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0039 PATRIOT WAY
. . _ �' e .: . . e � 0 a g m i 7476 1. c)�6 S Z Z'i 3 z•' 0 _1M --T- 4 0,O U {� CEPYIFIED PLOT PLAN 0 77 y NEW C®NSTRUCTION ONLY : CC/V-TEr2v TOP OF FOUNDATION IS FEET ADOBE LOW PINT OF ADJACENT ROAD. SCALE: / 4D DATE : 3 i6 �7 CLIENT' Lv�n. NEB I CERTIFY THAT THE tOVND�F7ry EOISTERE® REGISTERED SHOWN ON THIS PLAN IS L6CATj0 CIVIL I LAND JOB No. -7 -,5 /o(/ ON THE GROUND AS, INDICATED AND EN®II`9EE1� SURVEYOR DR. ®Y: A'A ILI CONFORMS TO THE ZONING LAWS OF DARNST I , A S. 33 N0. MAIN ST 712 MAIN ST. CH. BY: 0. YARMOUTH,.MASS, HYANNIS, MASS. SWEET-Y. OF DATE REG. .LAND SURVEY® �� ASD _ t " TONN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma /�� Parcel C I y 01�0 / C p / Application Health Division Date Issued —Yi_17A 1!� Conservation Division Application Fee Planning Dept. Permit Fee .. Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village lt Owner Address S,- C Telephone_ Permit Request Yn7 k I P 4A a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed 9 Total new ' Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type rn Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family O-**' 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 U new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name Mile McCarthy Construction Telephone Number PO Box 52 Address Nest Dennis, MA 02670 License # Cell (508) 280-6964 Cst.-_s8633 HIC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION i FRAME r� - R. ,t INSULATION r. ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ti FINAL BUILDING s DATE CLOSED OUT ASSOCIATION PLAN NO. ° o Town of Barns agile Regu oxy, Services seier+steaue ' Richard:.St.ii,;bkector ����`0 I3i�ildxng;�Divisiuia r Tom Yerry,lxdlding.Co=iWs'sioner 200 Main Stireet�Hi annis;:MA 62601 ovww.towu.barnstable ina.us Office: 5.0.8=862-4038 Fax: 508-790-6230 Property CY7Acr'Mus.t Gompletie an>`1*q This .Section If Usir a A Bbilder 4 as Qiuner of.tlie s ubjecr propeny hereby-authorize S T�c UC:T eo act,on mybe4 1f in aU matters.relative to work authorized by this building permit application for: 9M P6111i0 MM A 6Zb _ {Address cif'��li)r a "''Poolfences and alarms are'the respons , ',,.tyQf the applicant Pools are not`.ta be:filled 0rut lized,before�'fence is`� nstalled and a final .inspections axe performed and accepted- tnre of er Signature of Applicant Print:Dame. Punt Name Date Q.FaRMS:o1VNE-�tPM,41SS10NFQULS rw f 41 I it Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-058633 MICHAEL J MCCAR PO BOX 52 s W DENNIS MA 0267 Expiration Commissioner 04/10/2016 I Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiratio /2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY -- P.O. BOX 52 rs. WEST DENNIS, MA 02670Update Ad ess and returnr change. 20M-05r11 Address Renewal L_. Employment Lost Card rA t �'\ The Commonwealth of Massachusetts Department of Inrlustrial.Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 wwlv.mass govAlia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pltimbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information coushi tictiollf lease Print Legibly Name(Business/Organization/Individual): Mee C a 3' —PO Bag$-52 Address: West Dennis, MA 02670 e280-6964 City/State/Zip: r- ir-r—SK 3#: HIC-169393 Are yoq an employer?Check th�propriate box: LfYJ7/ Type of project(required): I. 1 am a employer with employees(full and/or part-time).* 7. El New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in $, Remodeling any capacity.(No workers'comp.insurance required.) 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]1 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole I I. Electrical repairs or additions proprietors with no employees. 5.0 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 12. Plumbing repairs or additions These sub-contractors have employees and have workers'comp.irtsurance.t 13.E]Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.90ther 152,§1(4),and we have no employees.[No workers'comp.,insurance required.] •Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. !Contractors that check this box must attached 2n 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. lam an employer that is provl(ling workers'coanpensation insurance for my employees. Below Is the policy and job site Information.Insurance Company Name: ATM'p�[ /M iji,i T,n> .'Maw-X t - Policy#or Self-ins.Lic.#: ���..')<r�— �i 7C� �c[y �j Expiration Date: ).� I— )IN Job Site Address:_ 3 +11 s— 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER-and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. !do hereby certify un tl al s and allies rjrrry prat the-information provided above is true and correct. Si nature: Date: Phone#: Official use only. Do not write in!Iris 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: t ii WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMPA.GE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 26158 POLICY NO. VWC-100-6017656-2014B PRIOR NO. VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 Box 52 FEIN:**-***3862 West Dennis, MA 02670 Legal Entity Type: Corporation Other workplaces riot shown above: See Location 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000,each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease. $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and RatingPlans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTEA 0712979 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV qGOV Deposit Premium $7,748 STATE MA State Assessments/Surcharges $28,601.00 x 5.8000% $1,659, This policy,including all endorsements,is hereby countersigned b Y 12/15/2014 Authorized Signature Date Service Office: Bryden&Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 ) Burlington MA 01803 So Dennis, MA 02660 / WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with Its nermissinn. �, 7)< � - '° � `MCCARTHY M . C 4- ' ,TRUCTION CO. aft sid it al and Commercial Builder IZ4710N SPECIALIST B . f+1 0 Date: 3° I w 00 Building Department W Building Commissioner M in St H_ 5 RE: Insulation Permits Dear Inspector, Pursuant to 780 CMR 109.2 "The building official is authorized to accept reports of approved agencies, provided such agencies satisfy the requirements as to qualifications and reliability". I Michael McCarthy certify that the work for inspection as described below conforms to 780 CMR,8`h edition and do hereby certify d the pains and penalties of perjury that the information is true and correct. Signature: Date: iG Permit# Location: �•��,r k> 1J.y �c••�c�y�) I� Type of inspection INSULATION CSL#58633 HIC 169393 MIKE MCCARTHY/MCCARTHY CONSTRUCTION - PO BOX 52,W. DENNIS,'MA 02670 Sincerely, Michael McCarthy McCarthy Construction � tOy Town of Barnstable *Permit 6 c) Ezpirrs 6 mnnL s fra sue Regulatory Services Fee Thomas F.Geiler,Director ,9 s,fflaing nivis;io>a . 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 withoat Red X Press Imprint Map/parcel Number Property Address residential Value of Work :�I Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name 2 Telephone Number f6t7 / F? k, 3 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) O Z 2—&d rS-Q ne MIT ❑Workman's Compensation Insurance Check one: FEB ❑ I am a sole proprietor 3 2012 ❑ I the Homeowner M-flh4ave Worker's Compensation Insurance TOWN of B ARNSTABLE Insurarce Company Namd 5 e _ Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit Permit R7Re-roof ek box) (stripping old shingles) 'All construction debris will be taken to ❑Re-ro f(not stripping. Going-over existing layers of roof) #of doors D Replacement Windo oors/s ers. U-Value__ h� (maximum.4.4)#of windows *Where required: Issuance is permi not exempt compliance with other town deparhnent regulations,i.e.Historic,Conservatian,etc. ***Note: erty er must sign Property Owner Letter of Permission. 0 o e me Improvement Contractors License& Construction Supervisors License is IGNATURE: . , 1WPFUMTORMS 7ding permit fm 7ni\D PRESS.doe -vised 07011.0 rr T 7se Commonwe aifir o,f Mt�achuseft D pwhnent o,f lndus&ial Accidents O, a of invesfigadons WQShinglon S&er Boston,M-4 02111- 1nb11 w nasmgf 1difl Workers' Compensatiun Insurance Affidavit: BudldersfC,antractors/EIe.ctzicians/Ph mbers Applicant Information Please Print Lead Nam v "o Address: 9-7 IS-AeXAQ 1A (A CityfStatef sp�P49s�.":s be(0 q!F Phone Are n an employer?Check the appropriate boa: . Type©f project(retlau-ed): 1_ I am a ernplt7yer with. Z_ - ❑ I am a ges$1 ctantrar;ttar an d I 6_ constructrc employees{full andfw part tune).* r have hired the sub-evs�traci s 1+I3=+h* Z_❑ I am a sole proprietor orpartrier- s listed on the attached sheet 7. ❑Remodeling' ship and have no l 'These sub-cuntractars have� ayees 8_ ❑Demolrticu Wcdring for me in any capacity- employees and have worms' . [No wod rs' comp.insurance comp.insurance-1 9. ❑Building addition required] We are a corporation.and its ID.❑Electrical repairs or additions afficers have exercised their 3.❑ I am a homeowner doing all s� 1 S_❑Plumbing repairs or additions my-self [No worlrers'camp- rightof esemgtina per b10- 12.❑ of repairs insurance required.]r c_152, §1(4),and:we have tic employees_[No Work 13. Otfrer 4 camp.irrsu mom nT ired.] Any app curt that checks boa#1:mnst also fill out th a sedina below showing rhea v�aake�'cnmpP,•��+"•�.policy information Y Homeost nm who submit this dMxvit iadirst ug they are dmug ail wat and dunime ouW&contiactnrs mns3 submit anew afdaeit mdicating sack_ It'aauartars that check this Loa mast itmcbed mm-as;t:An-t sheet showingthe nzme of the sub-canuvam and state whether ar not ftM entities hope employees. If the suh-costmams have empleyees,&ey—lsi provide 15esr Wakes',tmap.policy number. I am an employer that is praiWng workem'compenswion z.imrancefor my ampk5y Bdow is thepr hey and job site ira�oraQ�bn. - 7n Company Name: C 6 A^, Q+` Policy-A Seff-ins.Lic Fxpifatiou te: l i Job Site Addmss: � �t��t.n't �� QtyfStateYzig:&,1 d V l Attach a copy of the workers'cagnpemsation policy declaration page(Showing the policy number and expiration date). Failrue to secure coverage as wades 5eclitau 73A of IhrIGL c_'12 can lead to the imposition of criminal penalties of e fine up to$1,500.00 andlor ioF ea ` nit,as well as civil penalties in tiye form of a STOP WORK OP=and a fine of up to$250-00 a day a ve advised that a c iy of this statement may be forwarded to the Office of InTstigatioas of&e.Drage vedfim icn_ I do hereby eertr;�'y the is a d pmahCes of wry that the in;1forma#urar ptvmdded above is true and correct S' Date.: / / Z Phone#L,5 OBLdal use only. Do not write in fld's exert,ID be complew by do or tol"i official City as Town: PermitfLicense# Issuing Authority(dmle one): 1.Board of Health 2.Bmilding Department 3.C ylFo"Clerk 4.Electrical inspecter 5.Plumbing Inspector ` 5.Other Contact Person: Phone#: -0pIHiEl � Town of Barnstable �. Regulatory'Services anaxsrAsi.E, 9 MASS._ $ Thomas F.Geiler,Director �p 1639• Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 ' w .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 J P P rtY hereby authorize kdVVI, 4Pe✓L to act on my behalf, in all matters relative to work authorized by ibis building permit application for (Address of Job) ignature o Owner Date t Q. Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. 1 Town of Barnstable P�'Of THE 1p�� Regulatory Services f �ABIZ Thomas F.Geiler,Director 9 MASS. p s. g j` s6gq. �0 Building Division TFp MA'I Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403,8 Fax: 508-790-6230 t HOMEOWNER LICENSE EXEMPTION Please Print DATE: ', JOB LOCATION: �t�� number street village "HOMEOWNER": name home phone# work phone# CURRENT MAU-ING ADDRESS: city/town °# state zip code �C ,r 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 swervisor. DEFINITION O HOMEOWNER Person(s)who owns a parcel of land on which he/she reside or intends to"reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detachedi truc es accessory to such use and/or farm structures. A person who constructs more than one home in a two=year perio shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official o!n a form acc- table to the Building Official,that he/she shall be responsible for all such work performed under the bul ildin ermit. (Section 109.1.1) The undersigned"homeowner"a sumes responsi ility for compliance+ `'th the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that /she understands the Town of Barnstable Building Department minimum inspection procedures and require ,ents and that he/she will compl\with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-f 'dwellings containing 35,000 cubic feet or larger will be req ' d to comply with the State Building Code Secti n 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 homeowpers who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for icensing 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 �- ' OtTiee o jCo�is�nmercAftai B is Regn " HOME IMPROVEMENT CONTRACTOR Type: Registration:,A62938 Expiration: M27CL013 DBA M HER BROTNERSOIdSUGTION MICHAEL AfIEAGHERJR, 97 EMERALD W MAP.STONSMILL,MA t)2645 Undersecretary License or registration valid foc individul use ouly before the expiration date. H found return to:. Office of Consumer Affairs and Business Reg"on . 10 Park Plaza-Suite 70 Boston,hlA 0211 Not v d wrtho signature. �• M.t.s•�• III achusetts- Department of Public Safeh Board of Buildir%, Regulations and Standards Construction Supervisor License License: CS 102260 Restricted to: 00 MICHAEL MEAGHER JR 97 EMERALD LANE MARSTONS MILLS, MA d260 - o— �"G Expiration: ll/5W12 t',nuui��inu'c Trz: 102260 t CERTIFICATE OF LIABILITY INSURANCE DA 1129111�I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TFdS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING !NSURER(S), AUTHORIZED REPRESENTATTJE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT* If the certificate holder Is an ADDITIONAL INSURED,the polley(ies)must be endorsed. If SUBROGATION IS WAIVED,su*d to the terms and conditiems of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the cert!ftcate holder in lieu of such endorsement s PRODUCER 508 T7`:-3.3OD,riow `T Olde Cape Cod Insurance P�i+� Martha Findlay 508-775-3821 i E-C.Na.EaG. —_ i tA2.Nola __ 296 WirderStreet LAODR-3s: --- Hyannis,MA02601 MICHA-3 oDUC� _ arine J Findlay i oMet'os -; PISuRBUS)AFFORDING CO%ERACTE W:C NSURM Michael Meagher �uu,RazA:Esse�i insurance Ocmpary � 39020 _ 97 Emerald Lane Marstons Mills.MA 02648 tNs�to: . i WSURERF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY TeAT THE°OLICE5 OF INSURANCE LISTED B=LOW HATE BEEti ISSUED TO THE ItSUREC HAMEE ABOVE FOR THE POaCY?ER!OD INDICATED. NOTWITHSTAND4913 ANY REOJIREMENT.TERM OR COV3STION OF ANY CONTRACT OR OTHER DOCUMENT W,TH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE WSUP.Ak-CE AFFORDED BY Tom= POLICIES DESSCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDM06VS OF SUCH POLtC'ES-L ACTS SHOFl-Jrd AMY HATE BEEN REDUCED BY PAID CLAIMS. IhSrn. ry'P=OF tivSIiRAN.'.E— !X Ev "LtCV NUMBER i 61PJDtY'(YY 1 Rhwor'YYY:' ,L4dn'S. trtRaL:caeur I ! 1 t,nR=t F _GI?k P.:IAL c�:aAL: rr I t c 50,00_ A X t _ MD2687 ! 03124h1 I =24112 � �•,�a__3a=r nce� !g 1.00 11,000.000 ;{ram u�At39r^ti<a 1F000.00 G°iA;.,=?FEGATEU;t=TawI_S='3:: i i i �or,_,kMS-.GpN.'r. :+.-� •f---'- -1FOQD.D(1 At-TORM&LE LIAEL171 S F:-I 4JT1 ,. `� i i C - . ^t o.^r�l Y ti _Y-,.F?r:C. 'i ! :.n,cr:A_TCS i itED1jLEt'P-1i C;b - ! t 1- - GFf=E—. OA!4ru5E :T WMEPSCOMPENSATIOH t -'-`'-T�L ' T:.• 4?O E1LP�lERB'LABUTY — t-.ry E!- •:N ELC!_EJS9-F'UC 44 .? , OESCWPTG3H�OPr3tP.Tk'RtS1L.CaT(O:v3ry@aCLE3 tttacn aCDRJ 107,ASoi�ona P.e:aarke Sche2m•.•ttros sPaee!c:ecuireEy Insured has workers compensation policy effective 11MMI-1119ii2 with travelers.!have ordered a certificate from the company and It WIN be sent o you directly. . CERTIFICATE HOLDER CANCELLATION TOWN-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE MAIL BE DELIVERED IN ACCORDANCE MTN THE POLICYPROVISIONS. Town Of Barrstable Building Department AJnHDpfZEDREPRE3EW AnVE Hy south street 3 Hyannis,!UtA 02601 f 1988-20D9 ACORD CORPORATION. All rights reserved. ACORD 25(2009109; ` The ACORD name and iogo are registered marks of ACORD 6:51 :3.1 !%M DAG 2/002 Fax SerVe,. . ACOP.D. CERTIFICATE OF LIABILITY INSIJPA!e -V 7KS CEI1 TE!}(:.'.TE.ti rSVE0 AS A MATTER OF INFORMATION ONLY AND CONFERS HO RIGHTS UPON THE CERTIFICATE HOLDER,TIOS r. CER iTti(;A'le LJlrS i l T AFFIFttiiATTVELY OR NEGATNELY AMEND,EXTEND OR ALTER,THE COVERAGE 4fT-OP-0 Fa PV•.7'a".:('LCIES C-ELOW. T•24 CFPT.z.^ATE OF INLSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEENTHE ISSUING INSURMS+,A UTW.FPRED gcoREgLM.ATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. BIPORTANT:R the certiiicote holder isan ADDITIONAL INSURED,the palicKis lmustbeendorsed.!tSUBROGATIONISWAIVED,m0eattothe truce mG a wifitium c l the palc;,cetrdn pokles nbg ir;4&6 and ondersenrerd.A Ate6rnant on This c"fic ds doss not confer rirjhtsto the rn.:i!kM.9 Mld-ro:!%n•of such ardorsam��+t(s). G aN_L=n CONTACT NAME: PHONE FAX OLDE i:e H 11,1:D I?IS AGC:Y (A C,No,Sid): FAX (ANC.No): 21,16 WISTT7fC SIRM, '4AML ADDRESS: " PRODUCER Y.YA.":li IS.MA (C1,01 CUSTOMER ID s: ZXRC INSURERS}AFFORDING COVERAGE NAICC INSURED INSURER A: TRAVELERS IN'DfAVM C(AIPANY INSURER B: MEAGUR`11CHAEL D$A NTAGIER CONSTRUCTION INSURER C: MURER D: 97 BIFA ALA STREET INSURER E: . :ULAtca WNS MILLS.'L4 02`:8 COVERAGES CERTIRUATE NUMBER: I:E:•!S ON IRIMBEP; '*10+RTT.(.EI.AFYTHA7 THEPOWTS OFINSURANCE L•STED BELOW HAVE BEEN ISSUEDTOTHEINQURED NAMED ABOVE FORTHE P LICY PERIODINDICATED. WT%1rk$TA.4iXNO ANY REWFIRAENT.TERMOR CONDITION OF ANY COW.UCT OR OTHER CERTIFICATE BAY BE*SUED OR%W?PERTA;N.THEINSURANCE AFFORD0 BY THE POLICIES DESCFUBW HEREIN 6 SUBJECT TO ALLT14ETERNK EICLUSIOM AND COMO10N90F Si;CH POLICIES, LIMITSSHON'NMAYt4AVE BEEN REDUCED BY PAID CLAM. _ - 6+IER AWLS'JBR -OLt"EFFDATE POLICY EXP DATE - TYPEOFtNSt:RANCE POL101rNUMBER (M1AD01"tYYYI @toomyYYYi UTARS - LTR - MR WYC - GENERAL LRABRdIY EACm OCCURRENCE al:14RCIAL G ct.'FR^L.:A?;L ITY DAIAAGE TO RENTED 3 C,-Af?n BADE 04XA ;. PREMISES(I-Dmmico) W-1)hAv(An-i one psmcn) $ PERSONA_&&ADV HJJUP.Y S i•.'i KG+3^c•a;.- l'r IS :°: :':f?R: GENER4L AGGREGATE S FOLLY PRCI;E:T IADC PRODUCTS-COW.'OP AC'G + ALt=OBILE LIABILTTY COMS1ED SUJGLE S ANY AUTO LMIT(Eaacade d) ALI.OWNED AUTOS E007LYIWURY S SCHEDULE AUTOS B00 LY IN41)URY S HIRED AUTOS (Pet weldeni) NON-GWNEDAUTOS c PROPERTY DAMAGE. S w L IPartocAenh UWiBRELLAUAS OCCUR ` EACHOCCURRENCE 4 EX'.ESS LIAR CLAINt$•MADE AGGREGATE S DEDUCTIBLE S RETENTSON 3 S WC STATUTORYLWITS OTWA - WORKERS COWENSATION AND EMPLGYER'S LIABILITY YIN U9 4MP64A-I f I1lFQ2011. t I!m0t2 E.L EACH ACCIDENT S 10C'000 ANYFRCFEFITOR/rARTHER'E:SCUTIVE - N E.L.DISEASE•EA EMPLOYEE S- '.t00,00Z �FI�FtME57BER EXC:LOW1 INhnde*ryknNH) - - - E.L.DISEASE•FOLICYUNIT 5 VX,000 -P.yss.dews tc wow - MSMPTICN OF OPERA7I04S oe;w: DEyjtmvi10!efFopERATIONSILOCATIOiv.VEHICL'rS:RES`F:c:rN7NS3PECIALNT£6AS M RM ACES ANY FRIOR CERTRRCA7E ISSUED TC IRE CLIYIIRCATE F01 DIM AFFPOM0 WOR-KEPS CONT COVirAGE, NE\GHFIR NOCF-AM S COVI M WC THE W ORKfRR rONIFEd'M Ttnu PI r',v HOLDER CANCELLATION TO WIV OF DAMSTARIE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED -FORE THE EXPIRATION Ir 1T':THEREOF,NOTICE 1VfU BE-XI 1:'CRED! 730 SORB STREET.- t.CCORGANCEVrITriTn•E POLICY P20rS'IONS. AUTHORIZED REPRESENTATIVE r�,Ivnls,MA �2i><ii Charles 3 Clark ACORD 25(2009/09) 19I6.2WO ACORD CORPORATION. Aii rights resst'Yed. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �-Z�S Parcel Application # 00(1 OL36T Health Division Date Issued z It Conservation Division � Application Fee .J Planning Dept. _ Permit Fee Date Definitive Plan Approved by Planning Board ` Historic - OKH _Preservation / Hyannis Project Street Address 4n Village C6241�e/,VAL7 Owner^S�NyAt � �(✓A✓ Address G tl- Telephone 17)V W- ;2-Lf 6 -�Ir/r� $P/ Permit RequestIV -1�� ��"C1°1 %�f �� � �c�'Tom. r�2o�►I+n ��n 0►� Square feet: 1 st floor: existing proposed/ 2nd floor: existing proposed Total new Zoning District Flood Plain Cz Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If-yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: WFull ❑ 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 L new Total Room Count (not including baths): existing new. First Floor Room Count=� Heat Type and Fuel: td Gas ❑ Oil ❑ Electric ❑ Other r Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑.Yes YNo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing news size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other. N) Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes (QNo If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� D WJ_ v a Telephone Number -7711'Z��f� �-- Address ,77 License# e' M(x Home Improvement Contractor# Worker's Compensation # &e:6�&ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Al A SIGNATURE DATE F f � d FOR OFFICIAL USE ONLY APPLICATION# - DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER. DATE OF INSPECTION: FOUNDATION FRAME INSULATION I; FIREPLACE xw ' ELECTRICAL: ROUGH FINAL I PLUMBING: ROUGH FINAL-. Y� GAS: ROUGH FINAL FINAL BUILDING 713 t f-Pt, 0 //'�'1` t DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth ofMassachuse ,r -Deparbnenf of-rndustrial Accidents Office of Imeskgations 600 Washington Street Boston MA 02III ` Workers' Com ensafion www.rnassgav1dia P durance Affidavit: Builders/Contractors/Electricians/Plani A ficant Informationbers Please Print Le 'b Name (Business/Or�tio vb&vianat)' •1��{ 0-1 A� Address: AA City/State zZ : , fla Lane Are you an employer? Check the a ro PP Prue box: r . 1.❑ I am a employer with 4. [] I am a general contractor and I Type of project(requir-4: employees(fall and/or part-time),* have hired the sub-contractors 6 ❑New construction 2. I am a sole proprietor or partner- listed on the ' ship and have no employees . These subh attached sheet; 7. ❑Remodeling . working forme in an capacity. ontractors have S, (�Demolition y aP ity. employees and have workers' [No workers' cow,insurance comp;insurance.$ 9. ❑Building addition 3.❑ required] 5. 0 We are a corporation and its I0. 4 I am a homeowner doing all work officers have exercised their ❑Electrical repairs or additions myself [No workers' comp. right of eXempf ion per MCL 11 []Plumbing repairs or additions insuurance required]t c. 152, §1(4), and we have no 12.0 Roof repairs, employees. [No Workers' 13.❑Other comp.insurance required] *Amy applicant that checks box#I mast also fiIl out the section below showing t Homeowners who submit this affidavit iar&cating they am ��WO��'compensation policy kfurmadm #Contraotms that check this box must attached an additionel sheet work and than hire outside coniractora must submit a new affidavit judic emploYc= If the sub-contractor have employees,they must p�de�wow,cf the sob-contractors and state whether or not those a ti ating such. vc _ amp.Policy number, iisforlrrati employer an that is .pr��g workers'compensadon insurance for Dry errroloyees. Below is the poficy and job site Insurance Company Name: Policy#or self-ins,Lic.# Expiration Date: Job Site Address: Attach a copy of the Workers, compensation policy declaration page(showingsty/State/Zrp: Faihu-e to secure coverage as required under Section 25A of M o P c. 52 can lead to.the Policy number and expiration date). fine up to$1,500.00 and/or one-year impziso R,eu civil the is position of criminal penalties of a Of up to $250.00 a day against the violator; Be Penalties in the farm of a STOP WORK ORDER and a fine Investi advised that a copy of statement ma be forwarded to the Office of gations of the DIA for i*+errrsrT,re coverage verification. � y I do hereby rlify nder the ems PenaWes of perjury that the inforrnafion provided a oNe is true and tarred Date: Phone# -"j > L r Official use only, Do net write in this area, to be completed by city.or town official d City or Town: Issuing Authority(circle one): Permit/L.icense# L Board of Health 2.Building Department 3,' 6. Other City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Contact Person: Phone#: r t`C �`� e �5'' L►cense or reg►stration valid for mdividOOe only Office o ousumer a►rs mess egu anon t R i before the exp►ration date. If found:return to: i HOME IMPROVEMENT CONTRAV Registration: _• 14288 Office o Consumer Affairs and Business Regulation }, 1 ='A, TY e• ,P 1 Expiration: 5(2812012 �g� l0 Parlcl'laza-Suite 5170 Boston,MA 02116 BAY BUILDERS a tOSHUA WILSON� � u - 1 ; 34 MAIN STREET CENTERVILLE, MA 02632 v- Uecretay 'u T,1ot vali wit out signature w - vlussachusetts- Department of Public Safety Bound of Building RegruIations and Standards Construction Supervisor License License: CS 82213 JOSHUA D WILSON 34 MAIN ST.., , ... CENTERVILLE, MA 02632' Expiration: 6/23/2012 Coliimissiuner Tr#: 6407 J Ltviac1 w4y CW/- t � s � l°a�' - 1 ��a���r� �r �����t� '6�0 � 61-C AWOOOW 6 IT EEE' 1 Fl 6 PT . �� �� -- - J Town of Barnstable t Regulatory Services Thomas F. Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street,gyanuyi,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:_ 508-790-6230 Property Owner Must Complete and Sign This Section If Us' A Builder l� , as Owner of the subject prop ertY hereby authorize -" to act on my behalf, in all matters relative to work authorized by this building permit - y - (Address of Job) #Pool,fences and alarmsy are the responsibility p tp of the applicant. Pools . are not to be filled before fence is installed and pools are not to be Utilized. until all final inspections are perfor ed and accepted. Signature of tore of pplicant . L .� VI- to - Trint Name Print Name Date F QFORMS:OWNERPERMISSIONPOOLS OF IMF Town of Barnstable Regulatory Services rZ, Thomas F.Geiler,Director KAM �b 0.19.lM{d' g�•� Buildin Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-40 8 - Fax: 508-790-6230 HOlY1EOWNER LICENSE EXEMPTION Please Print DATE: e JOB LOCATION: f number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/to'wn� state ' zip code ' The current exemption for"homeowners"was extended to include owner cc ied dwe s of six units or less and to allow homeowners to engage an individuals for hire who does not pos ss'a license,provided that the owner acts as supervisor. t DAWITION OF HOMEO R Person(s)who owns a parcel of land on which she resides or inte ds to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures a cesso to su ch use an person who constructs more than one home in a tw rY door farm structures. A eaz period s not be considered a homeowner. Such "homeowner"shall submit to the Building Official on form suable to the Building Official,that he/she shall be responsible for all such wo rk rk erformed unde r the boil ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for c liance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she and tands =e Town of Barnstable Building Department minimum inspection procedures and requirements and th t he/she icomply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containin 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction ontrol. HO EOWNER'S EXEMPTION The Code states that "Any homeowner perfo iiig work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.I-Licensing of constructi 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 exemptio are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Su sors,Section 2.15) This lack of awareness often results in serious problems,particularly, 1 when the homeowner hires unlicensed persons. In is 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 i i n 04 12 07: 15a Michael Hinckley ^ 508-420-2274 p. l Town of. Barnstable , Regulatory Services r 9 �AT ni inas F.Geiler,*.Dirac tor �r XAJM Building Division tb eN� Tom Perry, Bui]ding.Commissioner 200 Main Street;Hyannis,MA'02601 x . - Fax: 509-79 0.623 0 Office: 50 8-962-4038 �A REQUEST FOR, ELECZ`R,ICAI1 INSPECTION ELECTRICAL PERMIT NUM 3ZR (Permit required is order to,process inmectio� w' t � d'Date of InepectOn' Todap's Date Regveste ``'h.erebp request an inspection under Massachusetts General chanter 143,msectio-n 237 CMR 4 02(3). ! Law _ } The in.ataDation will bs ready for inspection at (Property Locatwn) 4, Type of inapection'requested� . ❑ Y erPice Re-In pectaon Temporary Service Excavation } `' Rough Re-inspectipn. 'Service In ° 'S ~ 'iaal Re-inspection .:: spection _ = (' 100.00 Re-in's)ecti n Fee) Rough Insp action for !� 5 c/w� �. , [] Final Inspection.for a ,e }yY+Xyy. [] Other r - Oer or tenan vfn t At iN� 117 wc►..1.' .~ate �'� is i } Licensee's nazhe addrese, and4phon� ! , 1N1�/L� � . ILicense number S�' 'J4.L Lic } ensee's'S ,rnafvre L _ \' ti mis section,to be caaipl a Barnstable Inspector of GPzz-es Inspection date JAN 0' 2012r p.0rove.d- ❑Not Approved r . 0 9 2012 , r r ' This work was not approved far violation of the lollowiug Articles:and Seciions.of tile,Ick I Electri.cel Code: Q:VrPFiles:fozmsxloctmquest ,. l,ommonmea(Xh o/MaMachu6eib ^f�l VjS�4�Y�/t /'1 •' q Apartm.d 4 ire Ser evice Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK -/ All work to be performed in accordance with the Massachusetts Electrical Code(MEQ,527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: 42-3-/;L City or Town of:- To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) 39 ?ogM,0e S WA Owner or Tenant 614 2.4&--T{a i s CDOIr 6,0J, N TdVb-6e,l'&-,0 Telephone No, \ Owner's Address Is this permit in conjunction with a building permit?, Yes No ❑ (Check Appropriate Box) Purpose of Building ?,E5I-D&VT7A L Utility Authorization No. Existing.Service JOO Amps 9 7 u I ZVO Volts Overhead Xf Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work: 4&W aebkooM "V Z; 5�� TO Completion o the followingtable may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil Susp.(Paddle)Fans No.of Total : Transformers KVA No.of Luminaire Outlets r No.of Hot Tubs Generators KVA,,, No.of Luminaires Swimming Pool Above ❑ In- El o mergency ig mg rnd. rnd. Battery Units No,of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones ; No.of Switches No.of Gas Burners o. Detection and , Initiatin DevicesTotal No,of Ranges No.of Air Cond. Tons No.of Alerting Devices Z eat Pump Number Tons KW No.of Self-Contained o�o No.of Waste Disposers ;l t Totals: Detection/Alerting Devices' CO Municipal o Z No.of Dishwashers Space/Area Heating KW Local❑ 0 Other Z�i2 Connection W _ SecurityS stems:* W No.of Dryers Heating Appliances KW y F.=z No.of Devices or Equivalent Z o Z o.of Water KW No.of No:of Data Wiring: Q Heaters Ballasts W Signs No.of Devices or E uivalent Ir- No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: o $ No.of Devices or E uivalent®LU OTHER: C.L'221 IT ow a Attach additional detail if desired, or as required by the Inspector of Wires. W U, a Estimated Value of Electrical Work: (When required by municipal policy.) a w>- W o Work to Start: l- 3-1 Z Inspections to be requested in accordance with MEC Rule 10,and upon completion. W �W 8 o w INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless W the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The a o a undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X. BOND ❑ OTHER ❑ (Specify:)' I certify,under the pains and penalties of perjury,thatthe information on this application is true and complete. FIRM NAME: /G trt 7, AL-Zt, LIC.NO.: 503,56 L Licensee: /V/a VML-7- T, t GLM Signature LIC.NO.: �O3,56 l (If applicable,enter "exempt"in the licens number line.) Bus.Tel.No.:_ 77Y-368- Da1`� Address: Z3 (rp4rL$tI 4,y L,,yH1r t 16 f-01 ,5, MA 0 Llv L-� Alt.Tel.No.: 56'1-L/ZQ-ZZr�y *Per M.G.L.c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature'below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's a ent. Owner/Agent Signature �Telephone No. PERMIT FEE: $ 2011 15:47 5087789312 BARNSHOUSAUTHORITY V PAGE 01/01 Leased Housing Dept: .508.771,7292 Barnstable Telephone 508.771.7222 ruwrosrAn+x FAX: 508,778.9312 MA bs w.1 ousing Authority 146 South street•Hyannis,MA 02601 ZONING VERIFICATION I TO: Lindai..Robin �.; FROM: Kim Go.inez,'Leased Housing coordinator PHONE NO#: 508-771-7292 FAX 508-778.931.2 RE: LEGAL RENTAL UNIT VERIFICATION DATE: ADDRESS VILLAGE: UNIT TYPE BEDROOM-SIZE \�7 MAP & PARCEL NO: /. I o2` The owner of the above listed property is entering into a. coati/ctith us -for rental of the property listed above. Please verify by signing below Oat the unit is legal and meets all Toning re iremen,ts for a.rental in the t of Barnstable. If it does not, please list tine reason below: i\nL ' ��- ha1 you for your assista»ce in this ma. SI Signature Print name Date: l SQn L b�s � - VIA FAX: 508-790-6230 -r1 e� FAA Equal Housing Opportunity Agency P. 1 Communication Result Report ( Jan: 11. 2011 4: 14PM ') 2 Date/Time : Jan. 11. 2011 4: 13PM , File Page No. Mode D e s t i,nat ion Pg (s) Resul f ' Not Sent ---------------------------------------------------------------------------------------------------- 3823 Memory TX 95087789312 P, 1 OK Reason for error E. 1) Hang uP or line fail E. 2) BusY' E. 3) No answer. E. 4) No facsimile connection E. 5) Exceeded max. E—ma i 1 s i ze 01/11/2011 15:47 U87789312 EARISHOUSAUMDRITV PAGE 81/81. .. Leaved Housing Dept:406.771.7292 Barnstable Telephone 509.77{.7222 FAX 50.17gs31a Hausi�ng Authority tority 146SoutfiSkr t•Hywni"MA07601 ZONING VERMCATICN TO: LinddRobin'. FROM:Kim Gomez;Leased Housing Coordinator - PHONE NO#:508-7.71-7292 FAX 508-778-9312 RE: LEGAL RENTAL UNIT VERIFICATION DATE: ADDRESS VILLAGE: UNrr TYPE BEDROOM SIZE MAP&PARCEL NO: /qo?d/S The owner of the above listed property is entering into a contract with us for rental of the property listed above.Please verify by signing'below that the unit is legal and meets all zoning r eats for a rental in the of B�'�b le.if it does not,please list the reason below: , Sin :{: m YY� c in your assistance in this Y .. ,CZyau t�� .1or Print name Date: l t 1 VIA FAX:308-790-6230 . i P. 1 Communication Result Report ( Jan, "19. 2011 4: 28PM ) 2) Date/Time : Jan, 19. 2011 4: 27PM — File Page No.. Mode Dest i'nat on Pg (s) Resul t Not Sent 3930 Memory TX. 950877893,12 P. 1 OK ---------------------------------------------------------------------------------------------------- Reason for error E. 1) Hang up or line fail E. 2) Busy E. 3) ,No answer E. 4) No facsimile connection E. 5) Exceeded max. E—mail size . 81_/11/2a11 15:87 5057789312 BARHSH2FiAUr0UTV' PAM 01/81 - - - 1Awod HmninZD*L 508.771.7292 - Barnstable TdgdwmSOB.M= 1 FAX:508.778.9312 Housing Authority 196 Snmh Sue•Hymni.,1AA 02001 ZONING VERIFICATION - TO: Linda/Robin FROM:Kim Gome4-Leased Housing Coordinator - PHONE NO#:508-771-7292 FAX 509-778-9312 - RE: . LE,/GAL RENTAL UNIT VERIFICATION DATE: JQ(1Q711.11Y A I A ADDRESS: �a VILLAGE: N4 UNrr TYPES 13EDROOM SIZI3 1\_L.V ' MAP&PARCEL NO: /9a bT IS �`w The owner of the above fisted property is entering into a con with us for rental of the ". =ty listed above.Please verify by signing below that the unit is legal and meets all zming eats f�cnl le.ff it does not please list the reason below: ' you for your assistance in fhis Signature Print name �- .__•— Date: It til j�Slh� Gtn, 2 t.�; 5f L*c blue- VIA FAX.-508-790-6230 l,k��,lt �p Yvn&x tUact.Y�n i rat — '1 Zo 4 1v8^1'ObL_�tJa��� rng APPRj 6 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH D� s TOWN OF BARNSTABLE 11iration for Dirlp11`ial Workli TottstrurtivitPrl2it Application is hereby.made for a Permit to Construct .( ) or Repair ( n Individual Sewage Disposal sy ..t. > lot Z a - d ss --••••. ------... pim ..._ .... .. ' okev . .........4.... Installer Address UType of Building Size Lot.:.............. .. Sq. feet Dwelling No. of Bedrooms------- Expansion Attic. Grinder a, Other Type.of Building ........................... No. of persons ( )Showers (Ga)�a eCafeteria ( ) Other fixtures ..-.. ----- --- ---- --------- -------- W Design Flow............................................gallons per person per day. Total daily flow...: ......................gallons. W . Septic Tank—Liquid capacity/DC.-.galIons Length., , Width................ Diameter.. ..... Depth—:............ x Disposal Trench—No. .................... Width.............. ....Total Length.---.............--. Total leaching area....................sq. ft. . 3 Seepage Pit No................ .... Diameter.................... Depth below inlet... Total leaching area.............,....sq. ft. Z Other Distribution box ( ) Dosing tank1-4 ( ) 1.4 Percolation Test Results Performed by-- -••-.--•-------------••--•-.........-------......•....-----.:....---••- Date........................................ 04 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs. Test,Pit No. 2................minutes per inch . Depth of Test Pit................... Depth to ground,water........................ 0.�i. ---------------- -------------------------------------••--•------..._._._...............--- ---•-----•- Descriptionof Soil.............................................................................. W ....................... •-••--...... . ...................... ...... ...•---• ••---•-•--••......-- •• ---------.....--- ......._-----......._.......... x ...............................................-........................................................I.-•••--•- U N ure of Re airs Alte o s—Answer when applicable..�1?-.5 /r....jo.�' ��/�G�c'( � -� .. -T. ..... ..•... ................................. Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code— he undersigned further a es not to place the system in operation until a Certificate of Compliance u by eta Signed ...... .......... ... ................................ ......... ..... .. .. ............:........--....... ... Application Approved _-:......... ............... ...... . . ...... Application Disapproved for the following reasons: ..................................................................................... ..... ............... --.. .... ......... ...... .. ,. ........ .... rDare Permit No. ...: ... Issued .........L..�.....1 ��...... Dare '— -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Celrtifi ate of (1 amplianrle THIS IS TO CERTIT� �yh�at e Indip dual Sewage Disposal System constructed ( ) or Repaired by............ ....... ..... (,, �/ n.cnllcr � at .......... �..... ..... :.. �l6'% .f:... flr� 1 .... ..... ......................................... has been Installed in accordance with the provisions if TITLE of The State Environmental Code as described in the application for Disposal Works Construction'Permit No. .......` ..., .. '-. dated ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS,A GUARANTEE THAT THE SYSTEM WILL FUKCT10 SATISFACTORY. DATE. (ate 1 d / ... + _. Inspector ... ..... '... .................. . I`r -- -- i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - TOWN OF BARNSTABLE FEE... onatn f Permission is hereby granted.......::......./— . (0 /f t to Construct ( ) or�Re air ( ? n Ind*virhi .$ewage Disposal S stem at No Street r as shown on the application for Disposal Works Construction Permit -:kMated.... ............................. f . � .r Board'of Hcalth ..�... DATE-•••-..... .... ....:::............•--•-••-••--•-••-...._..... FORM 36508 HOBBS A WARREN,INC..PUBLISHERS oFtHE ray, Town of Barnstable ' Regulatory Services * BARNSfABLE, MASS, $ Thomas F.Geiler,Director 0.19. A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA`02601 Office: 508=862-4038 Fax: 508-790-6230 January 21, 2011 Elizabeth Cook 39 Patriot Way Centerville, MA 02632 RE: 39 Patriot Way, Centerville, MA, Map: 192 Parcel: 215 Dear Ms. Cook: Upon a recent inspection at the above referenced address, a bedroom and bathroom was observed in the basement. The bedroom and bathroom were constructed without.the benefit of proper permits. The bedroom in the basement is declared dangerous and unsafe due to insufficient emergency escape as required by 780 CMR and is use must discontinue immediately. Furthermore, the work done without permits must be removed or the proper permits must be obtained followed by successful completion of the:required inspections: Failure to comply will result in further action by this office and may include; but is not limited to, fines and/or criminal prosecution to the fullest extent as allowed by law. By Order, 6Q .e--- eLV. Lauzon Local Inspector (508) 862-4034 Q:zoning5 � �sit r .. � '• =r e Y-. t 'h. . .✓ \\_, 'you .�-~ ' 1 44 �T�----- -� • its i 6 s U - � _ �- 07 1i 5Fm S 9 I . f - •f r Z 2—' {� 10 N 1 UU 57 0 7 WA y _ -d''�`''7_'*.ti~"�-"'._:3.�s."'�i*".**p^s"-""'"s y'r ti«':rr;"e-��=--e-`�>:-*'-y5'----'-'---^'-----e.•sn.-,-...-..._may._-, :•-•.•a r-:�.,.. '_e '"'"" ` CERTIFIED PLOT. PLC NEW- "CONSTRUCTION ONLY : E TOP OF FOUNDATION IS FEET IN R®A®E LOW POINT OF ADJACENT A 4 TABI SCALE: / 40' DATE :- 3 >6 -/ I > , EL®RE®GE ENGINEERING CLIENT I CERTIFY THAT `SHE FyL/A44,4�ry� riNGISTERED RE®BSTE6�ED - SHOWN ON THIS PLAID, IS LOCAT JOB�NO. 7,5 ON THE GROUND AS INDLOATED AND CIVILILAN® CONFORMS TO THE ZOB�IONG LAWS E ®BN�ER SURVEYOR DR. I3Y. �' �:"7 OF ®ARNST BA S• r` � � 33 N0. AGAIN ST 712 MAINMAINST. CH. SY'' 3 3' � . SO. YARMOUTH, MASS. HYANNIS, MASS. SHEE OF / F. DATE:. RED. LAND SURVEYOR - M TOWN OF BARNSTABLE 21107 �.. a Permit No. -------- _-- _-_ 1 sARISTAIL Building Inspector Cash — ' 1 �YL OCCUPANCY PERMIT Bona _'t 4(4r� "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Bader Cons tructiori Address 7U� 1T:?St I}SaIII t. , 21ri23 lot #4 39 'atriot W:ay, Centervil-le wiring Inspector j Inspection date Plumbing Inspector ' � Inspection date Gas Inspector Inspection date - . t%Engineering Department �,��-`, Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. { P r .. ............. 19 ....................... ..... �� Building Inspector Assessor's map and lot num�z/ r .. "• � /92 �.0* E T�f� Sewage Permit number ..... ..... :........................... SEPTIC SYSTEM MUST SE��Q INSTALLED IN COMPLIAN House number ....�3.9 V�!!TI! ARTICLE II STATE Zs BARNSTABLE, i SANITARY CODE AND T01P�.''�00,,�0 pY Pi'ULATIONS TOWN OF ' BAR.NTABLE BUILDING - INSPECTOR01, APPLICATION FOR PERMIT TO ll Q 0 0 TYPE OF CONSTRUCTION ..........l( .J.�..�1�. .............�C�.�.�..........................................................17N 2- -Z .............19 TO THE INSPECTOR OF BUILDINGS: - The undersigned hereby applies for permit according to th following inf mation: Location ........ ............... ....... kf!. ...... .... .. ..... ... i� .V. .................... .1. v'�1 ............................................ .... .. ..Proposed Use ...............� Zoning District ....................... 1...................................Fire District Name of Owner .. -G !`.� .4.. I�E �\ �5 ��/.: ress ....... ... ..... .......... �c. Nameof Builder ................. A } .........................Address. ............................. �............................... u� Name of Architect .......................... ...........................Address i �!y< . Number of Rooms ....... ...............................Foundation ... �� .�!I^ ...( f! Exierior .....`...... �a`... ..... �. .............Roofing ........4-Lai6z............ I Floors ....clec.. ... -(cf., . ........ . .N..................Interior ......L.\1 Heating ....... 1..M . ...... .... . Plumbing ..... .. .... Y. ...... ... P.. .... .... Fireplace ..:............:.......1..�l.tJ..a..� .................................Approximate Cost ... . ..... �.. ....................... Definitive Plan Approved by Planning Board ________________________________19________° Area .......................................... Diagram of Lot and Building with Dimensions Fee _T SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of t\eTown of Barnstable egarding the abov construction. ��((Name .. .. .� . ...... .l`�.� �. Leader Const, Az192-21 5 No 2.13.Q7...... Permit for Bud,1d..si.ngj,&........ ....f=jly..dwelaIng...... . ............................ Location Lot..4.-Patr-3*.-Qt--Wa-y.......................... Centerville ............................................................................... Owner ....................L.........eeadCo . ..r.........nst.......................... Typ6-of Construction Wood Frame .......................................... ............................................................................. 4 Plot ............................ Lot .....4........................ .......................... Yermit Granted ...March...2.1....................19 79 Date of Inspection....... 19 Date Completed .................19 , 41 PERMIT REFUSED ................................................................. 19 ............................................................................... ............................................................................... . ............................................................................... ............................................................................... Approved ................................................ 19 ....................................................................... .............. ..... 51-1191 A;