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HomeMy WebLinkAbout15/19 OLD STAGE ROAD 70' l " Old S1. 9 Cot-- 1 t 1 S wI ll i o d ry s a •, ,, ',, �, is -, «, "`�.,. v '` a�' �.. ," , - r � 156 14 ,I �.3 rt ice- •�` .,, ' v ' .. Y '. � .�:,�- ... � G i ,. �... �} r. i n :.. � �•�_ if• _ M c µ ' - - ^X .. - .. _ ..� �•. .`.. .. � e n. '�� re a rM `' ceD}�ao� iss 19 I j4�e�l � , C'eril ol P '� �c�,ll 6� «„`fie•- � 5 + ach iss TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel, / S p p ion # Health Division Date Issued a 1 Conservation Division Application Fee � 5 !��, Planning Dept. Permit Feed Date Definitive Plan Approved by Planning Board r Historic - OKH Preservation / Hyannis Project Street Address l T D ST>9' e /7©Ab Lf�"7 9Z lie 1 Village ��0 Owner J�kl' E&Yelt-N'eS CC 1AP Address. Z j O/P s e l-zo Telephone 6 h—S/� Permit Request i2Peodle 20-klyld i Pnue&2 m, >',Oe AA94 AA0 �o ► 4,11rook.Si Lo w0a/%+ & iem wl 6Pa,L14he -10 4- 1 �GAtc o 0l8 6ulat9ie. 't�co il. , :;r,,sY(.( (i&4L o 'J odi' f�� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation N' 0D®0 Construction Type All �w��l��i� V ill Inc lip to Lobe. woy2tEj vVlt& Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentatio . Dwelling Type: Single Family ) Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes No Basement Type: ❑ Full It Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) A)A Basement Unfinished Area(sq.ft) Number of Baths: Full: existing / new Half: existing new O Number of Bedrooms: Z existing 0 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing ALNew Existing wood/coal stove: ❑Yes L No Detached garage: Or existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn:.0 existing r❑ newi size_ ..� t Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: i r Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ! ' , Commercial ❑Yes XNo If yes, site plan review # f Current Use �� 17J�s�l�'l�i'(. Proposed Use �5�� ( APPLICANT INFORMATION (BUILDER OR HOMEOWNER) y Name Zeno&� 604Felephone Number ? � �`7 Address >?� �' P �'�y License # %4!�214. Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE c I-f { FOR OFFICIAL USE ONLY APAICATION# DATE ISSUED y. MAP;/PARCEL NO. J ADDRESS VILLAGE j OWNER F DATE OF INSPECTION: 1 FOUNDATION" aN•s J {. FRAME OG 7 �1 i, y. INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL F , GAS: M . ROUGH iC-1 „ FINAL �,,, FINAL•BUILDING ' DATE CLOSED OUT i ASSOCIATION PLAN NO. �LL s�z, " � Town of Barnstable Building Department - 200 Main Street ASTABLE. • Hyannis, MA 02601 9 MASS 1639. , (508) 862-4038 RFD Mfg A Certificate of Occupancy Application Number: 201300220 CO.Number: 20130109 Parcel ID: 208155 CO Issue Date: 09/27/13 Location: 19 OLD STAGE ROAD Zoning Classification: RESIDENCE D-1 DISTRICT Proposed Use: MULTIPLE HOUSES ONE PARCEL Village: CENTERVILLE Gen Contractor: PROPERTY OWNER Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: G/ Building Department Signature Date Signed �.. TOWN,-'OF BARNSTABLE BUIllaing �- ■ A 201300220 r * ERNSTABLE, Issue Date: 03/12/13 ` P e I m.J t. MASS. i639. Applicant: EK PROPERTIES LLC Y rF� A ''Permit Number: B- 20130504 ' Proposed Use: MULTIPLE HOUSES-ONE PARCEL Expiration Date: 09/09/13 —` ., r. ' Location 4-TOLD STAGE ROAD Zoning District RD=1 Permit Type: RESIDENTIAL ADDITIONXALTERATIO Map Parcel 208155 Permit Fee$ 204.00 Contractor _ PROPERTY'OWNER Village- CENTERVILLE App Fee$ 50.00 License Num OWNER Est Construction Cost$ 40,600 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND REMODEL KITCHEN,CONVERT ONE BEDROOM INTO TWO BATHS THIS CARD MUST BE KEPT POSTED UNTIL FINAL COVERT SMALL GARAGE TO BED,2 WIND,,SLIDER-INT ONLY! INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH n Owner on Record: EK PROPERTIES LLC BUILDING SHALL NOT BE OCCUPIED UNTIL.A FINAL Address: ' 23 OLD STAGE ROAD INSPECTION HAS BEEN MADE. CENTERVILLE,MA 02632 ' Application Entered by: TP Building Permit Issue By: - THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARH.Y,O'i PERMANENTLY ENCROACHMENTS o I?UBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER T-HE BUILDING CODE MUST BE APPROVED BY THE JURISDICTION,,STREET OR ALLEY GRADES AScWELL AS DEPTH AND LOCATION OF Pajillg SPkYERS MAY BE OBTAINED FROM THE DEPARTMENL'OF PUBLIC WORKS THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK:. , 1.FOUNDAT,ION OR FOOTINGS. # x. 2.ALL FIREPLACES MUST BE INSPECTED,AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED, 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). a,•. 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. ` WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE.VARIOUS STAGES OF QJNSTRUCTIONs PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION_ WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. ` L` PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). elw i .. -, ,..'.: - : " .`fro ��.... � ..•. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS , ELECTRICAL,INSPECTION APPROVALS , 2 „ . •L - 4 3 ti ' g 1 Heating Inspection` pprovals Engine' rA� Deptx;a b Ir 61T� rr. r F e Dep x F q,; a l ' d of Healt ';` ' LSY Q•.�3 ac _ tf_' cT, i 1 i7 K ''r�a i i (�,. 'dC,W a�'�t q, rod:✓ �v'�'� �'G': y✓�. 1'•#_'' ' "K y� "� ,r �'� '. „sv l� F�' at`G�'3 : i •S-?;1�'lRt t � - . a _ �° ¢,,•r ^a� "f,��v, b .., NAM: ADDRESS: PERAffT# �o ► 3 a j PERMIT DATE: M/P: LARGE ROLLED PLANS ARE IN: BOX' � SLOT _ Data entered in.MATS program on: 3 3 -BY: j 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 LeLyibly Name(Business/Organization/Individua]): K /� i(�L `rrr'Pyl litc ✓j Address: / D //0 Si e F4A> City/Sta.&Zip: C64Telt Wile OF4,;'Z Phone.#: (P Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-tim.e).* 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 workingfor me in an capacity. employees and have workers' Y P ty $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. a corporation and its Electrical repairs or additions required.] - 5. ❑ We are 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right 6f exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required_] "Any applicant.that checks box#I must also fill out the section below showing their workers'eompcnsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subrnit a new affidavit indicating such. kContractors 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 informatiory. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 WA for insura0e coverage verification. I do hereby certify un r t pa' and penalties of perjury that the information provided above is true and correct. Si mature: i Dater Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 1.Building Departrnent 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: Information and. Instructions Massachusetts General Laws chapter 1S2 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 tiustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelli than ng house having not more an 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 Iocal 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." ' r Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contiactor(s)name(s),-address(es)and.phone number(s)along with their certificates)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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of lndustrzal Accidents Offtee of lnvestigations, 600 Washington Street „ Boston, MA 02111 Tet. #617-727-49-00 ext 406 or 1-877-MASSAFE Fax# 617-727-774R Revised 11-22-06 www.rnass-gov/dia Town of Barnstable Regulatory Services BAWMAERMAM s Thomas F.Geiler,Director ib o Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: D! /J �I / /J'� ���./�✓✓!"`/ number 2 street ``� village "HOMEOWNER": �' �� '��'S / I/5 1C'n�►(J✓1 �P r7'�rlC/— l L�V name home phone# j work phone# CURRENT MAILING ADDRESS: ceA•A-Arlk dZ63 Z city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor: DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"home er"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedur a r uir ents and that he/she will comply with said procedures and requirements. �L Signs m of oeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\ContentOutlook\DDV87AAZ\F.XPRESS.doc Revised 072110 �tM Town of Barnstable Regulatory Services BAIWSTsBLF' * Thomas F.Geiler,Director 'b'°�Fc �"•� Building Division Tom Perry,Building Commissioner, 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 February 8, 2013 EK Properties, LLC Attn: Edward Lennon 23 Old Stage Rd. Centerville, Ma. 02632 RE: 15(19) Old Stage Rd.., Centerville, Ma. Map:208 Parcel: 155 Dear Mr. Lennon: This letter is in response to application number 201300220 submitted to remodel the building at the above referenced address. Unfortunately,the application is not approved at this time for the following reason; 1) The construction documents submitted are incomplete. f a) Plans are not marked for the installation of smoke and carbon monoxide y detectors. b) No framing plans submitted. c) Compliance with 2009 IECC not demonstrated. Respectfully, �az on Local Inspector ' jeffrey.lauzon@to,A,n.bamstable.'ma.us (508) 862-4034 From All Business Communicatio 1.781.693.0601 Fri Feb 1 10:33:26 2013 MST Page 1 of-3 MA SOC Filing Number: 201007009160 Date: 06/22/2010 4:16 PM ............................ .................._............ ........... ......_..........._......... ...... ............................... ............................... ... .. ............................. :.............................................................................................................................................................................................----.....................................> The Commonwealth of Massachusetts Mlnimum Fee:$soo.00 William Francis Galvin ' Secretary of the Commonwealth Corporations Division �' oTPo r One Ashburton Place, 17th floor Boston,MA 02108-1512 ii1'CsV X�: Telephone:(617)727-9640 00 Federal Employer Identification Number: 272896309 (must be 9 digits) 1.The exact name of the limited liability company is: EK PROPERTIES,LLC 2a. Location of its principal office: No. and Street: 23 OLD STAGE ROAD City or Town: CENTERVILLE State:MA ZO: 02632 Country:USA 2b. Street address of the office in the Commonwealth at which the records will be maintained: No. and Street: 23 OLD STAGE ROAD City or Town: CENTERVILLE State:MA Zip: 02632 Country:USA 3.The general character of business,and if.the limited liability company is organized to render professional service,the service to be rendered: REAL ESTATE 4.The latest date of dissolution, if specified: 5. Name and address of the Resident Agent: Name: EDWARD LENNON No. and Street: 23 OLD STAGE ROAD City or Town: CENTERVILLE State:MA Z0: 02632_ Country:USA I, EDWARD LENNON resident agent of the above limited liability company, consent to my appointment as the resident agent of the above limited liability company pursuant to G. L. Chapter 156C Section 12. 6.The name and business address of each manager, if any: ------------------ Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code _.......... .... ......................... ...... ...................... ............._........-........._...._.._.._.. .._.. MANAGER EDWARD LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA MANAGER KELLY LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA MANAGER EDWARD LENNON 8 CASTLE DRIVE MANSFIELD,MA 02048 7.The name and business address of the person(s)in addition to the manager(s), authorized to execute From All Business Communicatio 1.781.693.0601 Fri Feb 1 10:33:26 2013 MST Page 2 of 3 documents to be filed with the Corporations Division, and at least one person shall be named if there are no managers. Title Individual Name Address ono PO sox) Last,Suffix Address,Cityor Town State Zip Code First Middle La Add es P SOC SIGNATORY EDWARD LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA SOC SIGNATORY KELLY LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA SOC SIGNATORY EDWARD LENNON 8 CASTLE DRIVE ............. . ................................... MANSFIELD,MA 02048 ------------- 8.The name and business address of the person(s)authorized to execute, acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property: Title Individual Name Address(no PO sox) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY EDWARD LENNON. e CASTLE DRIVE MANSFIELD,MA 02048 REAL PROPERTY EDWARD LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA REAL PROPERTY KELLY LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA 9. Additional matters: SIGNED UNDER THE PENALTIES OF PERJURY,this 22 Day of June,2010, . EDWARD LENNON (The certificate must b" signed by the person forming the LLC.) ©2001 -2010 Commonwealth of Massachusetts All Rights Reserved REScheck Software Version 4.4.4 Compliance Certificate Project Title: Addition/Alteration Energy Code: 2009 IECC Location: Centerville(Barnstable),Massachusetts ® `=-' CD Construction Type: Single Family -� Project Type: Alteration Conditioned Floor Area: 0 ft2 a Heating Degree Days: 6137 �. Climate Zone: 5 Permit Date: (!) Construction Site: Owner/Agent: Designer/Contractor: 15/19 Old Stage Rd. Ed Lennon Centerville,MA 02632 23 Old Stage Rd. Centerville,MA 02632 Maximum UA: 212 Your UA:204 Envelope Assemblies Nis 0 • Ceiling 1:Flat Ceiling or Scissor Truss 786 38.0 0.0 24 Ceiling 2:Cathedral Ceiling 516 35.0 0.0 , 15 Wall 1:Wood Frame,16"o.c. 1,170 21.0 y 0.0 53 Window 1:Vinyl Frame:Double Pane with Low-E 195 0.320 62 SHGC:0.00 Door 1:Solid 40 0.300 12 Floor 1:All-Wood Joist/Truss:Over Unconditioned Space 1,140 30.0' 0.0 38 Compliance Statement: The proposed building design described here is consistent with the building plans;specifications,and other calculations submitted with the permit application.The proposed building has been designed to meet the 2009 IECC requirements in REScheck Version 4.4.4 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title: Add ition/Alteration'- Report date: 02/21/13 Data filename: Untitled.rck Page 1 of 7 REScheck Software Version 4.4.4 . Inspection Checklist- , Requirements: 13.0% were addressed directly.in the REScheck software N Text in the"Comments/Assumptions"column is provided by the user in the REScheck Requirements screen. For each requirement,the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed.Where compliance is itemized in a separate table, a reference to that table is provided. 2009 IECC Pre`Ins ectionlPlan Review Plans Verified Fleld Verified P Value a Value C omp es s/A ns y Comment ssumpt�o M411� � 9 ' nd r_ x ,� 103.2 :Construction drawings and �1 ❑Complies [PR1]' :documentation demonstrate energy — ❑Does Not Comply i code compliance for the building I ;envelope. a [:)Not Observable Inl: ❑Not Applicable 103.2, "Construction drawings and ❑Complies 403.7 i documentation demonstrate energy ❑Does Not Comply: [PR3]' code compliance for lighting and ' = ._❑Not Observable ,Q) I mechanical systems.Systems serving r M ❑Not Applicable I multiple dwelling units must demonstrate compliance with the commercial code. 466 Heating and cooling equipment is Heating: Heating: ❑Complies ; [PR2]2 )sized per ACCA Manual S based on Btu/hr s Btu/hr ❑Does Not Comply i a loads per ACCA Manual J or other f Cooling: Coolin ❑Not Observable t � approved methods. g' g' Btu/hr Btu/hr - El Not Applicable Additional Comments/Assumptions: t . 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) e3"d Low Impact(Tier 3) Project Title: Addition/Alteration Report date: 02/21/13 Data filename: Untitled.rck Page 2 of 7 I 20091ECC� '� Found�yon"Inspection��/ ,_� �Compi`ies� � �iCo merits/Assumptions � � '303 2 1y A protective covering is installed to ;❑Complies ;Exception:Requirement is not applicable [F011]2 protect exposed exterior insulation :❑Does Not Comply and extends a minimum of 6 in.below;❑Not Observable .j m grade. ❑Not Applicable = 403 8 ,Snow-and ice-melting system ;❑Complies [FQ12]z r' a controls installed. ❑Does Not Comply', ❑Not Observable j❑Not Applicable Additional Comments/Assumptions: f 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) N,:'Low Impact(Tier 3) Project Title: Addition/Alteration Report date: 02/21/13 Data filename; ,Untitled.rck. Page 3 of 7 I , 20.Q9IECC Framing t R6U`ghrtn,fnspectlori, Flans VerifedFtelii'Verified Value �Ualue �Compl es� is/ sumpt Commen As o 402.1.1, i Door U-factor. ; U- ; U- ;❑Complies ;See the Envelope Assemblies table for 402.3.4 i ❑Does Not Comply:values. [FR1]� ❑Not Observable 041 ❑Not Applicable 402.1.1, ;Glazing U-factor(area-weighted ; U- U- ![]Complies ;See the Envelope Assemblies table for 402.3.1, average). El Does Not Comply values. -]Not402.3.3, Not Observable 402.5 ❑Not Applicable ; [FR2] 303.1.3 ;U-factors of fenestration products are ❑Complies [FR4]' determined in accordance with the a� ❑Does Not Comply! NFRC test procedure or taken from „ TM ❑Not Observable I ;the default table. ' 4 ❑Not Applicable 402.3.5 Sunrooms enclosing conditioned U- ; U- ❑Complies' [FR8]1 space have a maximum fenestration ❑Does Not Comply I U-factor of 0.50 in Climate Zones 4-8. ; -]Not Observable New glazing separating the sunroom . ❑Not Applicable from conditioned space must meet 1 code requirements. 1 402.3.5 ;Sunrooms enclosing conditioned U ❑Complies ; [FR9]1 space have a maximum skylight U El Does Not Complyl ;factor of 0.75 in Climate Zones 4-8. ' ' ❑Not Observable []Not Applicable 402.4.4 'Fenestration that is not site built is „x ❑Complies ; . [FR20]' listed and labeled as meeting El Does Not Comply iAAMAM/DMA/CSA 101/I.S.2/A440 or has infiltration rates per NFRC 400 r ❑Not Observable i that do not exceed code limits. ❑Not Applicable ; 4024 5 'IC-rated recessed lighting fixtures "TINE � ❑Coin I' r Pies [FR16] sealed at housing/interior finish and m � ❑Does Not Comply: 1 labeled to indicate 2.0 cfm leakage at H y l �'75 Pa. y - .. '� []Not Observable ,; - _ ❑Not Applicable 403.2.1 1 Supply ducts in attics are insulated to ; R- ; R- ;❑Complies [FR12]1 I R-8.All other ducts in unconditioned R_ I R ❑Does Not Comply spaces or outside the building ; ❑Not Observable I envelope are insulated to R-6. ; ❑Not A a pplicable 403.2.2 All joints and seams of air ducts,air a ❑Complies [FR13]1 ;handlers,filter boxes,and building 'a v ❑Does Not Comply I cavi ties used as return ducts are r `- ❑Not Observable ;sealed. - []Not Applicable 403 2 3 fi Building cavities are not used for H / ❑Complies ; [FR15]3 s supply ducts. s ❑Does Not Comply 1 ❑Not Observable _ �'❑NotApplicable 403 3 ;j HVAC piping conveying fluids above ; R- R- ❑Complies [FR17]z 105 OF or chilled fluids below 55 OF i -❑Does Not Comply are insulated to R-3. -]Not Observable ❑NotApplicable ! 40141 jOl Circulating service hot water pipes.are R- ;'R- ❑Complies [FR18]2 insulated to R-2. I . ODoes Not Complyl' `3 `. I ❑Not Observable ❑NotApplicable 40315 "'-Automatic or gravity dampers are ❑Complies 'H19, ,j installed on alloutdoor air in and y''• ' [ lr , ❑Does Not Comply 1 exhausts. T 1 � d � ❑Not Observable , a ❑Not Applicable ' Additional Comments/Assumptions: 1 High Impact.(Tier 1) 2 Medium Impact(Tier 2) 3 , Low Impact(Tier 3) , Project Title: Addition/Alteration Report date: 02/21/13 Data filename: Untitled.rck R. Page 4 of 7 , , t - `• +ems a •u.. _ "' ' Plani� enfietl Freld Uenfierf 2009tI�CC in latron InslSectronf Com Tres? CommentslAss1um Mons i i p P J Ualue alue� Y• r w 303 1 I All installed insulation is(labeled or the ❑Complies ;Requirement will be met. [IN43]2 'installed R-values provided. \ !� ❑Does Not Comply h ❑Not Observable ❑Not Applicable ;F 402.1.1, ;Floor insulation R-value. R- R- ❑Com lies ;See the Envelope Assemblies table for 402.2.5, 1 ❑ Wood ❑ Wood ❑Does Not Comply 1 values. 402.2.E !❑ Steel ❑ Steel ❑Not Observable 1 [IN1] El Not Applicable 1 i I 303.2, ;Floor insulation installed per y ❑Complies ;Requirement will be met. ❑Does Not Comply:, 402.2.6 manufacturer's instructions,and in . , [IN2]' substantial contact with the underside ' ❑Not Observable of the subfloor. E]Not Applicable 1 402.1.1, ;Wall insulation R-value.If this is a t R- R- i❑Complies ;See the Envelope Assemblies table for 402.2.4, mass wall with at least'/of the wall ❑ Wood ❑ Wood El Does Not Comply values. 402.2.5 ;insulation on the wall exterior,the ❑ Mass ❑ Mass ❑Not Observable [IN,]1" :exterior insulation requirement lapplies. ❑ Steel ❑ Steel ❑Not Applicable ; � 1 1 303.2 ;Wall insulation is installed per ❑Complies ;Requirement will be met. [IN4]1 I manufacturer's instructions. ❑Does Not Comply:, r ❑Not Observable ❑Not Applicable ; 402.2.11 Sunroom wall insulation has a. R R- ❑Complies [IN8]' i minimum R-value of R-13.New walls E f El Does Not Comply separating the sunroom from ❑Not Observable I conditioned space must meet code requirements. :[:)Not Applicable ---— — _ 303.2 Sunroom wall insulation installed per -- = s w ❑Complies ; [IN9]1 I manufacturer's Instructions. ❑Does Not Compl I y = Y ❑Not Observable ❑Not Applicable 402.2.11 ;Sunroom ceiling minimum insulation R- FYI R- ❑Complies ; [IN10]' R-value of R-19 in Climate Zones 1-4, ❑Does Not Comply: ` land R-24 in Climate Zones 5-8. ❑Not Observable, 1 ❑Not Applicable 303.2 ;Sunroom ceiling insulation is installed y ;, ❑Complies [IN11]1 iper manufacturer's instructions. ' ❑Does Not Comply� • ❑Not Observable ,. G ❑Not.Applicable Additional Comments/Assumptions: 1]High Impact(Tier 1) Jk,2 I Medium Impact(Tier 2) 3 Low Impact(Tier 3)' Project Title: Addition/Alteration Report date: 02/21/13 Data filename: Untitled.rck Page 5L of 7 i � r ' Plans Ve�ifietl ' F[etd Uenfied � � 2009 IECC Final inspects 4�Ovl5ronComphes� CammentsiAssumptlons " ri Value al �a t Raw 402.1.1, i Ceiling insulation R-value.Where>R-; R- ; R- - '❑Complies _ ;See the Envelope Assemblies table for 402.2.1, 130 is required,R-30 can be used if Wood ;❑ Wood ❑Does Not Comply values. 402.2.2 insulation is not compressed at eaves.; Steel ❑ Steel ❑Not Observable [FI1)' R-30 may be used for 500 ft2 or 20% i whichever is less where sufficient ; ❑Not Applicable :space is not available. 303.1.1.1, ;Ceiling insulation installed per ❑Complies ;Requirement will be met. 303.2 i manufacturer's instructions.Blown ❑Does Not Comply; [FI2]1 ;insulation marked every 360 ft2. No❑ t Observable , ❑Not Applicable 402.2.3 ;Attic access hatch and door insulation ; R- W W; R- :❑Complies ; [F13]' i R-value of the adjacent assembly. ❑Does Not Comply: . ❑Not Observable ❑Not Applicable 402.4.2, ;Building envelope tightness verified ACH 50= ACH 50= ❑Complies 402.4.2.1 by blower door test result of<7 ACH I ❑Does Not Comply [17117]1 :at 50 Pa.This requirement may ❑Not Observable ;instead be met via visual inspection, . ; I UNot Applicable in which case verification may need to occur during Insulation Inspection: 492 4 3' Wood-burning fireplaces have F' ❑Coin lies [FI8)Z u'f gasketed doors and outdoor ❑Does Not Comply: . combustion air. ❑Not Observable ❑Not Applicable 403 2.2 Post construction duct tightness test cfm cfm ❑Complies ; - [F14]1 result of 8 cfm to outdoors,or 12 cfm :❑Does Not Comply: across systems.Or,rough-in test ❑Not Observable ' ' result of 6 cfm across systems or 4 ; cfm without air handler.Rough-in test E ❑Not Applicable verification may need to occur during ; Framing Inspection. ; 403 1 1 Programmable thermostats installed ❑Complies [FI9)2 l »i on forced air furnaces. ❑Does Not Comply j , r ❑Not Observable ❑Not Applicable ; 403132 ' ;Heat pump thermostat installed on ❑Complies ; [F110]2 heat pumps. i i❑Does Not Comply: ❑Not Observable I � r �.. ❑Not Applicable p3A ,Circulating service hot water systems ❑Complies [Ft11]z �'a have automatic or accessible manualHWE]NotApplicable ❑Does Not Comply i ' wi,ncontrols. ❑Not Observable 403 9 1" ';Readily accessible switch on heaters f "❑Complies ; [FI12)3 for swimming pools. ❑Does Not Comply: ❑Not Observable W ❑Not Applicable -- - 403 Timer switches.on pool heaters and r- ❑complies ; [FI19]3 ;pumps are present. C„- )❑Does Not Comply ❑Not Observable ' [I Not Applicable 1 403 9 3 Heated swimming pools have a cover. ❑Complies [FI20]3 [Covers on pools heated over 90°F yl :;[--]Do Not Comply <i are insulated to R-12. = ❑Not Observable , J r ,., ❑Not Applicable . 404.1 ;50%of lamps in permanent fixturesr Complies [F16]1 i are high efficacy lamps. . ❑Does Not Comply I ❑Not Observable I { � ❑Not Applicable 1 High Impact(Tier 1) 2"Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title; Addition/Alteration Report date: 02/21/13 Data filename: Untitled.rck Page 6 of 7 1 g�PlansVerifled Field verified .. }` 2pp9,lECC Final inspection PrOVIS10nS Comphes5� Comments/Assumptions j �� Value Value Y [ h p p ❑Does emu,. 401 3 F17 ��� 'Com liance certificate posted. � � '��` ❑Complies Not Comply; V, y ❑Not Observable I ❑Not Applicable Manufacturer manuals for mechanical �` '❑Complies [FI18]3 and water heating equipment have []Does Not Comply: ;I been provided. 'tJ 1 ❑Not Observable _ a . '. a^ ❑Not Applicable Additional Comments/Assumptions: F k 1 High Impact(Tier 1) 2'" Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Addition/Alteration Report date: 020/13 Data filename`. Untitled.rck Page 7 of 7 gy Efficie.ncy Certificate } Wall 21.00 Floor 30.00 Ceiling/Roof 38.00 Ductwork(unconditioned spaces): 4 Window 0.32 Door 0.30 Heating System: Cooling System: Water Heater: Name: Date: Comments: • SPECIFICATION DATA 1. : Product Name ,Van r. .. ; Foam It Green®12, 202 and 602 Class I Fast and Slow Rise Low Pressure ' Disposable Spray Foam Kits z— y ) 2. Manufacturer t Guardian Energy Technologies,.Inc. `y 2033 Milwaukee Ave#136 i Riverwoods;,IL 60015 Ir Phone: 1-800-516-0949 Fax 800:-516-0949 - . Email: help@guardianenerevtech.com Web: www.SprayroamDirect.com 3;: : Product Description Foam It Green®12, 202 and 602 Class I ASTM E84 Fast and.Slow Rise are disposable,closed-cell, low-pressure spray foam kits consisting of:two chemical components(Component A: isocyanate.and Component B:polyol blend), patented U-Control p. dispensing gun,two multi-purpose mixing nozzles(Foam It 12)or ten multi-purpose mixing nozzles with three fan spray tips (roam It 202 and 602),nitrile gloves,and packet,of petroleum jelly. These systems contain a flame retardant formula, meeting requirements of ASTM E-84 as a.Class I product.:They do:not require any external power source.: ry 4 C>.Technical Data � .�— . Foam It Green® 12,202 and 602 Class I Fast and Slow Rise Spray Foam:Kits have the following.prope5tres: c �= O DENSITY(ASTM.D1622): CO -Free Rise 1..75 lb/ft In Place 2.0 Ib/ft3 _ ,.... R FACTOR at 1"thickness(ASTM C518)i 6.7 pj • t� COMPRESSIVE STRENGTH(ASTM D1621)i . ...13.8 psi(parallel) . .. r WATER ABSORPTION(ASTM D2127): 0.039 ib/ft2 CLOSED CELL UNTENT(ASTM D2856):. ... >95% DIMENSIONAL STABILITY(ASTM D2126):: • Foam It Green®does not contain any CFCs,Penta-BDE's,VOC's,or Urea- Change,158'F;100 RH;7 days 201 _.. . Formaldehyde.::. . %Volume Change,-60°F,7 days -0;42 TEMPERATURE TOLERANCE: Published yields are theoretical:and High.TemperatureTolerance _. : 2507F vary based on several factors,including ambient conditions and specific Low Temperature Tolerance -250°F application. AIR BARRIER;PROPERTIES at 75 Pa(ASTM E283): 0.005 L/s/m? PERM RATING(ASTM.E96): • Always usesuggested personal:. . . At 1" _ 7:14 Perms protective equipment when using ... r At 3 3.13"Perms„: polyu ethane foam products. Refer to . the:Material Safety Data Sheet for FLAMESPREAD at 2'thickness(ASTM E84): 25 additional information on safe use and SMOKE DEVELOPED at 2"thickness(ASTM E84): . :. 300 ha�ing �Foa7 Green®kits. K FREE TIME: 30-40 seconds RISE TIME: :: O seconds . YIELD: Foarn It 12 Class I 1 ft3 12 ftz @ 1"thick Foam It 202 Class I(Also Slow Riise) 16.5 ft3 l_198 ftz_@ 1"thick Foam It 602 Class 1(Also Slow Rise) so 50 ft3 1660.ftZ @ 1"thick 5/1/2011 � l /� UM a . IcaOASTAL INSULATION 95 Washington Street Suite 104-163 - Canton, MA 02021_ Office: 781-708-3626 Fax: 78.1-459-0202 -FICAluri INS-ff L _)*,1'N CIERT T" This form must be filled out and posted to comply with building code requirements. Meets IRC Sections N1101 .3, N1101 .41 , and N1101 .8 requirements. The following spray polyurethane foam product(s) has/have been.installed. Bayer Materials Bayseal OC Open-Cell Spray Foam Insulation Consult International Building Code, Chapter 26-Plastic and International Residential Code (IRC) R314 Foam Plastics for specific requirements. The spray polyurethane foam insulation system(s) has/have been installed in accordance with manufacturer's processing guidelines to provide a thermal resistance of: Area Insulated Aged R-Value Thickness** Attic Area R- 38 At 10 inches Sloped Ceilings R- 24 At 6 inches Walls 2 X 6 R- 21 At 5.5, inches Walls 2 X 4 R- 15 At 4 inches Floors over an unheated crawl space) R- 30 At 18 inches Crawl Space Perimeter R- At inches Basement Exterior Walls R- At inches Other Location: R- At inches **Nominal thicknesses are representative of field, spray-applied foam material Jobsite Address: 15 Old'Stage Rd Centerville, Ma. 02632 Back House Date of Installation: 7/15/2013 Building Contractor: EK Properties LLC Insulation Contractor: Coastal Insulation Systems Phone: 781-708-3626 Installed- By: Scott McNulty INSULATION CERTIFICATE -DO NOT REMOVE -Please Post Near Electrical Panel- s E� -42-03002 Cd/3 o.6 oFtHGE Town of Barnstable = *Permit# 4� 0� Expires 6 months from issue date �r Regulatory Services ., Fee AB Y Y * BNSTABLE, + y - e - v� M�1 . � Thomas F.Geiler,Director Building Division PE Toni Perry,:CBO, Building Commissioner � '� 200 Main Street,Hyannis,MA 02601 FEB _ w.town.barnstable.ma.us " 2�13 ww Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - .RESIDENTIAL QXW ,'OF gARiVST Not.Valid without Red X-Press Imprint AEILE Map/parcel Number zo Property Address �D Sit TZO .r+, �L1C �rIZ G/o�4e 65 Residential Value of Work A. �� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address FROPerVl PS .l L h°44 n A ;( Z DLO S-hbe Zb Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable): Construction Supervisor's License#(if applicable) ' ❑Workman's Compensation'Insurance Check one: ❑ I am a sole proprietor . nI am the Homeowner . .' I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy.# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof hurricane nailed (stripping old shingles') All Z s s construction debris will taken J 5 s be toe to O a' ( PP g g ) 1� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side #of doors. Z [� Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows_J ❑ Smoke/Carbon Monoxide detectors 4 floor plans markedwith red.Sand inspections required. Separate Electrical&Fire Permits required. *Where required_ Issuance of this permit does not exempt compliance with other town department regulation's,i.e.Historic,Conservation;etc. ***Note: Property Owner must sign Pr petty Owner�Letter of Permission. A copy of the Home in, ment Contractors License&Construction Supervisors License is required, SIGNATURE: . (ti TItA-4) >° C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 I oFtKME ra Town of Barnstable ti 0 Regulatory Services s s en MA M. ' Thomas F.Geiler,Director v� 039. �FnMpts Building Division Tom Perry,Building Commissioner 1 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION ' DATE: L/ j•I l ZO Please Print JOB LOCATION: I b L �M 11 lL Ili I�/�C 1c1) (-� ►�lG�` numLer street c/. village "HOMEOWNER": 7rM iz,-, name ? home phone#- work phone# CURRENT MAILING ADDRESS: 7. 7 Q l q a � eIISC n7 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire Who does not possess a license,provided that the owner acts as supervisor. DEFINITION'OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,-on which there is,orris intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who'constructs more than one home in a two-year period shall not be'considered a homeowner. Such"homeowner"shall submit-to the Building Official on a form acceptable to the Building Official,that.he/she shall be responsible for all such work performed under the building-permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersign "ho eo er"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedur a re a is and that he/she will comply with said procedures and requirements. SignaturVof omeowner Yd�41$5 U- Approval of Building Official - Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction`Control. HOMEOWNER'S EXEMPTION The Code states that: 'Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing'of construction Supervisors);provided that if the homeowner engages a person(s)for hire to,do such work,that such Homeowner,-shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,:Section 2.15) This lack of awareness often results in serious.problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed.person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To.ensure:that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and.adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\MicrosoftCWindows\Temporary Internet Files\C6ntent.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 ` fih C navt rs th'46f Mass.ack seas d3a�r141tf�a: s�e4a �e r -Offi i cO,f lnves#g ons TT?a�sfi�ragtaaar 'irea?t C, B j?s� yAL4 02111 e � _ �ur#*re;nr�gamfrtia Workers' Compensation I z46e vtt: slCoit et�ra �I c n ` Viers Applicant IHformaten Plea se Print Name asiikeWOTani23ft eAi vuv ti' �j Yl'�4�o e✓%s. As: csa � p �l j z 'Are you an employe ? eck the ap' pri#e lase. T I a� ccantrac#or and I Typeg,praject(r°e�u -, 1_❑ -Y roue einplc�y�with 1rr f®11' taddor * have fired sub wcons 6: ❑I�Te � Y ( .. I El am a sole proprietor crr w ,listed on the adiched� 7 strip and have, Theseb cr actc hate fi: ❑DeMe litiun. 9 f w0flEing far in any c pacrty eu yL._S have , s jNo vrsarkets`cow.;,ate; „re cow, urance 9__❑Building addition.. .5 �❑ W are a carp sratio and ids 1{3❑El al repairs car ec�rc gas 3. I atu a homeowner doing alt:work vfficei s lsave.esereised.tl�ir 11-❑lsl g's�aairs ar�drL#ibns myself [No workers'camp nigh#eaf #sauper'MGI: y 1�. Rneif insurance rerlasirpd] c 152,§,IM atiawe 1x�4 ❑ eaupl®yew.[No cede 13.❑G en cored:Msttrame requ .) ;Any app3i=that checks bx#1 m i also fill ow t1 a s�tao�4rIau staoa�iag pi err',€ '" p�lacy i�aaaaats�a . Homeowners who subumitt this affidsvff imdicatimE they ;doin all>x amd ) c�ttxae�ss mmst skit�sew affadavat amduati sa[ch r-`- Ccmatractmrs that cheek than max test t3dditiumal met t1 m taf the s c a®a1 stag aw}medxer of not those 62mik hive emphryees. If the sub-contmctnnUve,e? alajeesa?heytss�astgrmiidet9t r w k s saber Z tiara as empIner that is p ari on aid;' sate . i�,fter�teat�aa� Insurance�arnpany Iatme _ J Policy#i+r Self-rear Lac_ on I}ahe_ Job Site Addr _ C41stated7sp ' Attach a copy of the Wor kern'rompensahori]]icy deda tioia page(�lrosriug the policy umber and espiratittn date).l' Failure to sei se coverage as required u dt r Section 25A of EtIGi 152'can 1ead;to t1�e iugaeasitiiaxa nfcr� l '' ®f fine up to$1,500...OD for 'me'y�r im x as wa s civil sin .of a STOP tel :#TRUER anti a f axe „ x of up to$25id: l a day #lie vice Se tri edthat'a copy o dais statement is y,be frrr rded br Office of Iuve*gatiosas cif DIA far' overage��rafxcaticm. ; I do hereby cerh;fjr tie he `:res pe�tretfies rr p ut theist the tarforaaa tie rart�gabad.a /irk is tetra°aa,crxrrert Si A _ . "aciet use only. I3ar rrnt ssrite in this urea,tt be caranpleted b :crt 0r town:a 'acixt C-ty or Town: lf'e tfi ie st'# Issztng Auttaorjty(Circle one) I.Bt►ard of Health I pa esf 3.C €y/Iawu d. G1erk Eleetrienl Inspectaec .Phamb Ili stfls �1'.Other, k CllrltaCt l'crsOu:` Phjc r' � t) L From All Business Communicatio 1.781J Fe __ MA SOC Filing Number: 201007009160 Date: 06/22/2010 4:16 PM ................................................................................... ............................................. ..............................................................I............................. ......................... ........ ............. ........... ..... ........................ .............. ................. The Commonwealth of Massachusetts Muftnum Fee:$500.00 William Francis Galvin S=eL-iry of the Commonwealth Corporations Division One Ashburton Place, 17th floor -1512 Boston MA 02108 ........... ... Telephone:(617)727-9640 fit. ........... ------------- Federal Employer Identification Number: 272896309 (must be 9 digits) 1.The exact name of the limited liability company is: EK PROPERTIES,LLC 2a. Location of its principal office: No. and Street: 23 OLD STAGE ROAD City or Town: CENTERVILLE State:NIA ZO: 02632 Country:USA .................... ................................................................. ......................... 2b. Street address of the office in the Commonwealth at which the records will be maintained: No. and Street: 23 OLD STAGE ROAD State:MA Zip: 02632 Country:USA - .LE-IE City or Town: CEN 3.The general character of business,and if the limited liability company is organized to render professional service,the service to be rendered: J: REAL ESTATE 4.The latest date of dissolution, if specified: it 5. Name and address of the Resident Agent: Name: EDWARD LENNON No. and Street: 23 OLD STAGE ROAD Zip: Country:USA State:NIA : 02632. City or Town: C_ENTERVILI-E 1, EDWARD LENNON resident agent of the above limited liability company, consent to my appointment as the resident agent of the above limited liability company pursuant to G. L.Chapter 156C Section,12. 6.The name and business address of each manager, if any: Title Individual Name . Address(no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER EDWARD LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA MANAGER KELLY LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA MANAGER EDWARD LENNON 8 CASTLE DRIVE MANSFIELD,MA 02048 7.The name and business address of the person(s)in addition to the manager(s),authorized to execute Commonwealth of Massachusetts. Sheet`Metal Permit Map d Parcel X-PRESS PERMIT Dater _ JUL 0 8 i2013 Permit# � 36 'V4 Estimated Job Cost: $ Permit Fee: $ T OF BARNSSTA E Plans Submitted: YES NO Planseviewed: YES NO Business License# Applicant License# / C� Business Information: Property,Owner/Job Location Information: Name:0 g cL t•' _ j�` Name: 2�� I�Cyi'? Street: .. G (�> l ✓ ,�° Str e � ° lcf �� I city/Town: �,%c/� c tyrrown: Telephone: '5 5 G �5 / Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES Staff Initial J-1/M-1-unrestricted licensee J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. :t. /-,2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept.Approval Institutional'-' Other Square Footage: under 10,000 sq.ft. — over 10;000.sq..ft. Number of Stories: Sheet metalwork to be completed: New Work: Renovation: HVAC e/ Metal Watershed Roofing Kitchen Exhaust System Metalo Chimney/Vents -Air Balancing Provide detailed description of work to be done: Cie)•-i L/e�? & 'C11)(, e � �, a - � All e Al _ 4 �I _ 1 NSURANCE COVERAGE: cl have a current i ill insurance policy or its equiv len is eets thte requirements of M.G.L.Ch. 112 Yes No El f you have checked YM, indicate the ty of coverage by checkking the appropriate box below: k liability insurance policy Other type of indemnity ❑ Bond ❑r OWNER'S INSURANCE WAIVER: I am aware that the licensee chi?e"�s"hot have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. ' Check 06e'6nly Owner ❑ Agent ❑ Signature of Owner or Owner's Agent . 3y checking this boxy,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and iccurate to the best of my knowledge'and that ail sheet metal work and installations performed under the permit issued for this application will be n compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES " NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: y ❑ Master rile ❑ Master-Restricted ; Ky/Town ❑Joumeyperson Signature-of-Licensee'---•---1 ermit# _--'—'� ee ❑Joumeyperson-Restricted License Nuumber.Check at www.mass:gov/dnl ispector Signature of Permit Approval The Commonwealth of Massachusetts Department oflndustrial Af ddentr Office of Investigations UV -600 Washington Street Boston,MA'02111 www.masr gov/dia ' Workers' Compensafion Insurance Affidavit: Bladders/Contractors/Eleetr-idans/Plumbers Appheant Information Please Print Lezily Name(Bnsmess/organiz�im,�r„�iyi���: e�vec _ Address: V City/State/Zip: Phone.#: �7`j ZZ� 5�vOe— l a Are you an employer?Check the appropriate bow of Project ect re -4. I am a general rrn.ca�+,z, -TypeP 1 ( . Q�� i •1.❑ I lover wish � ❑ i� � and T 6. ❑New canstrncfion . loyees(fnn and(or part one).* have hired the snb=contaci�s 2. I am a•sole proprietor or partner- listed an the'st#ached sheet 7. Q Remodeling ship and have no These sub-corhactrss have . employees8• []Demolition . Working for me is any capacity, enmployees and have workers' [No workers' camp.MS==a comp.n,•crrrance.�' 9. []Bmldmg addition required-] 5. O'We are i corporation and'its . 10-EI Electrical repairs or additions 3.❑ I am a homeowner doing in-work' officers have==cised their 11.[]Phunbing reP ails or additions ' myself [No workers' camp. rigs t of exemption per MGL 12•[]Roof repairs r.wed-]t c. 152, §1(4), and we have no ❑Other employees. [No wo�S' 13. comp.insurance regrdred] *Any applicant that cbecks box#1 must also M out the section below showing fl=iswail='compensation policy infmmation. t Hamcowums who sub=dt this affidavit nxEcaiing they are doing all work and then hire outside ano actors most subm t a new of oavitmdicatmg suriz. $'n r fzacf m flint check this boot most attached an additional sheet showing the name of the sub-co�and sty whetba ornot those entities have . employers• if the sub-contrddon bavo employccs.$fey mustFrwidc then• wad.='camp.poficy Cr. I am an employer that is providing workers'compensation insurance for my employees Beiow is the policy and job site information. . Tnsarmce Company Name: Policy#or Self-ins.Lic.A ExghationDktn: Job Site Address: Chy/Statel7ap: Attach a copy of the workers' compensation policy decIaraf on pa.ge'(showing the policy number and expiration date). Fare to.secure coverage as requimd tinder Secti m 25A of MGL c• 152 can lead to the imposition of anal penalties of•a fine up to$1,500.00 and/or one-year rropmiso—ems as well as civil penalties in the form of a STOP WORK ORDER and a imE 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. InvestiRations of the IDIA for' CDVM7RZe veij4�.at; I do hereby airs p alfies of pm jw y that the information provided above is true and correct Simzainre: c Date r� Phone# � Official use only, Do not write in this area,t0 be camplefed by eft y or•town official City or Town:. PermitUcense# .Issusmg Aldhority,(circle one): 1.Board of Health 2.Bmldiag Department 3.CiiylTown Clerk 4.Mectrical Inspector S.Plmnbing Inspector 6 Other a Cor±kct Person. Phone si r • 4 s gufatary Services Thomas F.Gea1e,,Director s�59- v ° 6 Bu flffing DI�nsaGIM Tom Perry,.Bufldkg Comm stoner 200 Main Street,Hyannis,llrit102601 +r� .toesmm.�a�Qs��1e.ffis_�ss Office: 508-862-4038 Fax: 508-790-5230 Frog erty Owner Mast Complete and Sign This Section If Using A`B der< Inc 4Nt &,P)o?61Ae51 t6 as Owner, of the xyect sub J P Pert:9 beteby autbotize �!/T 7 G �" ) �"`� �`'I ^ to act on mp behalf., in all matters tclativeto work.authorized:by this building pc=t. (Address of job `'Pool fences and alarms are the responsibility of the applicant.- Pools are not to be f lli e before:fence.is installed and pools are not to be udhzed until aR.f nftl 'nspeetions :are.�erf�x�med — accepted. ; 1`it✓_7QP A Si ature of ner Sn�:tre,ot Alicaszt = w #, y;x, Pxizrt Name ?e,,; �i GGL Arint e - _ l.7afe y ;4 QFORM&OWNERPERMISSIC)Ni'O S ., pplIMO1�IWEAL.TH OF'IVIASSAG�IS ram • _ • • f • • • Px SHE.ET META+ WORKERS AS A M 4�7r iINRESTRICTED a: _fSSUES THE ABQUESL�ICEAISE TQ x Y i T . Vp 14 CLEVEL � J'D BROCKTON, M4. 0;'2301 2332� i 17:78 . 01/ZSi14 170789 � Town of Barnstable p� Permit# Expires 6 months from issue date Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 `w W.town.barnstable.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 / >� Property Addres l S 0. Ef Residential Value o ork f�c9 ��. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor .IE PERMIT ® I am the Homeowner ❑ I have Worker's Compensation Insurance AUG 2010 t: Insurance Company Name BARNSaABLE Workman's Comp.Policy# 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 p existing layers of roof) Re-side (��✓-^��a #of doors ® Replacement.Windows/doors/sliders.U-Value (maximum.35)#of windows Si'ZeS ��, . *Where required: Issuance of this permit does not b7tempt compliance with other town department regulations;i.e.Historic;Conservation etc. ***Note: Property Owner must sign operty Owner Letter of Permission. A copy of the me Im vement Contractors License&Construction Supervisors License is require - SIGNATURE: ,// V V r C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content 0utlook\DDV87AAZTN?RESS.doc A Revised 072110 The Commonwealth of Massachusetts 'Department of Industrial Accidents l Office of Investigations 600 Washington Street Boston, MA 0.2.111. s www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �/� 5 / (/e u`C�'� Address: /c �w J�O City/State/Zip: L-A t` �� G� !fl' Phone #: Are you an employer? Check the appropriate b.ox: "Type of project(required): 1..❑ I am a employer with 4. I am a general contractor and I * have hired the sub-contractors.. 6. ❑New construction employees(full and/or part-time). - - - 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 a Building addition No workers' comp. insurance comp. insurance.I required.] 5. F] We are a corporation and its . k I O.❑ Electrical repairs or additions 3.❑ I am a homeowner,doing all work officers have exercised their `1 1.0 Pltimbing repairs or additions myself. [No workers' comp.'. right of exemption per MGL 12Q Roof repairs insurance required.] t c. 152,§1(4), and we,have no employees. [No workers' 13.❑ Other comp. insurance required.] ' *Any applicant that checks box 41 must also fill.out tho,secdon below showing their workers'compensation policy information. t Homeowners who submit this affidavit,indicating lheyarc.doing all work and then hire outside contractors must submit a new affidavit indicating such, .. tContractors that check this box must attached an additional sheet showing the,name.of the sub-contractors.and state whether or not those.entities have employees: If the sub-contractors have employees,they must provide their workers'comp.policy number. " I am an employer that is providing workers'.compensation insurance for my employees.. Below is the policy and job site information Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of.criminal penalties of a fine up to$1,500.00 and/or cne-year imprisoament,.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 cover ge verification. Ldo hereby certify under the "ains nd p, alties ofperjury that the information provided above is trite and correct. Si nature: 'Date: �hb 1 � l Phone#: _ Official use only. Do not write in this area, to be completed by city, or town official City or Town; Permit/License# Issuing Authority (circle one):' x V L'Board of Health 2. Bpilding Department 3, City/Town Clerk 4. Electrical Inspector 5. PlumbingInspectox 6.Other Contact Person: Phone#: Town of Barnstable Regulatory Services g Y �Director Thomas F.Geiler, snarrsraece. _ 9039. Building Division Fo Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATIONa �/ STi ' !70✓ [ ��L �trG/t° number J street village "HOMEOWNER': name ' home�phone# A work phone# CURRENT MAILING ADDRESS: _z O jpn S /✓/5�(��7�+,/{�Y t c /town �� 9 `state zip code - The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building peimit (Section 109.1.1) . The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection oced s and requirements and that he/she will comply with said procedures and requirem Signature If meow ec Y t Approval of Building Official , Note: Three-family dwellings containing 35,000 cubic feet.or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: °•`Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. y_ Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities;many communities require,as part of the permit application, i that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. - t b Q:forms:homeexempt ' I MA SOC Filing Number: 201007009160 Date: 06/22/2010 4:16 PM. ' �1 . Sy} The Commonwealth of Massachusetts Mini mum Fee:$50000 .� William Francis Galvin Secretary of the Commonwealth,Corporations Division One Ashburton Place, 17th floor Boston MA 02108-1512 a_ r. h _ �`•�.-�., Telephone: (617)727-9640 TT . t i Federal Employer Identification Number: 272896309 (must be 9 digits) 1. The exact name of the limited liability company is: EK PROPERTIES,LLC 2a. Location of its principal office: - No. and Street: 23 OLD STAGE ROAD City or Town: CENTERVILLE State: MA Zip: 02632 C4untry:.USA x 2b. Street address of the office in the Commonwealth at which the records will be maintained: No. and Street: 23 OLD STAGE ROAD, City or Town: CENTERVILLE State: MA Zip`. 02632 Country: USA 3. The general character of business, and if the limited liability company is organized to render professional service, the service to be rendered: REAL ESTATE - r 4.The latest date of dissolution, if specified: 5. Name and address of the Resident Agent:, Name: EDWARD LENNON No. and Street: 23 OLD STAGE ROAD City or Town: CENTERVILLE State: MA Zip: 02632 Country:USA I, EDWARD LENNON resident agent of the above limited liability company,consent to my appointment as the resident agent of the above limited liability company pursuant to G. L. Chapter 156C.Section 12. =; 6. The name and business address of each manager, if any: Title Individual Name Address(no PO Box) First,Middle,.Last,'Suffix Address,City or Town;State,Zip Code MANAGER EDWARD LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA MANAGER KELLY LENNON 23 OLD STAGE ROAD CENTERVILLE, MA 02632 USA Y MANAGER EDWARDLENNON 8 CASTLE DRIVE y MANSFIELD MA 02048 ry 7.The name and business address of the person(s) in addition to the manager(s),authorized to execute documents to be filed with the Corporations Division, and at least one person shall be named if there are no managers. _ Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY EDWARD LENNON 23 OLD STAGE ROAD CENTERVILLE, MA 02632 USA SOC SIGNATORY KELLY LENNON 23 OLD STAGE ROAD i CENTERVILLE, MA 02632 USA r SOC SIGNATORY EDWARD LENNON 8 CASTLE DRIVE s MANSFIELD, MA 02048, 8. The name and business address of the person(s)authorized to execute, acknowledge, deliver and record any recordable instrument purporting to affect an interest in real property: Title Individual Name Address(no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY EDWARD LENNON - 8 CASTLE DRIVE `- MANSFIELD, MA 02048 REAL.PROPERTY EDWARD LENNON 23 OLD STAGE ROAD CENTERVILLE,MA 02632 USA ~� .STAGE ROAD CENTERVILLE,. SA s: REAL PROPERTY KELLY LENNON 23 OIL 9.Additional matters: r x SIGNED UNDER THE PENALTIES OF PERJURY,this 22 Day of June,2010, EDWARD LENNON (The certificate must be signed by the person forming the,LLC.) - 4 t 02001 -2010 Commonwealth of Massachusetts ! { All Rights Reserved MA SOC Filing Number: 201007009160 Date- 06/22/2010 4:16 PM THE COMMONWEALTH OF MASSACHUSETTS I hereby certi fi that, upon examinatiomof this`document; duly submitted to me, it appears that the provisions of the General Laws relative to corporations have been complied with, and I hereby approve said articles; and.the'filing fee having been paid; said'articles are deemed to have been filed with me on: June 22, 2010 4:16 PM w WIL•"LIAM FRANCIS GALVIN Secretary,of the Commonwealth X 0-804-0 ; s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 'Z o Parcel Application # Health Division Date Issued 1, v Conservation Division = Application Fee r q Planning Dept. "a Permit Fee S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis ;t Project Street Address /°I Village Owner (,mac Ay4 'Address Telephone 0- Permit Request [Ze-o&At Awktejo., aJ /- 3 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 101o9® Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 'I Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes XNo Basement Type: A Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: Z existing 0 new Total Room Count (not including baths): existing new First Floor Room Counts;, Heat Type and Fuel: A Gas ❑Oil ❑ Electric ❑ Other :w V ,J Central Air: ❑Yes 4FNo Fireplaces: Existing New �— Existing wood%coal stove: ❑-Yes ❑ No Detached garage: W existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing -U new= size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ _Commercial—gYes _OtNo. _ , es, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name AM /7/99AI � � Z,4.*tO "' Telephone Number Address Z2i 00 0 4­11> License # •. ���A�-''f �(�C. / 01 PIL ©Z ( 3 2 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ,rj��i 't� SIGNATURE DATE FOR OFFICIAL USE ONLY f APPLICATION# -DATE ISSUED: "- �•_'' r —MAP/PARCEL NO.-- !: i ADDRESS. - VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION 1 r FRAME ��`>!�lo ISr� ri t FIREPLACE I l r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:—4v ROUGH :?" FINAL L. : rZ'FINAL•=BU'ILD.ING i V. :DATE-CLOSED OUT ASSOCIATION PLAN NO. s - The Cominonweallh ofMassacliusetts ,Department of Industrial Accidents Office of Investigations 600 Washington Streei t� J Boston, MA 02111 sy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information' Please Print Legibly Name (Business/Organizatiorvindividual): //L Address: 7 Zj O td S r e Z� ;City/State/Zi : / Are you an employer? Check the appropriate box: • Type of project(required): 1. ❑ I,am a employer with 4. ❑,I aim a general contractor and I 6 ❑ New construction t - have'hired the sub-contractors-. ,employees(full and/of part-time). - --- --- o - --. . 2 m.eI a a sole proprietor.or partner- listed on the attached sheet. 7 ❑ Remdeling ship and have no employees These�sub-contractors have g, ❑ Demolition workingfor mein an ca aci employees and have workers' y P h 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5: ❑ We are a,corporation and its 10.❑ Electrical repairs or additions oficers have exercised imn 3.(� I am a homeowner doing all work h their 11 � Phbig reairs'or additions p myself. [No workers' comp.' ri fght of'ezemption per MGL 12.❑Roof repairs insurance regpired.] t c, 152, §1(4), and we have no v employees. [No workers' 13.❑ Other comp,insurance required.] *Any applicant that checks box 4) must also fill out the section below showing their workcrs'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name'of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workcrs'comp,policy number. I am an employer that is provfding workers'compensation insurance for my employees. Below is the policy and jab site info rmatio n Insurance Company Name: Policy# or Self-ins.Lic. #: Expiration Date: Job.Site Address: City/State/Zip; Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required,under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year nprisonment, 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 cover ge verification: I do hereby certify under the ains d p Ities ofperjury that the information provided above is trice and correct. ate.- �/z 70 0 Si nature; Phone#• Q'S ' 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 Inspectore'5,Plumbing Inspector 6, Other Contact Person: Phone#: information and bstructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensalion 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, Corp ration or other legal entity, or any two or more of the foregoing engaged in ajoint enterprise, and including the legal r presenlatives of a deceased employer, or the receiver or trustee of an individual,Tartnership, association or other 1 gal entity, employing employees. However the owner of a dwelling house having not more than three apartments a who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance constniction or repair work on such dwelling house or on the grounds or building appurte pant thereto shall not becaus of such employment be decmcd to be an employer." s L MGL chapter 152, §25C(6) also states that "every state or IDCB licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to c struct buildings in the commonwealth for any applieantwho has not produced acceptable evidence o1co pliance with the insurance coverage raquired." Additionally, MGL chapter 152, §25C(�) s al subdivisions shall tales "Neither the onunonwealth nor any ofits politic enier'into any contract for theperf6fthancXfpubJic--w)rk til acceptable evidence.ofcompliance with the insurance requirements of this chapter have beenpresc�nted to the co ract)ng authority." Applicants Please fill out.the workers' compensation affida ai co letely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s) name(s), addre s(e and phone munber(s)along with their cerlificaie(s) of insurance, Limited Liability Companies (LLC)or L filed Liability Partnerships(LLP) with no employees other than the members or partners, are not required to carry worke ' compensation insurance. 1f an LLC or LLP does have employees, e policy is required. Be advised that this a )davit may be submitted to the Department of Industrial Accidents for confirmation ofinsurance coverage, lso be sure to sign and date the af0rdavit, The affidavit should be returned to the city or town that-the application r the en-nit or license is.being requested,not the Department of Industrial Accidebts. Should you have any q'uestio s regar .ng the law or if you are required to obtain e„workers' compensation policy,please call the Department the numb listed beloW,,Self-insud companies should enter their self-insurance license number on the appropriate ne. ' City or Town Officials Please be sure that the affidavit is complete and tinted legibly, Tb Department has provided a space-al the bottom of the a�davil for you to fill out in the event the Office of lnvestigah ns bas to contact you regarding the applicant. Please be sure to fill in the.permiUlicense numbe which will be used a a•reference number. In addition,an applicant that must 'submit multiple permitflicense applica ons in any given year,\need only subrnit one affidavit indicating currenti or Policy information(if necessary) and under"Job ite Address'.' the applic nt should write"all ]Qcahons in town),"'A copy of the affidavit.that has been off tally stamped or marked by the city or townaY be provided to the applicant as proof that a valid affidavit is on file or future permits or licen ,s. Anew affdavi4.must be filled n>il each year, Where a home owner or citizen is obtaining a license or permit not related to any busines:sor commerci a l venture (i,e, a dog license of permit to burn leaves etc.) s d person is NOT required 10 complete this afffi'davlr• rattan and shou➢d youhaye an uestions, The Office of lnvestigal�ons wou M1 r, o Ih �n arJva fo-r�our cr�ar, Y 9 please do not hesitate to give us a call. The Department's address, telephone and fax nu her: j - The.Co onwealth'of Massachusetts Depa meet of Industrial Accidern±s ffice of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406'or 1-877-MASSAFE Fax # 617427-7749 Revised 4-24-07 www.mass,gov/dies r Towd'of Barnstable ,Regulatory Services Thomas F. Geiler,Director >vtwss. • 16.9. ,�� Building Division 'rfo µerg Tom Perry,Building Commissioner 200 Main Sfreet,__Hyannis, MA,02601, www.town.,barnstable.ma.us Office: 508-862-4038 ;,Fax: '508-790-6230 j HON EO'WNER LICENSE EXEMPTION '..`Pleare Print (.. DATE: s t � JOB LOCATION: / ) [ number s`trxt , village W"HOMfiONER": �6197�/l �o0 ,G!�� �r �6 name �j home phone# ,�` work phone# CURRENT MAILING ADDRPSS: L �i C�L� fiyASP /GtJ pf, city/town state 'zip code Z, The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that.the owner acts as supervisor_ DEFINMON OR HOMEOVr7%EI2 Person(s)who owns a parcel of land'on which he/she resides or intends to reside, on which there is,or is intended to- - be, a one or two-family dwelling, attached or detached structures accessory,to such use and/or farm structures. A person who constrgcts more than one home in a two-year period shall not be considered a homeoRnei. Such. "homeowner"shall submit to the Building OfEM' o`n a form acceptable to the Building Official, that he/she shall be responsib)e for all such work performed under the building?permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for co#liance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned "homeowner"certifies that•he/she understands the Town of Barnstable Building Department minimum inspection procedures Od requirements grid that he/sbe will comply with said procedures and r requirements. a , Signature o _V cr ., 4 Approval of Building Official Note: Three-family dwellings'contai.ning 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Constriction Control`: HOMEOWNER'S EXEMPTION. The Code states that "Any homeowner performing work for which a building permit is requirzd shall be exempt from the provisions of this scc6on.(Srcdcn I D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for hire to do such work,that such,Homeovmcr shall act as supervisor. Many homeowncn who use this exemption are unaware that they arc assuming the responsibilities of a supervisor(sec Appendix Q, Rules&Regulations for Liccnsing Cpnstruction Supervisors,Scction 2.15) This lack of awareness often results in serious problems,particularly When the homeowner hires unlicenscd.persons. In this case,our Board cannot procced'against the unlicensed person`'.as it would with a licensed Supervisor. The hoThcovencr acting as Supen-isor is ultimately responsible. To ensure that the homeowner is fully aware of hisAcr responstbilitics,many communities require,aspart•of the permitapplication., that the homeowner certify that he/she underssnds the responsibilities of a Supervisor._On.the last page of this issue is a form cuirent]y used by several towns. You,may care t amend and.adop't such a fom-/certiftcation for use in your community. Q:for ms:homccxcmpt ie 1 ry . TKEri Town of Barnstable Regulatory Services v ' KA & $ Thomas F. Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.towri.barnstable.ma.Lis Office: 508-862-4038 I Fax: 508-790-6230 Pr erty er Must Complet and Si n This Section If sin Builder I, le-Pt as Owner of the subject.. Jbjproperty hereby authorize to act on my behalf, in all matters relative to work autho ' d by building permit application for: (Ad ss of rob) Signature of Owner Date Print Name If Property' Owner is apF ing for permit please complete.the Homeowners License Exemption Forma the reverse side. Q:FORMS:O WNERP ERJY1TSS10N MA SOC Filing Number: 201007009160 Dater 06/22/2010 4:16'PM The Commonwealth of Massachusetts Minimum Fee:$500.00 William Francis Galvin Secretary of the Commonwealth,Corporations Division '.g One Ashburton Place, 17th floor Boston,MA 02108-1512 ` Div, Telephone: (617)727.-9640 03, ,'.. . s `3 t t z i �� u kt i Federal Employer Identification Number: 272896309 (must be 9 digits) 1. The exact name of the limited liability company is: EK PROPERTIES,LLC p 2a. Location of its principal office: 1 No. and Street: 23 OLD STAGE ROAD City or Town: CENTERVILLE State. MA Zip 02632 Country USA 2b. Street address of the office in the Commonwealth at which the records will be maintained: cy No. and Street: 23 OLD STAGE ROAD t City or Town: CENTERVILLE State:'MA Zip: 02632 Country:USA 3. The general character of business, and if the limited liability company is organized to render professional i service, the service to be rendered: REAL ESTATE 1 4. The latest date of dissolution, if specified: 5. Name and address of the Resident Agent: ° t Name: EDWARD LENNON ° No. and Street: 23 OLD STAGE ROAD City or Town: CENTERVILLE State`. MA Zip: 02632 Country:USA I, EDWARD LENNON resident agent of the above limited liability company, consent to my appointment as the resident agent of the above limited liability company pursuant to G. L. Chapter 156C Section 12, 6. The name and business address of each manager, if any: Title Individual Name Address(no P6 Box) •, First,Middle,Last,Suffix ' ' Address,City or Town,State,Zip Code MANAGER, EDWARD LENNON • CENTE23 OLD RVILLE, MA STAGE ROAD T ' 2 USA` ° 7 .. T MANAGER a „ KELLY LENNON pp �_ k '23 OLD STAGE ROAD CENTERVILLE, MA 02632 USA • MANAGER EDWARD LENNON _ ' • • 8 CASTLE DRIVE MANSFIELD,MA 02048 7.The name and business address of the person(s) in addition to the manager(s), authorized to execute d . documents to be filed with the Corporations Division,and at least one person shall be named if there are no managers. • t Title Individual NameAddress(no Po Box).: First,Middle,Last,Suffix Address,City or Town State,Zip Code SOC SIGNATORY EDWARD LENNON 23 OLD STAGE ROAD i CENTERVILLE, MA 02632 USA .¢ SOC SIGNATORY KELLY LENNON 23 OLDSTAGE ROAD CENTERVILLE, MA 02632 USA y SOC SIGNATORY EDWARD LENNON 8 CASTLE DRIVE # MANSFIELD, MA 02048 µ C 8. The name and business address of the person(s)authorized to execute,acknowledge;deliver and record any recordable instrument purporting to affect an interest in real property: Title Individual Name ~ Address(no PO Box) t First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY EDWARD LENNON . B CASTLE DRIVE MANSFIELD, MA 02048 REAL.PROPERTYDWARD LENNON f 23 OLD STAGE ROAD CENTERVILLE, MA 02632 USA REAL PROPERTY KELLY LENNON 23 OLD STAGE ROAD CENTERVILLE, MA 02632 USA 9.Additional matters: a SIGNED UNDER THE PENALTIES OF PERJURY,this 22 Day of June,2010, EDWARD LENNON 4 ; (The certificate must be signed by the person forming the LLC.) - e , ©2001-2010 Commonwealth of Massachusetts All Rights Reserved F MA SOC Filing Number: 201007009160 Date: 06/22/2010 4:16 PM THE COMMONWEALTH OF MASSACHUSETTS I hereby certify that, upon examination of this document, duly submitted to me, it appears that the provisions of the General Laws relative,to corporations have been complied with, and I hereby approve said articles; and the filing fee having been paid, said articles are deemed to have been filed with me on: June 22, 2010 4:16 PM r WILLIAM FRANCIS GALVINs e ' r •y Secretary of the Commonwealth 0-804-0 T BoiseCascade Double 1-3/4" x 7-1/4"VERSA-LAM® 2.0 3100 SP Floor BeamT1301 BC CALC@ 3.0 Design Report-US 1 span No cantilevers 1 0/12 slope Friday,August 13,2010 Build 440 File Name: $NewDefault Job Name: Lennon Description: case opening header Address: 15 Old Stage Rd Specifier: City, State,Zip: Centerville, Ma Designer: BC ' Customer: Company: Shepleys Code reports: ESR-1040 Misc: 04-06-00 BO,3-1/2" 61,3-1/2" LL 60 Ibs LL 60 Ibs DL 46 Ibs DL 46 Ibs Total Horizontal Product Length=04-06-00 Live Dead Snow Wind Roof Live Trib.(in.) Load Summary Tag Description Load Type Ref: Start End 100% 90% 115% 133% 125% 1 attic Unf.Area(psf) L 00-00-00 04-06-00 20 10 01-04-00 Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 96 ft-Ibs 1.1% 100% 1 1 -Internal. Completeness and accuracy of input must End Shear 64 Ibs 1.3% 100% 1 1 -Left be verified by anyone who would rely on Total Load Defl. L/38,092(0.001") 0.6% 1 1 output as evidence of suitability for Live Load Defl. L/67,3,44(D.001") 0.5% 1 1 particular application.Output here based 0 on building code-accepted design Max Defl. 0.1 /0 1 1 properties and analysis methods. Span/Depth n/a 1 Installation of BOISE engineered wood -- products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2"x 3-1/2" 106 Ibs n/a 1.2% Unspecified or ask questions,please call 61 Post 3-1/2"x 3-1/2" 106 Ibs n/a 1.2% Unspecified (800)232-0788 before installation. BC CALC@,BC FRAMER@,AJS- Notes ALLJOIST@,BC RIM BOARD TM,BCI@, Design meets Code minimum(L/240)Total load deflection criteria. BOISE GLULAMT"' SIMPLE FRAMING Design meets Code minimum (L/360)Live load deflection criteria: SYSTEM@,VERSA-LAM@,VERSA-RIM Design meets arbitrary(1") Maximum load deflection criteria. PLUS@,VERSA-RIM@, VERSA-STRAND@,VERSA-STUD@ are trademarks of Boise Cascade,L.L.C. Connection Diagram LI b d a —• �• • c . • t. a minimum=2 c=3-1/4 M . b minimum=3" d= 12" Member has no side loads. Connectors are: 16d Sinker Nails Page 1 of 1 BoeseCascade Double 1-3/4" x 7-1/4"'VERSA-LAM® 2.0 3100 SP Floor Beam11713O2 BC CALC@ 3.0 Design Report-US 1 span No cantilevers 1 0/12 slope Friday,August 13,2010 Build 440 File Name: $NewDefault Job Name: Lennon Description: beam over kitchen Address: 15 Old Stage Rd Specifier: City, State,Zip: Centerville, Ma Designer: BC Customer: Company: Shepleys Code reports: ESR-1040 Misc: 11112 +/ i�/7 i. .-, ., i:; ..�fawra✓. .s�..n�e/�iui.` ., .... ... .:e ' >:a' .,,,n,.�i%i.„�,r�w _ 10-00-00 BO,3-1/2" B1,3-1/2" LL 1,124lbs LL 1,136lbs DL 604 Ibs DL 614 Ibs Total Horizontal Product Length=10-00-00 Live Dead Snow Wind Roof Live Trib.(in.) Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% 1 ceiling load Unf.Area(psf) L 00-00-00 10-00-00 '20 10 11-00-00 2 FB01 Conc. Pt. (Ibs) L 06-00-00 06-00-00 60 46 n/a Controls Summary Value %Allowable Duration Case Span Disclosure Pos. Moment 4,039 ft-Ibs 48.2% 100% 1 1 - Internal Completeness and accuracy of input must End Shear -1,448 Ibs 30.0% 100% 1 1 -Right be verified by anyone who would rely on Total Load Defl. L/386(0.297") 62.2% 1 1 output as evidence of suitability for Live Load Defl. L/595(0.192") 60.5%-- - 1 - 1 particular application..Output he based Max Defl. v/ on building code-accepted design 29 7 . 1 1 properties and analysis methods. • 'Span/Depth 15.8 n/a 1 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide BO Post 3-1/2"x 3-1/2" 1,728 Ibs n/a 18.8% Unspecified or ask questions,please call B1 Post 3-1/2"x 3-1/2" 1,750 Ibs n/a 19.0% Unspecified (800)232-0788 before installation. BC CALC@,BC FRAMER@,AJS- Notes ALLJOIST@,BC RIM BOARDTM,BCI@, Design meets Code minimum(L/240)Total load deflection criteria. BOISE GLULAM- SIMPLE FRAMING Design meets Code minimum(L/360)Live load deflection criteria. SYSTEM@,VERSA-LAM@,VERSA-RIM Design meets arbitrary(1") Maximum load deflection criteria. PLUS@,VERSA-RIM@, VERSA-STRAND@,VERSA-STUD@ are trademarks of Boise Cascade,L.L.C. Connection Diagram b d f a c a minimum=2" c=3-1/4 b minimum= 3" d = 12" Connection design assumes point load is'top-loaded'. For connection design of'side-loaded' point loads, please consult a technical representative or professional of Record. Member has no side loads. Concentrated loads are not considered in side load analysis. Connectors are: 16d Sinker Nails , Page 1 of 1' i ■ i■�■�■� � i : �■��� �i®ter ®��1�1�1�6� ■i■ ■■■■ ■■ ■■■■■ ■ ■■■■■■■■ ■■ ■■■ ■■■■ ■�■■ ■�■�■■■■■ i al�L� 2X�+a7141 � Z ac �, t T\ W 1 r � -�. ...... w .ram r..�-..w..aA1��-{•.�d� � ,. a z. (:; 4 PERMITTown of Barnstable *Permit# � ,dP SS Ezp=onthsfrom JAN 1 4 Regulatory Services F Thomas F.Geiler,Director �t�WN of SARNSTASLE Building Division oK i II 1006 Tom Perry,CBO, .Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable.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 O 4Sf - z Property Address .c- n0 %Residential Value of Work ,,&Ze o a Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Named44 / if b� �"1.� 2i�� Telephone Number Home Improvement Contractor License#(if applicable)' Construction Supervisor's License#(if applicable) kman's • ompensation Insurance Ch one: I am a sole proprietor ❑ fam the Homeowner VI have Worker's Compensation Insurance r Insurance Company Name �� �'� � f S N CoC Workman's Comp.Policy# to t4 7 4/,q C-. (r� L/ 5 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to . ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side �C] Replacement Windows/doors/sliders. U-Value , 3 (maximum.44) *Where required: issuance of this pemtit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Lett of ermissi n. A copy of the Home ove ent Contrac ois Licen is ed. SIGNATURE: Q:Forms:expmtrg Revise061306 r • 4 ' 67'�ie �omvmo�uuea;�z a��/�.a�ac�ittael`t .. ' Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR Registration: ,114330 Expiration =8127/2009 Tr# 132612 jMYpe '.Individual " PAUL T.HUNTING TON ,e PAUL HUNTINGTON.F 124 ROSEMARY LANE BREWSTER, MA 02631 Administrator ' 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 Lefibly Name(Business/Organization/Individual): rA 1, l Al Address: / .4 is 44 � City/Stateizip: M hone t 0 Are you an employer?Check the appropriate bog: :Type of project(required):, e to er with 4. [] I am a general contractor and I 1.0i . eelnv y 6. ❑New construction . loyees(full and/or part time)•* • have hired the sub-contractors 2. T am a'sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• []Demolition avarkin for me in an capacity. employees and have workers' g Y P ty $. 9. ❑Building addition [No workers' comp.insurance COnIp.insurance. 10,0 Electricalr airs or additions required.] 5. ❑ We are a corporation and its ' repairs officers have exercised their 11. Plumbin repairs or additions '3.❑ I arri a homeowner doing ill-work . ❑ . g P myself[No workers' comp. right bf exemption per MGL 12,0 of repairs insurance.required.]t 152, §1(4),and we have no e 13. �' Other-6d�w f��rc3'Io�J employees.[No workers • comp,insurance required,] *Any applicant @gat checks box#1 must also fill out the section below showing their workers'compensation policy information. t 1:m=wners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating'such. x-=tmctors 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,theymust provide their workers'comp,policy numbcr. I ani an employer that is providing workers'compensation insurance for my employees. Below isthe policy and job site information. Insurance Company Name: Ae � Policy#or Self-ins.Lic D Expiration Date: //• a P Job Site Address: City/State/Zip:(���'l 'L`'�1/if a2.6 Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Fail=.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip tti$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the-Office of Investi 7ations of the biA&Z �i-suranCe vera a verification. I do hereby certz;�under the nd p n. '-s of perjury that the information provided above is true and correct - Date: ,Ole Si ature. .� — Phone# Official use only. Do not write in this area, to be completed by,city or town.official City or Town: ' Permit/License# Issuing Authority'(circle one): .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other ; Contact Person: •Phone#: Y Town of Barnstable ' Regulatory Services yBA I'F$ Thomas F.Geiler,Director �A s63y. �m rE16j;q A Building Division Y Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Us irig A Builder I, , as Owner of the subject property hereby authorize �� �� to act on my behalf, in all matters relative to work authorized by this building permit application for. (Add6ss of Job Signa r of Owner D e Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM S:O WNERP ERM IS S ION 41' Town of Barnstable 'THE tip o� Regulatory Services BARNSTABIX Thomas F.Geiler,Director MASS. 1639• .•� Building Division ATED IJIA�p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-86`2-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXE PTION Please Print DATE: JOB LOCATION: a e,0,4/0 ewVTf.:2.V1LL, �Lnnuum r street village "HOMEOWNERY:`T/'/ O J�7 name ho phone# work phone# CURRENT MAILING ADDRESS: R D ty/town state zip code The current exemption for"homeowner "was a tended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an indivi al r hire who does not possess a license,provided that the owner acts as su ep rvisor. E ITION OF HOMEOWNER Person(s)who owns a parcel of land on w 'ch he he resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attach or detac d structures accessory to such use and/or farm structures. A person who constructs more than one me in a two- ar period shall not be considered a homeowner. Such "homeowner"shall submit to the Bui ing Official on a orm acceptable to the Building Official,that he/she shall be responsible for all such work erfo ed under the buildin ermit. (Section 109.1.1) The undersigned"homeZne 'scames responsibility for co iance with the State Building Code and other applicable codes, bylawregulations. The undersigned"homefies that he/she understands the To fB stable Building Department. minimum inspection pr requirements and that he/she will co said procedures and requiregipts ignature of owner Approval of Building Of cial Note: ee-family dwellings containing 35,000 cubic feet or larger will be requir to comply with the State Building Co e Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Cod states that: "Any homeowner performing work for which a building permit is required shall be exe t from the provisions of this section(Sec on 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s or hire to do such work,that such H meowner shall act as supervisor." Many omeowners who use this exemption are unaware that they are.assuming the responsibilities of a supervisor(see ppendix Q, Rules&Regula ons for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problem, articularly when the home wner hires unlicensed persons. in this case,our Board cannot proceed against the unlicensed person as it would with icensed Supervisor. a homeowner acting as Supervisor is ultimately responsible. T ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit applica'fin, that the ho eowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used b; several tos. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt aTown of Barnstable ' `"Permit#��--�' Expires 6 n+onthrftom Lnus dale e o RX��pu. Regulatory Services e �R6 OL ie39. Thomas F.Geiler,Director m rc . T Building Division MAY . I Tom Perry, Building Commissioner, 2 �QO� 200 Main Street, Hyannis,MA 02601 TQ Office. 508-862-4038 - VVN of SARIS Fax. 508-790-6230 �qB�� EXPR+SS PERMIT APPLICATION - RESI DENTLkL ONLY Not Valid without Red X-Press lbtprint Map/parcel Number , Property Address n kuResidential Value of Work c Owner's Name&Address Q 1 Contractor's Name �Gy l J �GZe t�l X)(�5 y�l Telephone Number �`�(),g) 1 t Home Improvement Contractor License#(if applicable) Conatxuction Supervisor's License#(if applicable) aP 325 03 fgWorkmau's Compensation Insurance " Check one: ❑ I am a sole proprietor ❑ I tun the Homeowner ' e I have Worker's Compensation Insurance Insurance Company Nam a I VrG-V�,�r`j 1 f1C1 a_t't� 1`�1 -1PJ U g: aax J G Workman's Comp.Policy# _ - - Permit Request(chock box) Ac-roof(stripping old shingles)J�All construction debris will be taken to s ❑-Re-roof(not stripping. Going over - existing layers of roof) t. •- ❑ -' Re side 4 ❑:Replacement Windows. U-Value (maximum.44) ❑ Other(specify) x ' 3. _ •Whera raquired °Issuance of thin pertmt does not exempt compliance with other town dcpUtment regulations,i.e.Historic,Cwieervat] etc ei- Signature VA Q.Forms:expravgN y; w` r x .4 Revised121901 " y Y Qom. ._..-.- DATE 60 DD CERTIFICATE OF LIABILITY INSURANCE 517/M/003 >RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION IL ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McShea In-turance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, Ma. 02655 INSURERS AFFORDING COVERAGE 508-420-9011 IISURED Paul J Cazeault & Sons Roofing Inc. INSURER A: WeStern Heritage In INSURER B: TravelerS Indemnity f I l 11no1 1031 Main Street INSURERC: Ostervllle, Ma 02655 INSURERD: INSURER E: ;OVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS rR DATE MM/DDlYY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $1 0 0 0 0 0 0 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE Fx�OCCUR MED EXP(Any one person) $ A TBI 04/30/03 04/30/04 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 0 0 0 0 0 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 0 0 O 0 0 0 POLICY PRO JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR l I CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ I, RETENTION $ $ C WORKERS COMPENSATION AND WC STATUS O rH- EMPLOYERS'LIABILITY TCRY LIMITS I-R 7PJUB-922X653-502 08/10/02 08/10/03 E.L.EACH ACCIDENT $100.000 _ B E.L.DISEASE-EA EMPLOYEE $10 0 0 0 0 ( E.L.DISEASE-POLICY LIMIT 1$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS I I CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL �_ DAYS WRITTEN — -- --- - - NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE:INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZfD,AEPRESENTATIVE ACORD 25-S(7/97) 0 ACORD CORPORATION 1988 �. Or I C: A s I-I b `-t o t:; I I G. J L i(J i ;-j i n-, I��c 1 oston fVla0?1 Tr, l'). • . :I, II, I .I Ir:l. alll .ill[I [.i..ni• � [.I .Ilhllc .'. Ilulllli..illull. DOAKD..01 UUJI_UINC; 1(I_(,UL.i1111.11I:;uCunuu: C(P ;Tl:uc Nulplf ur:'C;i Gxpiru;,:::1JIL 0/20/;'OG:• I'r. ln lu Ku�A1'1'c1ud:'00 PAUL i CAZLAUL'1 15U5 MAIN ,'t 05T�I�VILL�, tvI A 01Wu _ i�✓l.',1. ., -col Board of Building Regina ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home In-iprovement Contractor Re Registration: 103714 Type: Private Corporation Expiration: 7/9/2004 PAUL J. CAZEAULT & SONS, INC. ' Paul Cazeault P.O. Box 2781 Orleans, MA 02653 Update Address and return card. Mark reason for clia nge. Address I I Renewal I mploymenl ! Lost Card Board of Ituilding Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building Regulations and Standards Expiration: 7/9/2004 One Ashburton Place Rni 1301 Boston,111a.02108 Type:. Private Corporation LSONS, INC. s FEE 03 TOWN OF BARNSTABLE, MASS. � a a 19 v 0 HgDo CD THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO � o MV ............................................................................................................................................................................... ......................................................................................................_.«... (PROPERTY OWNER) (ADDRESS) N E.1 (BUILD) (ALTER) (REPAIR) d "h A .........................................................................................................................................._..........._................................ ...............................................«.««..........................._...__.... O � _.« t. (TYPE OF BUILDING) (APPROXIMATE SIZE) \ O w do p LOCATION ................................................................«........................................._..... ...«......................................................................_............_......I....._............. J y (STREET AND NUMBER) (VILLAGE) NAMEOF BUILDER OR CONTRACTOR _....__...._.........................._......_..................-..................«.._....._......_........._.._..........._........_............_......__ A APPROXIMATE COST «.. cl y I. Boca I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN �M OF BARNSTABLE REGARDING THE ABOVE CONSTRUCTION. o Pq c °tc rW (U' W (OWNER) (CONTRACTOR) CIS V O U '+ O _.........__._......................._....__......_........._.........__................................................................................... yR BUILDING INSPECTOR Subject to Approval of Board of Health. 44, €Ye5 .' a.r^� 3i - zi oL . 4 x p It in ak — 7 w w� „ .. f is �. �+ � �' � §ail ` .- .• ¢' wE s CENTERVILLE VARIANCES REQUESTED: ROUTE 28 1) S.A.S. TO PRbPERTY LINE (10' MIN".. 5' PROV.) 5' REQUESTED 29 2) S.A.S. TO CRAWL SPACE (20' MIN., 15.7' PROV.),.4.3'.REQUESTED I! � / �,4o-Mtt_ L1ntE2.P�ov.t[aED� t ' _ O N za r. o � / l k c� 04 m PARCEL ID: 30 F� PARCEL ID: 208/157 208/156 { LOCUS N 77 40, "E 1 PINE TREE DR 30 5'S 11 33, 20. ' T � A • 15.7�. �72.�8' PAT10 . :�.�/ -B LOCUS MAP CV PLAN REF: 287/42, 277/4, LCP 12422F & 124221 ALSO EASEMENT PLAN BY BAXTER & NYE (09/05/80) 19 -/.. o o ./. . # , ^wV , ✓ TITLE REF: CTF#63808 (ESTATE OF MAYA JAKLITSCH) 5' / / ` PARCEL ID: MAP 208 ,LOT 155 S 6 5' . 3-.BEDROOM �, f��Z ZONING: "RD-1" SETBACKS: 30'F-10'S-10'R 16.5 DWELLING N 7F •J FLOOD ZONE: "C" COMMUNITY PANEL 250001=15C DATED:08/19/85 TP i OR. CRAWL SPACE ACCESS Ro. - SEPTIC SYSTEM — D BOX, PIPING & LEACHPIT � i ELEV.=33.4 TO BE REMOVED moo, _fi t Jr ��� `�' , ,. REPAIR PLAN LOCATED AT: #19 OLD STAGE ROAD TP 2 M - — CEN.TER VI LLE, M A. GAS ' PREPARED FOR o w WM , AsP EDWARD 8� KE LLY 6�. - — 7 5g ., AL T — O�� w N� _ oRl�EwAr - LENNON PARCEL ID: 59.73'_ —, ' SCALE:. 1"=20' 208/031 / � / — / — W U . — — JULY`-07, 2010 TN OF A{qs _oA Or hk O m ( / //.Co /// ,, ' DAVID GN ��� WARD GI,aj /2-BEDROOM./ W FLAH TY, J A N�'S PARCEL ID: DWELLING o� WV S 0 E m � 208/155 ci ; . . N 1 Iq m AREA=11,005f S.F. z , 2-CAR •/ ° 28 �o z �.: E ;/ . TCF=36.0;0� / \� co.� �'�STER�o s, GARAGE j /. / \� I I S4n'!T. 1F AL LANDS 17.5' j .. . S2. O j .tea. wv p.5' �9, R�oo�, Col- Q s N89'06'00"E 55.00' �p po F N I , E. A. S. S ^ SURVEY, INC. 36 .7 141 ROUTE 6A GRAPHIC SCALE s• ®- - — — — — —— — _ �_ / SALT POND BUILDING 20 0 70 20 P.D. BOX 1729 •.T, C C , PINE TREE DRIVE 1i E—T— c�yo� SANDWICH, MA. 02563 P i "' N ( IN FEET ) - 1 inch = 20 ft.. BUS:(508)888-3619 CELL:(508)527-3600 SHEET 1 OF 2 J 1255SEP n 4 pew+ j Ni lkjn ! i',Yt4 S§��s .,YTE i D I V I S IT 1-, I 19"on Centers i 2x8 Ridge 12 2x6 collar ties - 1 2.25 12 board sheathing R 30 insulation —7 ..._ 2x6 rafters 16"oc -- 2x6 rafters 16"oc R 30 insulation 2x6 Ceiling joists 16"oc board sheathing `O board sheathing R15 insulation ;R15 insulation r' 2x4 studs 16"oc 2x4 studs 16"oc R19 insulation R 19 insulation 2x8 floor joists 16"oc 2x8 sleepers concrete slab 8"block foundation r 20'-0" 10'-0" Right side Section IA,ridge board — -- 12 Ix6 collar ties 19"OC 12 2x6 full dimension rafters R 30 insulation R 15 insulation 16"On Centers R 30 insulation 2x6 raftes 16"OC ; 2x4 ceiling joist 2x4 full dimension studs 19"OC 8 9 16 "OC C1 Board sheathing 2x4 studs 16"OC R 15 insulation R 19 insulation 11 risers 2x8 floor joist 2x8 floor joists 16"OC concrete slab Stone foundation �---- 14'-0" 10'-0" I Front Section EK Properties, LLC / Ed Lennon / 5' 19 Old Stage Rd, Centerville, Ma Existing Sections 4 Front and Right Drawn by WHE Scale 1/4" = 1 Foot