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0760 SOUTH MAIN STREET
le, civic ono-I'MY, ;4 k: It Q. pull 'All 69 Air tyi%, q7 "W111" ' W Ink WPM �X, 4, �Z 10, Ah, "'A Ilk Armi,, �112 'RIT..1 1,pj "T, 021 MHUMN, *11 ,- EON N ,V� , it, RAI z I'M! NO i,,qjj gg m i i t f5 iw , I I - -I WNW � i ''1 7.1 'i W"n I--- —A ", ��Aiv�uijtki y;A, kk tot;if 1 WE It VAR, CIO "gig W All I , x � D ,��g,, Our, R"Qv MR 'pit Wg KqA 111MT1;J-k1'1I i'pft�""VAAM Alt Ai1b, If IJR� 1 11) f Not 41 I 9111)"1 1" I I 56 �tg �f, Mao wolh lam MAY '46� RUM Im IS 1"i D NAR WWI ANNE" PDA ,ly, it p"RUN II 1, 91, 1 fs %'A q C� 'Al ri F hit, i A - it" 41 WOO Tj VAli Inn MM, 6'kii 1 rl Mu ye!:ygf�aq 1 1 ,0 klqg fill K ATS 4. My I& owl 104, il% _F 4"Alif�Ewuqqi f7 UPI ggmjqj�,�, I mire. -It�-,Jnj WIT N M wj,WUH011 A4 e Vt 1P 1,1 Ru pi T IN P ,i,I j0 I !�g 41)�g�.' MOST!` M-0 Ir�lilep,Ni�t �T)m qm 43 NMI jy�n,�j�jy 11-)gvxp. al WHO M WIN", w 7� 1% -mom, go WWI tX, N 3 WO "0, A—q ko.", ;gQ VAI 0.14 sposes, Tom Kill, ON 'Xi'W;x MGM. KNOW! 'Nowfulso 41- TI IN& "'I TOWN OF BARNSTABLFy-BUI-LDINGeP—ERMIT,,;APPLICATION Map Par I © `' APRQ�� 1 Permit# Health Division 0 ,,': .�-awe '.°z --�jhDate Issued —� /� / 1, Conservation Division /i 51 !®/ Fee o Tax Collector 'y PTIC S Treasurer ' ��-Q 7/ � d� INSTALLED IN Co E �1ST S� i OONIPLIAND Planning Dept. � �iVVlR�WITH 1'iT'LE 5 Date Definitive Plan Approved by Planning Board �°� �91°AL CODE AIM N REGULA?I®., Historic-OKH Preservation/Hyannis Project Street Address 7A Villageuenn,�%\/ .Q, Owner VI) .,.,, � Address S �` Telephone, 3 r 344 r Permit Request (TN,r4 1 A, Square fee 1 st floor: existing proposed 2nd floor: existing �So c) proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size 7(SU fi°1 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ur Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes A190 On Old King's Highway: ❑Yes eNo Basement Type: ❑ Full awl ❑Walkout ❑Other Basement Finished Area(sq.ft.) U Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new �Z Total.Room Count(not including baths): existing new 0 First Floor Room Count Heat Type and Fuel: CVGas ❑Oil 0 Electric 0 Other Central Air: ❑Yes LlAo Fireplaces: Existing New Existing wood/coal stove: O Yes 0 No Detached garage: __0��existing ❑new size Pool: 0 existing El new size Barn:0 existing ❑new size Attached garage:Vexisting ❑new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes, site plan review# .Current Use Proposed Use BUILDER INFORMATION Name �, ,,� Telephone Number D Address �� (� P� 3`3 LI License# o L, W 9-�( �G.nf,-„ cam_ Home Improvement Contractor# 1 1 -7 6 1 0 c2D66R Worker's Compensation# r ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I FOR OFFICIAL USE ONLY PERMIT NO. � tit ••, ! . - * n .. ..•+ - - R _ - - t ` _ `{ DATE ISSUED _ 44 t r i r ~ r r MAP/PARCEL NOS J "' t ADDRESS e.- _ VILLAGE _ t OWNER " DATE OF INSPECTION rJ `i FOUNDATION I..` FRAME INSULATION ; FIREPLACE ' C _ FINAL ELECTRICAL: ROUGH € PLUMBING::* ROUGH t FINAL GAS: ROUGH , - FINAL { •� FINAL BUILDINGV. r f t r DATE CLOSED BOUT t #': K ASSOCIATION PLAN NO. F -: QUERY PERMITS : QUERY END QUERY PERMITS PENTAMATION----------------------------------------------------------- 12/04/97 PERMIT NUMBER 27094 PARCEL ID 185 010 760 SOUTH MAIN STREET PERMIT TYPE BADDI BUILDING PERMIT ADDITION DESCRIPTION REMDL EXIST GAR. /ADD MUD RM/BATH/CARD ON FIL CONTRACTOR PERMIT FEE 223 .20 VARIANCE STATUS A ACTIVE CONSTRUCTION TYPE 434 GROUP 'TYPE 1 APPLICATION 11/14/1997 EXPIRATION VALUATION 72000 . 00 DATE ISSUED 11/14/1997 COMPLETED DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE---- (N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR (0) PERTY/ (I) NSPECTIONS/ (H) ISTORY/ (F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E) XST i PENTAMATION------------------------------------------------------------12/04/97 PERMIT NO 27094 PARCEL ID 185 010 760 SOUTH MAIN STREET PERMIT TYPE BADDI DESCRIPTION FEE CODE FLAT/BASE FEE TOTAL UNIT COST AMOUNT PAID RESVALUE 0 . 00 223 . 20 223 . 20 f TOTAL CHARGES FOR PERMIT 223 . 20 CTRL-O UNITS CHARGED/ CTRL-W PAYMENTS/ CTRL-V VALUATION/OTHER UNITS/ ESC EXIT I i:e C,ommOnwe=j of massaclirrsa= Department of rndusvial Accidents. 600 Warhr�n Sheer Boston,Mam 02111. 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Imida= copy o!this rratsmerst=x1 be rotwaTded to the Otaee otlaresri;adons of tlma=Lfortn"mPTl iftufm I do nezby carify rasda rhr p��paialties ojp�t�the iit�orm�ia�t pravidcd a3at�r is trua and corrrct Date P.r:a I-Q V iz ofIIdai use ottijr do not write is this area to be completed by city ortawn omcfal dry or town: to ❑Baadlat DePar= J ci cci,if iaunediate response u required QLltrasmt Bad ❑Selse�ra':OS'IIu �Hnith Drpsr�a' Contact person: phoneme - ❑ �� 1 1 11 1 1 r l l 1 1 1 � • • .1 M. .11 • ♦• MITI• • .. • • • • • • M •/•1 ... �Id • • • .tt1. • • • /Iw1 • / got• • • 1• • of some .. •... .1 • - •.I .goo •11 • •• .t• •11 •) • • -1 � gore .Told • • • • • of• • • . tr • • .1 011.1 «ot rl • • ... • /• bia, .o . d to• •1 •.. .• w 1 U •.. ..• •11 • •) . -• wore weld so 1• t 1•• 1• 1••1 1 .sees 1 . .. 0 1 • • .• .01.1• • • .11 .• . . .• .11.1•w•Y etlr roll l\.11 ergo .r1 .1 .Yee• •1•. •r• ♦. . . l n • .• • all .• v • .• • • •• • ../1 • .• •Y. � . • •w«:1• v •1 ♦• ••• wt11• • • 1/w11 . •_wet_• /• • -.1 •••.11. • 1 w • d .rt • ruw, •.r.1 ...1 •:1. 1Ott1 r: Yd1 'lll Jl ' . • • .• .1 1 . 1- . '/ll ..+.A 1/ .1 VI 1 . 1 M 1 1 • 11 / • • . : • I I Y I V r III• :/1 r 1.1 .1 I I 1 1 Y 1 1 MI .� • 1 . •.11•*Ole 11•r. • i • .• ..• . 11 .• ••..: 7• • .1 • Av •u '/. � wellw /11,d .11 • r•1.1..: w 1.1 .• •.•1 •• ••1 .•• • •1 • ••.1/. 040/41 • .r•na• .got ' 11. •• /I �••.:.• —• ••• -.••.w.1., •1 •u •n•vu Iw gore • • . • N • .• . .••qH..y- good // 1. - •1•.•H... r•qN•«•A-r.• •1. .•�• gore 1 •r•tn -1• • r._M.�•/ • of . ..: got✓.. _.• • .,t I• 1 'tIHYe. .It ..•• else olives 1.1.0 6-1 dl• •/ . H• •.• w.y J• • • e/.r1. .U..I .-•.. •rI1• 111 rw •.• rU •1 u1.`IHr.• . � gore • /� • • / •.. got• •. .1 le .n v.•r. .,• 1 1 11 t• 1 I • • • •/ . • 1 t • . . • .••,•.•—• .• e.. •II • •1 1. •'/1 .tYI I, ..• . •�.• ere 1.1 •.•/1 •/ 1 . •• .K• •.• el ego.I .1. `I..Y. APIN « •wll� II .11 • • 1 tr • .Ir • el•w•1• •I.A .tle • • •1 • .• •..sn. gone•«w roan. .��r;.e1.•. . • . ..c 1. `••.•=•..1.1�r1 _. •• •Igoe.• •y •...• • • Not qa . r,• / .Kt •ego .l •r .I • • ._• • . .• •• ••...w • • • • d •.• s. .. w•I .• fin• r •. of . •re•1.1. _ I✓ 1. r.re1✓. M •$lotwr. ..te • 1• .•.• ✓..yl /• •...• ••'••. else.. •« ' .e M _ • IL •Ire • •..•• • • n • .n V, • ••« .•gore. y«.• .1•, .r Ole •.•• .ego• r.►' .l.u. •r• • goof 1 1 1 • , 1 � 1 ( 1 1 1 1 1 1 ESTIMA TEO PROJECT COST WORKSHEET Value LIVING SPACE square feet X$1151sq. foot= (high end construction) (above average construction) square feet X S961sq. foot= (average construction) square feet X S571sq. foot= (UNFINISHED) square feet X,S251sq. foot= GARAGEa l � square feet X S201sq. foot= _ FS — PORCH square feet X S151sq. foot DECK = _ R square feet X S??lsq. foot OTHE = Total Estimated Project Value The Town of Barnstable 9 MAN& Regulatory Services 16"1 1e Thomas F. Geller,Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street.Hyannis MA 02601 Office: 508-862-4038 Fax: 508-7 90-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142.k 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 ar 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: R a ,�{,�r, b1�w,,Qn,�l Estimated Cost � 1orb Address of Work: ) �A - Owner's Name: `Vl ,_..,�-� Date of Application: I hereby certify that: , Registration is not required for the following reason(s): []Work excluded by law []Job Under S1.000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGYED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. 91a2/r� 176 ! D Date Contractor Name Registration No. OR Date Owner's Name I 1iaCAR A;p.m=j Tihls.tS2.Sb(aoas�aad) Praaip�e il=k =for&s sad Tws•Famiif AasidsumW B-ad icy gaumd with Fa=i Faris MAXIMUM I lHEYMIUM L Crs WaII Floor g Slab'('�) R•vaEsa� EGvsiue� R.vstu� WallP R hxj zwzi 3"1 to 600 Han Ii �Drimw Dire? a40 1 31 13 19 10 I 6 I Harassi R IZ:', 1 osZ 1 30 19 19 10 1 6 I N==i 3 ►T.1 I OJD I 31 13 19 I to 1 6 I IS AFtTE T 13% a3b ( 31 13 21 WA ( WA I Norasi U a46 I n 19 1 19 10 I 6 1 NOS v 0.44 1 31 t3 29 WA I WA I CAME a IS'di 1 —am 1 301 i9 19 1 to 1 6 I ISAFUE - x Is% I a3z I 31 13 2S I W-m-7 WA 1 Nm=zi Y 11'/. I 0.42 31 I 19 2S I WA I WA ( N=mzi Z 11% I 0.42 1 n a 19 10 1 6 1 90 AFUE AA 1E7. ( asD 1 30 19 t9 I 10 I 6 1 90 AFEJE I. ADDRESS OF PROPERTY: 2, SQUARE FOOTAGE OF ALL EMMUOR WALLS. Ll LSD 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(0 DIVIDED BY#2): S. SELECT PACKAGE(Q—AA-see:hart above): I NOTE: OTT—MORE INVOLVED METHODS OF DETERMINING MNERGY REQUMEMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. B=iNG INSFEC 7OR APPROVAL: YES: NO: 780 CMR Appendix J + Footnotes to Table J5 1b: ` Glazing area is the ratio of the area of the glazing assemblies (including sliding glass doors, skviights. and basement windows if located in walls that enclose conditioned space, but,excluding opaque doors) to the gross wall are:. expressed as a percentage. Up to I%of the total glazing area may be excluded from the U-value requirement. For example,3 it'of decorative glass may be excluded from a building design with 300 ft of glazing area. After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRP'test procedurr, or taken from Table Jl S.3a. U-values are for whole units: center-of-glass U-values cannot be used ' The ailing R-values"do not assume a raised or oversized truss construction. if the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-39 insulation may be substituted for R-49.insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the stem of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall.For example,as R.19 requirement could be met EITHER by R-19 cavity insulation OR R-I3 cavity insulation plan R-b insulating sheathing. Wall requirements apply to fra wood- me or mass(eoncrem masonry,log)wall coasnuaions,but do not apply to metal-frame construction. 'The floor requirements apply to floor over unwed spaces (such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. •The entire opaque portion of any individual basement wall with an average depth Iess than 50%below grade must mee: the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glaring. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R Z for heated slabs ' If the building utilizes electric resistance heating use compliance approach 3, 4, or S. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the seletxed package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.I a NOT O: a) Glazing areas and U-values are maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b) Opaque doors in the building envelope must have a U-value no greater than 635. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1S.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(Le,may have a U-value greater than 0.35). c) If a ceiling, wall, floor, basement wall,slab-edge, or crawl space wall component includes two or more areas with difr'cr ent insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R.value requircment for that component. Glaring or door'components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(035 for doors). BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR h : Number�CS 049879 �� ( +Expires.051=002 Tr.no: .25093 Restricted To 00' STEVEN L MELLOR _ f� PO BOX 334 �, i1,l� W BARNSTABLE, MA 02668 Administrator ✓1ze iJomvntaiuoea a�✓ aaaac�uc�, Board of Building Regulktions and Stardar HOME IMPROVEMENT CONTRACTOR Registration: 117610 Expiration, 10/25/2002 . Type: INDIVIDUAL STEVEN L.MELLOR STEVEN MELLOR 1S9 PERGIVAL DR/PO BOX 334 W BARNSTABLE,MA 02668 Administrator c�N7FK r»,�D�EE G f3�E wi-r'�} �Ew sHED '1>09,rVIIE LA-5 E- Rr! 3!o gNTj .2 310 ANb a 3t0 L ' NEvJ Sr'tEl� ]�RY1nE(Z AP?tZu*tY-ACTIE as .�E LorlG s-r�P ,rl 411 Efltrt•F GA-Y3�-�.s�cT-:orJ'�PP12oX.��.1�• s t�E o F fi �r�PPeD r3A�c s£c�p�s StD� ESE-gA== oN 5c..%�E `14 f�PPRe�4. 4 FT i i ! - � J"� ` 1 6 1 r c"• F i L v a. i Nub:. N£w 6 K►Mf- A PPRo�I: a a P-r- Lo�-1 G- . y ,L I EAT-t+ CtOrOLE nEC- o �'- - �c.ts-rrwG Houses � . fNew 5N4� "b0 2v,nE fL . u�w '*bortmC-� Lam. -- W i fi�l1 S TI r1 G too u 5£ I 'l(o V5 e ' j�1C�5-T}7�1 Cr }�v�8�. � V ' -.. . ��O fZC..1^I' t iAPPR�x�m�'s-E,�.� la: FT - � - , e �� �_ 1 a - -- �RoN-r EL�v►�-�uu i :� s N E w .�rya won rn ►2 r lJ _ U1 Ii N�w 7--A- -5 �0 2rv�E�2 Town of Barnstable *Fermit<P?0 Expires ti ha It fro n i e eme Regulatory Services Fee aARNsrAUL% MASS. Richard V.Scali,Interim Director s639. Building Division ������ Tom Perry,CBO,Building Comntissior 200 Main Street,Hyannis,MA 02601 VU www.town.bamstable.ma.us NOV 2 5 2015 Office: 508462-4038 TTnnrr�,/�I : 508-790-6230 �ER EXPRESS NIIT APPLICATION - RESIDEIV`T'1�A(tF TAB LE 1 O Not Ytdld without lied X-Press ImprintMaplparcel Number rr _,,nn Property Address � �-l'V [Residential Value of Work$ V \1 V y• Minimttm fee of$35.00 for work under$6000.00 O,vvner's Name&Address Vv\ffic q) "U_h 4- v '(L 1 C � 'I Contractor's Name qu 2 Telephone Number y - Home Improvement Contractor License#(if applicable) 1 A �l Q _ Email:sbovqp t r' Construction Supervisor's License#(if applicable) ❑Worlunan's ompensation Insurance CheyK 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 Re u t(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 (maximum.35)#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 si vrner Letter of Permission• opy of th I provement C actors License&Construction Supervisors License is requ •e SIGNATURE: Q:\\VPPILES\PORMS ' mg permit fonm\EXPRESS,doc Revised 061313 OFTVE r Town of Barnstable Regulatory Services + BAMSTABLE, k y � g Thomas F.Geifer,Director so 59. Building Division Tom Perry,Building Commissioner 200 Main Street',Hyannis,MA.02601 www.town.barnstable mains Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all mattets tela.tive to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools ate not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner ' e of Applic Us\ Print Name Print Name Date QXORMS;ONVNERPERNSS1ONPOOL'S 612012 f � J 1' _77te Comrrtairwea th ofMassachusefts Degarment of lr dusftirrl Accident s Of,�`ive a,f.Investkations ir 600 Washhigtoyt SMeeit Bostorr,MCI 02111 wmionasngovIdia Workers' CompensationIumn-anceAffiidavit:Baziiders(Con€mctvrsMectricianslPlumbers Applicant Infoi-mation Please Print LegibIy Name(Bttsinessldrganizatianlfndi�idnan_ Address. City/StatrJZip: W)() Are you an employehBeckthe spprapriate box: Type of project(required)_ 1.❑ I a employer with 4. ❑I ara a general t rmfractor and I 6_ ❑New oonstruction loyees(full and/or part-time}_* havehired the sub-contractors 2. am a sole proprietor or partner- listed on the attached sheet 7_ ❑Remodeling ship and have no employees These sub-contractors have S. ❑I)emolition wo for me in an c ci �. employees and have workers' �ffi Y � � 9_ []Building addition [No workere Comp-insurance comp.imsurance-I 5.❑ We are a corporationand its 101-1 Electrical repairs or additions officers have exercised their 1L PI bin airs or additions 3.�I am a hnmt;rnxxter doing all wail;. 2���� S repairs [No workers'canT. right of exTmption per MGL 1 of repairs iumnance required.]t c.152.§1(4),andwe have no employees-LNo workers' 1313 Other comp,insurance required-] *Any epPIr'��t checksbox#1 umsta%o filiout the sectionbetowsboming ffi&voAmI * compenseiionpolic�infarrmtian i Mznwwnm Rho submit this affidavit indicating they ue doing allvoak and then bite outside contc uors t sUbm t s new affidavit indicA�mdL TOnntmaom that cflea thls box must attached in Witional sheet shmcing thenmneof ffm sift-couftarton imd state ubeIhW ornot those eatitieshmm employees. Ifthe snbtontractots hvt a rmplo T:e%6sey mmrst provide their warkess`comp.policynumber. I arri air employer ihatkprotading it orke-s'contpenrnlioit ins7irrrrtce fat triy ettW&yees. Beloty is fhepolicy turd job silo 27rforYfrfLfTP1l. Insurance ComparryName;_ --- Policy#t or Self-ins-Lic.#: Expiration.Date: Job Sits~Address: City/Statelzip:. Attach a copy of the workers'compensation policy declaration page(showing the policy number And expiration date). Failure to secure coverage as requireduttder Section 25A of MGL c. 152 can lead fo the imposition ofcrt_m±nal penalties of a fine up to$1.500.00 and/or one yeari nprisonment,as well as civil penalties in the form of a STOP WORK ORDER-and a fine of up to$250.00 a day against the violator. Be advi.-ed that a copy of this statement may ba forwarded to the Office of Investigations of the DIA for insurance co verification. I do fret - tTrep "is sir per afperjury that trio information prinideif al a is tru mlt�orrect Si Date: Y Phone# �� Oseiai rise onTy. Do trot write in fh err,to be cPurpleted by ciity or torvll o,QScfaL City or Town: PermitUcense# TssuingAuthoiity(circle one): 1.Board of Health I.Building Department 3,City/rown Clerk 4.Electrical Inspecfor S.Plumbing Inspector 6.O her Contact Person: Phone It: 6 t Massachusetts-Department of Public Safety l Board of Building Regulations and Standards Construction Supenlsor Specialty License: CSSL-099138 ,``:i,i All j JAWS P CURLED 287 FU LIER ROAD Centerville MA 06321V 1 aria'` Expiration Q1l28/2016 Commissioner v ' V�8�OOi7 J7f.077..cueccLl�a�V/laadac�c�let� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 11 310 Type: Office of Consumer Affairs and Business Regulation Ex iration= 6Z372Q:t7; Individual 10 Park Plaza-Suite 5170 p - - _ Boston MA 02116 James Curley F x = F t James Curley 287 Fuller Rd. ^�i orx Centerville,MA 02632 Undersecretary 't valid without signa re I — TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Li Map 1 �J Parcel 010 Application "t Health Division Date Issued I� �f) Conservation Division��C� Application Fee p � `� Planning Dept. - Permit Fee-, Date Definitive Plan Approved by Planning Board _. Ac jo�SlttUZ Historic - OKH _ Preservation/ Hyannis Project Street Address 1&b 50 Uc`4 1M A—) Village 1 L Owner W1 L--)AYY1 fP • MkA1Zt0C44 --rk Address 6 PJm �- _rf_�'t CAnrl� L-UOJ Telephone �57�� -� 3� Permit Request pr���' �.�2 .6 UL-K&F-j" T'O Square feet: 1 st floor: existing �proposed n _2nd floor: existing proposed Total new Zoning District ft> - I Flood Plain .No Groundwater Overlay Project Valuation 3, Construction Type e—f-"f VT_ Lot Size a 3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 26� Two Family ❑ Multi-Family (# units) Age of Existing Structure - Historic House: ❑Yes '%No On Old King's Highway: ❑Yes )(No Basement Type: )d Full *rawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) o Basement Unfinished Area (sq ft)`i - o Number of Baths: Full: existing new Q Half: existing 12 n w—?5 Number of Bedrooms: existingnew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: *Gas ❑ Oil ❑ Electric ❑Other ?d , Central Air: ❑Yes VNo Fireplaces: Existing New ® Existing wood/coal stove'' ❑Yes *0 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 l (No If yes, site plan review# Current Use h5-1�bf:�, -n A-L_ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) t� Name i_• ) emj�. PYIAA,&()CA. 3t Telephone Number q r313 7" Address YYYP )?J `TT- License# C,f NTMNTI L L . YY1' Home Improvement Contractor# ® JU 3`?-- Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7 �_ LNk, P) LL SIGNATURE DATE a FOR OFFICIAL USE ONLY t APPLICATION# s DATE ISSUED MAP/PARCEL NO. b �S ADDRESS VILLAGE e I , OWNER t DATE OF INSPECTION: FOUNDATION 1 - FRAME INSULATION r E FIREPLACE , ELECTRICAL: ROUGH , FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING I DATE CLOSED OUT R ASSOCIATION PLAN NO. r The Commonwealth-of Massachusetts. _ Department ofindustrial Accidents Office of Invesdgations _ W. 600 Washington Street Boston, AM 02111 www mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lembly Name (Business/orgmimtion/Individnai) ) I LL l ry\ 1\iA b OC' Address: q&o mi► 1M, I A F '�, CC ty/State/Zip U I L U,;MDitone#: - 75 3 Are you an employer? Check the appropriate box: 1.❑ I am a employer with 4. [] I am a general contractor and I Type of project(required): employees(full and/or part-time),* have hired the sub-contractors 6 []New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demofltion working for me in any capacity, employees and have workers' [No workers' comp, insurance comp,insurance,# 9• ❑Building addition required.] 5. ED We area corporation and its' 10.❑Electrical repairs or additions 3 I am a homeowner doing all,work officers have exercised their 11. Plumbing myself. [No workers' comp. right of exemption per MGL repairs,or additions insurance required] t c.-152, §1(4), and we have no 11 Roof repairs., . employees. [No workers' 13.[Q Other_(� _ comp.insurance required.) 'Any.applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information,; t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such; $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ' Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Erne up to$1,500.00 and/or one-year imprisonment,;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be`advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby c rkfyj under the airs and penalties of perjury that the information provided above is true and correct.:' 7 Si attire: Date: 3/3 , Official use only. Do not write in this area, to be completed by city or town official, City or Town: Perniit/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#, Town of Barnstable - �. Regulatory Services * * nes * BMMSTAELE, • Thomas F.Geiler,Director MA88. 16391. �•� Building Division rED IVIA'I A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:. 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:_ ( —I 01 JOB LOCATION: /&D zfo"T 1^619)Al JT 0_C XI—jE9_V1LL number street {� -- � village ••HOMEOWNER": W 1 L.I_1� . m lA 12 DQc� z��_ 5N !/17.S —3/3 name a-]/ home phone# work pho e# CURRENT MAILING ADDRESS: [ p o CAN 7FA , I L-Lf 0"103 � 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 lments. Signature of Ho owner 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:fonm:homeexempt �T Town of Barnstable Regulatory Services STMg.16 Thomas F. Geiler,Director 3q. �� Fn►r+N�'' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property s Owner Must ,Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. 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'0�4+MT^I *iY 5 -Gov I Y WW4�_a alep & i N''yeinwr-E17T ...-..ONT. �:Yi°ES f �6iil 77t a+ly,Isla ILZIP 4: �_ �:. _Q .!✓:_S',(E UV3 tC r s�: g Iw/ �v��• rsrte'.acmxrM wow t� ~.. ,�+.• r 1 _ NIL.... II R' TM1 sin .. .. 4. .ttrs:meib�Ns 4 Z xr. - �' e ,.t sa.' �,31 .'ll w j1 I �w�s a�•i�f i :' - 6 � r�eeA�ao&.naaoe t't4 ;��.vwkc -._r, q.w•k� s{<a pal..ad o.cw0 -•T(X ��'' L4�lww • 20UWt7DIT ON PLAN wm-*47'fTR►�{nf•-.- +fkf:Pl l'd jlbM�°F 4w -4 max., C } y h2 :: hEG 100 D{ _-.:..E- - ne... .Wei wMrrwewepngbrl C`'"' k 9 „•.{L,,pr.r r :}h�1e.ws�.{pwrowenlaranl►ara.re.MloN+i� '" ,� � . l .Herb YrrrwrM/ee Wkvv.♦gwManawrprrrrl�nlAq ! *-W—r{IrnWrr{wwr ena/ae4erereer}Mrt d�• }` I� .;.' 'rWnrt b.wiMM erwMe weeeelxee 1e�ey er awil rx arra.wrb+. -'t'- �1 �53L: �;'' b a �y c _ - t R I him: FMI "I--Z�' x I -.r.I r-A 'rr L- P-e .=Qo3u�a�+x+vrncn>•. c'�Padb�9ES�S3�� _. ex SFGb�iD 1=l OdIZ 1=1Z1►�lC� l ` , S •lit... Kea- , WAS P t II -_tICP.! � eegpMI W6;EQa IN w 00 ca z 110 B 1A.M.INXMI se d, Q 3_ HIM isaPLY c. 3 2�8iIj�9Qi�Yi�tQ�e its 1 ul i. n 7J' ►� Wc-� BAN �., ..,a.d ' R� SRAM a 9 R� . I s LEUerJv t � 5T nlq RI&H --_— PI+oMu C. Rew�b+Go O Nu.®.oT.°aim: S ID zrad oull � Ifil 5 .. _ I .�i.�'•cw�a�r I I I I �'3a4�e 6% ka ne Usal Mal �. II� �RG�RMEhLMN S IN.Yvsf JTE - - I� II 1 r Me e _ �MouTlo�l EXIST:C N. L II r n�� _� n ;..a r,-f+i,.�,: AIL • Map ' Parcel � ermit# Conservation Office(4th floor)(8:30-9:30/1:00- 2:00). 5 a aYe Issued Board of Health(3rd floor)(8:15 -.9:30/1:00-4:45) 171 Engineering Dept.(3rd floor) House# NZO AND 05-28-a6. Ns r TOWN BARNSTABLE Building Permit Application Project Street e `7&d LK"T-t+ MNP4 k Village L/L IE- Owner 1n>>t.L 1PrW1 . VK�nR�pCi�rJ / `pf- rA.SC#MLQbdress ,Telephone 15bg 11 S 3 f 3 Y Permit Request R�PL fte_f. ZA)5-r N U W )tSbQvJS Prsu*ts '3bn 0b A.&)N-) !�l„ CAME =' w)N_�o ) �s E_ .s 11"6 ® F- J±�kA5f_- A-ND REFLft(_E_ C1,A-P6bA_A_b First Floor square feetP� Second Floor square feet Estimated Project Cost $ 6Z7D Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use ;e(-..5 A L Proposed Use Construction Type 1a�e b-b F� Commercial Residential Dikelling Type: Single Family �. Two Family Multi-Family Age of Existing Structure /5U Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths o?. No. of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel W G�_6 • Central Air Fireplaces o2 Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name 6 Uj /Le"-1 Telephone Number _6-69 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 SIGNATURE G a, DATE ,rj-�,��� ` 0 BUILDING PER T ENIED F.FOLLOWING REASON(S) FOR OFFICIAL USE ONLY - ~� P MIT NO. D ISSUED - 4 M P/PARCEL NO. € - ADDRESS VILLAGE OWNER - •r DATE OF INSPECTION: FOUNDATION FRAME; t f INSULATION _ FIREPLACE z - a F ELECTRICAL: t ROUGH FINAL PLUMBING: ROUGH.y ° - FINAL o = t GAS: ROUGH'c FINAL t - FINAL BUILDING: DATE CLOSED OUT ASSOCIATION;PDAN NQ. r • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE. oZ 8i h JOB LOCATION l�C) /Y l�" J� ( /✓`'�'Y�V 1 I�� 6 2� 3 r � t Number Street address Section of town "HOMEOWNER" ti � . v4D6C M 7?1-- 3/3y .333- � 7 Name H AhiN S eo�Qa,.` Home phone Work phone PRESENT MAILING ADDRESS 'S Cr 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 su ervisor DEFINITION OF HOMEOWNER: Persons) 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 Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building ermit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Stat, 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 U APPROVAL OF BUILDING OFFICIAL - Note: Three family dwellings 35, 0.00 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. r 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 a Home Owner engages a person (s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see 'Appendix Q, Rules and Regulations for . licensing Construction Supervisors, Section 2. 15) . This lack of awarenes 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 "dwner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, man 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. dt of Barnstable The Town Department of Health Safety and Environmental Services Building Division 367 Main Stieet,HYanais MA 02601 Ralph Cros= Off ce: 508-79o-6W Building Comm F= 508-775-33" For office use only • ' Permit no. Date AFFMAVIT HOME II4iPmROTTVEMENTO RLcCTIONw SUPPLE cxion,alterations:imovation,=pair = �tzou,conversion, MGL c 14ZA itgiiires that the"t� i ed remmml, demolition. or cottstrttaioa of an addition to wlu�ad}a� tmprong con. at least one but not more than four dwelling units or �� �� building containing aed c�atract M with ccrWn c=cptions, along to such residence or building be done by tegist requiraaeats. Type of Work: LxEst _ Address of Work: owner.Name: eAjM i, �� Date of Permit Application: I herrin certify that: Registration is not required for the following rcason(s): Work excluded by law Job under SI,000 Building not own r-oaapied Otiviier pig own Notice is hereby gn'en that: CpNCRAC'IORS OWNERS PULLING TIMR OWN PERMIT OR DEALING DSO NOT CON' A THE FOR APPLICABLE HOME IMPROVEMENT UNDER,MGL c 142A ARBrr ATION PROGRAM OR GUARANTY FUND SIGNED UNDER PENALTIES OF PER'URY I hereby apply for a permit as the agent of the owner: Date Comtraaor name Regisuation No. OR w Tile CunrnrunH-cal of Afassaclrusetts Department of Industrial Accidents �~ -!!� OflICP01//IY�981/ODS • ;.;E;. �'a. 600 «aslrin;;tun Street Bemun.Ma3w. 02111 .,try•as. �- Workers, Compensation Insurance AMdavit Iec:ttinn 1 L ociti, ghnne j, fib$ 7?5-313 am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ am an emplover providing workers' compensation for my employees working on this job. c ciri• nhone#- incurince co Holley# ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who the following workers' compensation polices: nv n address: i nhone#! .,''• Halley# .... curnnce cA ,psreser+-r-Trr«sr+tt^� -�7VR�3+Ja1 ,7,�Rs *��.sse•Rr•-�df4s*s +�-- 1.7 m im•na e• address: city nhone#- ' cur�nr �� '' Holier# • :Atiach additl'onai'sheei frtieeeasar :mow: 'H`^�"= "'�'r�`' .::•: :""`�•" ��w Eaiiure to secure coverage as required under Section 3A of A1t;L 1S2 can Ind to the imposition of erimiaal penalties of a fine up to SI300.!?0 sac one pears'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a tine of SIOOAO a day agaian me. l understand th. copy of this statement ma)•be forwarded to the Otiice of Investigations of the DIA for coverage verifindon. I do lterebt•cen �.uralcr, ilia pains and pen pe 'urr that the information pttndded above is trae and cotfea Signature IA alties ate • phone# ��� . 775 '3/3 Print n official use oniv do not write in this area to be completed by city or to ofticiai cih or town: permi0cense# r1guilding Department Qt,Icensing hoard Q check if immediate response is required O5eieetmea's Oltice C311nith Department • contact person: phone#t nother. Information and Instructions :a Massachusetts General Laws chapter 152 section 25.requires all employers to provide workers' compensation for employees. As quoted from the "law-, an entplitree is defined as every person in the service of aliother under any contract of hire, express or implied. oral or written. An employer is defined as an indi-il•idual, partnership, association. corporation or other legal entity, or any two or rr the fore_oing 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 owner of a dweiling house having not more than three apartments and who resides therein, or the occupant of the dwcllin`, house of another who employs persons to do maintenance, construction or repair work on such dwelling_ or on.the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplo MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or rencival of a license or permit to operate a business or to construct buildings in the commonwealth for any ;applicant ,who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any 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 chapte been presented to the contracting authority. r �. ...�++.�. ..�'�—�•::4.•f� ',�".'+, ... =.p.. .i!Y�v';.aa.Nr{..._.?iw�s:.._ZL��•:•..?S::uce.:.�a��f T_'.7 '�"'._•e` .77 w�.+t. Applicants Please ell in the workers' compensation affidavit completely, by checking the box that applies to your situation an 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. TJte 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 requi to obtain a workers' compensation policy, please call the Department at the number listed below. • .. � icy.. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottotr the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. F be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returne 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 quest: please do not hesitate to ;_ive us a call., The Department's address. telephone and fax number. The Commonwealth Of Massachusetts ` Department of Industrial Accidents r' Office of Investigations ' 600 «'ashington Street Boston,Ma. 02111 fax#: (617) 727-7749 nhnne # (617) 727-4900 ext. at;fs, 409 or 375 t i � 7 DEPARTHENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Npaber Expires: Refit ctedmTO;� 00 r sr w ST6VEL HELLOR YO BOX 334 Vi BARNSTABLE, HA 02663`. W" - MPROVEMENI CORTRACTOR • ' �`:, INDIVIDUA�� �. S�PB iC15/98 SO BOX�< ' R144 p 334 gy ER �2668;'` NSTA9LE'-0�; 4F . } _ j T/tc• CU1111t1011 H'crtlt/t of.1 rassachusern Dc partnretrt of Industrial Accidents Officeef/aY9=9atlons • �� irw 6118 if ashit gwil Street •'�;,�.�-.a-•�:��• B��stu�r. ,'Hass UZlll Workers' Compensation Insurance AMdavit AI'Pilon—t intortnati�li _ f Ic;se PRINT lebZiily"�'—��—M�- _- name (3cA t-•A Inc•ttinn• I 1 I nhnnr [j 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 form}•employees working on this job. Jr— ' room my n imt A4. O �'�1 I— . ftlrlrccs "1 1 \ dt �S \l(A/� �� 1� cin ��� DMA 43Qx Y�1� nhnnr#• 15� incur-ince zn Wa4. 1`Qy A U . .....'ram:_•,,.a,•,• ...__......-....-..a_..�....�.....�..�—��--.-...._-. . . __•- I am a soic proprietor. general contracoor. or homeowner(ci(circle oirej and have hired the contractors listed below who hay; the following workers compensation polices: cmmr,•rrry n trnc •tdrirccc• cin'• nhnnr+t• incur-nrc rn cmmninv nninr- adtlrrcc• cin•• nhnnr#• incur•tncc cn neiicy Attach additional sheet if necessary i�'^-'�' -^��"''" vr �e a..,_'+'►�•. ~—�~: '�� F:ulurc to secure coycrat a as requ und ired cr section_SA of 111GL 112 can lead to the imposition of enminal penalties of a line up to Si.500.00 andiur lane cars' imprisonment as well as civil penalties in the form of a STOP%N'ORK ORDER and a fine of s100.00 a dad•al ainst me. I understand that n cope of this swicntcut mat be forwarded to the Once of Invcstications of the DIA for coveracc Verification. 1 do herehr cerrili•wider the pains and pelt hies of perjun•that the information prorided above is true and correct. Si_nawrc Print name �T-.!?1l�Y1 � Phone tr b w - ntrtcial lase only_ do not write in this area to be completed by city or town ofrtciai ci» or tntcn• permit/license euildin"Department I ❑Liccnsinr.Board [ t Selectmen's Ufficr t [] check if immediate response is required ❑ �. ❑dearth Department k phone contact person: #• r•iUtltcr i` t information and Instructions r. Massachusetts General La-%%•s chapter 152 section 25 requires all employers to provide workers' connpetnsatian employees. As yuOted from the "ta��". an einptnree is defined as every person in the service of anotlier under any Contract of hire,.express or implied. oral or written. npfewer is defined as an individual. partnership_ association_ corporation or other legal entity. or an}• two or ,r„ the foregoing cn��a�ged in a joint enterprise. and including the ie.:al representatives of a deceased employ or the . ';*rccciN-er or tntstce of an individual , partnership, association,or other legal entity, employing employees. Ho%re%,cr ' owner of a dwelling house having not more than three apartments and who resides therein. or the occupant of the ' dw cuing boost of another who employs persons to do maintenance, construction or repair work on such dwcllin�_ or on the __rounds or building appurtenant thereto shall not because of such employment be deemed to be an empie., MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance oi• �U111a n l of a license or permit to operate a business or to construct buildings in the commotweaitlr for snv !cant m.-ho has not produced acceptable evidence of compliance with the insurance coverage required. Ad c.:ionall\•. 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 chaptc- _.. been presented to the contracting authority. Applicants Please company names. address p till in the workers' compensation affidavit completely, by checking the box that applies to your situation :.nd suppfN,n`�• and hone 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 aMdal it. The 'Ja%•it should be returned to the tiny or town that the application for the permit or license is being requested. rn :hc Deparmnent of Industrial ,accidents. Should you have any questions regarding the "law"or if you are recuire 'o obtain a workers* compensation policy. please call the Department at the number listed below. Citv or -i moils Please 5e sure that the :affidavit is complete and printed legibly. The Department has provided a space: at the bottom .. the a," davit for you to fi;11 out in the event the Office of Investigations has to contact you regarding the applicant. N be _ to fill in the permit/license number which will be used as a reference number. The affidavits may be returned one 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 an-, questie please do not hesitate to _give us a call. Tile Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents -• Office of lnvestigatinns 600 Nashington Street Boston,Ma. 02111 fax ;T: (617) 727-7749 phone :ii. (617) 72'-4900 exr. 406. 409 or, 375 C1F tMe • The Town of Barnstab e Department of Health Safety and Environmental Services BuiIding Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Cmssen Fax: 508-790-6230 BuiIding Commissio: For office use only Permit no.1 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• Est.Cost=� 11 � Address of Work: rer u . � 1 �r' 6-1 '�'1 l l Owner's Name 112)Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner puffing own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH. UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MWROVEMENT 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: t' � i , Date Contractor Name Registration No. OR a Engineering Dept. (3rd floor) Map j Parcel °/ '�3 Permit# ' ')Q q q House# �'(�O�' Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30 _ 4 y4 A;1;''Fee 9IC2,2 3 ae) Conservation Office(4th floor)(8:30-9:30/1:00-: 1142.00) _. _� Ct.3 YE61� 9 d n ;.� x Planning Dept.(1st floor/School Admin. Bldg.) - TALLER IN Co t:E �1 Definitive Plan Approved by Planning Board ENV f�l i� 19 D TOWN OF BARNSTABLE ' Building Permit Application Project Street Address Village , Owner Will►c zm tc\u kr Cx n r Address f Telephone p ` _ Permit Request t JSL•vc/ ins 4A SEC s R n �, First Floor �i� �o` square feet Second Floor L)©Q square feet Construction Type a o 0-"A- Estimated Project Cost $ 7�, 66 y Zoning District Flood Plain Water Protection Lot Size ` a 0 Q O Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 0 , fib! Historic House ❑Yes 4No On Old King's Highway ❑Yes E(No Basement Type: ❑Full I Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count not including baths): Existing New 1 First Floor Room Count — Heat g ) g� �!— Heat Type and Fuel: ❑Gas 0 `Oil ❑Electric ❑Other Central Air ❑Yes Ll No Fireplaces: Existing INew _ Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ('Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name _ V� oy- Telephone Number Address e, 0,, r;D A. y q(\-q Q License# (� � \A) q.r ry o-�, Home Improvement Contractor# 17 6 \. 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 3 l SIGNATURE DATE_ 11 /1,36-7 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) UAA4 F 130 --Cc)I l e cf�0 r', sc FOR OFFICIAL USE ONLY If PERMIT NO. r DATE ISSUED MAP/PARCEL NO. • ADDRESS VILLAGE+ OWNER DATE OF INSPECTION: FOUNDATION• r •>�� .' + # .. .' .. } # -. ." ',� FRAME INSULATION i FIREPLACE-- 't fn ELECTRICAL:N R>GH FINAL , r PLUMBING:-- Rl FINAL ` U: S GAS:- ! eC'I FINAL IU FINAL BUILDII cr { ; `v00 ; DATE CLOSED QUT � t ASSOCIATION PLAN NO. it F QyofTMETo�� TOWN OF BARNSTABLE EAHHSTAELL i O6Ya\e�, RUIL I G INSPECTOR APPLICATION FOR PERMIT.TO ..... rr:. ....... � �X4� TYPE OF CONSTRUCTION ................................... Ca ice.... . '' ;,..... .... ...... Z��/..............19.r1...<.. TO THE INSPECTOR OF BUILDINGS: ►7�, , � The undersigned hereby applies for a permit according to the following information: Location ..... �...... 4+°..t /.�.... ....................... ProposedUse ....................... 2 y,. ............. .,��,�,.�rt�-�C,, ....� �..P........................... Zoning District ................9......h........ ..............................Fire District ... Name of Owner ........ � ..... �� !L ....Address .................................................................................... Name of Owner ........A Name of Builder ...... .. �.r.... .... Address ... G''�. 4:.... .c>S��c�Y .`�,�rjw.l` a,.4��%?7r�, L Name of Architect ............... .....................Address P IL / C Number of Rooms ....j. . ....... ..=.. ,!� ., 4i24 .Foundation ....................��..................... Exterior ........................... � .............................Roofing .................. .. ..... : .. , Floors, A...... C +: ...........Interior ............. .. Heating ............................ ..C= �..x..AV4 ......Plumbing ................................. .............................. Fireplace ..........................6......:.. ........................Approximate Cost ... .. .. .., ..�..(,... ......�.)... A C... � -,? Difinitive Plan Approved by Planning Board --------------------------------19___ Diagram of Lot and Building with Dimensions (b mI LU 9,0 ,� � j = oo Z ) IJ �O o ff, a r ocn ¢ re- ( _ o " Z) LU co 4 , I � . u J J = 0 vLd CL Q I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...(f.... ........... � ............ | � ' Bzloev John -- V��:� �� �� ��, � . . :�^~� w / . , No Permit for �dd--tm—.� *�- — ��n | ' fami —.�:��,*«. —` Location —. —. � .................... ................................... . � - | � Owner J��n � --^~.~..�e+�+��--._--------.. Type of Construction —..�zaMe.------.-- ' ----.—.—..—.---.-------.------ ^� � � Plot ............................ Lot ................................ : . ^ ' ' Februar ZL �I Permit Granted ..�.���.���—.-----]�— Date of Inspection —.—.]g 71 l Date Completed ...................................... . . / � \ \ PERMIT REFUSED / --~--~------...,^.--~—..—. lR r ~ � .-.--.-..—...-_..--,--~~..—.—...---... ' ^—.-...-,..—_-------.~.—_,—.....--. . � . | � .,_-.-..,--.-_--_-------.-_----., � . y ...—~..—.—^.--.----.—,..—...-..~..—.-.— ] Approved V ......................................... lg Y � -------.—.----,—......—,—.---.—,, ----.------.----..--..---..—..— . &�^ i - CENTERVILLE �G CUDDE BAY /O PARCEL ID: ` 186/067 to) �� 4.11v ��q.9°' ��► �` LOCUS N 9-.0' J 1 V M SEPTIC AREA 1 G LOCUS MAP CD SHE o LOCUS INFORMATION 48.7' DECK T PLAN REF: 69/37 (,W 1 , TITLE REF: 22865/283 /.GAR. I -/ /////// W PARCEL ID: MAP 185 PAR. 10 IQ FLOOD ZONE: B 02 COMMUNITY PANEL: 250005-0016—D DATED:07/ /92 C� 7.6' r r CERTIFIED PLOT PLAN cn HOUSE I o� I % PARCEL ID: I LOCATED AT: I #760 185/010 I 760 SOUTH MAIN STREET AREA=13,140t S.F. I I CEN TER VI LLE, MA. m ; PARCEL ID: PREPARED FOR 185/009 ► D PATIO ;, j WILLIAM A. MURDOCH, JR. & CD D W JAYNE M. SCANLON p I is i pc�o�1 SEPTEMBER 28, 2011 I D ��ro �P,// N OF 414SS9cyG I o A. I G oy� \ / STONE N \ _ N j .289 W B _ _— _ — 7 ( 5°, 79-o5 - H Mp,IN E. A. S. c ov T SURVEY, INC. J GRAPHIC SCALE 141 ROUTE 6A SALT POND BUILDING 20 0 10 20 40 so P.O. BOX, 1729 SANDWICH, MA. 02563 ( IN FEET ) BUS:(508)888-3619 CELL:(508)527-3600 1 inch = 20 ft. SHEET 1 OF 1 J 1374