of co Ilan a with the insurance coverage required,". Additionally,MGL chapter 152, §25C(7)states"Neither the co wealth nor any pf its political subdivisions shall enter into any.contract for the performance of public work until a ptable evidence of compliance with the insurance requirements of this chapter have been presented to the contractin ority." Applicants - Please fill out the workers' compensation affidavit completely by chw ' the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and one numb )along with their certificate(s)•of insurance: Limited Liability Companies(LLC)or Limited L' bility Partners ' s(LLP)with no employees other than the members or partners,are not required to carry workers' Qom ensatim insuran , If an LLC or LLP does have employees,a policy is required. Be advised that this affida 't may be submitte o.the Department of Industrial Accidents for confirmation of insurance coverage. Also b sure to sign and da the affidavit. The affidavit should the city or town that the a licatim for the ermit or license is bein requested,not the Department.of ed to Pp be return tY , Industrial Accidents, Should you have any questions reg ding the law of if you�ar equired to-obtain a workers' compensation policy,please call the Department at the n ber listed below. Self-in ed 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 egibly, The Department has pro 'ded a space at th6 bottom of the affidavit for,you to fill out in the event the Offic of Investigations has to contact yo regarding the applicant. Please be sure to fill in the permit/license number whit will be used as a reference numbe In addition,an applicant .that must submit multiple pormit/license applications ' any given year,need only submit on affidavit indicating current policy.information(if necessary)and under"Job Site ddress"the applicant should write"a locations m' (city or town)."A copy of the affidavit that has been officiall stamped or marked by the city or town ay be provided to the applicant as proof that a valid affidavit is on file for a permits or licenses. A new affida ' must be filled out each year. Where a home owner or citizen is obtaining•a h ense or permit not related to any busines or commercial venture (i.e.a dog license or permit to bum leaves etc.)said rson is NOT required to complete this affidavit. The Office of lnvestigations would hke to.thank y ' 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 numbe ; The.Comm nwealth of Massachusetts �epat-t� , of ludwiiial Accidents Gme Of Innsuptions. �a0€1 ashiri gton Sheet $a oh, A 02111. Tel,# 617-'27-490 ext 40.6 or 1-977-M- AS E Fax.#€ 17-727-7749 Revised 5-26-05 WWW ass.ao dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: print Town--- Applicant Phone: 77Z' /- 5/Q 1- Applicant Signature: Date of Application: NEWTRUCTION: (choose ONE of the following two options) 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE, AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab Basement Fenestration exposed Wall Floor Perimeter Wall AFUE HSPF SI l 21 R' U-factor floors R-Value R-Value R-Value R-Value R-Value and Depth National Applituice Energy. R-10, Conservation Act(NAECA)of 3S R-38 } R-19 R-19 R-10 4 ft. 1987 is amended,minimumsor greater as applicable i Note: This form is.not required if you choose either of the two versions of RESCheck as,listed below. ❑ Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed (780 CMR 6107.3.2 RE'Scheck--Web which can be accessed at littp://www.ei-ierkycodcs.gov/i-eschccld ADWTIONS,'Ok ALTERATIONS TO EXISTING.BUILDINGS.'OVER S YEARS OLD* *Buildings under 5 years old.must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b a) � '�-742�-SF 100 x..gQ %:of glazing.,. (b) Glazing area equals., C' SF b I If glazing is <5 40%o use.0ie chart below. Zfglazio is> 40.,/o proceed to "SUN- ROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE:ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter 9 ElFe allnestration Wall Floor Basement W ] U-factor Exposed floors R Value R-value R-Value R-Value R-Value`: and Depth 39 R-37 a - R-13 R-19 R-1.0 R-10, 4 feet R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e. not compressed over exterior walls,and including any access openings). SUNROOM-An addition or alteration to an existing building/dwelling,unit where the total glazing.area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition;. Note:. Owner to fill out Consumes-Information Form (found in Appendix 120•P) DEC 19,2008 09:17A IMPRESSIVE _BOSTON 17818120236 page 2 . T A T NTRM " WIDTH A4LSIZES 0 "1 Cry: N. eslk TYPE:-:S . TPE 3 " 2211 52661.1 . a 5piFt� i 68 t ij P P - 22 _. -g I[. 76" y $ �` MMA 91Yt:E;NUr�9ER..... gy y A A1��'�RRt���tg�ry �} vp.�R:�e}Lkp�ye�lkv�,��✓n.�., -{ R A.l3Jlt'Lt� kJ.'a7 Ci 1 R R7RI!111�i.t.[i�GEet.1-1!t�^7.. - .. .. .. 40. _ �� , �� DEC 19,2008 09:04A IMPRESSIVE BOSTON 17818120236 page 1 GtISTC}kIER J - F � SYSTEMS..`- loam �rCITY 13 x HOME .PHONE: � � C L L CFI-NE 3 1 3' ..+} &"'; 1l.: - i...•�:3'"�' { 'mot�' �X�C?'�L ;:,.; n .. $r ! ` `�{ • a ice,:iC CA 1 yn re7 . i t 1 a r a. u 7 _ VZf . " INM ' WALLS APPROX. TF2{Prl F Cc(?R PREr[t,1SFiEta�tiH1Y� �r' OAK _._ . rut:$PC7E APPRi3X.LTt F? �f�.. rSK FFRP {JUTS S t: AL7�}.�3FtFAKEF{S .� �iTATSbAF2C1 CtC3QRS. fit}'. sz". 35'' S1WUCHES S F.AN .L BIE.63LQ DWRS- 3t} �36' 9�" �:4"{? 72 ! Ci;N'LPu! T5 l rGTRt{ MOVES . .CEILING ARPFROx so F — tR, 4.x l_!�:+s31' 4 F.P.0'+ 'N.R:AP'u � GEjLIN0 TIL.E:$i�,E r - ' C-DUNG DRIOP LN F: L. i A€NRC7 Sca I"7 q.ARr.E.T ;aTA RS r AG �Eff ING 5?Y!E s7t:NEAT VtitvTS .CART ET Sr E _ ._ r 4'� 30 09 12:57p p.1 I e5e3 T3Z9 SbS 8vZ ( d auTP73 sicN1e1 c8g:T0 300Z110 UdV vt 1.1 BASEMENT No SYSTEMS Submittal Sheet I Description Ins l�tion Beard Specifications � Impressive Basement Systems is a new approach to Labo alory Source reports available on request finishing a basement that utilizes conventional building methods. Our system follows all of the accepted building Fla a Spread 25 practices just as if it were a typical drywall installation, Sm k Development 50 The only difference is that we use a 1 inch thick high NR ;i (Noise Reduction) density fiberglass wall board covered with an acoustical R - wall fabric, in lieu of the drywall. 1 inch :hick 6 pound density Facirio� plain to existing foundation, The system begins with standard steel stud framing FSK to storage that conforms to accepted building practices, such as Appt'c ;on studs on 16 Inch centers and so forth. The doers are Knaut ns lation Board is a versatile product for thermal hung on the steel stud framing using conventional meth- and a u t cal applications stich as:heating and air ads- condiii ni r1 ducts, powar and process equipment; boiler no.,tack installations, metal and masonry walls. 1 The ceiling Is an Armstrong suspended ceiling accept- wall ps neG:yslems,curtain well assemblies able for both residential and commercial applications. and ea walls. The electrical work is installed per code as in any typl- spec fr idlon Compliance cal residential or commercial application with conven- In U. tionat rough and final inspections performed with no un- ASTP CIE12; usual steps required as may be the case with other sys- -Type IA(*.6,2.25. 3.0,4.25,6.0 pcf) (26, 3 48, 68,96 kg1m3) terns. -TypeliB :l.0,4.25, 6.0 pcf)(49, 68,96 kg/m3) •AS7 C�795 The acoustical wall panels are attached to the metal •ASTi% C1136(facings); studs with small PVC intermediate strips the allows the -Type 1, l, 111, IV(ASJ) IN panels to be removed in orderto access the foundation -Type It, (FSK, PSK) wall. Califo i 'l itle 24 HH B 14 13;Type I(ASJ facing},Type II(FSK, The base boards and casings are conventional trim of PSK f3 In .) t the customers choosing. t -FormIt" lass ` (1,6,2.25,3.0,4.25,6.0 p�1) (26,35 4 , $8.96 kg1m3) = Features and Benefits -Form A, , lass 2(3.0,4.25.6.0 pcf) } • Fast, clean installation (48,69,i9 �Ig/m3) • Strong Steel Stud Framing •W11L4-I- k44C • Mold and mildew resistant •N PA 90A- and 9013 c t • Removable wall panels •NRC e ,Guide 1.36 - 65% noise reduction Co j • Self healing fabric in bmany colors Continu d 1 pags 2 0 f a1 1. I r,nn;innr� Jan 30 09 12:57p p.2 t aAec, ?CZ5 S45 8bz , d eulelz STMoq d6s: 1C, So'oZ, to UdV SYSTEMS YS EMS ' 28 12 ; 44 Top 'View 12_ 8xisting Foundation Nall I FIR"'2 20. Metal Studs 22. Open area available for additional insulation 2 I 24. Open space to allow for moisture to escape i I 28.Acoustical fiberglass panel 24 r; 34.Intermediate PVC strip 36.Acoustic Fabric l 44, Slot in PVC strip to roll in eheess fabric ` I IJ , ` 38 44 40 I 3 28/36 Front 1 Elevation 'View i 14. Existing basernent floor 2$136 Fabric cover wall panel � 42 � I.S. Suspended ceiling grid 40. Suspension wires ' 42. Base molding v Jan 30 09 12:57p p.3 ab c' T$�9 S S B6v a auleTa sEma� d6S �0 20071TO bd, ;ASEt1 ENT NUM �SYSTEMS 1A 1 � � i2 9A 24 28 2 i 22 i . t4 28 f 1 Side Elevation �iew 12. Existing foundation oval! I.A.Open Space 14.Existing basement floor ,';f. PVC base panel support 16.Existing Floor joist A.Fabric covered accustic panel 18, Top meta) stud track I:0. Top J channel 20. lvlatal Stud C 2. Base molding 22. Bottom me[a] stud track Jan 30 09 12:58p p.4 7 ebtJ'. T8Z9 S59 96Z I a aUle=rg d6S:TO 80GZ'�0 $dd Technical Data A lo�3tical Wall Fabric Specifications Surface Burning Characteristics(UL Classtfled) Lab rahry Scurce reports available on request Unlaced cr composite(Insulation,facing and adhedve) Does not exceed 25 Flame Spread,50 Smoke Fla Spread 5 Developed when tested In accordance with ASTh4 $ �,, Developed index 100 E 84,CAN/tJLC S102-ht 1rt88,NFPA 90A and 906, NFPA 255 and UL 723(except PSk ASTM E 84 Co t .nts 100°le recycled Polyester and UL723only). We'g t 16 once per linear yard Temperature Range(ASTM C 411) CI i rig Coda - till-S - Fabric may be -Operating temperatures from l7°F to 450°F(-18°C Cleaned with mild water j to 232°C). free or water based Corrosiveness(ASTM C 666) I cleaning agents or foam •Will not accelerate corrosion of aluminum.steel or j copper. Spe It)�:atlon Compliance -Meets the stress corrosion requirements of ASTM C In S : 795, Niil--i-24244C and NPC 1.X Su acf!Burning Characteristics (UL Classified) Puncture Resistance AS IL1 iE:84-05 (TAPPI Test T803)(Beach Units) •FSK,PSK facings: 25 Tea 30 pounds per ASTM D 2261 •ASJ facing:50 Water Vapor Transmission F (ASTM E 96,Procedure A) 8re ki1'. 50 pounds per ASTM D.,O34 •FSK,PSK and ASJ vapor retarders have a maxAmum vapor transmission rate of.02 Deans. Water Vapor Sorption (ASTM C 11041 •Less than 5`h by weight when exposed to air at 120OF(49►C)and 95%humldity for 96 hours. Shrinkage(ASTM C 356): Lsss than 0.3%linear shrinkage. Microbial Growth (ASTM:C:1338, G21, G22) •Daes not promote or support the growth of mold, fungi crbacteria. rigid insulation board where necessary to conform to curved surfaces, Fiber Glass and Mold 91bar glass insulation will not suitaln mo'c growth. However,mold can grow on almost any material when it becomes wet and contaminated with organic materials.Carefully Inspect any Insulation that has I been exposed to water. If it shoves any sign of mold it must be discarded. if the material is wet but shows i no evidence of mold,it should bs dried rapidly and thoroughly, if it shows signs of facing degradalioa from wetting.it should be replaced_ Notes The chemical and physical properties of Knauf Insulation Board represent typlcal average values determined in accordance w:th accepted test methods.The data is sub(ect to normal manActuring variations.The data ig supplied as a technical service and is sublact to change without notice, References to numerical flame spread ratings are not intended to reflect hazards presented by these or any other materials under actual Fire conditions. Cheek wltrn your Knauf sales rapresentative to assure information is currant. 2 j Jan 30 09 12;58p p.5 4� Impressive Basement Finishing System Patented Track System Our patented track system has an upper and lower channel that allows the acoustical panel to"float" which means that it can adjust with the settling of your foundation walls over time—preventing bowing or sagging. Our solid vinyl uPVC lineals will not shrink,warp or rot. This is what holds each panel to the next. This allows the wall to maintain structural integrity for the life of the product. uPVC is .1unplasticized vinyl chloride. It is 100% virgin vinyl. The properties of the vinyl track system and the lineals allows it to keep its original form over time. Our lineals allow us to create solid edges where each panel meets the next,and also permits us to create one of a kind outside comers on the wall l system. This is a first in the basement finishing system industry. Basement Wail Panel Details Double sided 6 pound density fiberglass panel producing a"soft wall"with a solid reinforced foundation that creates insulation and sound deadening qualities. This is especially designed for basement conditions. The rigid fiberglass core panels provide built-in thermal performance and sound control. Moisture and damage resistant panels are ideally suited for the conditions of a basement. The rigid fiberglass core panel provides built-in thermal performance and sound control. Moisture and damage resistant panels are ideally suited for the conditions of a basement. Additional infill options are available for special applications for increased thermal values. The panels are engineered to be moisture resistant to prevent the growth of mold and mildew. Panel material does not retain moisture and will air dry after getting wet. A burst pipe or sudden heavy rain can ruin conventional construction. The affects of that leak or flood could be dealt with quickly by lowering the relative room humidity in the basement through proper ventilation. This means the wall panel will not become a source of moisture—unlike wood products that absorb large amounts of moisture—and after being covered by drywall can take months to dry completely. This trapped moisture allows the growth of mold and mildew. Class A fire rating for safety and piece of mind. Modular design of the panel allows for easy access to foundation walls for repairs or Winning electrical wires, phone and cable lines or speaker wire. With conventional drywall construction you would have to rip apart the drywall to,get to the foundation walls for repairs. L The panel creates a damage resistant wall facing that"gives"instead of"dent". Ideal for a playroom for the kids. both young and old. Unique tackable surface lets you hang pictures without any damage to the wall material. Conventional drywall finished walls are easily damaged and can be messy and time consuming to repair. ci Panels have built in acoustical sound control so the kids can play, watch TV or listen to music E, without disturbing people upstairs. Conventional drywall requires both the applications of k insulation and sound control panels to achieve the same level of acoustical control—adding .: extra cost! Impressive Basement Finishing System Cc?2006 33 I - ��117-11 ALL CAPE ENGINEERING - — REGISTERED ENGINEERS AND LAND SURVEYORS 49 HARBOR ROAD - HYANNIS. MA 02601 TEL.: (40 778-0058 May 2 S, 00 l"as.,£Ceno,te K��.tead 260 lVott incdsam 3a i.ue 02601 Jo (fibom Pt /'•lay COncean, AW•tet duey�(nr tot # 19 at the aboue a te" it because obu-i6u.& •thci a ahed bu i)t on tot # 18 a d de ina-to caeae •l thine, and ehoatd. be &r,te zoned ,tons M&6. K teadl,& p,topeaty and put , ba k the "4ai red &etbacA. tZ° ec t juVq daL'n"t ted hn �'-ilne WP c i . L f , / z-7.zr j l i i p tHE . � The Town of Barnstable INACC Department of Health Safety and Environmental Services 1639.lEo 3� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner June 9,2000 Tammy A.Cruz 248 Nottingham Drive Centerville,MA 02632 Re: Shed set-backs 248 Nottingham Drive,Centerville,MA Dear Ms Cruz: A problem concerning a shed that you had installed on your property at 248 Nottingham Drive has recently come to our attention. We have received a drawing from All Cape Engineering showing that this shed is located over the property line of your next door neighbor at#260. This shed will have to be moved . because sheds must conform to the zoning setbacks which are 10 feet on the side and 10 feet to the rear in your area. The plan that was submitted on September 15, 1997 with your shed registration showed that these setbacks would be conformed to. This move will have to be completed by June 23,2000. If we can be of assistance,feel free to call at 862-4034. Sincerely, n Thomas Perry' Local Inspector cc Elenore Kirstead Pine Harbor Building Certified mail Z 368 667 517 RRR g000609a - /Engineering Dept: (3rd floor) 'VaP- Parcel Permit# Mouse# ��_ DaaJttgg, ssxi�i; , _f./s�T� lV Board of Health(3rd floor)(8:159:30/1:00- Fee S74L Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) ���� � of � � a b Y ,�az Planning Dept.(19t floor/School Admin. Bldg.) d 1HE Definitive Plan Approved by Planning Board 19 TOWN OF BARNSTABLE. , 1 Building Permit Application Project Street Address �O d ✓l/p / i ty%� Village Owner os Svr''J Address e mp Telephone Permit Request S14 u/A t First Floor square feet Second Floor square feet Construction Type ,�� Estimated Project Cost $ Zoning District r Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 4-1 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 Areas .ft. Basement Unfinished Areas .ft ( q ) ( q ) 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 ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(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 Nameo 1i� t'i cr'� Telephone Number Address ,A1 License# Home Improvement Contractor# Z/-5?.9-,9::r Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCCT'ION DEBRIS RESULTING F/R�OM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i'l✓yG/ j ��� BUILDING PERMIT DENIED FOR THE OLLOWING REASONS) ��0 FOR OFFICIAL USE ONLY _ PERMIT NO. DATE ISSUED+: MAP Y PARCEL NO. ADDRESS VILLAGE+ OWNER DATE OF INSPECTION: FOUNDATION FRAMEJ INSULATION ' FIREPLACE + ELECTRICAL: ROUGH 'FINAL s ' PLUMBING: ROUGH FINAL _ r GAS: ROUGH FINAL FINAL BUILDING . 1 s ' • : 1 - t DATE CLOSED OUT ASSOCIATION PLAN NO. a r oFTME t� °. The Town of Barnstable WAM• tusivsreata: • �e�' Department of Health Safety and Environmental Services � 6 Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissione For office use only i 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. Type of Work: �io�ed✓� Est.Cost ✓ Address of Work: Owner's Name E'er 2,_1 L/ 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 F` 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: a �rf r l' 15 Date Contractor Name Registration No. OR Date Owner's Name