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HomeMy WebLinkAbout0286 NOTTINGHAM DRIVE AaTIVE ~ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .F Map 17 1 Parcel. O LtO Application # Health Division Date Issued i O Conservation Division Application Fee Planning Dept. .' Permit Feel Date Definitive Plan Approved by Planning Board ok lol3'6t Historic OKH _ Preservation / Hyannis Project Street Address d g (►° i„g �.�, Village Owner Mtz-� AARS W55_0 s Address SA�� Telephone Permit Request S �f AeLj system i n ATE t U'_ (,moo wh rt � ng All (2aomS (U i11 CQ;1In4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7,�o Construction Type Lot Size - Grandfathered: ❑Yes ❑ No If yes, attach supporting docume gtation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King s Highway:r 6 Yeg❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) - } V) Number of Baths: Full: existing new Half: existing new, ) w 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 ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 1 Name Ft I Z gerA , P Telephone Number Address License C 2'�i e r V nn A Og(0.3 a- Home Improvement Contractor# Worker's Compensation # 63C ALL.CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO /3,4110 S►,SIr _A1\ SIGNATURE DATE i ? FOR OFFICIAL USE ONLY y � t APPLICATION# DATE ISSUED ► r MAP./PARCEL NO. s - k 1 j ADDRESS VILLAGE OWNER J DATE OF INSPECTION: 1 i _.FOUNDATION ' ,f FRAME 'INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH ,.=° < _ * FINAL r `FLNAL-B_UILDING ®k OW Y '6 ' z� .DATE CLOSED OUT 4 ASSOCIATION PLAN NO. J s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 )Washington Street 1 l II IIII i Boston,MA 02111 www.mass go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: �(, i�� h9 /x M r City/State/Zip: 6 eZ_ef to f MA- `Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 1 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8-. ❑ Demolition working forme 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,❑ I am a homeowner doing all work right of exemption per MGL I LE] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4) and we have no 12.❑ Roof repairs. insurance required.] t. employees. [No workers' 13. Other 1 S /�lC comp. insurance required.] Ott *Any applicant that checks box#1 musi'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. xContractors 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: pee rle55 . S-�tpeep C- 15 Policy#or Self-ins. Lic. #: O1.0 B (,(6 G 6 Expiration Date: (,/d Y ( t a Job Site Address: .1 119\npA. r City/State/Zip: CeIO(I r u14- 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 cert�o under the pains and penalties of perjury that the information provided above is true and correct Signature: IL4 Date: Phone#: [Eth only. Do not write in this area;to be completed by city or town official n: Permit/License# hority(circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector son: Phone#: Information and Ins ructions Massachusetts General Laws chapter 152 requires all employers to provid workers' compensation for their employees. Pursuant to this statute,an employee is defined as ...every person in the s rvice of another under any contract of hire, express or implied, oral or written." a, An employer is defined as"an individual,partnership,association, corpo tion or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal rep esentatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legs entity,employing employees. However the th owner of a dwelling house having not more than ree'apartments and w o resides therein, or the occupant of the dwelling house of another who'employs persons to do maintenance, co ction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not Ncause of su h employment be deemed to bean employer." MGL cha ter 152 25C also states that"ever state or Iota. 'c P , § (,� y �It ensi g agency shall withhold the issuance or renewal of a license or/permit to operate a business or to construct uildings in the commonwealth for any applicant who has no produced acceptable evidence of comp[iainc with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commoo ealth nor any of its political subdivisions shall enter into any con tr ct for the performance of public work until accep ble.evidence of compliance with the insurance requirements of thi chapter have been presented to the contracting a onty." Applicants { �� t . Please fill out the Porkers' compensation affidavit completelylbesubmitted g th boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and pumber(s) a ng with their certificate(s)of insurance. Limited(liability Companies (LLC)or Limited Liarships( P)with no employees other than the members or partners,are not required to carry workers' compeance. If LLC or LLP does have employees,a policy isVequired. Be advised that this affidavit mitted to the D'yartment of Industrial Accidents for confirmAdon of insurance coverage. Also be sud date the affidavit The affidavit should be returned to the city ortown that the application for the permit or Iic nse is being requested,t not the Department of Industrial Accidents. Sh uld you have any questions regarding the la or if you are required 4btain a workers' compensation policy,plea call the Department at the number listed be ow. Self-insured-companies should enter their self-insurance license numIr on the appropriate line. City or Town Officials ti Please be sure that the affidavit is mplete and printed legibly. The D.ep ent has provided a space at the bottom of the affidavit for you to fill out in event the Office of Investigations 'as to contact you regarding the applicant. Please be sure to fill in the permit/license umber which will be used as a ference number. In addition, an applicant that must submit multiple permit/license app ' ations in any given year, ne d only submit one affidavit indicating current policy information(if necessary) and under"Jo ite Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officia stamped or marked b�the city or town may be provided to the`•, applicant as proof that a valid affidavit is on file for fu. , e permits or licenses. A new affidavit must be filled out each i year. Where a home owner or citizen is obtaining a licens r permit not relatad to any business or commercial venture i.e. a do license or permit to burn leave etc( g p s said erson is OT required t complete this affidavit P 4 P The Office of Investigations would like to thank you in advance for ,our coope a'on 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 Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-8'77-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass..gov/dia 1 , Try Town of Barnstable o� F Regulatory Services MA- Thomas F.Geiler,Director s659- ta'� `TEnr '' Building Division Tom Perry,Building Commissioner 200 Main Street Hyannis,MA 02601 www.town.b arnstab le.rna.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must - Compl ete p ete and Sign This Section If Using A Builder I' Q I a5 Owner of thesubject.sub' .property hereby authorize 11 Fi i2gew,g i p pf� � 2,I P to act on my behalf, in all matters relative to work authorized by this building permit application for. 6 rG c�ile (Address of Job) Signature of OwneCris Print Name If Property Owner is applying for permit please complete'the Homeowners License Exemption Form on the reverse side. Q:F0 RM S:O FVNERP EP MISSI ON tKE r.�y Town of Barnstable „�. o Regal"atoty Services Thomas F. Geiler,Director MAIM Lbsv. ",�� Building Division ED k Tom Perry, Building Commissioner 200 Maid.Street;_Ayannis,MA_02601 www.town.barnstable-ma.us Office: 508-962-403 8 Fax: 508-790-6230 HO>MON NER LIMISE=MFTTON Please Print DATE: JOB LOCATION: .4-ber str=t village "HOMEOWNER":- namey home phone# work phone# CURRENT MAILING ADD RFS city/town state zip code The current exemption for"homeown "was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an indivi for hire who does not possess . license,provided that the owner ants as supervisor. ' DE}I9AMON OF HOMMOwlr'ER Persons)who owns a parcel of land an which h`e�/she resides or intends to res lide, on which there is, or is intended to be, a one or two-family dwelling, attached or detaclied structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a orm acceptable to t1�e Building Official, that he/she shall be responsible for all such work performed under the building permit; (Section i 09.1.1) Th,e undersigned"homeowner"assumes responsibility for compphance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that"he/she understands the Town o �smstable Building Dcparlanent mi1111num inspection procedures and re:gL rcments and that he/she will comply�vn said procedures and 'requirements. 4` . Signature of HOme6wncr Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOhmowNER'S EXEMPT bx .The Code states that: "Any bomeowncr perfbmring work for which a building permit is requimd shall be exm'npt from the provisions of this section.(Section 1D9.1.1 -Liccnsiiig of construction Supsnzsors);provided that if the homeowner engages a persons)for hire to do such wor'r,that such Homeowner shall act as supervisor.^' Many homeowners who use this cxcmptiom am unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Ru)cs&Regulations for Licensing Construction Supwisors,Seetion 2.15) This lack of awareness bften results in serious problems,particularly when the homeowner hires unliccnscd persons. In.this case,our Board cannot proceed against the unlicensed person as it would with a licensed supuvisor. The homeowner acting as Supervisor is ultimately responsible. To erasure that the homeowner is fully ewers of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the rmp=bilibcs of a Supervisor. On the last page of this issue is a form currently used by several tawns. You may can t amend and adopt such a forrrJcertifreation for use in your community. Q:fornrs:homccxcmpt OP ID:CR CERTIFICATE OF LIABILITY-INSURANCE DA 04`;1 o;1 JIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS /AATE-DOES-NOT-AFFlRMAT1VEL--Y-GR-NEGAT♦VEL-Y-AMEND,-ECT-END-ORS-ALTER-THE-COVERAGE AFFORDED BY-THE.POLICIES.- • - THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED SENTATPIE OR PRODUCER,AND THE CERTIFICATE HOLDER. RTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(fes)must be endorsed. if SUBROGATION IS WAIVED,subject to Irtificate, erms and conditions of the policy,certain policies may require an endorsement-A statement on this cerdfieabe does riot confer rights to the holder in lieu of such endomeme s. )DUCER 781-914-1000 rrr na C Drnas Gregory Associates Inc. 781 246-2601 PHONE Fax No: I Edgewater Drive S235 � ikefield,MA 01880 ADORrs: ris Hawthorne TAR NLLI-6 INS AMRDNGCOVERAGE NAICE u ![lam Fitzgerald dba INSURER A:Peedess Insurance Co. 24198 Mr.Plumb-Rite NsuRERB:Peerless Indemnity 376 Nottingham Drive INSURERC: Centerville,MA 02632 INSURER D INSURER E INSURER F AVERAGES 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 TH18 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. RDL SUEIR POLICY EFF POLICY EXP LIMITS li TYPE OF INSURANCE POLICY NUMBER GENERAL LIABIUTY EACH OCCURRENCE s 1,000,0001 X COU9MERCIU.GENERAL UABIM CBP2240275 10/16M 0 10/16M I PRMANr---J = 100,00 (LAIMS AIADE OCCUR MED EXP(Arty one ) $ 15,00 PERSONAL&ADV INJURY s 1,000,00 X NOAH-$1,000,000 GENERAL AGGREGATE S 2,000,00 GEN'LAGGREGATE U MIr APPLES PEIr PRODUCTS-CO1MPIOP AGG S 2,000,0 FOUCY PRO- LOC Em Ben. s NON AUMMOSILELI Eny COMBINIED SINGLE LIMIT S ANYAUIO BODILY INJURY(P-pw-n) i ALL OWNED AUTOS BODILY INJURY(Per ac idwd) $ SCHEDULED AUTOS PROPERTY DAMAGE S HOLED AUTOS (Peramlderd) S NON-OWNEDAUrOS s X UMBRELLA LIAR NX OCCUR EACH OCCURRENCE i 1,000,00 ALIAS CLANS44ADE CU8733556 10M6t10 10M6/11 AGGREGATE 1,000,00 S DEDUCTIBLE X RETENTION 9 10,000 S TH- WORKERS COMPENSATION. WC STATU- ER AND EMPLOYERS'LIABILITY 04/08/11 04t0N1z EL EACH ACCIDENT S 500,00 ANYPROPRETORIPARTNERIEXECUTIVE Yin NIAE-1 J C876666$ j j3Lmd�M NHf 1�� EL DISEASE-EA EMPLOYEE S 500,0 ttyor, n E.L.asmI "d DISEASE-POLICY LIMIT S SOO,OO DESCRIPTION OF OPERATIONS briar j i MCRIPTION OF OPERATIONS!LOCATIONS 1YEHICLES(Atdch A0=101,AddrBeml RWAft Sehsdds,B mam space is nrpdmdi Ij i ;E2TIFICATE HOLDER CANCELtAT10M BARNS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. FAX: 508462-4717 230 south Street AUTHORITY REPRESENrATNE Hyannis,MA 02601 f 01988-ZD09 ACORD CORPORATION. All rights reserved. (CORD 25(2009109) The ACORD name and[ago are registered marks of ACORD CIO MMONVIi EALTH OF MASS • ACHu SETTS AS q MgSTER_ .. . . U1�RESr ISSUES THE'ABO.V Rl C-r& w r E LICENSE r0 G FrTZGERA 37 LD 6 NDTTINGH ILLE c1 :i ,. Mq .02632: 213.E 6417 . : ; 10128/I 2 i �,` Home Energy Raters LLc BTorrey @EnergyCodexetp.com Box 989,E.Sandwich,Ma 02537 888-503-2233 Duct Leakage Test Address 286 Nottingham .Dr, Centerville Ma Date — Sept 30, 2011 Test Type Post Construction —Leakage to Outside Conditioned floor area = 1684 Sq FT To comply with Section 403.2.2 Of the 2009 IECC Code in this home the Maximum duct leakage CFM = 135 CFM ( 1684 /100 x8=135) Duct leakage tested = 108 CFM This Home complies with Section 403.2.2-Of the 2009 IECC Code Date of Test.9.30.1-1 Technician: Larkum Test File:Untitled Customer Plumb Rite . E3ui ng Address: (286 Nottingham D( Centerville,l'dllA Phone Fax-, ' Test.Results 1.. Measured Duct Leakage 106.0 CFM 120.0 sq.ire:(+a-0.0%) 2. Duct Leakage as a.Percent of System Airflow 3. Duct Leakage as a Percent of Building Flioor Area; 4. Leakage Split: Supply Side: 'Return Side: a 55. Duct Leakage Curve: Flow Coefficient ): 15.4 ;Exponent fn):* 0.600(Assumed:) . 6 Test settings: Pest Mode: Pressurization Test Pressure: 25.0 Pa Equipment: Series B Minneapolis Duct Blaster Test Type: Outside Leakage (Combined Duct Blaster and.Slower Door Test) Contact our office with any questions, Bruce Torrey, Certified HERS Rater Home Energy Raters LLC t FtHe T Town 0f Barnstable ' *Permit, Q�° EYpires 6 mrowhs from issue date Regulatory.Services. Feed"7 + BARNSCABLE, MASS, Thomas F. Geiler, Director l Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barns table.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 1 Not Valid.without Red X-Press Imprint Map/parcel Number Properly Address f Rcsidcntial Value of Work —2 9R r d _ Minimum fee of$25,00 for work under$6000:00 Owner's Name& Address C��b �` (�V< Contractor's Name A�'�� � S Telephone Number .2,�p lL l . I lome Improvement Contractor License# (if applicable) �_1 (� Construction Supervisor's License# (if applicable) _I U `T ❑Workman's Compensation Insurance Check one: X-PRES. S PERMIT ❑ I am a sole proprietor ❑- I am the Homeowner. OCT 2 0 2008 2I have Worker's Compensation Insurance TOWN OF B RNSTA.BLE- Insurance Company Name i ✓� 1 ��0 4 _ L=3 _ CX1 Workman's Comp. Policy# 761 L ,9, LSb Copy of Insurance.Cornpliance Certificate must be on file. <I ►`� �_ cr; p t.> Permit Request (check box) _1 (; ❑Ze-roof(stripping old shingles) All construction debris will be taken to C . �'I `P > t;) ❑ layers rrn Re-roof(not stripping. Going over existing of ❑ Re-side ❑ R6placement.Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner mu �sig ro erty Owner Letter of Permission. A copy of e Ho e T ro .ement Contractors License is required. SICNA`1'URIa:: Q: WPFILES\FORMS`buiWing permit Forms\EXPRESS.doe Revised 100608 1 The Comrrconwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ',. ,•�' www.mass.gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Information l A licant Info Please Print Le gib . - Namt (Business/Organization/Individual): . 1A.)(")I— Address: City/State/Zip: C�� � Phone L(1`;k r'o � Are you an employer? Check the appropriate box: .Type of project(required)-. �/ 4. [] I am a general contractor and I 1,L=) 1 am a employer with__ 6. ❑New construction . employees (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 g, []Demolition working for me in any capacity. employees and have workers' 9. El Building addition comp. insurance. [No workers'.comp.insurance 10.[]$lectrical repairs or additions required.] 5. We are a corporation and its officers have exercised their 11.❑Plumbing repairs or additions '3.❑ I am a homeowner doing all work . • myself.[No workers' comp. right of exemption per.MGL 12.[4�dof repairs insurance.required.]t c. 152, §1(4), and we have no I3 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 Homeowoers•who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 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: (fit Policy#or Self-ins.Lic, I In L9 I yp 1 �;L Expiration Date: Job Site Address: A3 In 1 `D 1-)V1 City/State/Zip:�leIN 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK,OR.DER and a fine of up to$250.00 a day against the violator. Be advised at a copy of this statement maybe forwarded to the Office of Investi ations of the MA for insuz ce c eragebeacation. I do hereby certify under he p s n. ena 'e erjury that the information provided above is true and correct. Si store: Date: Phone Official use only. Do not write in this area, to be.completed by,city or town official City or Town: PermitfLicense# 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: 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 hiie, 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 tru.stee�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 n e dwelling house of another who employs persons to do maintenance,construction dwelling repair work on such w g hour 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 ehapter_152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall r 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 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 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information-(i_f necessary) and under"Job Site Address" the applicant should write"all-locatious 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,Co.wmQnw(,-aM of Mmsa hwu tts tDf,-partmi:mt of Indvs al Arxid is Office of Investigatim 604 Washingtoii S.tmd- B.Wcn,.MA 02111 TO. #f 17-727-4900 ext 40G or 1-877-.MASSAFE Fax##6.17-727-7749 Revised 11-22-06 W .Mass.gov/dia y } F,, Y r �,^.�• f 7-r S a s.. _ t a t , r~ a r k .' r 7.: 7 i Y s s, -: it xt .�,� s �.x k�.4�'�•¢X��Y�� ���4 �¢ r � '� r iA•I , C ti n � �,,: x d � ,� ,:W a f.. Ca'Y'" s"��r. 7�• v .r �. 1 c, F rtt � it.s` ( :yi q R _ - t .7 n t; .r -.z .7 y ,�rJ'�{� �Y�y� � a. < "� .x<A er:. 5' } iV�A K=HERB,,ST 7;•'•r° _ , _ „ � �z . r 35 PEEP TOAD ROAD CENTERVILLE MA 03632 4 h t r 508-420-6216/774-238-2936 `` .M 1 to www•markherbst•com " r 7 4` k .` a• PROPOSAL SUBMITTED T0: WORK PERFORMED AT: h Carol Higgans wxs 7' 286 Nofingham Drive same f" x CentervilleVA 02632 508-428-3245 ,. We herby propose to furnish the materials and perform the labor necessary for the completion of: New Roof. Remove 2 lavers of existing shingles r , Install ice&water shield at edge Install 8"drip edge Install 151b.felt paper ' Install Ce►fainteed shingle of choice c r r Storm nail all shingles i r Replace plumbing boots ;> �, ' All debris cleaned daily rt 7 Certainteed XT 25yr.algae resistant 7,280.00(� Certainteed Woodscape 30yr,algae resistant 8.6 U..00( ) Y s *Please check&initial choice above. Thank You All material is guaranteed to be as specified. The above work will be performed in accordance with the specifications submitted k r and completed in a substantial workman-like manner for the sum of: f� As specified above&verified with your initials r Dollars(`] �O)with payments as follows:full amount due upon completion *Any alterations from above proposal involving extra costs will be added under a separate written agreement and become an extra charge over and above said proposal. t RESPECTFULY VB ED 1011 108 4j Mark Herbst { f « ACCEPTANCE OF PROPOSAL k� ;a The above price,specifications and conditions are satisfactory.I herby accept this proposal. You are authorized to do the worksand payments will be as specified above. ,° iP SIGNATURE: ' 5, This proposal may be withdrawn by said company if not accepted within 30 days. ` Y r 7ro1 . :< r� t{"`hT+.id � TE�•� �r EE - � �� x 't'°i .vi .x.#' 3 ci�•..Y+°aiirxt7. s;��+�` a 7 t. _ 7 e,� -', V i ���• ti .-: % , t..' +"•"i+�Y�:7� a r•".�'t:�x ;art' '"� xi S �'rrk : �w + 4k - - .. t� .,.� . . . ... ...,.. ,v -:t'.. ,r.. -..._._ k, .._tx . - n'x3:.se::1K3...�.vx_..»i,sir.'.:a�.�un��fiv"..1L2•.zs..:"i.;-:+ -.,. — " NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES The Commonwealth ®f Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 611-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22&. 30, this will give you "notice that I(we)have provided for payment.to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE,P.O. BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY AWC 7016215012008 01/10/2008 - 01/10/2009 POLICY NUMBER EFFECTIVE DATES P 0 Box 494 Leonard Insurance Agency Inc Osterville MA 02655 (508)428-6921- NAME OF INSURANCE AGENT ADDRESS PHONE Mark Herbst 35 Peep Toad Road Centerville, MA 02632 EMPLOYER ADDRESS 01/04/2008 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her,own physician.. The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employes are hereby notified that the.insurer has arranged for such attention at the NEAREST-AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER ,per ----- < Board of Building Regulations and Standards _ License or registration valid for individtil use only - HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return for Registrat on:, 126480 Board of Building Regulations and Standards E - "69'io6 (%8/2010 Tr# 267766 One Ashburton Place Rm 1301 �A yFi• Boston,Ma.02108 + e Indiruidual Typ ' MARK HERBST' ! N f MARK HERBST >, f . 35 PEEP TOAD RD:��. � ,.�'•n� CENTERVILLE, MA 0 632' Administrator Not valid without signature + k'Construction"Supervisor Licenser,, Li nse CS i 48546 , c , Explra /27/2010. Tr#, 14362"- F. SRes`trictron 0(G # MARK D :HERBST 35 PiLET70AD RD � E' Vim/-'�-- r r �. } CENTERVILLE,MA 02632 f"'I� Commissioner f, 'T Town of Barnstable *Permit# 0 4-wondajraM.issue da . ."Z x Regulatory Services � i6 �. 1� Thomas F.Geiler,Director N1``� Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w X.p ES S PERMIT Office: 508-862-4038 Fax: 508-790-6230 OCT 1 9 2001 EXPRESS PERMIT APPLICATION NotVdUwithoutRedX-PrezImprint TOWNOFBARNSTABLE Map/parcel Number '0 L Property AddressAJq7q,,Ag esidential OR ❑Commercial Value of Work ' �.3 0=0 Owner's Name&Address ryl a / Contractor's Name 90 11-P-MM Telephone Number Home Improvement Contractor License#(if applicable) 7y0 'Construction Supervisor's License#(if applicable) C S O 72 7q Upw/orkman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner .have Worker's Compensation Insurance Insurance Company Name a2 —C/Can Workman's Comp.Policy# UJG 3 I - 017 — 7 p 6—GU Permit Request(check box) Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of r000 Re-side Replacement Windows. U-Value (maximum.44) - �ther(specify) dZ2&--5 . — r t � *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature /�x �it�C�_ ��, &2jCL expmtrg °F TMe rq� ,. .. . %Y The Town of Barnstable 9 MAMM&"ELL8 Department of Health Safety and Environmental Services �''°rfo�'„p¢,�►`� Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION Location of shed(a ess) Village Property owner's name Telephone number xis 1� l® 101 �l Size of Shed Map/Parcel# Cad Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction?. Conservation Commission(signature required) S/70� 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 Q-fortis-shedreg TOWN OF BARNSTABLE BUILDING PERMIT APP, i•ICATION Map Parcel I q I-fly Permit# � Health Division � z,f Date Issued J� 1 i Conservation Division - Fee Tax Colle r - k Treasu plapAiRg I—gate'Definitive Plan Approved by Planning Board � - Historic-OKH Preservation/Hyannis , Project Street Address © 1 Village V •�-�� Owner w lo,i.A YQ L H t,CA t N.S ` .Address Y'V% . Telephone Permit Request 0 V N! O 2i d - Square feet: 1 st floor: a isting� proposed 2nd floor: existing � proposed Total new ' r o Estimated Project Cost �i Cl0 0 Zoning District kesi deN-1A)Flood Plain _ Groundwater Overlay Construction Type N 1040 l— Lot Size v y l CYt S Grandfathered: ❑Yes U<0 If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure •Y-S Historic House: ❑Yes 411r On Old King's Highway:. ❑Yes b1 o Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �T�fl g' dumber of Baths: Full: existing new Half: existing new Number of Bedrooms: existing J new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: UGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes U o Fireplaces: Existing _� New f Existing wood/coal stove: ElYes No Detached garage:❑existing ❑new .size Pool:O existing nO' ew size Barn:0 existing ❑new size Attached garage:igexisting ❑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 f BUILDER INFORMATION Name ► Telephone Number '/�O .72 Address l 'So 1'' t.o-Y! ye Le License# Home Improvement Contractor# - Worker's Compensation# � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY - -" PERMIT NO. z> r DATE ISSUED I s`' � I .' S, � r .n; .. = ..• - _ i =_ � . MAP/PARCEL NO.) I•. a� �j � + .ram __..-A �.,_e ; i i •' N� '. .' t � M, 7. ADDRE SS' f i Y t r I 'VILLAGE - - .i � � Y'" � ; � I i —. _ ~^� ! SIT 4 t 1 s T _, ,Y .+ ` - S L !1 ..� ', .• . ,. y k. OWNER? I a _:_ i.. , r ../; ,_ • -i DATE OF INSPECTION: FOUNDATION FRAME ' INSULATION -� REPLACE ELECTRICAL: ROUGH FINAL PLUMBING: -- 'ROUGH FINAL ,. GAS: ROUGH FINAL * _ FINAL BUILDING DATE CLOSED.OUT -� ' ASSOCIATION PLAN NO. f. • - s . 1 a own ot i5arnstaime BASNSi'ABI.E. • 9� 1659�6- `0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 ' Office: 508-862-403 8 Ralph'Crossen Fax: 508-790-6230 Building Commissioner 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. I gLI I I i 1Type of Work: O U C Estimated Cost �Dtl Address of Work: r Owner's Name: k I Al Date of Application: -5�— qs. — l I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under S 1,000 Building not owner-occupied [30wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the. gent of the owner. 06-9� Date Contractor Name Registration No. OR Date Owner's Name UU q:forms:Affidav L.n h W-Q }• 40-0" Maw y4' rV 4 j' 4 L 1\0 / LI.•tle• Q - - V•0'�� — s.,pl, j LiJ D•f..,— �„�• r......d Is °°",. ,1°.1 rl...,1..d ''�1<CURVED WALL PANEL DETAIL PLAN SIF�AIGIIi WALL 'ANAL DETAIL —S �A 1 ►.rl. r"•.'I. _—51d 16nr •d•d I �„—S/d. thl oftd .rJJ . ...,nf •djwf.w•.w d.4•:1 - N .1 nrb Vb.1......Ip....•1• •� io ♦ t �/p1 ELEVATION I - I }', •O I — •r.• ��1, .` O r i r SAMPLE -STRAIGHT WALL POOL HRACE 1 K/ BRACE" RAC N_nN-A Jll;i ABLE AUU5 A DJU A P VS L•n n 2l0' re 400• I s i Al?CF�NQtE -"r ALTERNATE 2 AN ERN PIN +{I � ALTERNATE Y. rf Ce. L313•149o— bel••4.Q r.IM S boil• y 1 Q ; 45•Anyt• Dn.•. / > LI) CORNER_D( lAtl COkNfk DETAIL BUTT SPLICE DETAIL 3 _I „ AT CURVED WALL e'o D..pj LLJ AiTTEI NAIE �I QLTLHNAJE 2 - A..... � �•-,+• PLAN NnTF S: ..rr,Yt.•° �I•.• D.lell —.n rf•1...« I. .... ...., •..ii . ,...•..I <•,...,nd cr-....,. IOCO p.•� ...I n. of 28 d..y° .. G....... -il -r..i ...r..• '0 0 . p• .1 .� .i .�. ....A 119bf • •fnlbd and r.o_.d. 9. n-.d feulf' Tln• e.,,,,,..q 'p, br p•.I ...e n.,f°</,,... 4 C....... ...1 1_..0 _,...•r - , —0, •—. and 0/ +s,•ce.o}le•. fe ng,•ind d•pfh 5 D. n of <.n. b..l... If . l.nl fA•1 +M+ h ... ...1• ..,.• b•h:nd wdb d.e, p..l .,b.,,., ,.u.,.9 c.n .nror . p•. [..•wlb.. f•• w1,.. o...i ., d.n.n•d. ib•I r.•1:�vw� 6. L�•••r. lanl E..r.I dr .1 li• <...rn•d ffon• .. .nd :• .+•II e...pa}.d e5.•n.f bxL d r•n•N 1••}v. r«I Of cONNf 1YIOr �r NII•d. P.....1. .•ly o- pe•.:... pn....• .• S.Jnll l• .•u•f e<I:v r.•..u.• w ..•f•• In r.•I. ,f/ r. na I.— h... I.nd wil... 10 1../ ./ 1 ELEVATION 3 -3 °e —v r •dy•. ' Pool �te SAMPLE —CURVED WALL POOL �o -----__,Y 8 DEXTER ROAD EAST PROVIDENCE,RI02914 • 401-434-6966 V , �2 ►,�+..� kTFr•,►,e,ra.e.Ts iv-o,u�oe Y rx. vmcnL writs 964mma. wl.jY uf1G 2" ' u�icrap 4 T.nc..L• , f•eTo2 f�—�——� --►----► a LA-4 I I rer Tr i a rv.Nefrn a Y t. FUL L ueO 1 I t~+trY w c Rerua/f v I uwwwn Y I I.T7 K MaD 3= W .E � I [rf ua e _ e/c MTT•ffJ� - 8 N s0 Ac •so.aes K Or eucT o _ _.TI A Tr oN L 02 • �y1p� '1— IS IL eot TirbJTA 1 san V.eIN�.� rfm a L.tMX. ITCwnfra iusAr.5w.AWa t s -J t.tam"1 /LdN. elIG1MN t•{.x�atL a�y/cFAmm!w arAf¢e�L.w. . • /di at.Sub,AX A`Voo_a+L.CAP A FR/WE AISem - ./+eAltlaAaa aN..twi 7YvrJa.NNelft •:::::. .. •_ F�r.T • TYP1c-A.y 90tU10LY - .e9•�e w s•r.4 N Mt'J!C is W.I M[t VIw.N:W.N.f ♦...fr..�w./1My r....✓ - AS SQL W40w:e'r�S'lll,B/.fi14O!KTHt 11fO0lAS�LCM. ° "ft ECTANOLF w/ C011NE11{ RECTANbLC-° O►nONT'° ECTANOLE w/: A OOIp1ER{ 0. 90e EL OPTION 60 EL W/: A.CORNERS { Y LAZY E O� faalf/an.a A CALLf.MM[ITI[S 2W.ASK A"MIMTT.on AIRS Oslo 0""Oran PA7A.A 1M16-p � P P Alf jl S.T.AM M f/llfRS.TT frTlowl STAIRS AnS ImaLm. u m -1 • N AS o.324 "moty 6Ce9NrCJL ; s,rre'., "it AL A rv,c,.,,a AM•f:/L N IF w At J a mra VFW 'In y �Y•cL1Y LAN! .rr{�}''.•i}~i•:' � �.Ft<fY Ut Y TU" N. 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J 1FSTAIUTNoIN.ora - w•LLAYO( .AFwWRRL Ln,..cn�L �dOeL.�r*� +e OOIPONeNT N016Tax O/OWL �rt 1AMPOOl61�IDICAImOIIAT7MTwPApew"oLl1MGw904t a Leb. T `may � - TOWA9l/�C . • l!G/J►1VAAT,ad S ftvp l F OM FFIOFI AATe1NIIL F>OFIdlONG TO ASTI M5451 OIAK 1EAT,FA/AIE 90R p FOOIT[AAFL4VE 9Ddi '_'q L�. GRM�I®�RwG L WFALL M r TIOI ex OOFIOtTE CdIM AT THE MR OF THE OV61-EIGIM110N AIlF/L . M4E P'rAEI SSiABFHB Ai AM'FF//llml ME ILAM FNON MOUIp TIE FIRL/'!/Dt79 OF OE FOOL PT L•.LI.nu 2f M y.FRL : • 1-7 i .•;A I/OI/LLC lO ASTI A.SIf MIIN M ASIM 6116 GILMRJ WMOM - f , E741ID 1 QION°U"T1 VVU K AgDMW AD CMMl.i.�109LVe1AR VOM • N 3 ••-• ,r, A :••• MO TgIEMEO CO'70iRIFR AAE KMfACMID fl10N FLL FOOL LRFN WAIN OUIIDIG EA07ilJNG FFAl61 l[YB SiW►NOT D1/FF31 FIION/A07IIL •"f— •'•••r - • . f01lOIO TO ASTF 14)OF,FEFIS;AS7L)f�AID ARE ms FIAT®, t[YR A FFOAE MAT OM FOOT. •. •` •••! ;� S�NA A , L961S M!4TMd11D EIIR RATFD� 4.AONOM.t HAUfMATOEMM WGT,MPWLSLOAE AWAYFIIOAI DOPING AT A171E �/��j� , •'.. oEo swat LOOO►9 oOF.FI®vc �, m NVTLESS THAT ww FEfFoot OVAL 4 KIDNEY e T m L •�.,LL STI 2'2 ° p. SJj�SS4'd � 061411. St 1N16 FOOL NNS NOT/®F Ot9O1®FOA A 911NUNIIQ IpAOwC SCRLE• L. AlGRAMID- n TY &AI'a EXCA%PTWN R WrAl sTE AFEMAA)FOOL ANo USE NR.T S"WU TO UM F"AI RCT FLUID PReM W I 'UCA( �L -I' �^=�Nv� .T Y�. • OF RETAINEp SUR TO>O la F(#a.rt.OA Itss p A� L 0 T 20 v + R 01 61D� f o0 'r LOT 1 286. �0 a LOT 22 , RES.. ZONE- "RC" This MORTGAGE INSPECTION Plan is For FLOOD ZONE: "C" Bank Use OnIv TOWN: _ REGISTRY OWNER: WQ4.,4_- ffMG1NZ_____________ DEED REF: _849_6,3_ZL__ __BUYER: _?MVJYQZ__________ DATE: _I 2,2=28_-------____ -- --PLAN REF: _247_84_ _ _SCALE:1LE:1"= 30 --- FT-- . I HEREBY CERTIFY TO _ _&A ATA ___THAT THE BUILDING YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS , SHOWN AND THAT ITS POSITION DOES --__ CONFORM `'` �` CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE TOWN OF NO&AELVfLA&Z_____________AND THAT Na 3498 40B INDUSTRY ROAD �: MARSTONS MILLS, MA. 02648 IT DOES__— L _ LIE WITHIN THE SPECIAL FLOOD HAZARD \ FF;S,oN� AREA AS SHOWN ON THE H.U.D. MAP DATED a._L9_ _ TEL: 428-0055 iW— unPanel # 50001-0015—C FAX 420-5553 "><• $� _ THIS PLAN NOT MADE FROM AN INSTRUMENT AUl 7� FRITH , PiS +�=�' SURVEY NOT TO BE USED FOR FENCES, ETC. 22512 .SDS