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0214 PARK AVENUE
A 0 Q Town of Barnstable Building �, �, uR ained"An",Job arid,#his hard Must befKe't Post.This Cartl So That itts Uis�ble.From,;the Street Approved PlansMust be et Posted Until FinalNlnspection Has e � v � ,z �� e ;,� �.y �„ BARNnA � Permit • ` <' r-v ccw anc �s Re uired�such=Biildm shall Notbe Occu �ed'unt�l aFinaf�lns ect�on�has been�rna'de.; Wherea Certificate of O - .. . Permit No. B-18-3008 Applicant Name: Mike McMahon Approvals Date Issued: 09/13/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 03/13/2019 Foundation: Location: 214 PARK AVENUE,CENTERVILLE Map/Lot 207 136 Zoning District: RD-1 Sheathing: Owner on Record: GILMORE,BRUCE P&GAEL B RContractor Name MICHAEL T MCMAHON Framing: 1 QV Address: 214 PARK AVE Contractor License CS 068111 2 CENTERVILLE,MA 02632 Est Project Cost: $7,777.00 Chimney: Description: Weatherization,weather stripping,air sealing' H&B16wnicellulose. Permit Fee: $89.66 Insulation: Fee Paid u $89.66 Project Review Req: � 3. 2D,atex 9/13/2018 Final: ... Plumbing/Gas 4 �JJ,r Y f Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by is permit is commenced within six monthls after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the"approved construction documents,,for which this permit has been granted. . All construction,alterations and changes of use of any building and structures shallbe in compliance with the local zon rig by laws an codes. Final Gas: This permit shall be displayed in a location clearly visible from access streetor road and shall be maintained open for public mspeion for the entire duration of the ` 5 work until the completion of the same. AJ Electrical The Certificate of Occupancy will not be issued until all applicable'signatures by the�Buildmg and,Flre Officals are,provded on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: . 1.Foundation or Footing - Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low,Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site O/v��� Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �F tfiE Tp� Town of Barnstable *Permit# W 0 ZOR f 'b Expires 6 nronths from issue date PERMIT Regulatory Services Fee • BARNSTABLE, " _ y M sst. Z 2009 Thomas F. Geiler, Director ArFD MP'�A TOWN OF BARNSTABL.E Building Division 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 pp J ti i Property Address & _ 1�( l!'� U-e— CPiZ ❑ Residential Value of Wort. Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address� Contractor's Name�,JcJ� Telephone Number 1 Ionic Improvement Contractor License#(if applicable) 1011 L`(.9 Construction Supervisor's License# (if applicable) ❑Workman's Compensation Insurance Chec -one: [3am a sole proprietor WI am the Homeowner have Worker's Compensation Insurance 1�C��CiC Insurance Company Name Workman's Comp. Policy # o.�C C LICcS; 1 aUU Copy of Insurance Complia'nee Certificate must.be on file. Permit Request (check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken t2PP2r"S_QP -,�L1 Los*► ?-co ❑ Re-roof(not stripping. Going over existing layers of roof) . L�-'Re-side (A-rcZ!�> 5t�i,.61 Replacement Windows/ oors/slid)s. U-Value �� (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATU11E: i:'U I'1 11.I:S+J t)I iv1S\hui ing permit forms\EXPRESS.doc kcviscd 100608 • R, j "��o�z"rea� ��2,�.�CrauultioP,tt Board of Building.Regulations and Standards v HOME IMPROVEMENT CONTRACTOR - Registrat'on`;,,101149 . ..i ExP 6L25/ ation 2010 I Type vidual Tr# 267680 JOHN P. DUNN f y '�1f 4-• , F # .: - i John Dunn _ 80 MARIE ANN TERR CENTERVILLE,MA 02632 MJ ^ i a _� Administrator - = ✓ ' Boar o m mg egu ati oris and Standards ' r Construction Supervisor License i � E License• CS 14007 r Expiration 5/25/2010 Tr# 23257 � � i Restriction OOf L�, � { . .• } l • JOHN P DUNN BOX 924/8Q MARIE;ANN'TER -'�— Ii CENTERVILLE,MA 02632^�� � 1 Commissioner M a r J . ,. ¢mots . • }o'Pl a4 . \ 0 A %1M`aXaa o*a oa 1't ' F po�N po�� ��a>> oe s aaeQ cAs , k` sPacQ�;��popo3o3pt�¢�p°�a o as Boar o ui mg egu atio s and Standards Construction Supervisor License License: CS 14007 Expiration 5/25/2010 Tr# 23257 • � � Restnct��on 00 �. - - JOHN,P DUNK 4 r BOX 924/80 MARIE ANNTER'Al �,.G.- CENTERVILLE,MA 02632 '" Commissioner T . Ul.r -LL-LUUOIicUI UO- U't �nnl.�Ul.m a frluaU UU rna,rnnn�r. Ir'nn I . UU 1; UUb " ACOR k CERTIFICATE 4F LIABILITY INSURANCE 10/22/20o PRODUCER (781)344-3200 FAX (781)344-1425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Malcolm & Parsons Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6 Freeman St. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 527 Stoughton, MA 02072 INSURERS AFFORDING COVERAGE - NAIC INSURED Jon Dunn ._,-, - INSURERA: Associated Employers Insurance DBA: John Dunn INSURERB: P.O. Box 924 INsukeRc ---- ----------- ------- Centerville, MA 02632-0924' INSURER INSURER S COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NMAED 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. INSR ADD' TYPE OF INSURANCE POLICY NLRBER POLICY EFfECTP/E POUF(EXPIRATION LIMITS - - GENERAL LIABILITY - - . - EACH OCCURRENCE - COMMERCIAL GENERAL LIABILRY - - ' DAMAGE TO RENTED CLAIMS MADE OCCUR r MED'E)(P(Any one person) S PERSONAL&AOV INJURY S GENERAL AGGREGATE S - - GEN'L AGGREGATE LIMIr APPLIES PER' - - PRODUCTS-COMPIOP AGG 5 ' POLICY JEC r LOC ---- AUTOMOBILE LIABILITY - COMBINED StlJGLE LIMB ANY AUTO - r (Ea awcienl) ALL OWNED AUTOS _ BODILY INJURY S SCHEDULED AUTOS (Per person) HIRED AUTOS� � � � "' BODILY INJURY _ (Peraaident) NON{1'v11NED AUTOS- t ' •. PROPERTY DAMAGE ' (Per accident) - - - i GARAGE LIABILITY AUrU ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S - - AUTO ONLY: * ACG S - EXCES&UMBRELIA LIABILITY - EACH OCCURRENCE -S - OCCUR CLAILLS MADE AGGREGATE S " - S -- DEDUCTIBLE - -., - - _ ---- S — ---- RETENTION S S — r r rr R- WORKERS COMPENSATION AND - IdICCS0046S8012008 09/29/2008 09/29/2009 EMPLOYERS'LIABILITY A. ANYPkCPRIETORh'APfNtRlEXECUTIVE E.L.EACH ACCIDENT S 500, WO OFFICER/MEMBER EXU UUED1` E.L.DISEASE-EA EMPLOYEE 5 500,000 N yes,describe under - - - SPECIAL PROVISIONS Mlrm E.L.DISEASE-POLICY UMI1 S -SOO OO OTHER r DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Carpentry Contractor ohn Dunn is-covered by the Workers Compensation policy. , CERTIFICATE HOLDER CANCELLATION ' SHUULU ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL ' - DAYS WFNUEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. ` BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Insured:'s Copy OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, Evidence Of Insurance r AUTHORIZED REPRESENT ATIVE David Parsons ACORD 26(2001/08) ©ACORD CORPORATION 1988 ;A The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizationtlndividual). 1.1t�� Address: SJrpyru City/State/Zip:_ 3A Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 1.El--I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2:❑ I am a sole proprietor or partner-' listed on the attached sheet. 7. .❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition, [No workers'•comp.-insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have emplgyees,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.#: ��'`�''t���,Y1�� � Expiration Date: p Job Site AddresS:A ( 0Aa Q)_ City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).06 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 DIA for insurance coverage verification: I do he eby certify nder the pains and penalties of peilury that the information pr'•vided above is true and correct Si ttue: Date— Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other . Contact Person: Phone#: Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, :. express or implied,oral or written." M, _. An employer is defined as"an individual,partnership,association,corporation or other legal entity or any two or more of the foregoingg-engag m a jomt-enterpriser ai mel0ff_g the legal representative �f degas �mpioyerar. receiver or trustee of an individual,partnership, association or other legal entity,employing em oyees.'However the owner of a dwelling house hag not more than three apartments and who resides therein,or a occupant of the dwelling house of another whd employs persons to do maintenance,construction or repair w k on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be eemed to be an employer." MGL chapter 152, §25C(6)also�states that"every state or local licensing agency shall 'thhold the issuance or renewal of a license or permit to operate a business or to construct buildings in th commonwealth for any applicant who has not producediiacceptable evidence of compliance with the insur nce coverage required." Additionally,MGL chapter 152, §2�SC(7)states`Neither the commonwealth nor any f its political subdivisions shall . enter into any contract for,the perro ance of public work until acceptable evidenc of compliance with the insurance _ requirements of this chapter X11 presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,b/na ng a boxes that apply to your situation and, if necessary,supply sub-contractors)names address(es)and phoe )along with their certificates)of insurance. Limited Liability Companies(LL )or Limited Liabili ships(LLP)with no employees other than the members or partners,are not required to carry workers'compensance. If an LLC or LLP does have employees,a policy is required. Be advised tha this affidavit mamitted to the Department of Industrial Accidents for confirmation of insurance coverag . Also be sure nd date the affidavit. The affidavit should be returned to the city or town that the application or the permit o is being requested,not the Department of Industrial Accidents. Should you have any questio regarding th if you are required to obtain a workers' compensation policy,please call the Department at th number ' w. 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 legib y., e.Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investiga ;ns has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,ne only submit one affidavit indicating current policy information(if necessary)and under"Job Site Addess"the applicant hould write"all locations in - (city or town).".A copy of the affidavit that has been officially stamped or marked by city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A ew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to comple this affidavit. i The Office of Investigations would like to.thank you in advance for your cooperation and s uld you have any questions, please do not hesitate to give us a call } The Department's address,telephone-and fax number: j The Common*th of Massachusetts Depari went of Industrial Accidonts Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext-406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 ' www.mass.gov/dia I 'All zHKE Town of Barn-stable Regulatory Services 9ui�s jE�, Thomas F.Geller,Director 1&6 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I, InUCL CILIAL&.2 , as Owner of the subject property hereby authorize�#�'�5:�SJ to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner CDate Print Name f If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM S:O WNERPERMISSION w . Town of Barnstable 'THE Regulatory Services Thomas F.Geiler,Director awxHsrwar.e_ auss g . tb Building Division prED Tom Perry,Building Commissioner -200 Main.Street,-Hyannis,MA 02601 P .. _..... ..... ..__. _.... . vr".town.barnstable-ma.us. Office: 508-862-4038� /if Fax: S08-790-6230 HOMEOWNER LICENSE EXEMPTION p Please Print r °' f DATE: f JOB LOCATION:— . umber street village "HOMEOWNER': name home phone work phone# CURRENT MAILING ADDRESS: cityhown state zip code The current exemption for"homeowners"was ex d to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for who does not possess a license,provided that the owner acts as supervisor. DE ON HOMEOWNER Person(s)who owns a parcel of land on which she resid or intends to reside,on which there is, or is intended to- be, a one or two-family dwelling, attached or tached strut s accessory to such use and/or farm structures. A person who constructs more than one home' a two-year perio hall not be considered a homeowner. Such "homeowner"shall submit to the Building fficial on a form acre table to the Building Official,that he/she shall be- rmponsible for all such work performed der the building ermit. ection 109.1.1) ' The undersigned"homeowner"assume responsibility for compliance th the State Building Code and other applicable codes,bylaws,rules and re lions. The undersigned."homeowner"ce ' es that.he/she understands the Town;of.. table,Build'.g Department minimum inspection procedures an,.requirements and that he/she will comply 'th said procedures and requirements. i t .y Signature of Homeowner Approval of Building Official Note: Three-fa.milytdwellings 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 ad 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 caret amend and adopt such a form/certification.for use in your community. Q:forms:homecxempt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION YC Map_ U Parcel.. 'Application # ;?09-/V0�: r Health Division Date Issued Conservation Division Xr� '�Appf cation Fee Planning',Dept Permit Fee - � Date Definitive,Plan Approved by Planning Board ' t { Historic OKH Preservation!Hyannis Project Street Add es Village Owner l Address Telephone � �s---�3L s J 3 Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District; Flood Plain Groundwater.Overlay Project Valuation a; 000construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ',° Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ a` Commercial ❑Yes ❑ No If yes, site plan review# cti 3:" Current Use �� Proposed Use i e APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 4, Telephone Number Address License # Home Improvement Contractor# do Worker's Compensation # /�' ALL CONSTRUCT ON DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY ' APPLICATION# G DATE ISSUED ,r MAP/PARCEL NO. ADDRESS VILLAGE OWNER 1 DATE OF INSPECTION: x - - FOUNDATION FRAME r INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL z PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING } E , DATE CLOSED OUT. r ASSOCIATION PLAN NO. ' r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations.- ' 600 Washington Street Boston, MA 02111 �� yy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 1/7 Address: �'®1G 7 City/State/Zip: Gr/ a hL.#: -� AyI( an employer? Check th appropriate box: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and F 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or'partner listed on the attached sheet: T. El 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.$, required.] 5. ❑ We are a corporation and its '10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑R epairs c. 152 insurance required.]t ' §14( )'and we have no 13. Other r employees. [No workers' comp.insurance required-] *Any applicant,that checks box#1 must also fill out the section below showing their workers'compensation policy info n. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ZContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: e• ,a Policy#or Self-ins.Lic.#: `� Ci O t� (o �y' Expiration Date: ' e)L U ' Job Site Address: City/State/Zip:-S/� 4 �aZ 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 maybe forwarded to the'Office of Investigations of the DIA for insurance covera2e v c lion. I do hereby certify unde"san l ' of erjury that the information provided above is true and correct signature: Date: _ 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,ora or written." An employer is defined as "an individual,partnership,association, corporation or other legal entity,or any two or more of the forego ing engaged in.a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other le 1 entity,employing employees: However the owner of a dwelling house haying not more.than three apartments and ho resides therein,or the occupant of the s to do maintenance, nstruction or repair work on such dwelling house dwelling house of another who employs person or on the grounds or building appurtenant thereto shall not because o such'employment be deemed to be an employer." MGL chapter 152, §25C(6)also states hat"every state or local li rising agency`shall withhold the issuance or renewal of a license or permit to operat a business or to cons uct buildings in the commonwealth for any applicant who has not produced•accepta a evidence of compli nce with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)sta "Neither the co onwealth nor any of its political subdivisions shall . enter into any contract for,the performance of p lic work until a eptable evidence of compliance azth the insurance requirements of this chapter have been presented the contrac authority." Applicants Please fill out the workers' compensation affidavit compl to ,by checking the boxes that apply to your situation and, if necessary,supply sub-conti actors)name(s),addresses)an hone number(s) along with their certificate(s)of . insurance. Limited Liability Companies(LLC)or Limited i ility Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compe Lion insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affi vrt ma be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also e sure to ign and date the affidavit. The affidavit should be returned to the city or town that the application for t1,arding; permit or li se is being requested,not the Department of Industrial Accidents. Should you hive-any questions re the law if you are required to obtain a workers' compensation policy,please-call the Department at thember listed belo Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 1 .Please be sure that the affidavit is complete-and printed legibly. The Department has ovided'a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact ou regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference numb r. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit o e affidavit indicating current policy'information(if necessary)and under"Job Si°le Address"the applicant should write"a locations in (city or town)."-A copy of the affidavit that has been officially stamped or marked by the city or town y be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit ust be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affivit 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 eonm onwealth of MassaGhusetts4 Departme4t of IndustiiA Accidents'- % j Office of InvestigadQns- 600 Washington Street Boston,MA 02111 Tel. #617-727-4940 ext 406 or 1-877-MASSAFE Fax# 6.17-727=7749 Revised 11-22-06 www.mass.gov/dia A C0RD DATE(MM/DD/YY) -TM -C-ERTIRCATE OF LIABILITY INSURANCE 06/24/2008 PRODUCER Serial# B3031 THIS CERTIFICATE IS ISSUED AS 'A MATTER OF INFORMATION DAVE`PIZUR&ASSOCIATES,LTD. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT-AMEND, EXTEND OR. 20800 SWEN$ON'DRIVE,SiHTE 160 ALTER THE COVERAGE AFFORDED BY THE POLICIES. BELOW. WAUKESHA WI 53186 -PH: (262)798-9280 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS'INSURANCE COMPANY HAYDEN BUILDING MOVERS, INC. INSURER B: - P.O. BOX 496 INSURER C: COTUIT, MA 02635 INSURER D`. ' INSURER E: COVERAGES 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 POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR- ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR - DATE MWDD/YY DATE MM/DDIYY LIMITS : GENERAL LIABILITY - EACH OCCURRENCE _ $ 1;000,000 A X COMMERCIAL GENERAL LIABILITY 660-866K679-6 06/24/2008 06/24/2009 °REMIsEsDEa occu ence $ 100,000 CLAIMS MADE Ex-1 OCCUR MED EXP (Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PEC T EC ED LOG J AUTOMOBILE LIABILITY - - - COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Perperson) $ 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/UMBRELLA LIABILITY EX-866K679-6 06/24/2008 06/24/2009 EACH OCCURRENCE $ 1,000,000 A OCCUR CLAIMS MADE AGGREGATE $ 1,000,000 $ DEDUCTIBLE $ RETENTION $ $ WORKER'S COMPENSATION AND WC STATU- TH- EMPLOYEP.S'LIABILITY TORY LIMITS PER ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED?If yes,describe under EL DISEASE-EA EMPLOYEE $ - SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT $ A OTHER 660-866K67976 06/24/2008 06/24/2009 150,000 LIMIT STRUCTURAL MOVER 5,000 DED. (2%D WIND/HAIL DED) COVERAGE DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY,ENDORSEMENT/SPECIAL PROVISIONS I .I,�1 A.1 _. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION' TOWN OF BARNSTABL B IL INGI DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN {Y} }� I I.RJMENT 23O SOUTH STR � �� " �� uU NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL -HYANN IS, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR /r REPRESENTATIVES. tJ I ~ AUTHORIZED REPRESENTATIVE ACORD 25(-2001/08) ©ACORD CORPORATION 1988 rti Town of Barnstable -' Regulatory Services . • SARNBfABL.$ • KAM Thomas F.Geiler,Director �EDµ6 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize �i'�Rv�- to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address's of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORM S:O WNERPERM IS SION THE t, Town of Barnstable ~? Regulatory Services RAPNST" Thomas F.Geller,Director MAIM 0.79. A.�� Building Division rED l� Tom Perry,Building Commissioner 200 Mairi.Street, Hyannis,MA 02601.. www.town.barnstable.ma.us /Fax: Office: 508-862-4038 08-790-6230 \HOMEOWNER LICENSE EXEMMON Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: eityhown `te cep code ccuuied dwellines of six The current exemption for"homeowners"was extend to include owner-o units or less and to allow homeowners to engage an individual for hire o does not possess a license,provided that the owner acts as supervisor. , DEFINITION O HOMEOWNER, ' Person(s)who owns a parcel of land on which he/she resid4 or intends to reside,on which there is, or is intended to- be,a one or two-family dwelling,attached or detached structures sory to such use and/or farm structures. A person who constructs more than one home in a two-year pen d all not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form a table to the Building Official,that he/she shall be res onsiMe for all such work erformed under the buildinga 't (Section 109.1.1) The undersigned"homeowner"assumes responsibility for co ce with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies thathe/she unders ..ds the T wn of Barnstable Building Department minimum inspection procedures and requirements and tha he/she will mply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35 00 cubic feet or larger will be regtured 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 pernrit 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 ad as supervisor." Many homeowners who use this exemption an unaware that they are assuming the responsrbr'iities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.1.5) This lack of awareness bflen results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board carrot proceed against the unlicensed person as it would with x licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsiWities,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the responnbilities 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. Q:forrns:homcexempt Taylor Design Associates P. O. Box 1313 2 Forestdale, MA 02644 Telephone& Fax: (508) 790-4686 March 7, 2009 Mr. Robert Hayden Hayden Building Movers, Inc. P. O. Box 496 Cotuit, MA 02635 RE: Gilmore Renovation �4-5 Park Avenue !� Centerville, MA Dear Mr. Hayden: On March 6, 2009, I inspected the existing conditions of the renovated garage area. Along two support lines a W8x28, A-36, steel beam will provide the required strength according to the Massachusetts State Building Code, Seventh Edition. The two beams will provide improved stiffness reducing long term deflection in both areas.- If you have any questions, please do not hesitate to contact me. jtk OF Sincere . A"Ft ,r. Ti 170 a R. Grego for ��gs �/ '.. President Enc. : �, a �r„: �•' ,JOB ' - trK Tt TAYLOR DESIGN ASSOC.,+INC SHEET NO ,.t OF ••f - ' P.O. Box 1313 `•� �' `'FORESTDALE, MA'02644 '_ * cucuwTEo sv' �'�r'l DATE TEL./FAX: (508) 790 4686 CHECKED BY— o ` SCALE v M a .. k " ¢ i .: 1'�l Ab 'i 3 c 't� o�,•J 3 �..e x �t e-tI�.E-tZ L� r,l�-�Ip �►z' ttatC_ s�. .At-al..: ......... .. .:. :...... -...._:. ..:-.. .: ..... .. # r; . t U ....................... • v s ZN� Z �4 > y.. sr 1 ` ...... : ............ � � 4o #r �S ' L + y ....1..! �_LI.. ...... .. L a >Z i ff a s. ..... .. 31.0 , w _... .........:... :.........: .... :.... .... ..... ... a S k Z 4� 3 1 3 �4 091YY1l.T]Mf(Gw G:eke791K-f(D�4d1 - :� - _ � 4'7 ,. JOB �Tltr Q,GwV,..Tto►� �.A.gt�Q�+7V TAYLOR DESIGN ASSOC., INC. - SHEET NO. of P.O. Box 1313 FORESTDALE; MA 02644 CALCULATED BY � DATE 09 TELWFAX: (508) 790-4686 CHECKED BY DATE e S. SCALE ... ..-....... 4 .... .... li ........... .. - - s CIO .. . sT C ... L f 1� N1. 4sC . J.R, lt.oZs-� )t�� ........ ..... e. .. ...... .. — ... ..... .. .... .. .... ............a... ... -... .< ...... ... .. .... - .... .. .. - _ .. _ ._ .. l ... 4.....4..c8• . .T .. . ... �1 v. - .. ' �I.t.iw� .:.... - i ...........:........._._...._.................._e..._..._........._.....i..........._........ ...... .._. _ .._. ...... _... _... ........... ....... ..... ...._ .._. _. _ .__ _._._ ... ._... ..... ..... ...._ .._ ..... ...... -...._-...�. ..... ....... n :.. -..... .._....: : ... ... .. - .. .. .... - ...... :. ......._.._. -: .... ... - ............ _. - ..._ ..... .......... ... .......... ... ..... ..... .. : .. .. ..... _ - .... c .. .e... ...- .. ..... _.... ... .... ......... ...<.. ..._..... - .. ...... ... .... .. .. ..... VRIgLtlT71Y115iw1c9nekl�hFtlP�ddedl : '. TOWN OF BARNiSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# 11, 4 Health Division '9(6 - 6 3 � Date Issued cam^ 2 2- U3 Conservation Division F1 Application Fee y`� Taz Collector Permit fee SEPTIC SYSTEM must BE Treasurer ®� INSTALLED IN COMPLIANCE Planning Dept. VWTH TITLE 5 ENVIRONMENTAL CODE AN ,2 Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address c I'L+ Village 0-,L t-J -T-M V i�L Owner M U C6 4 6 AeL 61L, op-E- Address tit-L Telephone S"® 9- 9 - b 3 6 Permit Request A00 vrt-a/%•' i (�"�'c�c�� + "ti-K ai-oS e- 4. / OF �0 UM Square feet: 1st floor: existing proposed 3 2nd floor: existing proposed Total new 33 L Zoning District Flood Plain Groundwater Overlay Project Valuation f-of OVO Construction Type V►/00.0 Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family tff- Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes & No On Old King's Highway: ❑Yes (NNo Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) , Number of Baths: Full: existing new D Half: existing new (/ Number of Bedrooms: existing_ new �Z Total Room Count(not including baths): existing _new 0 First Floor Room Count Heat Type and Fuel: ❑Gas O Oil ❑ Electric ❑Other r Central Air: ❑Yes YNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size --'Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:lexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 'allo If yes, site plan review# _- Current Use- - --_ Proposed Use BUILDER INFORMATION Name C4�&C-0 Telephone Number S-0$ 7, 4 07 A Address / 1 v`' S %. License# V14 Home Improvement Contractor# ®5-L7f Worker's Compensation# 1 •04`T l Q ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Q fi4e-S j?461,c SIGNATURE DATE FOR OFFICIAL USE ONLY "PCRMIT NO. DATE ISSUED MAP/PARCEL NO. t ADDRESS l VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME _ t� I Z- 6 9- 0 INSULATION ��� 1 2"23^U'2, FIREPLACE ELECTRICAL: ROUGH FINAL € . x� PLUMBING: ROUGH ._ t: FINAL r ' GAS: ROUGH S FINAL i .FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts -- - - Department of Industrial Accidents ' = Office oflnyestfgatfL _ -600 Washington Street - ' + Boston,Mass. 02111 Workers' Compensation Insurance AffidaVit 'Sing n,`r name: ` location: . hone# ,city all work myself. 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Yth. •'?iv r.•t•. ^r x• rs. 1:'tO:hY}:•:Sv:?•ir: 'ith}}•.•,• }.:{,.}: ,..::r:e.Yi,:?h• ......... ...... ...:}::::•.• .......,..•..•,•.,v,n :.w.v:;::.,h::r. .^}r::^'•. if,..:•.v........w:•n.,..,. ....;., ,...;...,:... rv; vr.....::....:.••: ...v w:.... ,.:..r:v.v.•::•:v. ;.}:{;}:{:ii K{•rv:^v:r:nYr:rv• :U.4.,n:•.v..{v,+r. •.. •: .;.v .: •k:..r::r.{..n. ,....:.,:::�::........:{:r....... ... w•}: n• is^:'i::' 'J4.iJ.i:4::::4vvr. .x.; }i3 C::x!.x+f.•:i+f/.•.'•}::x•x}:vfv.,•n:k:•}}.t•.::L:?:;.....:, h}ii:::ntiti:;ry;}.{:•::;}i?•;iix?•n•. �.0!x}iv.{{} it ,ti...,,�•..,..,{J1ii� :;�v.v?.}:NLS{x:. rdred mtder Sectio 25A of MGL 152 can lead to the imposition of ertminal penaltin of a Sae IIP to 51,500.00 and/or to secure coverage as teq n��in the form of a STOP WOE ORDER and a flaw of S100.00 a day against me. IHnderstud that s one years,imprisonment as Drell as dvff p copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verincadon I do hereby certify under the p d penalties ofpelury that the information provided above is tru'and correct Date . gignatttte �l�r� r t. Print name r7 u` t ✓ �1`I ��G�i �o Phone# offidsl use only do not write in this area to be completed by city or town official perndt/license if ❑Building Department city or town: ❑Licensing Board clsdechmen's Office ❑check if immediate response is required ❑Health Department phone#; Other contact person: _ 554 Oevisad 9195 PJAa r f Information and Instructions Massa chusetts Gener aws chapter 152 section 25 recluir`es all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is de d 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, assod ation, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including th'legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a 3 � dwelling house having not more than ter�e apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do marri�nce, 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. section 25 also states that eve state or local licensing agency'shall withhold the issuance or'renewal MGL chapter 152 s , 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,neither the commonwealth nor any o its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of comp with the insurance requitemerrts of this chapter ve been presented to the contracting authority. jhk Applicants vit c el b c ecking'the box t applies to your situation and Please fill in the workers compens on affida omp eft Y� Y applying company names, addres and phone numbers along with certificate-of' ce as all affidavits may be submitted to the Department of In Accidents for co do of insnranC11 E coverage. Also be sure to sign and date the affidavit The affidavit sho d be returned to the city o to that the a 9 ication for the permit or license is being requested, not the Department of dustrial Accidents. Sho ou have an questions regarding the"law'or if you are required to obtain a wormers' compens 'oa policy,please call the epartmentt the tuber listed below. City or Towns a`* Please be sure that the affidavit is complete and p ' legibly. The Deparmient Provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inv 'gations has to`,contact yo `regarding the appliearrt. Please be sure to fill in the permrt/ltcense number which will be as a reference number. T$e affidavits maY be,retBmed to the Department by mail or FAX unless other arrangements ha been made. The Office of Investigations would like to thank you iri advance for ou cooperation and should you have any questions. Please do riot hesitate to give us a call. / / The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents flfflce of lavesllgellons 600 Washington Street Boston, Ma. 02111 fax 9: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 1)H*E Town of Barnstable ti Regulatory Services snxxsrnBi.E Thomas F.Geiler,Director MASS. 039. a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: PY00!T�v '" ���"� 141a 1° 0° Estimated Cost Address of Work: I0+Z K A✓G G it" �2 ply mot, r ,�'✓►$�S dn�by i Owner's Name: 13 A`c G '4 G L 11,^o ff Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby-apply for a permit as the agent of the owner: C5 03��®� Date Contractor Name Registration No. OR Date Owner's Name Q:formslomeaffidav RESIDENTIAL BUILDING PERNIIT FEES MPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations S25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE _ �1 square feet x$96/sq.foot= x.0031= , q plus from below(if applicable) ALTERATIONSMENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.f " >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 - 100.Q0 sf >1000 sf-1500 . >1500 sf-Same as new building perarit: x.0031= square feet x$96/sq.foot= STAND ALONE PERMITS x$30.00= Open Porch (number) x$30.00= Deck (number) e iace/Chimney J x$25.00 Fir p (number) aground Swimming Pool $60.00 Y Above Ground Swimming Pool' $25.00 -iWocat on/Moving $150.00 (plus above if applicable) Perrnit Fee 7io CMR Appendix J Table J5-1Ib(continued) prescriptive Packages far One and Two-Family Residential Buildings Heated with F01af1 Fuels ck . MAXIMUM MINIMUM ell Floor Basement Slab H•eating/Cooling Glazing Glazing Ceiling eter Equipment Eflieirncy� Area'('/,) U-value= R-valuej R-values R-values wed R-value' Parkge 5701 to 6500 Heating Degree Days' Normal6 Q 12% 0.40 38 13 19 10 6 Normal R 12y 0-52 30 19 19 10 6 ES AFVE g 12% 0.50 38 13 19 10 N/A Normal T 15% 0.36 38 13 25 N/A 6 Normal U 15% 0.46 38 19 19 10 NIA E3 AFUE V 15% 0.44 3E 13 25 N/A 6 15 AFUE w I5Y• 0.52 30 19 19 10 NIA Normal al 18Y• 03Z 38 13 25 N/A NIA Normei y 18% 0.42 38 19 25 !/Ay I8•/. 0.42 3E 13 19 0 6 40 AFVE AA 1 g•/. 0 50 30 19 19 ID 6 90 AFVE 1. ADDRESS OF PROPBRTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: �)q Six o 3. SQUARE FOOTAGE OF ALL GLAZING; r �• 4, %GLAZING AREA(#3 DIVIDED BY#2): OS 31 5. SELECT PACKAGE(Q-- AA-see chart above): S NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q4orins-580303a r , 780 CMR Appendix J Footnotes to Table J�.2.Ib: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows'if located in walls that enclose conditioned space,but excluding opaque doors) to the gross wall area, expressed as a percentage. Up to 1%.of the total lazing area may be excluded from the U-value requirement. For example, fl�of decorative glass may excluded from a building design with 300 ft of glazing area. Z After Januarylk, 1999, glazing U-values must be,'tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 11.5.3a. U-values are for whole units: centerz�of-glass U-values cannot be used. The ceiling.R-values do not assume a raised of oversized truss.construction. If the insulation achieves the full insulation.thickness over the exterior walls witl o t compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted llfo R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulatin",sheathing (if used). Fors ventilated ceilings, insulating sheathing must bd placed between the conditioned space and the ventilated portion of�he roof. Wall R-values represent the'\su�m.of the wall cavity insulation plus insulating sheathing (if used). Do not include siding, structural sheath i g, and interior dr wall. For example, an R 19 requirement could be met EITHER by\R 19 cavity insulation OR R- cavity insul I plus R-6 insulating sheathing. Wall requirements apply to woo&ftdie or mass(concrete,maso , log)wall1constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors der unco�nitioned spaces(such as unconditioned cnwlspaces, basements, or garages Floors over outside air must me t the erling requirements. base e t wall with an average depth less than 50%below grade must The entire paque portion of any individual meet the s R-value requirement as above- a walls. Windows and sliding glass doors of conditioned basements must a included with the other gl g. Basement doors must meet the door U-value requirement described in Note 'The R-value require ents are for unheated slabs. dd additional R-2 for heated slabs. ' If the building utilizes lettric resistance heating se a ih-pliance approach 3;4, or 5. If you plan to install more than ne 'ec�of cooling equipment, the equipment with the lowest than one piece of heating uipment or more efficiency must meet or excee the efficiency requir d by a selected package. 'For Heating Degree Day requir ents of the close ci or town�see Table J5.2.1a NOTES: a) Glazing areas and U-values are m ' um accepts le evels. Insula n R-values are minimum acceptable levels. R value requirements are for insulation on and don elude structura omponents. b) Opaque doors in the building envelope Inhave a -value no greaterrTa\n 0.35. Door U-values must be tested and documented by the manufacturer in accord a wi the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an ag U-value rating for thats�oor is not available, include the glass area of the door with your windows and use the ,� ue door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may ve a U-value greater than a35). c)If a ceiling,wall,floor,basement wall,slab-edge, or crawl pace wall component includes two or more areas with different insulation levels,the component complies if the area weightedaverage R-value is greater than or equal to the R-value requirement for that component. Glazing or door r�omponents comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(a:35 for doors). l fi 1 ' J A'I.. ,*IMF r Town of Barnstable P� ~c Regulatory Services 9� I E' ' Thomas F.Geffer,Director prE 619. Building Division - Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Gc�► �c . C�1+M,or� I. p , as Owner of the subject property hereby authorize sir r 1 aa�—�o to act on m behalf . y , in all matters relative to work authorized by this building permit application for: (Address of Job) ; 3 ignature of er Date Print Name a Q.FORMS:OWNEUERMLSSION I uo I - —ITT-FFR - I`I Fee-A,T ELE V ATI,- ) I � 1-EFT Lc y.A7-IC AJ LrL ITA -17 f T T _ . iZ A R {=L,E v AT7 O/J - R le,F!7- t wv�m F x roT• ------ ]HYb•3 _ ' • LANI p�+,-�l- 4iI GCMaL �/ t` /O�LET I I SPADE I V Q Q � p Dtn/ Laces- ' I d D1 s �j I, •I jj tLoo12 W IL• LtiJT I I•• Q� wIG "ryQ ,. � �/ I � �I x Q - I i Q "ex) Tom• _ •,*- i DELETG 4iA" nIEA C.4�y A ' I I 3/3"CO.W 1 D 6l ETIL WAtt It OV Ef>` F�..yM- I - COL. r-/Lt �s«o Nor 8-aw& usED [ cuup6a yA" yrcc ynVa1 DA^fl oM PLA AJ Q �•�� x0(' FOAL OTWEN. All.& 1.Ya O I 2 I GCS q�E ,fY"=I-A" i � Goal. LADS ` I Q 7 lb JALV12. ® I V-come. SLA CAGY 'COAL CALLf ew i ti S 8 C I I Y � Pf A7 TtCM �- tw�iy'x9"GONr. r�s. I FLORA P►A•IJ carat vAay It 7 ALE �lA["_I-O" y'= ANGNo2A-A— � PKDor- -Pi.e DE � f'"YS® ., C c A&V4 Oven .WjU Lh77 opl A'R3o GL6 <�.ya 3'_/O•. L V" y-\�7 Q,v- I L o t rL /tDD 1 MiA TLN i; Mi DDD bE E V5&CT74O4 TOo VEE-a- A4 Ol6K. VL. D i;4 y 6A.' ) I AS PH AL.r Irevr OVER Pay, i y. UE.JT, J EXIy1• I �: R�Dvc+.GO.0 j0 F=17 .D2tP enss t 1%-T£D AACW�f IKS /x.3 AAIcc• � F.EVA•A nit TcD Q*. 6wbria, JAA-O 51dL5.) 3 RllISEe TER) AS A;oTeD /HB FAfL/A.- wA-7c14 . .. 6 Sot u a r- I £rt.yr. 4ja-soF/r L-waw 4M" Iiv-) S/y-Tr - 41CLD•LAu. /xlo FRIEZE xl/St0 MLOL. MATGIl y- W/NDOW GME DU LE aJ 1!.1 ry RuOi - - d•�,ryTiP PA/•TEf J [Stc Lw.etL yyCtILD j - AIUM EK. RO• Lk G Ir>E sPtcS) �: H 6ia CTuDO/AI ✓AuLL..7.,ADSu T pa y)rE Ir/�- a8vc-� F c 5 } s 8 c21 Y5. ?r lstTN. UlIG ,� —,RNY 6"aF- T r CCU q ► 51 DIA)& D ANY/ I W �I �T 'LAA7T FROA;T GLA-POVART> - M'•T.T.W.r- dCV 3S)DB.3 w/G SIF/Nb LEs ' �Q o TyvEK G R �2"GDX.P4� E 'T+65u6 T-i. 6 Er w/� � V y Z )x•S TRI.'I VERAsy !uI t.> T2)N IxY-i_ F xI 0<. .vc/a �•'OC. boa _ .C/SOD I D fi—C EN 9 oP c .; cxw.U� �-dx/o Sox IA.I CANT, dx/u B0. (A)M �iJI}T� ALLOTHiiRS 3�a'GOIJC. w >x;b P.T. yqLL hI�SEAI 1 1 I COA;C. 7-49••.40,6V2 �- �Y'AI/A) Y'GOAIC. LA9 �IS77A;6 6kAA;L $PA[E 5 D ANP PRAOr BE:LeIJ 6.e40+' rRAAA/AI(- CiEGT7DA.)- ClAt AI'— L®CATION O F P F20 R . Y LI N S MAY N oT E3 E A ATE STANDARD LEGEND NOTE:not all symbols will appear on a map ------ ------- 0.H ,,,• --------- - `-- --- --- ---------------- GOLF COURSE FAIRWAY _ EDGE OF DECIDUOUS TREES ~~ EDGE OF BRUSH -- -- • ORCHARD OR NURSERY Map 207 Y T ED GE OF CONIFEROUS TREES . ,. 22 22 '. •. _; "„\" MARSH AREA # ll " • -• ' ' --• - •---- EDGE OF WATER DIRT ROAD DRIVEWAY PARKING LOT %•`•��—.14 Ma PAVED ROAD DRAINAGE DITCH 144 A�OO/��aw — PATH/TRAIL PARCEL LINE i ma110 E----MAP# Ma 207 / 2 1-PARCEL NUMBER #1860— HOUSE NUMBER 1 - j 2 FOOT CONTOUR LINE —10-- 10 FOOT CONTOUR LINE Elevation based on NGVD29 4.9 SPOT ELEVATION cx x STONE WALL X----X— FENCE RETAINING WALL —4-1—f—+— RAIL ROAD TRACK => STONE JETTY POaL j SWIMMING POOL PORCH/DECK j ] 0 BUILDING/STRUCTURE DOCK/PIER HYDRANT {Y� / e VALVE O MANHOLE 0 POST 0' FLAG POLE T O W N O F B A R N S T A B L E 6 E O 6 R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U' N 1 T n SIGN ® STORM DRAIN M PRINTED SCALE IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James ❑ TOWER 1"=100'scale map and may NOT meet of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 oeriol photographs by GEOD 0 UTILITY POLE w e 0 25 50 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards s 1 INCH=50 FEET* enlarged sole. on the map. at a scale of 1"=100'. Parcel lines were digitized from FY2003 Town of Barnstable Assessor's tax maps. ¢ LIGHT POLE O ELECTRIC BOX r r - 1 �1I I REGULATIONS BOARD OF BUILT License: . ONSTRUCTION SUPERVISOR Numb! 031802 �T 3 Bin�a 26101' 4 Tr.no. Re' ret � ART►-IUR M PAC ', 26.NANCYS LA p26 r� Admiri►strator HYANNIS, MA • r. i e The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis,MA 02601 862.4038 790-6230 PLAN REVIEW ier: l_'► i U1'l c SV L Map/Parcel: :c —PC CL C-i tAddress: 2 1 4 ?h� k)L Builder: following items were noted on reviewing: C (^ 0. 1Q ------------- mi]IV- �� bankt--- -Braman, P.K 2k 4 914ry 4V.G 10 $arbor Point Rd tA A Gaamageid, MA 02637-0361 to - V2- o� 'c'-)E'EN! svo tl l2' 2�y �Q.� W to X Zt� +D x I'L 0 p k Cls� W' l C$ t (®cabs or ►►��s°dam of 14af���� DANIEL E. G s BRAMAN --e.kt �y�r. ;' STRUCTURAL N U q NO.36595 p CC a3 Slout ro_titi-�3 RAUSBEAM V2 . 0 - Gravity Beam Design Licensed to: Dan Braman, P.E. Job: 214 Park Ave. Centerville, MA Steel Code: AISC 9th Ed. SPAN INFORMATION: Beam Size (User Selected) = W10X26 Fy = 36. 0 ksi Total Beam Length (ft) = 12 . 00 Top Flange Braced By Decking LOADS: Self Weight = 0 . 026 k/ft Line Loads (k/ft) : Distl Dist2 DL1 DL2 Pre DL1 Pre DL2 LL1 LL2 0 . 00 12 . 00 0. 180 0 . 180 0 . 000 0 . 000 0 . 480 0 . 480 SHEAR: Max V (kips) = 4 . 12 fv (ksi) = 1 . 53 Fv = 14 . 40 MOMENTS: Span Cond Moment @ Lb Cb Tension Flange Comp Flange kip-ft ft ft fb Fb fb Fb Center Max + 12 . 3 6. 0 0 . 0 1 . 00 5. 31 24 . 00 5. 31 24 . 00 Controlling 12 . 3 6. 0 0 . 0 1 . 00 5. 31 24 . 00 --- --- REACTIONS (kips) : Left Right DL reaction 1. 24 1 . 24 Max + LL reaction 2 . 88 2 . 88 Max + total reaction 4 . 12 4 . 12 DEFLECTIONS: Dead load (in) at 6. 00 ft = -0 . 023 L/D = 6260 Live load (in) at 6. 00 ft = -0 . 054 L/D = 2685 Total load (in) at 6. 00 ft = -0 . 077 L/D = 1879 I ROOF BEAM.=` TJ-Beam(TM)6.06SerialNa�umb'e"`''r 7�,0""2,032 2_Pcs._of 1-3/4"-x 9 1/2"1.9ExMicrollam® LVL User:, Engine Versi003 ,2A7AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Page, Engine Version:1.6.44 CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope:OM2 Roof Slope77M2 b 14! 1 All dimensions are horizontal. Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member, Tributary Load Width:7'6" Primary Load Group-Roof(psf):30.0 Live at 125%duration,20.0 Dead SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 3.50" 1575/1489/0/3064 L1: Blocking 1 Ply 1 3/4"x 9 1/2"1.9E Microllam®LVL 2 Stud wall 3.50" 3.50" 1575/1489/0/3064 L1: Blocking 1 Ply 1 3/4"x 9 1/2"1.9E Microllam®LVL -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s): L1: Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 2991 -2590 7897 Passed(33%) Rt.end Span 1 under Roof loading Moment(Ft-Lbs) 10218 10218 14719 Passed(69%) MID Span 1 under Roof loading Live Load Defl(in) 0.391 0.683 Passed(U420) MID Span 1 under Roof loading Total Load Defl(in) 0.760 0.911 Passed(U216) MID Span 1 under Roof loading -Deflection Criteria:STANDARD(LL:U240,TL:U180). -Bracing(Lu):All compression edges(top and bottom)must be braced at 2'8"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code NER analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S/BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: OPERATOR INFORMATION: GILMORE JOB Bill Rubel CENTERVILLE MA Mid-Cape Home Centers PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright O 2003 by Trus Joist, a Weyerhaeuser Business Microllam9 is a registered trademark of Trus Joist. � RIDGE BEAM "�� r AV�EyerhaeuscrBusin. 1 3/4" x 14"..1.9E MicrollamO P TJ-Beam(TM)6.06 Serial Number:7002103362 User:1 10/31/2003 8:16,42 AM - - --J Page Engine Versiom 1.6.44 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope:UM Roof Slope17M2 F_ L it 20 d 17-6" L All dimensions are horizontal. Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width:7' Primary Load Group-Roof(psf):30.0 Live at 125%duration,20.0 Dead SUPPORTS: Input Bearing Vertical Reactions Ply Depth Nailing Detail Other Width Length (Ibs) Depth Live/Dead/U pl ift/Total 1 Stud wall 3.50" 3.50" 1824/1709/0/3533 N/A N/A N/A L1: Blocking 1 Ply 1 3/4"x 14"1.9E Microllam@ LVL 2 Glulam or solid 3.50" Hanger 1851 /1733/0/3584 1 14.00" N/A H6: Face None sawn lumber beam Mount Hanger -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s): L1: Blocking,H6: Face Mount Hanger HANGERS: Simpson Strong-Tie@ Connectors Support Model Slope Skew Reverse Top Flange Top Flange Support Wood Flanges Offset Slope Species 2 Face Mount Hanger HUS1.81/10 0/12 0 No N/A N/A Douglas Fir -Nailing for Support 2: Face:30-10d,Top N/A,Member: 10-10d DS DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 3465 -2991 5819 Passed(51%) Rt.end Span 1 under Roof loading Moment(Ft-Lbs) 14764 14764 15161 Passed(97%) MID Span 1 under Roof loading Live Load Defl(in) 0.562 0.852 Passed(U364) MID Span 1 under Roof loading Total Load Defl(in) 1.088 1.136 Passed(U188) MID Span 1 under Roof loading -Deflection Criteria:STAN DARD(LL:U240,TL:U180). -Bracing(Lu):All compression edges(top and bottom)must be braced at 1'10"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. PROJECT INFORMATION: OPERATOR INFORMATION: GILMORE JOB Bill Rubel CENTERVILLE MA Mid-Cape Home Centers 'PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright 3 2003 by Trus Joist, a Weyerhaeuser Business Microllam® is a registered trademark of Trus Joist. Simpson Strong-TieO Connectors is a registered trademark of Simpson Strong-Tie Company, Inc. RIDGE BEAM�� sWa"j kyeTcl rBucinm TJ-Beam(TM)6.06 Serial Number:7002103362 1 3/4�� x 14" 1.9E Microllam@ LVL AM Paget EngineV son:1.6.44 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application,input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code NER analyzing the TJ Distribution product listed above. PROJECT INFORMATION: OPERATOR INFORMATION: GILMORE JOB Bill Rubel CENTERVILLE MA Mid-Cape Home Centers PO Box 1418 465 RTE 134 South Dennis,MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright 0 2003 by Trus Joist, a Weyerhaeuser Business MicrollamC is a.registered trademark of Trus Joist. Simpson Strong-Tie® Connectors is a registered trademark of Simpson Strong-Tie Company, Inc. i I , I i I I J i r R f 1 J r Poo r Door i �no� CU�n1� /V I a ��1_ �fS ' � �' Arthur M. Pacheco 720 Main Stree Hyannis, MAss. 02601' 508-771-0986 Date:2/20/04 Ref: Building Permit# ` 71143 _ 24 Park Ave JI Y gyp..,; CenetNille, Mass. 02632 Dear Building Dept, x . In reguards to permit# 71143 issued to me on 8/29/03 for an addition at 214 Park Ave. in the village of Centerville;wish to withdraw my name from this permit as the contractor and also wish for this permit to become null and void. Reason for this request is for nonpayment for work �t performed for the contractor and its subcontractors, Also, if the owner , ` wishes to pull his/her own permit or have another contractor I hope that the same stipulations are implemented to them as they were to me, i.e. windows 0 over whirlpool area have to be tempered glass and other. a " Th ou, Art Pacheco F 2/10/04 w AMP - y j v 4 F , Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration:j05488 One Ashburton Place Rm 1301 Expiration: 7/17/2004 Boston,Ma.02108 Type: Individual ARTHUR M.PACHECO Arthur Pacheco 26 Nancy's Ln. ----- Hyannis,MA 02601 4dmini0rutor Not valid without signature �le Pomvino�uoea�i a�'� aaQaclivaa�a BOARD OF BUILDING REGULATIONS F License: CONSTRUCTION SUPERVISOR e .,1 Number CS 031802 . B.irthdate ..06/15t1953 Ex irps:06/1W004 Tr.no: 26101 — Restrrcted ..00- ARTHUR M PACHEC:O 26 NANCYS LANE HYANNIS, MA 02601` Administrator i I r ' E �L' °EtHE ra,, Town of Barnstable Regulatory Services • BAMSTABLE. • g, Thomas F.Geiler,Director �ArFDMA'1A,0 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR L — uL� I 6111 MCie- , owner of property located at Z 1 H PA-P—K � WV I L LL , hereby certify that A (Z1Ny R ?AC H�Zy is no longer Construction 'Supervisor listed on the application,for the project under construction as authorized by building permit# 3 , issued on V2 q 200(5 . I understand that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the records of the Building Division. PROPERTY R DATE q/forms/newcontr reference R-5 780 CMR rev:080102 h oFt►�,� Town of Barnstable Regulatory Services w s�uvs7aBze Thomas F.Geiler,Director 9 Mass• g �A 039. Building Division TEc �s Tom Perry,Building Comnilssioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print 4/ 1z/ay DATE: /� JOB LOCATION— number street-7 I E'e f village ..HOMEOWNER,,: U U c 6 1 n, 61 t m al-aE , 367-M-3 -� name n home phone# work phone# CURRENT MAILING ADDRESS: 2_1 q � �'Q J U e— Lett. -(rwv /L t 0"'19 p 2(3 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"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and re ements Signature of Homeo er 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. Q:forms:homeexempt F ,Er Town of Barnstable o` Regulatory Services saax I,E,$ Thomas F.Geller,Director 9g 1619• Building Division '°raa MAC k Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Of{ce: 508.862-4038 Permit no. • Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUppLEMENT TO PERM APPLICATION MGL a 142A requires emaliti ec orscoonstruction of an addition to anypre-existing oovn�er occ pied ion, •improvement,removal,d scent to buildi.g containing at Least one but not more than four dwelling units or to structures which aze A such residence or building be done by registered contractors,with certain exceptions,along with other requirements. or$• Estimated Cost Type of W Address of Work: Owner's Name' € Cl VM C)OS Date of Application: 2 l q, ' by I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑lob Under$1,000 []B ' ding not owner-occupied WAmet pulling own permit Notice is hereby given that: OWNERS PULLING MIR OWN Y,1.1.HOME nYgRO MENT WT OR DEALING WITH ORK DoNOT HAYS CONTRACTORS FOR APPLI ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY ..I hereby apply for a permit as the ageAt of the owner: Contractor Name RegistrationNo. Date 2 - 12 " C) Date Owner's e The Commonwealth of Massachusetts -- — Department of IndustriatAceidents _ • . '�I6I i1�11' r1�s' � ' 6601 Washington Street _ Boston,Mass. 02111 Workers'..Com ensation.Znsnrance Affidavit-General Businesses } / l�rIx+C• yy�+e".. 'tit :'�"!'�•' '':T�ae+•+'++Fb,r"1'+.. � � r .^•°'F.. .:� �� �a:�t1 . address: - state: 2i hone# work site looatioli full address : ❑ I aia.a sole proprietor and have no and ' $usiness ape: Ej Oe❑ SeMuraut1Bing Real Estate,Establishment os�ttc•)' working in any capacity. Q C I am an em to er with etn •lo ees full&' art time;. ❑Other % �% M I am an ployer providing viorkers' compensation for my employees working on this job.. . ., %1r • ::it�'sf?�1:f?' r:r. •F.• 'i,ott• •,G :i.,. .;,'3,;;I'. t. —u' '•a••S i,`•': (iy. ./;> r:caw+�•• ',.•;' •''tL.,-` :," , 'ti'":. raja -.• t. •'/r :,. . cOIIi"eII BIIie: ' n r,.. ,�:J•• :,; i• t+,t:�. .:'..:1+�°,.;: +ryi , ��' {:f .• •• ' '". s `+,1 ,:' - J •� •J•••-%: ,"•e f. ,n•S>..:.+'.�:.'a r7•^,•'•-:.• >t: t• .'t,{ ^y.a%: S;•t Ffct: �4. ,5•+•;��.:.,tia.� ,•'i _ i .: ,,d�eY �._ $daregs:' \ ..r• f...:: :t•, >'••'•• �.e 9:..:. :c r.:a t::5°j:"': .. ... y,•:'1.. ,i.,',tip •.K ii,''YZ ..: �'' � "''•!•. '•'',:..' ,•.J: .•i :j' '}', :'\: ., t i r n• .t:• V. hone.. Ii571rfliice.COS a: ••J+ T am a sole proprietor and•have hired the independent contractors listed below w MINEho havo the following wozkers' compensation polices: J 4. :. .:..,: . .{?l :, •: ;: -.:i^ it.'•i:,•;:C:ti�''"i' %.5T''+t.°•;�-• ..i,: T°•_rr:•i.:." 'r;�,,.•. .e' i�t :', g,..rud..:y::,a;' •''.l"r:K+(~+ aF y. t: :>=.-::�. COnl 813 nflme: t. �.. :r:. "L�L.r;J' .: r rt:::.:',r' i, ;4.r• it i •�':•r . "r.i r�: �'••• f1'i(; 7 «:i:i,? e.::,i•. +:: .....J it ' i!. it„.,}t+,�J',' ~••!•' �r' '�, ! i• rsJri ,1.+:•rr:.•wn ••I ,... ++�, J •,:t ' •sadness:. '• ;• .4•F'. • ,'t •. .. ��; ••r .>r`•••rr i:'.. ..J.. • ,. t .C.•'1 ' :,q I 'L ' ,.''' '• .t�i• "i. '•r'• - .!:}/ L,''': ,�.. :r°•'•.S:°.rr•t t•,,: h'oIie' :. r Ci! ....r r. :''li.t\','.�^a�r' .�hyl l.:.. :;+i'f'••t.ttt.•i"'nS� -lit�'�h':•�'' ''t•• ' l: ?:. .1, 'r.,,°v:y'Fr; •'�;,' r: t l 3'• •, r;.yr'S, .�::.. ''1:}l,:.s`• ''l•:` '; ,.i. sjlrance'co. :F: :t: ,e!•a„� ,/ .,t :.i, ,:.:' •:t: ioi: t. :.: r:'t•:+ .:'y' 4 •:t r+�.':.'r n:�. 4• y '•i.!• ' . /L: '. ,;w .{% :.t'I;J: .'�.:r:S+..c:y�' '.t.�'.,;:. '�ei,?��•} •.'�' •'n.?t.+i+s:,s,+, •'i`n i •'�•'.C. cum any. Deitie:.J, fit:• it , a. :. •CI` ',::. ••l r •�• ..irr• • . •n.t re.•x'. ,nr A.�,.t;..=:•:<:. '' :r^ .:hti'�'.t.S',,: •.�, i}! r",A •i•: ��:�Ji:ir .. + •;%s�.•.y :�' �'^,�.,•. :: ti 1,,, :;•�+: "i r f:':��.•• 9' .J. r';i: ,:t� .1."'' �yuy '� '' 'A.t, r: ;r f .,•. ' '•J.',::i '�. :p. :.!•+: '.: 'q• •. -OZ1C,':'tt•• '!': ,i�,t l' F. ::,,i":''" •t •i: •4, . .. :.� ,'� •.{, r.: •�,%t•,. <' it.i.'-a•°' Cti >Si:w'.l.d a: ';•� fnsiirancVoF r:: • rC of it ne up t Failure to secure coverage as required under sectionec he fvi m of of ae STOP WORK ORDGL 152 can lead to the E and a fine of$sition of cr$11000 0 day againstt me. I understand that$L one years'imprisonment as well u cfvil}ezt 1 copy of this statement maybe forwarded to the Office of Investigations of the DlAfor coverage verification I de.hereby certi under t n and penalties of perjury that the information provided above is true and correct Date l 2 `b p Signature �0 Print name 6�L�i !!,r►'l C Phone.# O� J�� 33 official use only do not write in this area to be completed by city or town official permitilicense# 7LBtment city or town: dffice0-checkif immediate response is required mentphone#-, contact person: _ (mvned Sept 2M) Info rmatio` tructlons. . . n and Ins Massachusetts General ws chapter 152 section 25 requires all employers to ovic�e workers' compensatidn for their. e ervice o another under confract ers in th s f e law' an employee' is.defined as every �S' employees-. As quotedfr th �yP of hire, express or=V. ed, or written. , association, corpora on or other legal entity, 6r any two or more of An employer is defined as an in 'vidual,partnership the foregoing engaged in a'Joint. erprise,and including the legal' 'res tatives of a deceased,employer, or the-receiver or trustee of an individual,-o ershi association or other legal entity, loying employees. 'Howevei.the owher of a dwe ' dwelling House havnag.'no#'more than ee apartments,and-who resid erein,or the.occup , . . ,ant of the llmguse of .ho another who.emploj�s•persoris to do. ' tenance, construction or rep work on such dwelling horse or on the grounds or building appurtenant thereto shall not b use of such,employment a deemed to be an employer. , MGL chapter 152 section 25 also'states .e'ry. state or The `censing-agency shall withhold the Issuance or renewal of a license or permit.to operate a business r to construct b 'Idings in the.cOmmonwea]th for any applicant who has not produced accepfable'evidenee'of-coinpli ce with the' urance coverage required: Additionally;neither the' ' commonwealth nor.any.of its political subdivisi shall ent into any contract for the performance of public work unto acceptable evidence of compliance with the insuran requir is of this chapter have been presented to the contracting . Authority.. 011011 Applicants Please f4 is the workers"compensation affidavit c etely,by ecicing the box that applies to your sitdation.•Please supply company name, address and phone numbers al with a sate of insurance as all affidavits maybe submitted to the Departrnerit of Industrial Accidents-for lion of insuran a coverage. Also be sure to sign and date the - affidavit. The affidavit should be returned to the ci or town that the lication for the permit or license is being requested, not the Department of Industrial Accideni . Should you have a questions regarding the"lave'or if you ai•e required to obtain a:workers.'•compensationpolicy, lease call the Dep tat the number liste below. , City or Towns . d ' ted legibly. The Department has ovided a space at the bottom of the Please be sure that the affidavit is complete an affidavit for you to.fill out in the event the Offic of Investigations has to contact you r ardi�g the applicant. Please be sure to fill in the pmuri icense number.whi will be used as a reference number. Th .affidavits may be.retmned to. the Department b .mail or FAX unless other gements have been made. The Office of Investigations would like to you in advance for you cooperation and sho d you have any questions, please do not hesitate to give us a call. The Departrnent's addr�esstelephoneand���faxnu/mer.�b . ' The Commonwealth Of Massachusetts Department.of Industrial Accidents Office of Wesfigatiens 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 Assrf�ar's map and lot number , '..1., 0...1: .1 :...1. � SEPTIC SYSTEM III', S 3E Sewage INSTALLED IN COMPLIANCE WITH c> �fi Permit number ... .. �` : .. ... s� APMCLE iI STATE SANI-TARY CODE A�N'D TOWN �Qy�F7ME � - TOWN.n. OF �BARNSL ,�ARLE L of t1, `k _ EAHBSTABI 4 • _ "�` BUILDING INSPECTOR s fps,1639. 'EG M Or• t. }I �. APPLICATION FOR PERMIT TO ..........................................................:.......................................:.................... 1 TYPE OF CONSTRUCTION .................................. ................ ............. . ..... . ?� 19........ a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby a pplL*c for a permit accordingto thejqllowing �'i'nffo'rmation: " I. Location ...... �.. .... .,.... C�-'L/.•.�•••ti•r. ..e��w4r................................ y� ProposedUse ..................... ... (,/..(,�..... .... . .......................................................... . ....................................... Zoning District ..... Fire District .............................................................................. Name of Owner ..�. . .. J. ��,1.... ...t..P/,k ..Address 421-.)... .. 'I!5 .... r�. . j91 � Name of Builder .U......., . ......Address ... . � ..................... Nameof Architect ...................................................................Address .......................................................:............................ Number of Rooms ..................................................................Foundation .. ::1!1!1N!r^. ......... .. ..m ..................... Exterior .... d...��.....p.....5.����...��..0........:.................Roofing .......... Floors 4 �... , .......1......I.....................Interior .......... )C'v � ............................................. ....Plumbing ............................................................... L ...........Heating " lL........... .... Fireplace ..................................................................................Approximate Cost ........ ? .©Qd...... ................. ......... Definitive Plan Approved by Planning Board -----------_______-----------19________. Area ............ ........ Diagram of Lo and Buildin ' h Dimensions Fee Q (- .. ................. SUBJECT TO A� OVAL OF BOARD OF HE 1 -o -, C3-_ cr 6 0 cn o �~ $9 ,. I hereby agree to conform to all the Rules an /e Town of Barnstable regarding the.above construction. Name ...... . .. .... .... . ........... . ......... 'Parker, Robert Do 19456 add to dwelling '- [ p",rmit for , "'K....................................................................... . Location .......:..214 Park Avenue Centerville ........ ; Owner Robert D. Parker , Type of Construction ........frame....................... f i r. 4 r a ........................................................ {*� Plot ...............:............ Lot ......... August 2 77 _ • ~_ �� .-Permit Granted .............:.. .....................19 F E Date of Inspection ...... " Date Completed ..... 7 .19 r. r - PERMIT REFUSED i^ r,• .................................................................. 19 ................... .............. + _ �. • + n y ...................F .................................................. R •.............................................................................. • ........................,..................................................... `♦ r�-' * ♦.�` t I •�.1, • r �f Approved .......................................... .. .................................... ... 19 •t ............................................................................... ..................... .......... . ........................................... 1 k l