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M M-AW, - ,, �I_ I: I gQ"qY"WqW@MMA MR 01 , "�-,�,��! �,�:,�:.", ��� -11��I'CLI'11�eVle!�4�� ,,:�, ,� AV , I- . . i '�� QQq � .,,� , ,,,,�� - , 41,1415y"'T,yyyy I:� "ww"Als ,:,I,,� , ii;�!,,1�,��,O�m;I"' � 11,�-,-,. ;__i, � i�, - ,- . � �L, - .�i� , ��, ,. �_ . L�*.,,,�-,_.t.-�,!�,,�t�. I "i. . ..w;, �.- it�n!� ;'��""� ��';­jj��,."­­,��' .:��lloczlztqt!lVown2stizitvtllm!E H SM I i Town of Barnstable *Permit# 3- 1 �Expires Regulatory Services Fee 6 monthsfrom issue date g rYOq * snnxsTnste. Mass.039. Richard V.Scali Director Building Division Tom Perry,CBO,Building Commissioner APR 2201� 200 Main Street,Hyannis,MA Q216 JlA t �yC www.town.bamstable.ma.us N OF BARN STA� Office: 508-862-4038 ►l Fax: 08-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number /! Property Address Residential Value of Work$ 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address `�� ✓�`(•� Ceti Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) X Y 6 o" Email: C1 2 Cat �— Construction Supervisor's License#(if applicable) Q o FMWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name `1�`L'^'sC- Workman's Comp.Policy# CA, Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Lk Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not_stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\AppDataUcal\Mi osoft\Win ows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 - The Conrrnonwealth of Massachusetts Department of IndristrialAccidents Office of Investigations wi 600 Washington Street. Boston,MA 02111 fr imn mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Conh•actors/Electricians/Plumbers Applicant Information cPlease Print Legibly Name(Business/Organiaationlfndividual): �(�"", G Zt� 6!l � �C���✓ Address. Pv< �f✓n��� /G City/State/Zip: �� ��/l //� Phone#: Are you an employer?Check the appropriate box: ,,rr�� Type of project(required): 1.[3 I am a employer with V 4. ❑ I am a general contractor and I 6. 0 New construction employees(full and/or part-time)_' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling. ship and have no employees These subcontractors have S. ❑Demolition woddng for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.' ❑ We are a corporation ventured.] 5_ oration and its ME]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.]i c. 152,§1(4),and we have no employees.[No workers' 13-W Other e comp.insurance required.] 'Any applicam that checks box#1 mast also fill out the section below showing their workers'compensation policy informatiaa T Homeowners who submit this affidavit indicating they are doing all wads and then hue outside contractors mnst submit a new affidavit indicating such. 1contra,ctors that check this box must attached an additional sheet showing the name of the sub-connectors and state whether or not those entities have employees. If the sub-conneaors dare employees,die)'must provide then workers'comp.policy number. lam an employer that is protidi►tg workers'coinpensation insurance for my employees. Below is the policy and job site ill MidtiOn. Insurance Company Name: ?' Policy 4 or Self-ins-Laic.R: A `k k r /P -366 Expiration Date: Job Site Address:/(� 7 S py �!(( CitylStatelZip: Ce Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 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 fom%rded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the '►ts an e►ralties of pe my that the it formation proidded above is h7te and correct Si tore: v� �` �� l �O Date: Phone#: 6� Official use only. Do not sprite 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.City1rown Clerk 4.Electrical Inspector 5.Plumbing Inspector ` 6.Other Contact Person: Phone#: CERTIFICATE OF LABILITY INSURANCE — OPJ17/2016 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.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE RUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the poliicy(les)must be endorsed.if SUBROGATION IS WAIVED,subject to the terms and conditions of the porky,certain poTKies may require and endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT McShea Insurance mwe Berldey Assigned Risk Services FAX 1550 Falmouth Rd RT 28 Ste 2 �No.Ex.• (800)634-4589 1 cw No 866) 215-8118 Centerville,MA02632 EMAIL ADDRESS:POlicySerAces@berideyrisk.com INSURED INSURERS)ACING COVERAGE NAIC# Richard Cazeault Jr `INSURER A:Acadia Insurance Co 31325 198 Five Comers Road INSURER B. Centerville,MA 02632 INSIIR� INsuRER D: INSURER E: INSURER Fc COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN INSUUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS. CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADM SUBR POLICY NUMBER POLICY EFF POLICY EXP MRWVD (gpypDfy " LIMITS WORKERS COMPENSATION AND', WC STATU- ❑OTHER EMPLOY6�'LABWTY ® TORY LIMITS _ ANY PROPRIETORIPARTNERI F L EACH ACCIDENT $50U,000 A Y ❑EXCLUDED?(YIN) WA MAARP300886 02/04/2016 02/04/2017 D��SE EnEMPLOYEE ExECUTiVE OFRCEILUMER $500.000 Nn NH) E1.DISEASE.Po1.ICY LIMrr $500.000 If yes,describe mar DESCRIPTION OF ' OPERATIONS below. ❑ ❑ ON-O OPERAims 1 LOCATMS f VEHICLES(—ACDRD 101.Addiwnw Renadcs SMedWe,if Tome space's r mWmd). DecOon catmary Eleglan Slats Ham Eifec6ve Expiration A0 kwjmd Er ft ISdsrd Caz�tlh Jr RIM LocaOon 198 Frye Carvers Road.Ceniem'Oe MA 0= COMENTS t CERTIFICATE HOLDER F CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Bamstable EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 367 Main Street POLICY PROVISIONS. Hyannis,MA 02601 REPRESENTATIVE i` A_ ' ignature: ACORD 25(2010/05) BRAC 3139 I ROOFING & REPAIRS PROPOSAL - Proposal No. 16-1231 April 2,2016 To: Mary&Brian Barth Work to be performed at 1017 Shootflying Hill Centerville MA We:hereby propose to furnish the materials and perform the labor necessary.for the completion of: NEW ROOF 1. Remove existing shingle roof(Remove skylight and Plywood over) 2" Install new aluminum drip edge 3. Ice&Water barrier first 211,all skylights and penetrations 4. Cover roof-with 15 lb.felt 5. .Re-roof with 30 yr architectural shingle 6. Install ridge vent 7. Flash all pipes and penetrations 8. Remove all rubbish from project Labor and Materials 1_ Main House $5,400 , Garage $1,600 Shed $600 Trim Rake replacement with Pvc Main House,Garage,Garage entry door and Garage door $2,200 ' TOTAL PROJECT COST $9,800 All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications and completed in a substantial workmanlike manner for t1he sum of.Nine Thousand and Eight Hundred Dollars$9,800 with payment as follows: Four Thousand and Nine Hundred Dollars$4,900 With acceptance of proposal and Four Thousand and Nine Hundred Dollars$4,900 due upon Completion Respectfully sub Richard P.Cazeault,Jr. HIC# 168607 CSL#100393 198 Five Corners Road Workmans Comp and Liability with Centerville,MA 02632 Mcshea Ins Ost, 508420-5482 Acceptance of Proposal No. 16-1231 The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified.Payment is outlined above. Signature Date r r •-- _ _ - �. •�re Office of O� rai�urel�!r Consamer 13 E PRE31t 'E 1tT I-A COATi'M&M fa "Ile dn1 ase only Lion _ m _ T e exPirattoa da i€fo�r d re2at o.. I '` xplrahon YR� _ oasnnset - _ } DBA ors aiad$a ,.. _ i. 10�ax$Fza-SuiteSI70 Matron`-., CAZEAU ROOFIJ+f<; iRs .: .• _ .. _ Bo5013ilVfll:02116 •RICHARD CAMAUCT 19�8 FIVE ���nCO �� R►1IERS D ,-Ao:, • Public SafetY Massachusetts Department u ations and Standards Board of Building Reg 393 License: CS-100 Y' Construction Supervisor. RicHARD P CAZEAUL7 JR " a 198 FIVE CORNERS ROAD. I CENTERVILLE MA 02632 [y . 77 Expiration: - �-•^-^ otiosrmis Commissioner r j. - r C( /'�� .• •s � .t � �, i � � i; :� � r _ ` , .. .. �, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION _ O BUILDING pEpT Map f Parcel ® Application # _�- Health Division JAN 2 6 2016 Date Issued 5 12 OF Conservation Division TOWN OF BARN Application Fee STABLE r 0 a• � Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board \1 Historic - OKH _ Preservation / Hyannis \ Project Street Address 1 � �� �' L� Village C P_ V I L _, ' Owner � �� T�> Address Telephone 5�8 _77_� Permit Request 0-D1A V C i-LT- EXII,5T1t,,i E NCL650D ?CSR L,+4 7—ID .Y r L�cacS" %vQ 1 1-+4 i?�u c...,L- BATH' Wrr�-y b Q Square feet: 1 st floor: existing YT proposed 2nd floor: existing proposed _ Total new ZoningDis trict Flood Plain Groundwater Overlay -7 ®© Project Valuati 1 �DD.'7 �onstruction Type Yl/l� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 1 C1 4 Historic House: ❑Yes blo On Old King's Highway: ❑Yes QNo Basement Type: 19'Pull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) "' Basement Unfinished Area (sq.ft) ' Number of Baths: Full: existing _ new _7-_ 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 WOil ❑ Electric ❑ Other Central Air: ❑Yes Flo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: 6existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed:0 existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑❑Y�esP ® No If yes, site plan review # Current Use ����-� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) M &+4Eaz C-U--k S Thu t..710 N C©� �-2 452; Name 72 `(� �� tQ �� Telephone Number Address License # L 5 [ © 2'-L Home Improvement Contractor# , (Zq a WCC. 58 5-oo5 iZzw 5 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO A_TNP-1) t)V1✓ —T L, SIGNATUR DATE I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. TOWN OF BARNSfXBLE BUILDING PERMIT APPLICATION Map f Parcel Application # al� ` ' Health Division , Date Issued .�1lw I?� Conservation Division Application Fee 50 . 00 G Planning Dept. - �_ � Permit Fee , � �)<• � Date Definitive Plan Approved by Planning Board.�117. Historic - OKH _ Preservation/ Hyannis 17 � Project Street Address Village C P_r,3 I - 'V I L—L-E , Owner r � E`2"(' Address72 -2 Telephone t5y 8 Z- -"� 71 Permit Request Cbt-A V 6 P-r- (1 T 1^*.1 NC L0 s E D Tb rz 4•1-4 -r o ®i� IISeD 'M UAllrQ c VC-L • UU , Square feet: 1 st floor: existing 1� proposed 2nd floor: existing proposed �`""' Total new Zoning''District I Flood Plain !V t.r. `' Groundwater Overlay � "6 37 ProjectValuatio�n �•""�"Construction�Typez �r - a/, { Lot Size Grandfateed LiY °tVO sT-+ ® If yes, attahs`porting documentation. Dwelling Type: Single Family .�Il Two Family O ..MuNti-Far,ily (#-,Lnits) Age,of/Existin Structure d Cl (-3 Historic House: ❑Yes kNO On Old Kin 's Highway: ❑Yes `� " g ,� g _ g g Y: � No. *Basement Type: t0 Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)_, .. '9 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 Wtil ❑ Electric ❑ Other Central Air': - ❑Yes V`No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No. t Detached garage: ®'existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Stied: ❑ existing ❑ new,, size _ Other: . 5 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial .❑Yes -o If yes, site plan review# Current Use 1 �.. Proposed Use 'VL I APPLICANT INFORMATION ` (BUILDER OR HOMEOWNER) U L rI Address License # Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ' ADP I16V SIGNATUREr DATE 't FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 2S h(o FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING `f/i h&I t DATE CLOSED OUT ASSOCIATION PLAN NO. ?7iz Conmarr weals#of Massy chusetts _ ff, cpara mtcfbwhuhiatAcciderds 02 i1'4'o 7Lf Fkgt lrllS 1y 6VO WaslziiWon Mreet __ -- BosytlorT�it/A(f�A�0 y2)/H/ I Workers' Cumpensafimlussax-ancerffidavat B.m-lder-jCunfrmcf-orsWer-tricians/Plumbers Applicant InfarFnat �If Please Print LearU J ✓ Name, CCLqS phaa� _ Are u an employer?Checkthe appropriate bax: ' Type of project(regmzed)•= I_ -am a empioy-,r gift '- ❑I am a general contractor andl 6- ❑New construction, employees(iuA an&1or part�e�* havelvre4 ie sub-contacton; 7. I-am a sole proprietor orpartne El R" r- Usted on the attached sheet: 7- rmodeling These sub-confracdorshave g_.❑Demolifioai .,. a em 1 ees. .. and h3S��Fi pay a for 7i1P_in 2n c_ �� employees aad.hare wo�cers wodda. g apa- F g- ❑Buildingaddifiosf [Na;vat~�ers' comp_issusance comp-mearanc l re ;* d 3. We are a-corporation.arid-ifs 10 Elect deal repairs or additions 3_El I am.a nomeoun.�er daitlg all urorlr officen have excised their 1L0 Piumbingrepaizs or additions tignt-of exemgfibn per 142t iepairs �ce equ,� [ c-I52,§I(4),and we have no 1?`��oar'r employees.LI:.V'o wodness 13_❑other comp-insurance required-Z "_ry appficuti�stcbec�slsaz�l must also a�]loutth-sectiQab Soarshmvag sus«�o3cess`compersariaupaHcpimDams`aaa- 7 =„ rcuhombt�t�is�da� ii3i- 13eyaz=_dffigsgua�taadtaenhiEoat9r,+*++T9� rs�stsabmitanem�d�-eeindiastin�saclL Zadn aa=faitdbklcuubammmrtrfncl�F�sde�7iaaslsitr=i5boRm�tl�n of snbca�Ggz=�dsfat��he sacnel�nseestat�shate e�m�R�.Ift�Sn7o-c_ Iutie mnpIoy-_es�dwY=zstpxas.1de&e'r warks'•aamp-PaHU.MmbeL Ian,an err ya r t7arri rs pray:riirtg workers'coQrperrsrtfim[iitsrirrrr[ta�or m}s entpiv}lees HerolvistriapoEcyamuofisffir inforaza on Insurance compalay ame: sSo C i �`��.�+ � I® 0 /Q-- Policy s or Self-ins-Zic_ .�('i✓� .�J 7 r t�6_5 F�piaa uI}ate_ / �v Job Sit--Ad citpl sweirp: AEtach a copy of the workers'compensatory.poNecy- cla6atian page-(sha'wilg the poricy=m1ber aad ezph3tion date). Failwe to secure.coverage as regpiredunder Section 25A o€MM c.1572 can lead to the imposition of criminal penalties of a us[e up to$U..4&OG andfor one year imptisonmexd.as w6n as civil penalties sn 1he farm of a STOP WORK ORDIIZaad a.Him of up to$250-00 a day;g inst the Violatar- Be advised that a copy of this statement maybe fonaarded fb tlse Office or Tmvestrgations of the DIA,for ius covemp Verlfrca#�afl I rfo herd cerft5t irau r tFrs ar[d psr[af xs garju thatthe i a bnna6Dn pro[' abc[ bars awl correct i2aattzre• bake: Phone d �4 d? Sial Rw 6Rjy:. IIa riot wreka in lids=aa,to be campLeted by city artemn t+�rcraL City or fan= - Permit Ucense;9 Issuing Auflar€ty(ch-de one): L B=d.of 31•eaI& 2. a3g Depar =t 3.My1rai a clerk 4 Fleetrkal InapeintaF 5.Plmbb,-,,Enpectmr 6.®ther Coact Person: Phone#: ---- - - - 6 r / �� j L�cense_or reg�strat�on vaLdwfor nduli use only `(ze oo�zmanziaeu a a� aczc zuaelf , Office of Consumer Affairs&:Business Regulation ` Qa►efore;the expiratton date$Tf found Hreturn toy OME IMPROVEMENT CONTRACT.QR .'Office oYConsumer Affairs and, iin6ss R41, egulation t e istration T e �OYark.Plaza $ e5170 F 9 162938 YP ry z WExpiration � 4127120t7.4 DBA Boston;MBA 02 6 - MEAdHER BROTHERS CONSTRUCTION *� t , a °f k. E ASS MICHAEL MEAGHER J{Z� '97 EMERAL-D LN ``a< f , Not v wI out s►gnjature # MARSTONSMILL,MA,02648" r ,Z $ Undersecretary; x r Unrestricted-Budvlgs of any use group which ii771111 x c ontaut less than 35;OUQ cubic feet(991m )of y Massachusetts -Department of Public Safety , , Board of Building Regulations and Standards . enclosed space. { .Construction Supen-isor # License: CS-102260 � MICHAEL S MEA,�HER�JR 'r '97 EMERAID.p&i r Marstons Mills MR 08 Failure to psess a current edKion of the Massachusetts State Budding Code as cause for revocation of ihis license. ��.- 14�`� for DPS Ucens ng information visit VA4WNOss.Gov/DPS Ar Expiration Commissioner 11105/2Q16 a s 3 - t } r F _ L x Client#: 16665 2MEAGHERCO ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/29/2015 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.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil Insurance Ag PHONE 508 775-1620 FAX 5087781218 973 lyannough Rd,PO Box 1990 -MA L°'E"t: ac,N° Hyannis,MA 02601 ADDRESS: 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Grange Mutual Insuranc INSURED Meagher Construction Inc. INSURER B:Associated Employers Insurance Timothy Meagher INSURER C: 776 Main Street INSURER D: Osterville,MA 02655 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OF INSURANCE NSRADOLSUBR WVD POLICY NUMBER MM/DD�Y MM%DD� LIMITS A GENERAL LIABILITY MPT125OG - 10/16/2015 10/1612016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE F—x1 OCCUR MED EXP(Any one person) $10 000 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 PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per axident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIMB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $. _ B WORKERS COMPENSATION WCC5050054422015A 6/23/2015 06/23/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $100 000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S160266/M158764 JM1 Irnic -.BAR\STAB1-E.MASS. - a Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder l as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: l� �4 roe (Address of Job) i Si ature of Owner / ate c� 1g, J Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEWN_Muilding Changes\EXPRESS PERMITIEXPRESS.doc Revised 061313 ^® •` �� o - N WALL 48 OI OMMOD47E exlsTmGW - - New wcmows CV 04 jol exlBTm nr a wmowa LOERED 6LA88 1 / MIN AIL O TO Be REMOVED} PANELS TD W L NEW 1XB WALLB I REMOVED �, PLOOR ;D i J018T8 AND O - - PLYWOOD TO PLoo eXIBTiNG DOO - l!P TO MAIN AND 8TEP8 TOR Be - - - 1D MOUBe LEVEL7 ReMOVeD - I o �� - —U-- NEWHIGHTRAN60M9 N RO 14' 7'-23• 2' �#�CH NEW BEDROOM a a BATH 'RIVATE RESIDENCE iOOTFLYING HILL ROAD-CENTERVILLE, MA SUED FOR REVIEW-28 OCTOBER 2015 EXISTING AND RENOVATED FLOOR PLAN 2� I :5-H DO i Yam--"-1 i r-! e-s" ��i f,..,-L- p D t --t j ATY.I.P. IL -co to d O Q M C N N WALL AS 1 3 TO N OMMODATE x LAYOUT � EXISTIM6 HEW ILL EXISTING WIDOWS LOWERED GLASS I R PI AMED •_ FRAMED A TO BE REMOVED REMOVED S TO BE /// lJ it REMOVED '-DEW R WALLS a r=lra 0 AND PLYWO b LYWOOO TO �p RAZE FLOOR EXISTING DOOR - VP TO MAID m ADD STEPS TO BE 1D MOUSE LEVEI.7 v REMOVED V f IIEWHISH TRAHSOb19 UN d � } RO 14' I, T-2a - &-sZEXISTING SCREEN PORCH NEW BF-PROOM a BATH 'RIVATE RESIDENCE 100TFLYINO HILL ROAD-CENTERVILLE, MA _ SUED FOR REVIEW-26 OCTOBER 2015 EXISTING AND RENOVATED FLOOR PLAN All 41 V.I.P. ti N 11 fl /�. v i 1160 N W WALL 49 1 � � COMMODATE z N TN LAYOUT � TO BE R WNDOW LOWERED GLAsa .l I /�/ IN INFILL TO BE REMOVED PANELS TO BE L - P��� Q REMOVED ', MEW 2XS WALLS a - FLOOR 0 j JOISTS AND O PLYWOOD TO .r �p RAISE FLOOR EXISTING DOOR - I,I W TO MAW NEW WINDOWS AND STEPS TO SE - 1D HOUSE LEVEL? a REMOVED - d00 I. — NEW NION TRANSOMS N ' RO 14' 7`23 EXISTING SCRF-FN l 12,_6�. Y. NF-W BF-DR00M EE BATH 'RIVATE RESIDENCE iOOTFLYING HILL ROAD-CENTERVILLE, MA SUED FOR REVIEW-26 OCTOBER 2015 EXISTING AND RENOVATED FLOOR PLAN A1. f r) D 0 V.I.P. to i I � 0 1 <Y WALL AS m OI OMMODATE' n 0 ��AY N LAYOUT EXL4TITIG HEW rlFWIDOWS EXISTING WINDOWS LOWERED GLASS - I // JEW M AMMO TO BeREMOVED PAWLS TO BE. L ��D �+ s„_ HEW WALLS �i REMOVED Tb FLOO .; JOISTSFfYWO OD 70 RAISE EXISTING DOOR9�1 UP TOV AHD STEP8 TO SE tD HOUSEREMOVED — NEWHIGHTRANSO iV R RO 14' T-2 6-31. F-XISTIN SCRF-F-1� 12'-6q° FORICH NEW BEDpoOM EE BATH 'RIVATE RESIDENCE iOOTFLYINO HILL ROAD•CENTERVILLE, MA " SUED FOR REVIEW-26 OCTOBER 2015 EXISTING AND RENOVATED FLOOR PLAN A1.� J VIP. I � d�N A, oiQ o I tOtP. cIID 00 O NEW WALL AS 1 QUIRES TO N TMOMMODATG O LAYOUT IOW WINDOWS B OWS LOWERED as La - 1 AALL TO OI O TO BEE R R WIIVEMOVED PANELS TO BE FEW REMOVED - FLOOR �D I UOISTO AND O PLYWOOD TO �p Up T PL.00R CXISTMG DOOR j J Up S MAN ,e AND STEFa TO BE tD NOUE LEVF17 REMOVED . / �so NEW HIGH TRANSOMS lk 1 RO 1E' 7-2 S. V-321.1 EXISTING SCREEN I CI I NF—\ / BEDROOM E BATH PRIVATE RESIDENCE SHOOTFLVING HILL ROAD-CENTERVILLE, MA ISSUED FOR REVIEW-26 OCTOBER 2015 EXISTING AND RENOVATED FLOOR PLAN A1.1 1 `i1 j t--r D T^r-- �. t ►mot a.�.t ta.._t..y , Ja 139 Queen Anne Road Harwich,.IVIA 02645 _ C'1 4E: ��'� �_ � Office 774-237=0410 n' Frontier Energy.Solutions, Inc. . Web: frontierenergysolutionsinc.com Certificate of.Insulation Work Job Site Address: Crew:Members on Site: V z 3 2- Description of Work Location:. Square Feet: Material: R-Value; too C lr�s J AF o � 06 cQMtAfa 41�;. R-Values per inch:Cellulose,loose:3.7,Cellulose,Dense Packed:3.2,Fiberglass:3.0,Poly-iso board:7,Closed Cell foam:6.5 r Air Sealing Completed: Attic Access Treated: Blower Door Result's: ` ❑ Attic 0 Pull Down Stairs Pre-Work Test: ❑/Basement �� ❑ Hatches Post-W Test: E{ Living G Space `� ❑ Doors- o Blower Door Test . None J Notes: a - certify that the address]isted above was insulated as,described'on this certificate, and that all work was,performed and installed in accordance'with state and local building c des. J F eman Date ° f v T OF ors l 1 V•♦is Vl JLF"K KA01.KR/iV "rerinit ff V �� p� Expires 6 months front issue date T. Services Regulatory Fee BARNSPABLB, A 16 ,0� Richard V.Scali,Interim Director ave do R/Mpt Building Division `/ 2,116 Tom Perry,CBO,Building Commissioner 6 T Nyr 200 Main Street,Hyannis,MA 02601 VV www.town.barnstable.ma.us, Office: nn Fax: 508-790-6230 EXPRESS�ERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number Not valid without Red X-Press Imprint J C 41 . Property Address tot `R Residential Value of Work$ 4Yt 2�00•C0 Minimum fee of$35.00 for work under$6000.00 IN Owner's Name&Address P (Ct t-,3 Q r L [Ul7 S LUo l oily Contractor's Name �ili ��1 y`L.4tU� Telephone Number Home Improvement Contractor License#(if applicable) �tc^.l i,_)8 Email: P l�C@ej�P/ ►�C. c�h Construction Supervisor's License#(if applicable) y `(j 2.2- ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value t _(maximum.35)#of window / #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire.Permits required. °Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pr perry Owner must sign Property Owner Letter of Permission. copy of th ome Improvement Contractors License&Construction Supervisors License is quired. SIGNATURE. T KEVIN_D\Buildi Changes\EXPRESS PERMITIEXPRESS.doe Revised 061313 Office of Consumer Affairs&Business Regulation ;*' before-the exptratlon�date Tf foundreturn to OME IMPROVEMENT CONTRACTOR %4 Office of?Consumer�lff#Its and°B,usmess Regulation __ egistration: =162938 Type: t lUTark Rlaza S' a 5170 ' Expiration 4127/2017" DBA lit Boston,MAzOIL •6 " ° -' ' ` la MEAOHER BROTHERS CONSTRUCTION a } MICHAEL MEAGHEFt JR 97 EMERALD LN f —' �xNot� outfs►gnature r£ - r -MARSTONSMILL,MA 02648 `°' s � s Undersecretary. A ' y Y Unrestricted" Buildings of any use group which 1 ! Massachusetts -Department of Public Safety contain less than 35;000 cubic feet(991m3)of'= Board of Building Regulations'.and Standards enclosed space i „3 Cot►structlon SUpCI'1150r License: CS-102260 MICHAEL S MEA, `HER 97'EM ILUAi L�1E i S l Marstons 11tills:1V� 028 !allure to possess a current edition of the Massachusetts `s . State 9 ilding Code Is'catne for revocation oft his license A . Foci3P5licensing informationvisit: WWw Wass GOV/DPS Expiration Commissioner' 11/05/2016 F , a_ a t. :.t`A fI rno-,cn r Iri A I c IJ IJ.oucu AJ A IUTA I I ctf Ur uvrvtilVlw I IUV UIVLT Aivu t;Ulvrtii,NU KlUrl I,UVULA 1 Mt laH 1 It-IUA It MULUtH. I t11ti CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ,BELOW.,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ;PRODUCER CONTACT Dowling&O'Neil Insurance Ag PHONE,Exf,508 775-1620 FAX I973 lyannough Rd,PO Box 1990 E-MAIL A/c No: 5087781218 Hyannis,MA 02601 ADDRESS: 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC f INSURER A.National Grange Mutual Insuranc INSURED Meagher Construction Inc. INSURER B:Associated Employers Insurance - Timothy Meagher INSURER C: INSURER D 776 Main Street , � Osterville,MA 02655 INSURER E:INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD/YYY LIMITS IrA GENERAL LIABILITY MPT125OG 10/16/2015 10/16/2016 EACH OCCURRENCE S1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S500,000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) S10,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE 52,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 j POLICY SECT LOG S AUTOMOBILE LIABILITY (Ea dED SINGLE LIMIT S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident S � AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) S S I UMBRELLA L1AB OCCUR EACH OCCURRENCE S f !EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS S B WORKERS COMPENSATION WCC5050054422015A 6/23/2015 06/23/201 X we sTATu- OTH- AND EMPLOYERS'LIABILITY Y/NIER j ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED? � E.L.EACH ACCIDENT s1 OOOOO N/A (Mandatory in NH) I E.L.DISEASE-EA EMPLOYEE 5100 OOO It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is named additional insured for general liability. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER . CANCELLATION - - _ R SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S160683/M160682 LS1 IKE HARNSTABLE. MASS a639. `0� Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79 - 2 0 6 30 Property Owner Must Complete and Sign This Section If Using A Builder I• �r t Q N l� ' as Owner of the p Pro subject property 1 . hereby authorize �Cnt � t `{� c,�C (� to act on my behalf, in all matters relative to work authorized by this building permit application for: tor? 01 (Address 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. T:\KEVIN_D\Building Changes\EXPRESS PERMMEXPRESS.doc Revised 061313' The C'auxrtzormealth az,f Mussad5z--mett7 i�e�r�t�efxt c�,,,�`�rrrFr�r- �ccGdeFrfs 3y 60D F3�as�a oF�,SYreet ._ -- Bas- tons 02M Workers' Canpensatian lusmaucz r &vft:Bu tders!Cunt mci-orsMec€iicians(Pl-ambers A4iPUcantIufwma-Qun Please Print Name. �trnt�dQal� C' e bL C AdcLe Co - Are . u a1r eragloyer?f heck_rlte appropriate box =yge-of project(required).: L lama emplo-ycr-ia \3 - ❑I am a general conicactor and I 6_ ❑New consCzucuoa etnplayees(ThR aid(or part-fie * liavahirerl.t�.sub ca3' cfor - Us�.d on the at#Erhed sueef. 7_ Ramode-ag 7_❑ I-am a sale proprietor a:partrei These sub-confracyors ha ve g_.❑S7emalifsort sip aid have no,en playees. ti a rar.tn?in z c_ ai employees zndbare o ers' Buildiu sa tiazE w � � y c rntnr;rrz� 4- ❑ I1Vo Comm.issu-- ces comp- + s or adc ns' rued �. ❑ Tie an a-corpor-tion anal ifs 10❑Eler:f deal repay' 3_❑ I am a Ftom ner doing all�: officers leave" Excised their IL[]I'Iumbingrepairs or addiduns my-m-,f LNO rcn=lmrs'tctp_ tight of meiapfion per M(3t 12❑Roofrgnim resranr a reruim&] t c-152,§1(4),andwe hwe na owe�eers' 13_❑�ltber employees-� - c9mp_msuranc--required-Z "A-y Fmaifc—ttlst cheedsbax=1 m5t also n'll out r=s hnabSnxsbofi+ ifz¢no es'comp saticapaIicgitmrmssaa 1_a ,,•�a•rzmossira ttns�aat •n. they—doingmuwa&m3Lu�L�cutzi?=��++*ter`+r�stsabmitar��dmtiT•�;�+�Psacti f%o���trt;���3cTrtr:baz m�-t Yff.S�ni'finn l�_2 shacrm�tb�-n�i�ot���r-ca�srizrs�3�stzuh�ri arnat�e eali�sha•� ?iLsnirt�=^Imdumhave�io�tueg'mustF &w nvis 'comp.poTi mmbeL -Tani a err ynr fltrtispru�:riutg x�crbets'iattrperesrdimt irtsrtrarrca�'os-m}s enrpia}�ees $ oav is tlt�paliry alx site ttr�ormr�iiorr. j ,� Q •--� . rus e Coupanyi ar�re: I�Sso d �`t-C (�, IL 10 c. Pohl-rrf-i tic_ e566 _")7 /S A F# ` ,/ Job site gddr-� l d l 7 Ice/ C`/,J i"r k t l 1 cirylSfafer C4L-A e ry t./1 r t�l 4 OR6 90 Attach a copy of theworkere coaapensafimpoIgc£-ded2raiion page-(sho-wing-the policy number and e�Th-xdou tia-te). Failure to secure coverage as rrquired under Section 25 k o€MGL c-15 can lead to the impo-i1im of Crimi-,a1 penaIRe2 of a 'Brie up to$UO G anNor aneyearimp=sos��as well as civil penalties is ale fast of a STOP WORK OR.DERand a Eae, of up to$P50-00 a dap against the violator. Be advised that a mpy or this statement may.be farwarded fo tlzz Office of Irrvestrgatiam ofrlle DIA for msupuce caverage e�itatifln g ida hereby ce.rfyy- uxdar tw s artdparralzs 'g that fJte i arwzat£trupratfdsd a eat is hzr a3 car�ert Date: I PIIons z V - 5i V(IS �},�,ct;iat ns�rrat£�:: ,Tarr not ttr�ftt iirrs urea,r¢lie caruaTete�b�t��rtat�n t�,�ficiaL City or Tanu: - PermftUcettse a Tssuing ttor (cucIeoae): L Boa'rd.of ffealffi BaRTax,-,Dep�t I faTfroR.0ierk 4 E?ectried hspEctflF S.Fhmnbbng Inspectar 6.®ther contact person: Ph&=#: Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 i 10-25-134o r Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, I This affidavit is to certify that all work completed for 1017 Shootflying Hill Rd,Centerville has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-30 cellulose(R-11 cellulose under storage area) Walls: R-13 cellulose dense pack Basement: R=19 fiberglass blanket in box sill All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 030 Application Health Division Date Issued Q Conservation Division Application Fee Planning Dept. ( Permit Fee Date Definitive Plan Approved by Planning Board iohy/n Historic - OKH _ Preservation/ Hyannis Project Street Address lollS� a i n A �1 Village CPO �V 141t'. Owner IE Address G�1 Telephone 500 3p 0 023 Permit Request AAA U1 , R -19„ and `�,— �� ce�` jo,5C :A-s R-30 ceUto6ge -+-o 4t 410br- �'l rsk9W in !t�c base � k wikA 5 w; C ll aAye, sca� ►e, afi� 6Ojr o W eWRa,4 l n &ffi Square feet: 1st floor: existing pPoposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation SOL 6 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Familya ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure l 9 cJ Historic House: ❑Yes ❑ No On Old Kiig' Highwaj7,: ❑ems ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (Jft) = E� Number of Baths: Full: existing new Half: existing N3w "HiNumber of Bedrooms: existing _new v Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new `size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes kNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) l Q Name , n-cr Telephone Number 56n0 31� 6�9g Address - fix 0 License# 7_(' l n Q6 q S Home Improvement Contractor# �l Worker's Compensation #-Iw C 5 5 9 6R ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO cLr' IQN,i� SIGNATURE DATE U I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r MAP/PARCEL NO. ' 4 ADDRESS VILLAGE G , F OWNER DATE OF INSPECTION: .4 t�rFO.UNDATIONei ,-,-; , �.,Y� ,; � i:�f . ' .ti FRAME INSULATION., FIREPLACE ELECTRICAL- ROUGH FINAL 4 X PLUMBING: ROUGH FINAL 3 GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. j i ! t i� Housing Assistance Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT & FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOMEOWNER. 1 f f Lrl hereby consent to and agree that weatherization work may be do .e by the Weatheriz tion Program of Housing Assistance Corporation (herein after referred as "Agency") on the property located at: 3 The weatherization work done will be based on programmatic priorities and availability.of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home 1 agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. - 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. Home Owner. (Signature) '�' Z� '� �. Date: 0�'' �;�" �"� �. � ' Agent: (signature) Dater HAC approved Weatherization Company . ran 10 ju lte� All Cape Energy Gape Cod Insulation ape Save fficient Buildings,LLC Frontier Energy Solutions. Lohr.& S.ons. .. • Resolutio-n Energy ►< The Commonwealth of Massachusetts Department of Industrial Accidents k Office of Investigations Congress Street, Suite 100 Boston,MA 02114-2017 ..�,. .� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name (Business/Organization/Individual): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with�� 4. ❑ I am a general contractor and 1 6 ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet 7. ❑ Remodeling . 2.❑ I am a sole,proprietor or partner- . ship and have no employees These sub-contractors have g. ❑ Demolition and have workers'employees working for me in any capacity. 4 •9. ❑ Building required.] addition workers comp. insurance.* comp. insurance 10.❑ Electrical repairs or additions required..] 5. ❑ We are a corporation and its �.El 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.❑ Roof repairs insurance required.] c. 152, §1(4), and we have no 13 ❑✓ Other Insulation 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 an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site, information. Insurance Company Name: Technology Insurance Company Policy#or Self-ins.Lic.#: TWC3353968 Expiration-Date: 04/09/2014 . c o 1 , 1� Job Site Address: ` II City/State/Zip: C eAer y Attach a copy of the workers' compensation p lic declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyunder the ains and penalties of er' o that the in rn:ation provided above is true and correct. Si nature: Date Phone#: 508-398-0398 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#: w , DATE A�00RCP CERTIFICATE OF LIABILITY INSURANCE 4/9/201D3 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. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONCT PRODUCER NAME Colleen Crowley Risk Strategies Company MIR,N . (781)986-440D FAC No:(7e1)983-4420 15 Pacella Park Drive Slate 240 INSURER 3 AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURER 0.SafetyInsurance Ccmpany 33618 Cape Save, Inc iNsuRERc:Technology Insurance Company 7 D Huntington Ave INSURERD: INSURER E: South Yaratouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL134960509 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . LTR TYPE OF INSURANCE ODL sta POLICY NUMBER POLICY DD �F MMIDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occcurrence $ 100,000 A CLAIMS-MADE ❑X OCCUR S199448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC COMBINED SINGLE T AUTOMOBILE LIABILITY Ea accident) 1,000,000 B ANY AUTO BODILY.INJURY(Per person) $ ALL OWNED SCHEDULED 208200 1/6/2012 1/6/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ X HIRED AUTOS M AUTOS Per accident) X Underinsured motorist BI split $ 100,000 A X UMBRELLA LIAR i X OCCUR 199448001 O/16/2012 0/16/2013 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ r WORKERS COMPENSATION Officers Excluded from X TKCYSTAT� I OER TH- AND EMPLOYERS'LIABILITY ANY PROPRIETORJPARTNERIEXECUTIVE YIN overage E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? � NIA 3353968 /9/2013 /9/2014 (Mandatory In NH} E.L.DISEASE-EA EMPLOY $ 500,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space Is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc., and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOIIS1IIg ASS15taIICe Corp ACCORDANCE WITH THE POLICY PROVISIONS. 484 Main Street Hyannis, VIA 02601-3698 AUTHORIZED REPRESENTATIVE chael Christian/CLC ACORD 25(2010105) 01989-2010 ACORD CORPORATION. All rights reserved. 1 Massachusetts Department or Public Safety Board of Building Regulations and Standards - Construction Supen-isor Specialty _icense: CSSL-102776 " WILLIAM J MC Ci,USIKEY-,. `= 37 NAUSET ROAD '' West Yarmouth RA 02673 Expiration Commissioner 06/28/2015 Office of Consumer Affairs and eusness Regulation ti = 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 _ Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 --- =- = - Update Address and return card.Mark reason for change. -- i Address FRenewal Ej Employment F,—I Lost Card LIPS-CA1 0 5OM-04104-G101216 Consumer Affairs& mess R uul Lion License or registration valid for individul use only Office of Consumer Affairs&B sines Regulation � Y • HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - vwRegistration 171380 Type: Office of Consumer Affairs and Business Regulation 1 r� Expiration 3114/2014 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPS SAVE INC:, .,. WILLIAM MCCLUSKEY 7-D HUNTINGTON AVENUE- SOUTH YARMOUTH;-MA02664 Undersecretary Not valid wit o signs 7 r t Town of Barnstable *Permit s( � D 3�71- Regulatory Services monticsfrom rssue date ` l+e • ssatvsrwsra, MASS 1659.. A Thomas F.Geiler,Director ib39 1b6 DMA<� Building Division -PRESS PERMIT Tom Perry, CBO, Building Commissioner 200 Main Street H J U N ! 0 /n 1' . . Hyannis,MA 02601 www-town.barnstabld.ma.us ...���� Qf F3ARNSTABLfr Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press imprint Map/parcel Number (� Property Address 'U/ �� h XRdsidential Value of Work / �'� � Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addresst3Lt/ o � Contractor's Name Telephone Number Home Improvement Contractor License#(i plicable) Construction Supervisor's License#(if applicable) ❑Workman7s Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner " ❑ I have Worker's Compensation Insurance rnsurance Company Name dorkman's Comp. Policy# 'opy of Insurance Compliance Certifi ate must accompany each permit. -rmit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of rood Re-side Replacement Windows/doors/sliders. U-Value FTC[ #of doors (maximum .44) windo *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. NATURE: PFILESTORMSIbuilding permit fo RESS.doe ised 070110 i The Common wealth of Massach useits t Department of Industrial Accidents rU. Office of Invesfiga&ns 600 Washington Street V14% Boston, MA 0211I c- www.mass govAdid Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly al:ae (Business/Or ganization/lndividual): Address: 7 �!' C! Y� , City/State/Zip: Phone #: 64 - �)vo 33 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4._❑ I am a general contractor and I 6• New construction employees(full and/or part-time).* have hired the sub-contractors 2,❑ Lam a sole proprietor or partner- listed on the attached sheet.t ?•. ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp. insurance. 9. Q Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10 Electrical re quired.] officers have exercised theirm pairs or additions 3, ]a a homeowner doing all work right of exemption per MGL 1 I..❑ Plumbing repairs or additions myself, [No workers'camp. C. 152, §](4), and we have no 12,E Roof repairs . insurance required.]t employees.[No workers' 13.❑ Other comp. insurance required.] �— *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, t.Homeowners who submit this of davit indicating they are doing 0 work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional shoat showing the name of the sub-contractors and their workers'comp.policy information. I am anmoe that iprodig works' mpnsain isuf eipco mloyees: Below is the policy andjob site inform Insurance Compan ame: Policy#or Self-in . Lic,#: Expiration Date: . Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy dec lion page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 132 can lead to the imposition of criminal penalties of a fine up to$1,500.00.and/oi-one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250,00 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 er by certify under the pains and penalties of perjury that the information provided above u true and correct Si Date: / Phone , O cial use only. Do not write in this area;to be completed by city or tmvn'vffuial 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 Information and Instructions Massachusetts General Laws chapter]52 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is clefined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees_ However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." 1 p MGL chapter 152, §25C(6 also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or.to construct buildings in the commonwealth for any r applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is-required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are.required to'obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line: City or Town Officials Please be sure that the-affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill but in the event the Office of Investigations has to contact yod regarding the applicant. Please be sure to fill in the pennit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permitAicense applications in any given year, need only submit one affidavit indicating current polity information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. . The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston,-MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MA-SSAFE Fax # 617-727-7749 " Tay Town of Barnstable Regulatory Services "r' MAM $ Thomas F. Geiler,•Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyamiis,MA 02601 www.to w a.barns tab l e.ma.us Office: 508-862-403 8 Fax: 50 8-790-623 0. Property Owner'Must Complete•and Sign This Section If Using A Builder r'• , as Owner of th.e subject,property hereby authorize to act on my behayf, is all matt-rs relation to work orized by this bu din ermit application for-. (.Address of Jab) Signature of Owner Date Print Name If Property Qvvneris applying' forpern itplease c ample te. the Homeowners License Exemption Form on :the reverse side. Yr>F r�D Town of Barnstable Regulatory Services i Thomas F. Geller, Director A l ANcr1R�, . XASM % BmUding Division �eD t.�ai` Tom Perry,Building Commissioner 200 Main-Street, Ayannis,MA 02601 �r.to�barnst:able.ma.us ' Office: 508-862-403 8 Fax. 508-790-5230 fiOMEOWNER LICENSE=MMoN Plcire Print DATE��C��1� lG JOB LOCATION: number strst village 'WOMEO WNER" 7 J 'O®3 3 ---� name home phone>k work phone# CURYJDq T MAILING!ADDRESS: eityltown rtato rip code Tate current exemption for"homeowners"was extended to include owner-occupied dwelling of six its or less and to allow homeowners to engage an individual for hire'vrho does not possess a license,provided that the owner acts as S=Cryisar. DEFT MON OF HOMiOVY/t'ER Person(s) who owns a parcel of land on which he/she resides or intends to reside, an which.thcre is, or is intmded to- bc, a one or two-family dwrl?o& attached or detaphcd Annctares accessory to such use and/or farm structures. A person who constrgcts more than 6ne home in a two-year period shall not be considered a bo=owner, Such "homeowner"shah submit to the Budding Official.on a form acceptable to the Building Official, that he/she shall be responsible for all such work iocrfigmed'mnder the bmi7dine pcnDit: (Section I09:1.1) The imdcrsigacd`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and rea,�ons. The undersigned`homcowncr'certifies tbat.Wshc.tmderstamds the Town of Barnstable Building Department minirrttrm msp6ction pr?cuiurts and rez*ir'*'TT+r'nts and that he/she will comply with said procedures and . requq nts. r' n 5 tisre of Hrnnemvna . Approval ofEurldmg•O$cial Note: Threc-family dwellings containing 35,000 cubic feet or larger wsll be required to comply with tha State Bmtlding Code Section 127.0 Construction Control_ HO1dF-O VV?aM'S EXEMPTION The Code states that Any hamrnwnQperfnnrung vtorJc for which a building permit is required shaD be exempt from the provisions of this section,(Section I D9.1.1-Ilcansmg of canahvetion Supervisors);provided that if the bomeoTy err eogagrs a pasoa(s)for hire to do such wooer,that suCc Homccwncr shallct a as supervisor>• Zhy homcownas who use this.ccmption are unawart that they art assurni'ng the responsibilities of a sgpavisor(see Appendix Q, Rules&Regulations for Licrosing Construction Supervisors,Section 2.15) This lack of awircress Men nsula in serious problems,particularly vhaa the homeowner hires unlieaiscd pa;gas. In this ease,our Board cannot proceed against the unlicensed person as it would with i];caned �upervisar. The:hamernmer acting u Supervisor is ultimately rrsponsible. To cnsurc that the homcaarncr is fully zwarz.ofhiAcriespormbilitics,many communities roquire,as part of the permit application, tat the homeowner ecrtify that hdshe understands the responsrbilitics of a Supervisor. On the Iasi page of this issue is a.form currvitly used by necral towns. You may care t amend and adopt such i forrrn/cm-dBextion for use in Your coumvnity. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel . Application'# Health Division Date Issued Conservation Division :Application Fee �"31^ Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street AddrJ�,L 0 �7 s�oc�f_t-•��U l�►9 ����� � R c0wner-fie M�� V C 4-- cl-A 015ess i ts2.."� 3"4 cL(M. t71 'I Qj Tele-hon��e� o C •Al.36 •7 661 �l'c'� �'�}yu�t p �� Y l5-� 3� 7 �P_ermit Reques nn(�Cnn vcG��a{ ,I�,w �a :�r�,n (pen,. Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Projectect`V�6r*j , DOD 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: ❑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 CID Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other C Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: C�Yes 0 No co Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ex sting ❑ne si e 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 BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE O / . . . ` FOR OFFICIAL USE ONLY. « . . . . . . { SAPRLICATION# \ .. A DATE $SUE§ MAP/PARCEL NO \ . \ ADDRESS . VILLAGE ; ƒ OWNER ' \ \ \ \ � \ \ DATE OF INSPECTION: \ FOUNDATION . \ 7 FRAME � / INSULATION - w . . . / FIREPLACE ELECTRICAL: ROUGH FINAL . . PLUMBING: ROUGH FINAL ƒ . . / GAS: ROUGH FINAL FINAL BUILDING f . DATE CLOSED OUT ` \ , \ ASSOCIATION PLAN NO. . ' The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations ' d 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/Organizationadividual) t✓ � cat Address /'d f? City/State/Zi 4:�"v1 L Phone.#: V W �'- Are you an employer? Check the appropriate box: general contractor and I 'Type of project(required):. 1.FT4.I am a employer with ❑ I am a g . employees(full and/or parttime).* 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 working for me in any capacity. employees and have workers' �• 9. ❑Building addition [No workers' comp.insurance comp.insurance. I0. Electrical repairs or additions r quired.] 5. ❑ We are a corporation and its ❑ p 3.Uam a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. o workers' co right of exemption per MGL Y � comp. 12.❑Roof repairs , , insurance-required.]t c. 152 §14 and we have no( ) 13.❑ Other I' employees. [No workers' comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins'.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the p li .number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the I.DIA for insurance coverage verification. Ido hereby certi der the pains and penalties ofperjury that the information provided above is true and.correct . r Sienature: Date: .7 ZOU Phone#: 3Ok' .3(o 7 ' 7&01 Official use only. Do not write in this area,to be completed by city or town ofj71ciaL 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." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the' dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not pro duced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the in.�ance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. 'The affidavit should e city or town that the application for the ermit or license is being requested,not the Department of ed to the p g q eP be return ty PP Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete•and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure.to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations in (city-or cia stamped or marked b the city or town may be provided to the town). A copy of the affidavit that--has been officially lly p y ty Y applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture license or permit to bum leaves-etc. said person is NOT required to complete this affidavit. a doh ) (i.e. g . P The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. ' The Commonwealth of Massachusetts Department of Industrial Acrid mts Office of Investigations 600 Washingtori Street Boston, NIA 02111 Tel. #617-727-4900 ext 406 or 1-877-M SSAFE Fax#617-727-7749 Revised 11-22-06 www.rnass.govhiia E'° Town-of Barnstable Regulatory Services * sAaNsr�s , z Thomas F.Geller,Director ED �a Building Division Tom Perry,Building Commissioner 200 Main Street, Hyamus,MA 02601 Office: 509-862-4038 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: �C,hn OAC. Estimated Cost (7 ,Lyj a Address of Work LQ I`) km A, M 143,11 r Owner's Name: Lyyut inG wt vt 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 DCFwner 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: Date Contractor Name Registration No. R d Date _^_Owner!s Name Q�'onns;home�dav oF1HE ram, Town of Barnstable Regulatory Services anxxsrnate, : Thomas F. Geiler, Director MAM 039. A,�� Building Division ED MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 'I�1' -7 Please Print DATE: J(I" 3 JOB LOCATION: Lot'] heaTt'�N.r1t,1 ,` /`K C(,�t lfe- MA, 0 T 4 aL number 0 street village S' / "HOMEOWNER": 41�m e Catn L name home phone'# r work phone# CURRENT MAILING ADDRESS: 04 d La�Llxj led f Z4 L 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 requi m s. ig atu of Homeowner 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 tTl 00 AICIJ �4 ITChdO. �. --Ewa4- aoS-- t - o. Nt Old_- h cti/4 e-- E f` MOB O B i! { if i r ? � i { 4 ' 5 t E � I Je. t a 0\ a j F a j i � 1 S { i Ae CT K6ck -4 7,N3Q tom ° A-5 1v7 ,�. L 1 o SZ rx e s7/aet(r o gerAj N 16S f I of Do OL I P N�w to r ae` cm) mea 4 s o F-- eq�� � 5-fi[-L. Esc.,ST g i 4 1 i v Jt I 7 y y' N � q 1017 Shootflying Hill Rd., Centerville 7/23/2007 r� WI r a, r� y, a 1017 Shootflying Hill Rd., Centerville 7/23/2007 r f OFTA BARNS B[ RE< ❑rs:�rc>R� til.lty 1<� .F 13uH_u1Nc vl�l�im �� STOP WORK �1Ir�srRrc-rL;RI:.��1�'oa rREa�lsr s Il,�s ra:l.�INSPLCTEDANDTHE FOLIlON'INGVIOLATIO" Ol-TIIE BUILDING CODE AND;OR ZON I- OR DI N.ANCE I L�1'E BE F,N FOI N'D: 1'OUARE HEREBY!No IIPIEI)111 T NO;IDDITION.ILNYORKSHs1LL13EUNDI:RT-11i1:N UPON'THESE PREiNHSES,012T1H.PRENHSES OCCUPIED UN'TILTIIEABON`E V'IOI.ATIONN ARE CORRECTED. AN 17 PERSON REMOVING THIS NOTICE WIT'HOI'T I'ROI'ERAUTIlORIZAI'IONSIIALLBI:LLABLE TOA PINE OP NOT LESS THAN FIP"t'1',NOR NIOIZETIIANONI HIINI)PR1,I)DOI1.aRl�. :Addles Duty Rud,lin�C'vnmissioucr p Par 4%0ermit# 17 3 7 Conservation Office(4th floor)(8:30-9:30/1:00--2:00) v %f, Date Issued 15-- a Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Engineering Dept. (3rd floor) House# �TNE ip�,_ e�ldg.) SEP MC S i`i BE ard— 19 . ONSTALLE U NCE �4 TOWN OF BARNSTABL ° R � CODE��® Building Permit Application TtAddress Village �.O < -� V Owner iA,.j, t io--" ,'�,,,, A Address Telephone -S^ 6 %o 7 ) �-Permit Request } First Floor t (} o square feet Second Floor square feet Estimated Project Cost $ 1 ,� C)U Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use 1 Construction Type Commercial Residential Dwelling'Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name( Telephone Number Address License# Home Improvement Contractor Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO GNATURE S E Gi,(Z;,- ' DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY P MIT NO. ` fir } D ISSUED - MAP/PARCEL NO. ' ADDRESS VILLAGE ' c OWNER j DATE OF INSPECTION: j 4 FOUNDATION i + FRAME' r a INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ I to � _ • - GAS: ROUGH 4 ' FINAL + FINAL BUILDING h'"its r i DATE CLOSED OUT �►! �$ ` + ` ' I f I ASSOCIATION PLAN-NO' AILED IN COMPLIANCE Assessor's offioe,(1st floor): /jW , WITH TITLE $ TNf Assessor's map and lot number* ..../. j....Q � ... of to ENVY F`,ONMENTAL CODE AND "?Board�f Health (3rd floor); Sewage Permit number ...g!"33. .. . .............. ... �I QI�.�► Z BasKAAIL LE, . Engineering Department (3rd floor): / ,^� f �� �r�` 'o YA°9 House number l v I os�tb3( APPLICATIONS PROCESSED -8:30.-9:30 A.M. and 1:00-2:00 •P.M. onlyr TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....o17Ld ru.-if:.-.m.f�t q(o....................................................................... TYPEOF CONSTRUCTION ...U1.0.0.C,. ..................................................................................................... ............................. ... y. ..19. f1.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..�0.i.�........S�t.ao ...Fit '. ...:U1....Rd..y.........-C f.1.. ..1��. .:................................................ ProposedUse .......✓.Q.! a..-. .el.............................................................................../.......................................1.._....................... Zoning District ........ °..................Fire District ...�en.:T - 1:1. ,c..... .C1. .7.L/:..Y�F./� Name of Owner .I.—11—.Coif.1.d..M:GL�ho...�..1.1Q.M.'66c1dress .......8.CAJfY.. t........C ,&......".a V.�e.............. Name of Builder .... f..-).......G.FC...1&.,....................Address Nameof Architect ..................................................................Address .................................................................................. Number of Rooms ..................................................................Foundation ...... .:Cal........ f° ./.�. .'/. 1!..t ....... Exterior ....tL.IZI Of-d.G.r..... (7.L1� .L�:,S.......Roofiing ...t `,sp. 1xj.4.......tS a.i.01J../cls............... Floors ...........Co.n..Q,!7..';lC...........................................Interior ......... .............Plumbing a �_ T Fireplace .......:—....................................................................Approximate Cost .....,5- o... ... ......................................... .. ... Definitive Plan Approved by Planning Board _______________________________19________ . Area Diagram of Lot and Building with Dimensions Fee ® '� SUBJECT TO APPROVAL OF BOARD OF HEALTH 130� C_ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ........................ .. Construction Supervisor's License .....97(.5................. CHAMBERS, BILL & MARTHA 31770 Build Permit for No ..................... Accessory.sor to Dwellin .............. ........ ....... ....... .............................g Location ...10.1.7....Sho.ot.f.lyinq.... .....Hill. - ....Road ....... .... .. .. .. . ... Centerville ............................................................................... Owner ....JU1.1... ftV.th A...ClIaMb.gr.5.... Type of Construction Frame............................ .............. ............................................................... Plot .... Lot................... ............ % Permit Granted .......;Apr i 1...4. 19 88 ,few Dqtq of.Inspection ........................ .. ........19 Date rCompleted ......................................19�)s 4 is to 0 In i Assessor's off ioe-(1st f Ioor): Assessor's map and lot number ..... j....Q ..... �oFTNETo� }'goard'lof Health (3rd floor): Sewage Permit number .... �.'33 ... 7,........... , "'"" Z 13AB39'f11.DLE, . Engineering Department (3rd floor): / v rasa House number o �63a a NO APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR (APPLICATION FOR PERMIT TO ...O.o.n.a.,<.rlJd...3�. ara.g.°e....................................................................... TYPE-OF CONSTRUCTION ...14..0.(..'V......................... cco. TO THE INSPECTOR OF BUILDINGS: W` The .undersigned hereby appliesfor a permit according to the following information: Location ..Inl.`7........1:).!1,CS.f7. !..!�........ 1 1 ProposedUse .......QQ Ca... .e ........................................................ .................................................................................... ^ / J / Zoning District r........ !�.J....................................................Fire District ....C n u.�n,.Jer..1�i1.1 . 0..�./fj ..�l.././eM_,' Name of Owner fi-1-.f-_an-d...rY..1.r'c' . hi(ha... .>nn. edc1dress ........�S.,..O...(!n-e..........01_% ........... .... Name of Builder .....4.).C�. .n......!^..1`. :.< .C�. ...................Address .. ....���.4 .5)t. ..�.�.....�. .....`�m,...1e.d.. .r.t�.A�T!.�!.��' Nameof Architect .............w...............................................Address ................................................................................ Number of Rooms ..................................................................Foundation ...... .C�.I"'.'.. ........ aP r,1'-.e . 1 Exie for ..... r........jhtnJPs�. Roofing ...( � -�'-- ....... .� � q. �.. . . j.............. FloorsC . ...................................... Interior ........ . ................................................................... . ...... r Heating _.......................... ....... ..........:....................................Plumbing ..... .. ` QU Fireplace ........`_'...........................`..........,.............................Approximate Cost ...... •. Q.........................................t' Definitive Plan Approved by Planning Board ________________________________19-------- . Area ....�., .......�4..!'......... d Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 1301 ` 115" I aclut ^� 31 a C� 0- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.- Name .. ,. ...................... .......... Construction Supervisor's License .....9,.9914. 5 r CHAMBERS, BILL & MARTHA A=191-030 No ., 1.770... Permit for ,Build rage Accessory to Dwe.11ing............. Location ...10.17. Shootfly,ing.... Road Centerville ............................................................................... i Owner ........B.ill & Martha Chambers ................................................. a Type of Construction ........Frame ................................................................. Plot ............................ Lot ................................ Permit Granted .......April 4............... 88 , Date of Inspection ....................................19 Date Completed ......................................19 f r ( - _-- r EVELAND'S�SHEDS K 209A IYANOIJGH'ROAD - HYANNkS'#�M&,62601 508-778=5667 800-386:5667 SPECIFICATIONS THE SALTBOX CLAPBOARD GARDEN SHfED FRAME - ALL LUMBER IS FULL DIMENSIONAL PINE 2" X 6" FLOOR JOISTS 24" O.C. 2" X 4" RAFTERS, COLLAR TIES 24" O.C. 3" X 3" CORNER POSTS 2" X 3" STUDS 1X VARIOUS WIDTH DECK AND ROOF BOARDS 1/2" X 6" CLAPBOARDS 5" EXPOSED TO'WEATHER OTHER SPECIFICATIONS PRESSURE-TREATED PILE FOOTINGS WITH TERMITE SHIELDS 6" TEE HINGES, METAL HANDLE AND LOCKING HASP ASPHALT ROOF SHINGLES 18" X 18" NON-VENTING WINDOW WITH SHUTTERS AND FLOWER BOX ENTRANCE RAMP 36" WIDE SINGLE DOOR 48" WIDE DOUBLE DOOR (OPTION) ALL HEIGHT DIMENSIONS APPROXIMATE =_ ' „f ; .�',�'; �td 'Y� } r6 '� t exit i k J.hS!; ` •,J,�Y:�r ; n �': xt ! {7 trR (k�F >l ,tf, LA EVELAND-S SHEDS 209A IYANOUGH ROAD HYANNIS, MA 02601 508-77&5667 800-386-5667 SPECIFICATIONS THE SALTBOX CLAPBOARD GARDEN SHED FRAME ALL LUMBER IS FULL DIMENSIONAL PINE 2" X 6" FLOOR JOISTS 24" O.C. 2" X 4" RAFTERS, COLLAR TIES 24" O.C. 3" X 3" CORNER POSTS 2" X 3" STUDS 1X VARIOUS WIDTH DECK AND ROOF BOARDS 1/2" X 6" CLAPBOARDS 5" EXPOSED TO WEATHER OTHER SPECIFICATIONS PRESSURE-TREATED PILE FOOTINGS WITH TERMITE SHIELDS 6" TEE HINGES, METAL HANDLE AND-LOCKING HASP ASPHALT ROOF SHINGLES 18" X 18" NON-VENTING WINDOW WITH :SHUTTERS,AND'FLOWER BOX ENTRANCE RAMP - 36" WIDE SINGLE DOOR 48" WIDE DOUBLE DOOR (OPTION) ALL HEIGHT DIMENSIONS APPROXIMATE �t e#"by rr`•�✓fhi t2f'}tt r..: �y�i s < M:�J.tS�l§. ,` ' si6� i Z 4�i'�. 'CA N � L77 *r�i }.tF '1 fp �x r�t�y.S''v-�ii.1 �'0r�'s c° ytK'4�TMya'y4� {�s��C•yt}1 �C N �y•� �. � r ad a s r t w ' "`'�' The Contn,0118-calt11 of Atassacltuscfts Department of Industrial Accidents • � tl ' 600 If aslun/►tm Street Boston.Allis 02111 �• Workers' Compensation Insurance.AMdavit A _ -_... . .. Please PRINT 11b_1 �,. � DDII Caflt�ififorrttation:. e����e�r•e � location, cit. nhone# - I am a homeowner performing all work:myself. I am a sole proprietor and have no one working in any capacity I am an emplover providing workers' compensation for my employees working on this job. camp nv nnme �ifNo— \CAS%CQ cow 's a ® nil d r eq3 G►®q W a o o's ` !Jh'• 0, ,n-E -b bA d CJ 1-41 1 11hone#• -7 r insur•rnce co dt,u�CA. ! Ce d nolicv# 15 t 7' � ® "' 0 q 6 3 q 1 am a sole proprietor,general contracto ,or homeowne 'role one)and have hired the contractors listed below who have the following workers' compensation poll comnam n•ine address '-su- co.— GL0 501Ell 01 i?A6 .r--:.----:.•.---:-r::-•- - �+e/grin•a.••.gas.-�-rr-r'�.et'ns*^+,�"� �raaros+reS�'�l^r�='+".r,+�'s'�?�,'�""".�,0,n;,�.,sY`:�""'f m v e• nddress- citti nhone#• -- --- nolicv# Atiach additliinal'sheet if neee failure insecure coverage as required under Section 25A of 41GL 152 can lead to the imposition of criminal penalties of a fine up to SIJ00.00 and/or une years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a line of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the OMcc of Investigations of the DIA for coverage verification. l do herebl'certify under the pains and penalties o Maq, at the'afornmtion pror7ded above is true and conva \Aianature , . • Print name E L Prot e.r 14 1Z V Phone# r' otTcial use only do not write is this area to be completed by city or town official city or town: p" nitilicense# Building Department k Ol.ieensing Board D check if immediate response is required pselectmea's Office �fiealth Department contact person: phone#,*. nOther__ Immued1V P1A) _ Information end Instructions ` Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",an empinree is defined as every person in the service of another under any contract of hire,express or implied. oral or written. An emp/ityer is defined as an individual, partnership,association.corporation or other ; gal entity, or any two or more c the fore-, ing engaged in a joint enterprise,and including the legal representatives of a deceased emplover 'or the CIOreceiver or trustee of an individual , partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwellin, house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment.be deemed to be an employer. MGL chapter 1'52 section 25 also states that every state.or local licensing agency shall withhold the issuance or tc a bus iness or to construct buildings in the commonwealth for any renewal of a license or permit to opera g applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter ira• been presented to the contracting authority. .ww.�+� �.ra. •a S D r^+::CAs:^iR Y� L.L..Y ,��..� �• w � In�.1•r:- '1. •�•n -.1: '�•ryi .- . M-• i�,•r„' .A •'tA� •Y.}:. .•�L. �). Appiicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying,company names. address and phone numbers as all affidavits may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. rM: -�i�..w`ly_:.}«!5r.41►dn���.�:.' .��.L'�i.v."S'��.�wiYji- •\7 City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant~ Pleas be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX.unless other arrangements have been made. The Office of investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. -j,: 7.+siv�r 'if.isi: •: ..r'. rw. �•:.'.3�+''' +Z?ir :w:E::•..... L - �...�a.w r. �_ ...�, .....:.++..r=r _ �i r._Z i:..�.;i s•I - . . r•4�t�:mir.• c.`�..::-rsa +'!•-wr.: The Department's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ,. Boston,Ma. 02111 fax#: (617)727-7749 •. phone#: (617) 7274900 ext. 406, 409 or 375 is . . ° The Town of Barnstable ' NAMg Department of Health Safety and Environmental Services 1"19. Building Division 367 Main Stores,Hyannis MA 02601 Office: 508-790-6227 Ralph C== Building Commis F= 508-775.3344 For office use only , Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW • SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,rq*,modernization,conversitm, terra% demolition. or construction of an addition to any pre-adsting owner occupied improvement,. 'at, building containing at least one but not more than four dandling units or to sttuctntes which are adjactat to such residence or building be done by registered coma==with certain eacceptions,along with other rarlirelnellm Type of Work: G`� '3 Est.Cost a; Address of Work: Owner.Name: \L) Fp-� Date of Permit Application: I hereby certify that: Registration is not required for the following rrason(s): Work ecduded by law _ _ob under S1,000 Building not owner-occupied 7Oan cr puIItng own permit Notice is hereby gi%=that: OWNERS PULLING THEIR OWN PERMIT R �G r N� �S�TOCTT� FOR APPLICABLE HOME 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 o"mer, Date Contractor name Regutratton No OR ' n,.e Owner's name • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION S Please print. DATE— -�/�-( �E,. ....... JOB. LOCATION jot Number 94-relaf address Section of town "HOMEOWNER" Name Home phone Work phone . - PRESENT MAILING ADDRESS 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 such homeowners to engage an in- dividual 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 re- side, on which there is, or is intended to be, a one to six 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 Officii on a form accBptable to the Building Official, that he/she shall be responsib: for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes . responsibility for compliance-with the Stz Building Code and other applicable codes, by-laws, 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 requirements. HOMEOWNER'S SIGNATURE ' APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet,/ or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person (s) for hire to do such work, that such Home Owne shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix 0, Rules and Regulations for licensing Construction* Supervisors, Section 2. 15) . This lack of awarene often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home ' Owner acti as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma. communities require, as part of the permit application, that the Home Owner 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 to amend and adopt such a form/certification for use in your community. r- - ;{ s.2 31 _ .�� / �j l; i/50.5 �{ � i r i{46 j - X 52.2 53.6 .6 . ,/ X 53.5 _ ^57.0 488 ; 47 9.5 r 5 ~s'7. " - ------ ----; 46 �- _ _ _ \/ 162. ti58.9 \52.0 4. ' ' l } 1 , C 0 �- 41 s .. ' t - t x � ! F 93 D Co. En 0-1 4 1t A: 1 ' } ' IRI i o N UJS :C -Ti r o m rn it 0� A rn MCI ( ::D M 0 rn DO'F 1 Cl) Ilk f _ d m g YTi •� a of rn � m c a. rr • .,ter. � , ;� • , -. , • . $ 1, j 1' 1 it� 1 t F t:� F• e .. F: _ 1� �r"4, a `� r C `�� 1 ` , •'It ., o;: , � r=••, '• �: , z ' , •i, - y},�s ,.� gip. . • t. e - , f T, t � , { '" ;$ `p Y.'i.• �. � to f � �,r �` "t9 '" �y i • .. . a 1. P3 r` { " ,..F..,...-..,.�..,--,.,.• .....-__.........-...�._....__..._,.,—____.< � ,fir• :. r } { ' !�' + 9,`` } tl ., .-g � ,,� •"i. P ,�. __. � ��'. a ,� ys.;� ,� tf +�:' a , • , 1