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Home My WebLink About0043 EASTWOOD LANE � ��'7zr/�o� ,C�rtJ� � - �✓ ( U yyr 1" a easonaTINight Gatehouse Attendant Supports overall beach operation by greeting the public traffic and maintaining security. High School diploma. C subjected to extremes of weather. REQUIRED TO THROUGHOUT TERM OF EMPLOYMENT. $9.50 houi 08-02-06 — 64103 Seasonal Gate Attendants (Sandy N overall beach operation by greeting the public, providin maintaining security. May be subjected to extremes of AND HOLIDAYS THROUGHOUT TERM OF EMPL and First Aid or equivalent. $9.00 hourly, no benefits. 08-04-04, — 66050 Seasonal Dockmaster/Assistant H Responsible for controlling use of town owned marinas ari property at Town marinas; ensures safety of vessels at d waters and enforces State and Local boating laws. High maritime field; knowledge of waterfront practices, rules equivalent combination of education and experience. C drivers license required. Must be able to perform general to operate a small boat. $12.00 hourly, no benefits. Please submit a cover letter, resume& fully completed Tow e Barnstable Human Resources Department, Positions open to the public are available for viewing on the Tow The Town of Barnstable is an Affirmative Action,Equal Opport who will enrich & contribute to t C du13 BIKE„ Town of Barnstable *Permit# ExpRegulatory Services Fee 6 onths sue e • BABxsTABt.E, + MAC Richard V.Scali,Interim Director i639 ♦� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Oz FQ Li n /� Property Address �Q Ewtujoa tQ Lei / �1/'r d& ❑Residential Value of Work$ !O,oce.00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name 1-tt;kC Mr- (, �p;- 01 Telephone Number( — Home Improvement Contractor License#(if applicable) JG Lj Z 7 SJ Email: y ll'iV_L4kr_L WILP Cr1CVr4R CC2 Construction Supervisor's License#(if applicable) " ❑Workman's Compensation Insurance pK" Check one: ❑ I am a sole proprietor OCT 11 2013 ❑ I am the Homeowner I have Worker's/Compensation Insurance ABI.E Insurance Company Name ��N'O�BARS�' Workman's Comp. Policy# (vim—S"Y90 �Q-0[��4t.3 a L,31'9 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 (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 sign Property Owner Letter of Permission. A copy of the.Home Improvement Contractors License&Construction Supervisors License is req d. SIGNATURE: Q:\WPFILES\FO uilding permit forms\EXPREoSS.doc Revised 061313 . ... .... .... The Cornmarnsmkh oof Vassachusetts Deprrhmn nt of hulusfrial Accidents Office of lmr ntigadans 600 Washington Street Boston,M4 02111 wtv"mass.goWdia Workers' Compensation Insurance 'idavit:B•iriId,ers/CentractorslEiectriciansTlumbers Applicant Information Please Print L 6MY N=e 9WsimWOrganizationli &idnal): VVtLP Q � / Address: �.s�? ��v�t-� �K: f'�s`►lu,y� PM oa i.,' City/StatelZip:. 6 J M* C)�t 5 Phone 4- CC V 6-4S— 867a Are you an employer?Check the appropriate box: Type of project and I Fire �oectr'� ��: 1-R I am a employer with 4. ❑ I am a con employees{full and/or * have hired the sub-contractors 6_ New oonsfiuction 2_❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition w for me in any capacity employees and have walkers' offing Y � tY- 9_ E]Building addition [No workers' comp.insurance comp-insurance': . required-] 5- ❑ 10_ We area corporation and its ❑Electrical repairs or additions 3-❑ I am a homeowner doing all wordy officers hoes exercised their 11_.❑Plumbing repairs or additions myself [No workers'comp- right.of exemption per MGL 12-❑Roof repairs insurance required-]f c_152, §1(4),and we hams-no employees [No workers' 13-.❑ Other comp.insurance required.] *Azcy WpHcwt that checks boot#1 must also fill out the section below showing their woaiten'compensation policy iafrr=diaoz T Homeowners oho submit this sfddsm indicstmg they are doing all tiwmk sad then hire outside contractors umst submit anew affidavit infliudzi sach- tConhactors that check this hoot must attached an additional sheet showing-the name of the mb-contractors aid state whether ornot those ewities have employees. If the sub-cantradflrs have employees,they must provide their warken'comp.policy avmber. I am an employer that is providing workers'compe salion irmirance for my employees Belau is thepoScy and job site information- Insurance _ Insurance Company Name: ssow'OtCC/� k&p 04C0 J=4,5 Policy#or Self-ins_Lit :ttJ�...S�y�C5"d(�Lt j - i�✓� Expiration Date: (� /'LaA/ Job Site Address- LIS City/State/Zip: ('t9 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required utter 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 irnp isamment,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 fior insararrce coverage verification. I do hereby ce under the and penalties ofperjury that the information provided above is bue and correct- Date: 60/JL4p Phone#: t.- 35-3 W 0,0kial use only. Do not write in this area,to be completed by cify or town official, City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityffown Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 ji Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 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-contractor(s)name(s),addresses)and phone mumber(s)along with their certificatc(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 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 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: ' The Commonwealth of Massachusetts Degai#ment of Industrial Accidents , Office of XuvestigatlQns 600 Washington Street Boston,MA 02111 Tf,-I.hL 617-727-490()W 406 or 1-977-MASWE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia ATE llk CERTIFICATE OF LIABILITY INSURANCEF5/21/2013'DD`.� ' 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 Margaret Viera Morse Insurance Agency, Inc. PHONE • (508)748-9577 AIC No:(508)748-9579 354 Front Street E-MAIL gg ADDRESS:ma ieviera@morseins.com Suite 4 INSURERS AFFORDING COVERAGE NAIC A Marlon MA 02738 INSURERA:SeleCtlVe Insurance Group, Inc. INSURED INSURER B-Associated Employers Ins. MLP Carpentry & Building LLC INSURER C: 207 Turner" Road INSURERD: INSURER E: East Falmouth MA 02536 INSURERF: COVERAGES CERTIFICATE NUMBER2013 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. INSR TYPE OF INSURANCE - DLSUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMA E TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE FX]OCCUR S 2067979 5/20/2013 /20/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,OOO,OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JFrT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED & 9091134 /20/2013 /20/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Optional bodil iri u $ 1 000 000 UMBRELLA LIAB OCCUR FACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ B WORKERS COMPENSATION WC STATU- X OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N❑ N/A (Mandatory in NH) C-500-5012113-2013A /20/2013 /20/2014 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500`000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Michael Palmer is included for coverage on the workers compenation policy. The General liablity policy includes blanket additional insured for ongoing operations, blanket waiver of subrogation, primary and non contributory wording if required by written.contract. CERTIFICATE HOLDER CANCELLATION rthowmaninc@aol.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. R.T. Bowman•LLC PO Box 201 West Falmouth, MA 02574 AUTHORIZED REPRESENTATIVE Margaret Viera/MMV ACORD 25(2010105) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025 oninn51 ni Thn A(inpn n2ma and Innn arc mnichararl mnrtr¢of A(non. e • / Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 y Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164275 Type: Individual N.r Expiration: 9/28/2015 Tr# 243824 • f571 N xxr-r'�5;. :-.t .. f MICHAEL L. PALMER r MICHAEL PALMER F 207 TURNER RD E. FALMOUTH, MA 02536 , ' Update Address and return card.Mark reason for change. ~` -•.'s` Address n Renewal Employment Lost Card SC49.0 20M-05/11' • ��e�o�r�rrco�recaeccll/o�C/�aas�ic�cc�eGtt 1---._.._____.___.. .— --_ . 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: registration 1fi4275 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration r 9i28/20T5, Individual Bostogalid 6 4 .,t MICHAEL L.PALMER — MICHAEL PALMER U 3 207 TURNER RD E.FALMOUTH,MA 02536 Undersecretary without signature �� F p. Rdassachusetts - • ?3oard Of g DePartrrlerrt of Pubdic S uilding Regulations an afiety Cunstructit>n Super1 isi- c#�Standards , License: CS-102901 PALMER L 4,. 207 TIER An EAST FALIVMO �_ U E[�rIA 02536 'Commissioner' Expiration, ` 08/25/2014 Townof Barnstable , of-ME o Regulatory Services . F f Tgornas F.Geiler,Director 9 ,m Building Division " Tom Perry,Building Commissioner 200 Main Street,Hys.MA 02601 f • .- www.tow n.barnstable.ma:us Fax: 508-79M230 Office: 509 862-4039 • • Property Owner Must Complete:and Sign xis Section If Usno A BuiJ.der , 3 as Owner of the subject property t . � f` 'G� to-act on my behalf; hereby authorize . ' in all matters relative to work authorized by this building permit t E 1 = (Address of.Job) # **Pool fences and alarms are the responsibility of the applicant.. Pools:. are not to be filled.or utilized;before fence is installed and all final t inspections are performed and accepted: SignatuLe_of Owner e of Applicant Print Name Print Nance } 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map—0 ' Parcel-Z,41 Application Health Division Date Issued I. Conservation Division Application Fe Planning Dept. Permit Fee �� ` cos Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address � J F4a5t Lt_1 V& �r) Village��, �t Owner Address I CO.St-La Telephone (6 (7) Permit Request �`!�_ S l ` x �?^ Square feet: 1 st floor: existing i�_�Proposed 2nd floor: existing proposed ( Total new ljy Zoning District Flood Plain f)n Groundwater Overlay Project Valuation Construction Type 1 Lot Size 1 G0 x ias' 9,f7� " Grandfathered:' ❑Yes ❑ No If yes, atta upportindoc�entation. , -0 Dwelling Type: Single Family %I1 Two Family ❑ Multi-Family (# units) Age of Existing Structure �' '�° Historic House: ❑Yes 51 No On Old Kid'3 Highw ❑'s 'W:No v Basement Type: A Full ❑ Crawl ❑Walkout ❑ Other c Basement Finished Area (sq.ft.) ® Basement Unfinished Area (sq ft) i c� Number of Baths: Full: existing new Half: existing 4w r n Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing new ( First Floor Room Count Heat Type and Fuel: 14 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 9 9 9 — 9 — 9 Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use - ' - - Proposed Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /I'!JCA l=,fin�tS'Su a Telephone Number ��7 Address �. �' �,� License kl:t vy\4 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO VCKJX-one, Vk� MaAaGiry tn-r Fact SIGNATURE DATE 1 • FOR OFFICIAL USE ONLY O PPLICATION# `'-DATE ISSUED MAP/PARCEL NO. ; 4, uL ADDRESS VILLAGE OWNER K DATE OF INSPECTION: FOUNDATION ' A-0 P" FRAME Z A= - 4*10--? ?S IVJ3 &xzw 4mg a i mq INSULATION )uS C� O FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING P A m i DATE CLOSED OUT ASSOCIATION PLAN.NO. .' R• . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations '- 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nam6(Business/OrganizatiorAndividual): _ Ly ii�,�o, [^_ k L.S s JV1 Q ;l IAddre ss. 43 F Ga S� � ��c� City/State/Zip: J� C%ot ,3 Phone #: 3 c9,S CA Are you an employer?Check the appropriate box: Type of project(required): 1.El am a employer with 4 I am a general contractor and I employees(full and/or part-time). * ave hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and'have workers' y9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its ME] Electrical repairs or additions l 3,.El am a homeowner doing all work officers have exercised their I LR Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Oiher. 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date.- Job Site Address: City/State/Zip.- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or 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 certify under thepains andpenalties ofperjury that the information provided ab ove is true and correct. Sinatuie: � _�,� Date: 2 D Phone#: (o t c3 D V V` Official use only. Do not write in this area,to be completed by city or town offciaL City or Town: Permit/Licensee# 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 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-contractor(s)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 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 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-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia Town- of Barnstable Regulatory SerAces 14 R ' � YARTt3TA�LE, �. Thomas F. Geiler,Dixector LD wilding Division Thomas perry, CBO, Building Con=ssioner_ 200 Main Street, Hyannis,MA 02601 www.town.b a rnsta b le.m a.us Officer 508-862-4038 Fax: 508-790-6230 PLAN REVEEW Owner: CtraSlt�e,4nJ Map/Parcel: Project Address y3 E*r?'e1ooO 4AC 07 Builder: ', E The following items were noted on reviewing: �i°;W x Cal cm cols rs o2 x 'o•c, _ /a i D �.X 8 16 OVC-A YAfA/ or Q 1/)CI-p oe.• �r�iW Vs e- 40S'€W T,W h}Au a y". r o ZO rN a a u1 401&t Amu 1,eE 7'LF-�AeneLc-Tb C-44SS /n! 4k*Xdea/• Reviewed by: Date: O Q:Forms:Plnrvw ,per The Commonwealth of Massachusetts \ Department of Industrial Accidents _ office oflnvestigations' 600 Washington Street Boston, MA 02XXX wwiv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/I+Jle6tricians/Pll[1lnbers .Applicant Information Please Print Legibly Name (Business/Organizatiorvindividual): Address: 1oy_nc~" City/State/Zip: (Yt\vvb; MA Phone.#: �02F 5;2-5 33 35 Are you an employer? Check the appropriate bo Type of project(required): 4. am a general contractor and I 1. I am a employer with . V 6. ❑New construction employees (full and/or part-.time).' listed hired the sub-contractors listed on the'attached sheet. 7.. Remodeling .2.M Tama soleproprietor or'pariner-' These sub-contractors have ship and have no employees 8. [�Demolition employees and Have workers' m working for me in any capacity. 9. ®Building addition o workers'•co insurance comp insurance. ' We are a corp required] oration and its 10 [1C]'Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their, 11.[]Plumbing repairs or additions myself.[No workers: comp. right of exemption per MGL 12.0 Roof repairs c. 152, §1(4), and we have no insurance required.] t. 13.[] Other - • employees. [No workers' comp. insurance required.] *Any applicant•tbat checks box#1 must also fill out the section below showing thcir 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether of not those entities have employees. if the sub-contractors have employees,they must providt;their workers'comp.policy number. I am an employer that isproviding workers' compensation insurance for my employees. Below is the policy andjob site information. Insurance Company Name: . Policy#or Self-ins. Lic..#:_ t1 Expiration Date:37,27-Z 0 Job Site Address: City/State/Zip: ('ate % 'lt`'U Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine dp 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. olator. Be advised that a copy of this statement maybe forwarded to the Office of of up to$250.00 a day against the vi . Investigations of the DIA fbi insurance coverage verification. Ida hereby certi unde t e pains and penalties ofperjury that the information provided above is true and correct Date Si afore: Phone Offxial use only. Do.not write in this area, to be compleled by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health '2.Building Department 3. CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other information and Ins* tructi®us 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 oron 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 produced-acceptable evidence of compliance with the insurance coverage required.`' AdditioriaIly,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 eviderce of compliance Frith 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-coneactor(s)name(s),�address(es)and phone numbers) along with their certificates)of insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships(LLP)with no'einployees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have e to ees a olic is required. Be advised that this affidavit may be,submitted to the Department of Industrial should mP Y P Y Accidents for confirmation of insurance coverage. A Iso be sure to sign and date the affidavit, The affidavitt.o be.returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the 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" (he 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 horge owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license oz permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: no Commonwealth of Massachusetts Depar ment of ladustr al Accidents Office of Yu�est�ga azzs 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIYYYY) 09/01/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Robert E. Bouchie Jr. Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1352 Rt 28A HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 400 ; I Cataumet, MA 02534-0400 INSURERS AFFORDING COVERAGE _ # ---"�NAIC INSURED �---�--- Michael Palmer INSURER A: PATRONS MUTUAL INS CO OF CT i 14923 207 Turner Road 'INSURERS: AMERICAN ZURICH East Falmouth, MA 02536 `INSURER C: _ j INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'Li POLICY EFFECTIVE 1 POLICY EXPIRATION LTR DTYPE OF INSURANCEi POLICY NUMBER ; DATE INIMIDDOMRAN JMMIODIM ! LIMITS A GENERAL LIABILITY CTRO010206 03/24/2009 03/24/2010 !EACH OCCURRENCE $ 1.000.000 j DAMA E TO RENTED COMMERCIAL GENERAL LIABILITY 50,000 CLAIMS MADE ijXj OCCUR i MED EXP(Any one person) ?$ 5,000 --_-�------ -----_.--..-_--. ( PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE--- is-- 2,000,000. GEN'L AGGREGATE LIMIT APPLIES -----',PER: PER: ! 1. PRODUCTS-COMP/OP AGG ; 2 O$ OO OOO r� j PRO- JECT �--_- -- -i. -- 2 0 L-- I POLICY : t LOC i AUTOMOBILE LIABILITY , COMBINED SINGLE LIMIT i! ANY AUTO ' i r I(Ea accident) $ ' I )ALL OWNED AUTOS n i BODILY INJURY SCHEDULED AUTOS !(Per person) I$ HIRED AUTOS k ?------ BODILYINJURY $ NON-OWNED AUTOS i j (Per accident) �- - - PROPERTY DAMAGE i$ i ! (Per accident) GARAGE LIABILITY i ! j i AUTO ONLY.-EA ACCIDENT is I ANY AUTO i -----, ; ; OTHER THAN —}—.--.------------ { AUTO ONLY: AGG $ EXCESMMBRELLA LIABILITY 'EACH OCCURRENCE 1$ —T OCCUR ;CLAIMS MADE ! AGGREGATE is is DEDUCTIBLE ;'j ,is RETENTION $ j I$ WORKERS COMPENSATION AND WC STATU. i OTH- 6 i 0304N163 3/27/2009 3/27/2010 1 TORY LIMITS �EMPLOYERS'LIABILITY -' j ANY PROPRIETORIPARTNER/EXECUTIVE I - I E.L.EACH ACCIDENT _is_-----1 OyFeFICERIMEMBEREXCLLIDED? QQ,QQQ I i i E.L.DISEASE-EA EMPLOYEE$ 100,000 describe under SPECIAL PROVISIONS below E.L.DISEASEPLICY LIMIT i$ 500 QQQ .OTHER i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION «" Linda CBSSman DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 63 Eastwood Drive- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL ` COtUIt, MA 02635 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ` • AUTHORIZED REPRESENTATIVE / ACORD 25(2001/08) 0 ACORD CORPORATION 1988 2OR DATE(MM/DD/YYYY) � �TM. CERTIFICATE OF LIABILITY INSURANCE OW=009 PRODUCER Phone: 508-540-6161 Fax: 508457-7660 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ALMEIDA&CARLSON INSURANCE AGENCY INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.BOX 554 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR FALMOUTH MA 02541 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Norfolk&Dedham Group 23965 ROBERT NAHIGIAN ELEC INC INSURER B: The Hartford PO BOX 1065 INSURER C: N FALMOUTH MA 02556 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH.THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRATION LIMITS LTR INSR DATE MNVDDIY DATE MMIDD�V GENERAL LIABILITY R0402818A 09/03109 09/03M0 EACH OCCURRENCE $ 1r00%000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED .$ 50 000 PREMISES(Ea ocaurence) r CLAIMS MADE a OCCUR MED.EXP(Any one person) $ 51000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ 2,000,000 POLICY171 PRQ LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ Per accident GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELIALIABILrrY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $- DEDUCTIBLE $ RETENTION$ $ WORKERS COMPENSATION AND 08WBCJR2499 04/15109 04/15/10 TG 8T.A;i s OTHER _ EMPLOYERS'LIABILnY E.L.EACH ACCIDENT $ 1001000 B ANY PROPRIETORFARTNERMXECUTIVE - OFFICER/MEMSER EXCLUDED? E.L.DISEASE-EA EMPLOYEE. $ 100,000 If yes,describe under SPECIAL PROVISIONS below - - E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MLP CARPENTRY DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Attention: OV Wiefta kNE'RGY CONSERVAT-ION APPLICATION FORD FOR ENERGY EFFZCICIENCY FOR ONE. AND TWO-FA-MILY DETACHED RESIDENTIAL CONSTRUCTION (7so cMx 6x.00) Applicant Name: �f , �'11�jd Site Address: pri"r Town: (� j 1� •y�ii+ T Applicant Phone; bl 7 Applicant. Signature; � � �� Date of Application: NEW CONSTRUCTION: choose ONE of the folloWila tWD'0 tions 780 CMR.TABLE 6107.1 PRESCRIPTIVE ENNELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FANRLY BUILDINGS MAI M MINMU-M Ceiling or Slab $asement Q Option 1: Fenestration exposed Wall Floor Wall Perimeter AFUE HSPF U-factor floors R Value R-Value R-Value R-Value RValue and Depth National Appiian°o Fnc R-10, ConscrYailoh Act(NAF .35 R-3 8 R-19 R-19 R-10 4 ft . 1987 as amcndcd,miner cater as applicab1c. Note: This form is not required if you choose either of the two versions of REScheck as listed below. 0 ption 2: RES check Version 4.1.2 or later variant software analysis must be completed 180 CMR 6107.3.2 REScheck—Web which can be accessed at http-HvrMw energyCDdes goy/rescheck/ A.bw-TX 0I VS'OR A LT AxI S.TO EN[STINC BMDTNGS'.O R 5 YEARS Ox.�* *)3uildings under 5 years old must use option#1 or 42 in New Construction section above. Complete the following formula to determine the % of glazing: `(a) CrrossuWall & Ceiling Axea equals Formula: (100 x b - a) - -1 S 100 x -` %✓ _ o€glazing b a (b) Glazing area equals `g SF If 'lazin is <'d0%°•il,.�e the chart beloW. If lazing is } 40 % roGe; •d to "SUNROOM" section 780 CNM TABLE 6101.3 PRESCR:IPTrn ENVELOPE COW ONENT CRITERIA ADDITIONS TO EXISTING LOW.-RISE RESIDENX'LA.L BUILDINGS MAXIMUM ' MINIMUM Ceiling and Slab Peru. Fenestration -Wall Floor Basement Wall R_Valt Exposed floors R-Value. R-value R-Value - and De • U-factor R-Value 3 R-3 7 a R-13 R-19 R-10 R=10, 4 a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e, not com ressed over exterior Walls, and includingan access openings). ' SUNROOM—An addition or alteration to an existing building/dwelling unit where the tot El glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of tl addition. Note: Owner to 611 out Consumer Infor7nafion.Form found in A endix 120.P AJ-YC Gtt.irle to 11/aod Coiisti'ttctiott in Hirrh YYirtrl Aj'(-cts: 110 /ttp/i I'Virtd Zone Massachusetts Checklist I'ol+ Coznp xance (780 cnrR53o1:2.l.l)' c Comp, 1.1 SCOPE 110 mph Wind Speed (3-sec.gust) Wind Exposure Category _ Wind Exposure Category................Engineering Required For Entire ProJect ................. 1.2 APPLICABILI-TY Number of Stories(a roof which exceeds B in 12 slope shall be considered a story) �, stories _-5 2 stories / p....a...... y/ Fig 2) . s 12:12 Roof Pitch ( .... - (Fig 2)..:............. .. �....... ft 5.33' Mean Roof Height ...................(Fig 3)...................:....................... Building Width,W ft 80, .................(Fig 3).........................•...................... . Building Length, L ..,... _ .......(Fig 4)...................................... -. 5 3' . Building Aspect Ratio UW ••••••••' ,,.,., ..`�• S 6'8 _ Nominal Heightof Tallest Opening .............(Fig 4)...............,..•••••••••••••••••••. 1.3 FRAMING CONNECTIONS ............... - connections................:...(Table 2)........... ...... .......•. General compliance with framing 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 �• Concrete................................................. .............................................. .•..................... .....•............................................ Concrete Masonry .............................•............... i 2.2 ANCHORAGE TO FOUNDATION"'. y Exs,°sir .� 5/8"Anchor Bolts••Imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete. • .......:.(Table 4) ......................... < n. eneral Bolt Spacing-g in. 6"-12" .Bolt S acln from endrolnt of late .............(Fig 5)..................:...............-• - ....,(Fig 5)...... ....................•....... Bolt Embedment-concrete.................................... in. Z 15" .............................. - Bolt Embedment-masonry.................. ....•.................(Fig 5)............1 >3"x 3" x - PlateWasher.................................................................(Fig 5).................... / 3.1 FLOORS .........., 'J Floor•framing member spans checked ...........:...........• (per 780 CMR Chapter 55)..................�ft.. 12 - • . Fig 6 .................................. Maximum Floor Opening Dimension.................................. ( )............:... — Full Height Wall Studs at Floor Opjanings less than 2' from Extenor Wall (Fig 6).....•......-•••• Maximum Floor Joist Setbacks ....... it 5 d _ Supporting Loadbearing Wail's or Shearwall................ Fi 7 Maximum Cantilevered Floor Joists <d Supporting Loadbearing Wails or Shearwall................( g )••••-••• ............................................................. FloorBracing at Endwalis......•.....:................... .......,......(Fig 9 ...... — ( e .(per 780 CMR Chapter 55)...................................4;' Floor Sheathing Typ :......•.............................. in. — Floor Sheathing Thickness ..................................:........:.....(p�r7B0 CMR Chapter 55 .....,....,..,...•...,. Floor Sheathing Fastening ......••••.••••• `.,(Table 2).. d nails at in edge/-L. field — 4.1 WALLS Wall Height (Fig 10 and Table 5) `�. ft �10 Loadbearing walls........................:.....•......................... -- Non-Loadbearing walls ...........::..... (Fig 10 and Table 5)................... 1`' ft 5 20' ;,..:..(Fig 10 and Table 5)..............:....IL in, 524(t .d Wall Stud Spacing ; (Figs 7 &8)..........................................•._ Wall Story Offsefs •.•......•...... 4.2 EXTERIOR-WALLS' / Wood Studs • r( ......(Table _, ft_ m, .........•2x u Loadbeann walls....................•............................. �•}........•........... -1-- g .................(Table 5) .....2xf�- ft':in. Non-Loadbearing walls ..............•................ Gable End Wall Bracing' 1... Full Height Endwall Studs (Fig 10)...................................... WSP•Att'ic Floor Length.............. .......... 11)...................,........................ ft, 0.9W Gypsum Ceiling Length (if,WSP not.used).....................(rig ....... r) R A n r (Fin 11)....... ...........................:.... _— A AFYC Guide !o 1Yo0d Consirrrctiott irr. Hil•"h Wind Ai,eas: I10 inp/I 1-Yirrd Zoitc� Massachusetts CheC dirt for Compliance (780 CnliRS301.2.1.1)` Loadbearing Wall Connections Lateral (no. of 16d common nails).......................'.........(Tables 7)....................................•................� Non-Loadbearing Wall Connections I . Lateral (no. of 16d common nails)................................(Table 8)...................... Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) HeaderSpans ........................................................(Table 9)................................ . ft6 K in.5.11' SillPlate.Spans ..................:.....................................(Table 9).........................:........ 7. f `c in.5 1 Full Height Studs (no. of studs)....................................(Table 9).......................................................`I Non-Load Bearing Wall Openings (record largest opening bUt check all openings for compliance to able 9) HeaderSpans.............................................................(Table 9).................................. ft in.s 12' Sill Plate Spans......................:....................................(Table 9)..................................3 �'ft c in.s 1 Full Height Studs(no. of studs)...:................................(Table 9)................................... ................. 1 " Exterior Wall Sheathing to Resist Uplift and Shear Simultanbously4 Minimum Building Dimension, W Nominal Height of Tallest OpeningZ ..............................................................&'..I......... 6 e" SheathingType...............................................(note 4)..................................................,... 16 . Edge Nail Spacing..........................................(Table 10 or note 4 if less)......................:.in. Field Nail Spacing .. Table 10 p g............................:........... ( )................................................. Shear Connection (no. of 16d common nails)(Table 10).................................................. ......• ' Percent Full-Height Sheathing .. Table 10 ° 5% Additional Sheathing for Wall with Opening>6'8»(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Opening2.........................................................................ty'fs 6113» SheathingType..............................................(note 4)..................................................... %-- Edge Nail Spacing.........................................(Table 11 or note 4 if less)...........:............ in. Field Nail Spacing.......................................:..(Table 11).................................................. Shear Connection no.of 16d common nails Table 11 Percent Full-Height Sheathing........................(Table 11)............................................ :....... 56A Additional Sheathing for Wall with'Opening > 6'8"(Design Concepts).................:.. Wall Cladding Ratedfor Wind Speed?.............................................................. ............................................................... 5.1 ROOFS. Roof framing member spans checked?.....d-.:��........(For Rafters use AWC Span Tool, see BBRS Website) Roof Overhang ...................................................(Figure 19) .............._Q_ft s smaller of 2'or V3 Truss or Rafter Connectlons at Loadbearing Walls Proprietary Connectors Upiift................................................(1-able 12)..,.............. ...........................U= PIf Lateral .............................................(Table 12)..............................................L=_�% plf Shear............................:..................(Table 12)............................................S=-7—'7 .Pif . Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T= 0 plf Gable Rake Outlooker...........................................(Figure 20) .............- ft s smaller of 2'or V2 ' Truss or Rafter Connections at Non-Loadbearing Walls Proprietary COnneClor5 Uplift................................................(Table 14)............................................U= lb. Lateral (no. of 16d common nails)...(Table 14)...................... ...........L = . lb. Roof Sheathing Type................:.•................................(per 780 CMR Chapters 58 and 59) ............. Roof Sheathing Thickness.....................................:..... ..............................................A_in.i 7116"WSP RoofSheathing Fastening............................................(Table 2)......................:..................I................ Notes: 1. This checklist shall be met in its entirety, excluding the specific exception noted In 2, to comply with the requirements of 78D CMR•5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are.not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. ' Exception:Opening heights of up to 8 ft. shall be permitted when 5% is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. "Town of Barnstable Regulatory Services S Thomas F. Geiler,Director awnxsrAsi.e; Building Division 10v ATFo a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma,us Fax:,508-790-6230 Office: 508-862-4038 _ - HOMEOWNER LICENSE EXEMPTION Please Print DATE:4 a �C a JOB LOCATION: ! J '16 ' village number street �r� c3�s�0ab� F� Gam "HOMEOWNER"' L c�� l YES �l work hone# name home phone hi, p CURRENT MAILING ADDRESS: �a �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 Persons)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 wilt comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three family dwellings containu-ig 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 169.1.1-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. Town of Barnstable Regulatory Services BARNBTABLE, Thomas'F, Geiler,Dfrector q� 1639. A b-b Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma,us Office: 508-862-4038 Fax: 508-790-62 Property Owner Must Complete and Sign This Section If Using A BA r T, 1n �� b,� , as Owner of the sub)ect property hereby authorize te— /� to act on my behalf, in all matters relative to work a thorize ythis building permit application for. Addres of Job) c/ Signature of er Date Print Name lease complete the . if P�Owxaer is applying for perrnit p p Homeowners License Exemption Form on the reverse side. LOT I� L07 16 z LOT a0 Fk S T 1 Frj � Z¢ V F �7,t f EXIST O `WELL ' A S� -D R, � t� i 40 ' Wl bE F 77, ti i FOIZ i' A pp G _13RR1 4.TA `rCCt? x3� > ' t—y l �� `' '�yG ,/G.-�/�7�siw• '�� t� i�C t��LrFG r � � �f'(.l�- �x ��/�G,� ��' }.��1 / } �i _R . .Nov �Un/D,4 T/n%�/ /S 4 > 4 1 1: > 6.4P-AID f /v // � ti.• I bfituw �. Y �f�� " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Applicatio V.1 t U Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner Address Telephone Permit Request j P Square feet: 1 st floor: existing ' proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family, ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King"sr.n Highway: l Yew❑ No ,. CD W Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other vJ Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ? Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and,Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air-" ❑Yes O: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 ❑ No _ If yes,.site plan review # - - Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) C.F ff__ Nam ti �"CVIGL �R/ � Telephone Numbe dress c�0� L��e� - License# 0 i `Aewo r4 m A r, -31� Home Improvement Contractor# 16 qa�U� Worker's Compensation # 03 U YN/ L- ALL CON RUCTION DEBRIS RESULTING FROM THIS PROJECT WILL B TAKEN TO \W/ GNATURE DAT 1 CJ 3 :6 w y , 1 t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE OWNER DATE OF INSPECTION: 1 FOUNDATION FRAME INSULATION 1 ' FIREPLACE ELECTRICAL: ROUGH FINAL F PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT' ASSOCIATION PLAN NO. P�oFtray Town of Barnstable Regulatory Services • Sp ASS LE MASS. Thomas F. Geiler�Director 9 $ ., g',,rEn ;�•`� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 50.8-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF LICENSED CONSTRUCTION SUPERVISOR ASSUMPTION OF RESPONSIBILITY I, V V \�P��4ae \ 1.• C C�lV1'le! , Construction Supervisor License # k02= hereby certify that I have assumed responsibility for the project under construction, as authorized by building permit# 9-CO 0j I S�-3 issued to (property address) 43 z cw3 wvoS Ply on `� , 200�. The following documents are attached: copy of my Massachusetts State Construction Supervisor's license or Homeowner's License Exemption form(if applicable) copy of my Home Improvement.Contractor registration (if applicable) Commonwealth of Massachusetts Workers' Compensation.Insurance Affidavit. Road Bond (if applicable) LICE E HOLDER DATE i The Cotnfnonwealth of Massachusefts .Department oflrtdustria[Accidenls Office of Investigations' 600 fflashington Street Boston, MA 02111' �, �, �°y• wwt�.mass.gov/dia . , Workers' Compensation fiasurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print T ezbly Name (Bug iness/Organizadon/Individua]): ` " 'l Phon City/state/Zip:/State/Zi e.#: -5��' � �� 3 Y p: a��,r�� yy� A Are you an employer? Check the appropriate bo Type of project(required): 1.[ I am a employer with 4 am a general contractor and I 6. ❑New construction employees (full and/or part-tim.e).* have hired the sub-contractors listed on the'attached sheet, T. ❑Remodeling .2.❑ I am a'soleproprietor or•partiler t These sub-contractors have ' •' ship and have no employees 8. •❑ Demolition . .employees and have workers' addition working for me in any capacity. 9. 0 Building [No worker comp. insurance.s'•comp. ` 10:0•Electrical repairs or additions required] 5. ❑ We are a corporation and its 3.❑ I am a Homeowner doing all work officers have exercised their 1 1.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp..insurance mquired.l *Any applicant,that chocks box#1 must also fill out the srz6on 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 anew affidavit indicating such. 1Contractors that check this box must attachod an additional shoot showing the name of the sub-contractors and state whctha or not those entities have employees. if the sub_contractors have employers,they must providb their workers'comp.policy number. lam an employer tltat lsproviding workers' compensation insurance for my employees. Below is lltepolicy andjob site information. r� Insurance Company Name: 17 Policy#or Self-ins. Lie.#: K.- ,-01 Expiration Date: Job Site Address'. l.l'7� 2" VWCna stx City/Statdzip:J(',, ' 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 crimir ql penalties of a fine tip to $1,500.00 and/ one-year imprisonment, as well as civil penalties in the.form.of a STOP WORK ORDER and a fine. y of this statement may forwarded to the Office of of up to$250.00 a day against the violator. Be advised that-a cop Investigations of the WA for insurance coverage verification. Xdo hereby cerli unde the pains andpenalties ofperjury That fete information provided above is true and correct Si afore: Date Phone#: O-fftcial 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 Departrrient 3. City/Town Cleric 4. ElectricaI Inspector S. Plumbing Inspector. 'ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 09/01/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Robert E. Bouchie Jr. Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1352 Rt 28A HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 400 i t Cataumet, MA 02534-0400 INSURERS AFFORDING COVERAGE NAIC# INSURED Michael Palmer INSURER A: PATRONS MUTUAL INS CO OF CT 14923 207 Tumer Road INSURER B: AMERICAN ZURICH East Falmouth, MA 02536 INSURERC: f INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES,DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L. POLICY EFFECTIVE !POLICY EXPIRATION 1 LTR D! POLICY NUMBER ; D DATE IMMIDDIM LIMITS A !GENERAL LIABILITY I 03/24/2010 I EACH OCCURRENCE $ 1,000,000 i CTRO010206 03/24/2009 COMMERCIAL GENERAL LIABILITY ( DAMAGE TO RENTED X....— _PREMISEsLoccurenceZ T$ 000 JCLAIMS MADE X i OCCUR �. I MED EXP(Any one person) _$ 5,000 —__.._._—_.---_ --• j PERSONAL&ADV INJURY I$ 1 moO GENERAL AGGREGATE $ 2,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: ! I PRODUCTS-COMPIOP AGG -i$_ _2 000L000_ r--� ;LIE i I i POLICY! JECTLOC I�UTOMOBILE LIABILITY !COMBINED SINGLE LIMIT ANY AUTO (Ea accident) i$ —J ALL OWNED AUTOS I u i BODILY INJURY SCHEDULED AUTOS i i i(Per person) I$ i I HIRED AUTOS - �� BODILY INJURY I I I j Per accident) I$ j NON-OWNED AUTOS PROPERTY... _DA--MAGE ... i— ---_._. .---------- I (Per accident) i { GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ;$ ANY AUTO i EA OTHER THAN AUTO ONLY: AGG 1$ EXCESSIUMBRELLA LIABILITY - j EACH OCCURRENCE I$ OCCUR CLAIMS MADE I 1—, r—� I !AGGREGATE __... .. .. ;$ is _.__ ...- . . _--.-.___...... ! I$ DEDUCTIBLE -- `is i RETENTION $ I i $ WORKERS COMPENSATION AND I WC STATU• ! i OTH-1 B i 0304N163 ' 3/27/2009 3/27/2010 TORYLIMITS ._ ._I ER EMPLOYERS'LIABILITY I E L EACH ACCIDENT i$ _ QQ,QQQ j ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? i ! E L DISEASE-EA EMPLOYEE j$ 100,000 Has,describe under I SCIAL PROVISIONS below ; E.L.DISEASE•POLICY LIMIT is 500,000 ;OTHER i I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Linda Cessman 63 Eastwood Drive NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Cotuit, MA 026355 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988 k Town of Barnstable Regulatory Services i s �$" ' I'E$' Thomas F. Geiler,Director o;p. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize. . . :.��;�` e.1 �g�M to act on my behalf,er in all matters relative to work authorized by this building permit application for y3 s� o l Line- Cet l (Address of Job) edfo Signature of Owner. Date - Print Name J If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q FORM&O WN ERPERMISSION Town of Barnstable �FZHE TpY.� c� Regulatory Services anRrtSMBLE Thomas F.Geiler,Director Btass. 039. 04. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT 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 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 requirements. Signature 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:\WPFILES\FORMS\homeexempt.DOC F � e Office of Consumer Affairs andiBusiness Regulation Wd 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement�Coritractor Registration Registration: 164275 u _ Type: Individual Expiration: 9/28/2011 Tr# 289236 MICHAEL L. PALMER '' a ---------._ MICHAEL PALMER 207 TURNER RDfl ,, E. FALMOUTH, MA 02536 " Update Address and return card.Mark reason for change. Address (� Renewal n Employment []'Lost Card µ •CA1 0 50M-04/04-G101216 License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration"\64275 10 Park Plaza-Suite 5170 Expiration 9/28/2011 Tr# 289236 Boston,MA 02116 i jp� Type-,,,,�IndiViduaf I " MICHAEL L. PALMER ' „ Eq MICHAEL PALMER- 207 TURNER RD E. FALMOUTH,MA025355 Undersecretary N valid without signature = Massachusetts- Department of Public Safety Board of Building Regulations and Standards Go nstructibmSupervisor License ,License: CS 102901"'-t l Restricted to 00 r '-jw io H M,PALMER C ICA E 1111 I . 07 TURNERtROAD G t^,11if#fdt i EAST FALMOUTHAM' 02536 "` t: Expiration: 8/25l2012 Tr#: 102901 `Op1HEipk� Town of Barnstable BARNSTABLE q" Regulatory Services 9 MASS. 0 039. Building Division piED MA'S s. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 4 Inspection Correction Notice > I � Type of Inspection �" Location '�3J95? U'/�U [.�/ o- r Permit Number a Owner Builder One notice to remain on job site, one notice on file in Building Department. ,Thh-e-following items need correcting: c 7' a 4 Please call: 508-8r62-403-8-for re-inspection. Inspected by�J 2-1: t om D to �11 : f c•i� s TOWN OF BARNSTABLE Permit No. __ { Nmn.K ; Building Inspector Cash ♦g ,639MAI P OCCUPANCY PERMIT Bond ----____ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to F ell e,,7en n Ferrone Address Roae. 3t Wiring Inspector l Inspection date Plumbing Inspector ~ Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. .....................................................1 19 ............................................ Building Inspector „�•'r” TOWN OF BARNSTABLE Permit No. 14846 t �,�.n.>c Building Inspector rua Cash ----- - —R- YPY M�� ilf�1'i OCCUPANCY PERMIT Bond — "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to TBllegen & Ferr'one Address lot #19 43 Eastuood Road, Gotuit Wiring Inspector Inspection date Plumbing Inspector { - Inspection date Gas Inspector Inspection date Engineering Department i, Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED-UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. „ j .................... r"�. ........, 1977_� .................. .Building Inspector .. 1f .S l- . . Assessor's map and lot number ... .. .. ..... ............ SEPTIC SYSTEM MUSS' BE. INSTALLED IN- COMPLIANCE Sewa e, ermit number ............................................/ ° g - WITH ARTICLE II STATE -•' — SANITARY CODE AND TOWN' J �*THE r� TOWN`` O F B AR�N'STAsB L- E 9� 9 �- BUI 1 D 1101r, INSPECTOR APPLICATIONi FOR,',; PERMIT.,TO 4�: ..`5..... .......................... :. .... TYPE OF CONSTRUCTION .........:.. .. ::LSD.......lTf/ ............................................................................. j .......... ew..................I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies" ca permit according to the following information: 24 Location ....... .. . .. ...... 1.`3. ...... /.. ...................:. . ................. Proposed .Use ......... .;e•`./�. .. ,."Fire District ........ � Zoning District ................ .. ...................................... 0 1................................................. Name of Owner T� lef.:it!..1�...T frn! .. :4.Address ............ S3.1..2.2....... It Name of Builder `'P ................Address ......................... ............... ............................ IC le, Name of Architect ................1 ................Address Number of Rooms ..............65............. .............................Foundation ... ./.Q..//.. �}r' .... o�'f/edP�� Exierior .... �.� f..l��...l�l ,... yfeU offing 3 5.......L�-�....... .`.... / ,�1.. Floors � .......... ./ .......f/.................'../ .....Interior ............ ..:., — `Heating ... F/.../�I :.. .............Q/.� .. ........Plumbing:..............`..-:....... ��.:....:�Q .......... Fireplace ....a..LS.G°..C.! .lv!',,,r!l� 4M .......................Approximate Cost ...1� .....cap o� rJO0 /�. Definitive Plan Approved by Planning Board -------------------_-----------19_______. Are ................ ...................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH G F / yk/ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. t / Tellelgen & Ferrone P�A� PF�14RNo ...... j ermfor .... ............. y . ..............1......stor ............ Location ..4.3..F4§WqqCA4A..PRt U: i.t............. 0 ............................................................................... Owner ....... ..................... i f t9 Type of Construction .....Woo.d..Ficimel............... E ............................................................................ Plot ............................ Lot ...... ................... Permit Granted .........Pej p.r..-.,2.0.....-....1977 0 Date of Inspection .....................................19 .....19 Date Completed` ..... � J..7f IV -PERMIT REFUSED 0 . ........................................ .................. .... 19 0 ............................................................................... /41 a ... ............................................................................... . ......................................... ............................. ............................ .............................................. Approved .......................................... ..... 19 0 ..............................................................................0.. Z• .......................................................................... Assessor's map and lot number .................. 4 Sewage Permit number ...-..................................................... *"E.r°�� TOWN OF BARNSTABLE L BBRISTABLE i 9� o pYa`e� BUILDING INSPECTOR APPLICATION'FOR PERMIT TO ......... /�N............!/.C--........................................................................................ TYPE OF CONSTRUCTION ............ tfr] ......T. -I/f7 ............................................................................ ................/ . R ...............19. TO THE INSPECTOR OF BUILDINGS: I 'The undersigned hereby applies for, a permit according to the following information: Location ............................... .......r............ ...................... ....................................................... .................................... MProposed Use ................... �'l/A/ P�l / r!l/ ...............................:.. :........................................ ......... .... ZoningDistrict ................. ..F..........................................Fire District .......l.... .4U. .!............................................... Name of Owner ...............................................r/ .�� 7 ,Address ............................................. ..........��). ,.. .� ��vl✓///!o i / rai 1,...................../%............................... Name of Builder ................�.D.� P .?'rN1/ ....................Address ............. :'�.. .. ....................................................... r Name of Architect ............../hv C!?"!� Address ................................................/.................................. I.....`;. . .............. Number of Rooms �. ..............................................Foundation ....... 1 / !�/<'�� /OvVCvf e ...//........ .......................................... Exterior : ? / n/114 1 1��o i.Xl/t�Ro�ofing ...................f^......3..�.... L 6 /�S/J`,4 hz / / ......�....................... ....../!�.... ly r�!' / �r q/ir/rF. //! Floors ......................................................:.......:.:......Interior ..................................................................r.............. Heating :�F %tJ ��/. ....... .Plumbing �vr-- .....//7471'tt' .......... 1................................................. ..�.. .... .. Fireplace ................ Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -------------------_-----------19________. Area .... . . ..../,.. Diagram of Lot and Building with Dimensions Fee .r:. SUBJECT TO APPROVAL OF BOARD OF HEALTH r9' OIX I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. " , / Talla�ao �� Ferroz�� ^�^ ~~�� / � x . " No 'P§4§—.. Permit for ......W9lUM---- , _ -------.1�..�1.AKY...................................... Location 4.3... 4At�WQA� - 1��t��l)� ' ~ — ` »�~~-'' --- o - � b .—.--..----.--.---..—.--------.. � � Owner —..%wl A..Ferz.ctne.------.. 3 A Type of Construction J��o� ��u��m —'' ' ----'' E 6 ................................................... o �- nor ' um � ° Permit Granted --. ..20.--]P 87 o . -Q Date of Inspection .................................... z Date Completed ...................................... Qr C PERMIT �� --.--.-~--.—.-------.---, l9 � � � � �0 ^^'--^----`—`--'^^'^^^^^^--'-----' ! ..._~...—....-..~..----.-.--.--.--.., � .-_ .—.~. ' Lo � ~ ^^'`^��'�p° ^—^^^ Approved ................................................ lA m � C�Y»"�m�� '!, 'y 8 ' ---_--'�---'' --''v^---'-------' � � � ----.---.--,---------.—.....-.. � - | -17 o 0T ICt La T Ii a ', LOT ot.'(7 i I Y Y / ,E)f"l3 7' O -WELL i :. ST O ".wTV ��. ry ov. ! 6 13 73 I �v rz�t�� r: ,•�r Tr< ,.� Fo , ' �0 CA 7'e-?% .�I S...5 �f��t Dili �A/ r % & 4 rt 4-off: f. 0 C. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map da J� Parcel ©A Permit# (551 791 Health Division 7 i J-79 ,— Sd ' 6 Date Issued '-31 Conservation Division (�l Fee ' Tax Collector . ,10 ,Off' �q/O/ Grj Treasurer r��,ak. -1 �'�Z R / SEPTIC SYSTEM MUST BE INSTALLED IN CCNIPLIAN'CE Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board N f t f �s ° ° 9 �°1,7) Historic-OKH Preservation/Hyannis U h L J r ! Project Street Address AUG 2 9 2001 Village Rv rZ yew Owner Address € ';) Telephone 01 :7 - 3,,' ji';) 5 ee vC H A—L 0622a. Permit Request ac 1x!s, Square feet: 1st floor: existing_ proposed 2nd floor: existing proposed Total new Valuation - Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes U<o If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: Mtu/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 n Total Room Count(not including baths): existing 13_" new First Floor Room Count _ Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric -❑Other CTGa Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes O'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 No If yes, site plan review# Current-Use .__T ,- - - _"- Proposed Use _ BUILDER INFORMATION Name Telephone Number 'o�a, Address 6:)( 146 License# Q 7,/c?,L'� _ & S�_AAk_ o4&. C 2 C Home Improvement Contractor# 1,2 fy Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE FOR OFFICIAL USE ONLY x 3 7 ' PERMIT.NO. ' DATE ISSUED MAP/PARCEL NO'. ADDRESS - _ VILLAGE OWNER DATE OF INSPECTION: -- f s FOUNDATION FRAME INSULATION III FIREPLACE ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL . c GAS: ROUGH' w, _ FINAL FINAL BUILDING to qq jj _ DATE CLOSED OUT • -- - '� , ASSOCIATION PLAN NO. r _f t r RESIDENTIAL BUILDING PERM FEES IT ' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq."I >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit. square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) permit Fee 3CJ-C. projcost �-'�� ✓�ie L�i�iinanu�e�n`� G`an;rrc�zu.seit�� Board of Building Regulations and Standards. HOME IMPROVEMENT CONTRACTOR Registration: .128592 Expiration: 04/27/2003 t Type: Individual KENNETH P.GOODWIN 3 KENNETH GOODWIN- '` 38 WEQUAGUET LANE CENTERVILLE,MA 02532 Administrator °Tip f x DEPARTMENT OF PUBLIC SAFETY i • xT CONSTRUiC-1,14 SUPERVISOR LICENSE jf Nl _Expires: j , srstedf KENNETH�P,&OO,OMIN �tf' 38 MEQU OHEi'lN '4$ CENTERVILLE, MA 02602 i,..` tI107 ",000 , . LJT 16 LOT oLO k O rt, r "WEI r i 4 - _ A f RMSTAME - ! DATA" `� _ 7.? NOV. 16 , 1973 �O AjZ)AT/Un/ LS LrJ Cam, O;"nF' h �^ �`� 1'VHEiV 7"�fE F'LA� v✓A5' �-7�tz�;� . 8� �nG LDT t9 : •�15 'SN�l. �� /,Aj �L A iv _ S: ND'T. `� i �O .S�f� � .{'� - �.3G-,4�Imo.�.3� �'�+,✓ "'/'�:•... ...,...� C3,A- p��.Y't,� i - 7- The Town of Barnstable r � • BAMSTABIX MASS. Regulatory Services Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work:^�� -`�� T' `'`� Estimated Cost ' Address of Work:,t,/O wner's Name: man "i- ton Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law FlJob Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL a 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav:rev-070601 The Commonwealth of Massachusetts, --` - Department of Industrial Accidents Office al/oaesdradvirs 600 Washington Street -- `; Boston,Mass. 02111 Workers' Compensation Insurance AffidavitM name "C1Z7d,—(, �� location: - h�v"t1S hone# �" ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one working in any capacity ////.=//,0%%%'/%O////////////////'�� / % //%///l////%'///i �/// 10 !% /O%////O////%//O%%/%%%%%�/��%/%%%/O�%///////O/%%%%%%%: workers' co ensation for my employees working on this job.:: :;: _:: :.:.::.:.::::..:::.:..>:.::.... rovidm mP Comp 9laE'eSS one:#:_ - _. .... h ci ::.2 .... �•:::: '::::1::1;:�';:J`y:.o- •isii:.i:::•:a>s;>:t.:>:�5:>S`i::i::::!?:::i:i i:i��:::: I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following ...........)mP on olives........... Al , ;:: ' y i :. ..............:. ... .::•:r.}}:•ivy' ... ..... ... .. .. .. ..... .rev ::.::. :•.....e ....:.... ... .: ............................................ �� .. .....................v:.�::.�:::v:::::::::.:?..........:.......... .::::.v:::!:n?}:.%tr:•.v:.;N:::::.}i'r':i:4}i:'::i:i:}:?ii:Li.; ...... ....... ... .... ..... .... ..................::::.�� .......::.v, vv.....:: :r:.:v::•:.�}:•.v:::::::::nv. �i:::r::. ..............:................. •.:w ...............................n....• .............. ........................::w:::::::::x:••......n S.x:•.:v::...•..1........... ..:..:.:.:....n.:............... / / .... M. e ............ ci ::: ..... ... . .. .: ............:..... ..:.................... .......... ;:::;`::>:; ozz Faflm a to seems coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal pennifln of a pae to 51,500.00 and/or am yam,baprisoriment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a Copy of this statement may be forwarded to the OfIIce of Investigations of the DIA for coverage verldcation. 1 do hereby certify under the pains and penalties of perjurY thai the information provided above is trry and coned Sigaature�r-•r �� !��Q o �4r-r��lz� Date -:6• Z9 .�) — Print name oincial use only do not write in this area to be completed by city or town official permitllicense 0 ❑Building Department city or town: ❑Licensing Board ❑Selectmen's Office check if immediate response is required ❑Hesith Department contact person: phone is; Other (1evuad 9/95 PJA) Information and Instructions etts General Laws chapter hapter 152 section 25 requires all employers to provide workers' compensation fV ctheir ontram employees. As quoted from the "law' an employee is defined as every person in the service of an of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any twohe more o or the foregoing engaged in a joint enterprise, and including the legal representatives of loe e�However the owner of.a trustee of an individual, ed employer, o partnership, association or other legal entity, employingemployees.' P y house of than three apartments and who resides therein, or the occupant of the dwelling or not more P . dwelling house having work on such dwelling house or on the.grounds another who employs persons to do maintenance, construction or repair th a ereto shall not because of such employment be deemed to be an employer. building PP urtenant MGL ter 152 section 25 also states that every state or local licensing agency shall withhold for any applicant who has of a liceenns or permit to operate a business or to construct buildings m the commonwealth d acceptable evidence of compliance with the insurance coverage required. Additionally,f-public neither until the not produce P contract for the performance p commonwealth nor any of its political subdivisions shall enter into any have.been presented to the contracting of this chapter acceptable evidence of compliance with the insurance authority. Applicants A lately,by checking the box that applies to your situation and Please fill in the workers' compensation affidavit camp c an names, address and phone munbers along with a certificate of insurance as all affidavits may be supplying omp y - of insurance coverage. Also be sure to sign and s submitted to the Department of Industrial Accidents °II application for the permit or license is date the affidavit. The affidavit should be returned to the city or town that the app ' ns regardingthe��w"or if you not the Departm of Industrial at Should you have any t the number listed below. are required to obtain a workers' comp being ' Department Of policy,please call the Department at the nu my NEW City or Towns rimed legibly. The Department has provided a.space at the bottom of the Please be sure that the affidavit is complete and p ons has to contact you regarding the applicant. Please affidavit for you to fill out in the event the Office of Investigations number: The affidavits may be returned to be sure to fill is the permit/Iicense number which will be used as a reference mail or FAX unless other arrangements have been made. the Department by ma The 0 ffice 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. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Ipyestigadons 600 Washington Street Boston, Ma. 02111 fax#: (6L7) 727-7749 phone #: (617) 7274900 ext. 406, 409 or 375 E IMPORTANT # ANY CONSTRUCTION THAT INCREASES LIVING SPACE BEYOND 1200 SO. FT. PER LEVEL MAY REQUIRE THE INSTALLATION OF ADDITIONAL SMOKE DETECTORS. NOTE: A SEPARATE PERMIT IS REQUIRED FOR THE t INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT DOES NOT SATISFY THIS REQUIREMENT. 1 � - - 1 Il (1 FEMout t'� ST. cDDf r i } 7010 3 — -- KI/oN-T ELIEV -T/riff" RE,4 ft �v r nT A/7> EL O 09 73 D-7 0 0� 6/7 538- �a ya 4 SCALE:/ ��_� -Q•. APPROVED By: IDRAWN BVS/I7 1 DATE:G- 7- gp00000ll REVISED i ir'H/C:J-1IIt1L0/ �- �ItiS�AJ 779.661 Yirl \ _ DRAWING NUMBER /Of .2 A5 P H ALT (<o o L Ta /Z I D &,F -#- V-E 77 2 I r" t E)6 C LjT. /(y Sr IZA 10 �&t oVC�N yHu/Zr, Af\.'a L/Py Pl% e'O 7T M��T NEW cODtj OnJ /�?/ti:7 UPL.j FT /S t= E E' A) /p,-l£ se 02 D LUNrr.';t ,4re77 StG�£ crux. 0 No 5or-z/ 7-f O acW Al iA�GJA IQ-0u45H (M.4TCt/) u'' N a c l o o tRIEZ-E v-f= K I>C FI + - 2OuGN ml 1 d d a C. 7t- y /rW'rcH Oi=OT yrz6 116hi%y r P aY" N�'aeE> 1.2 VE 'r N ACC£g5 THRU �J 51 DrNC� d O �>uSt7t�� ALL (�1H ITF f --G� -E Hinl(��ty - A E� 8� �. 7yvt�.rtJ� cr-5' a' irk. PSI x 5 /x� ca' r�o��/✓ o C�oStfs a I awTcµ Ex r, axe' 02 c Ili" SNuTTtr-S -F/< I,• OtiL� x � x /'!'S PAAu 7 X y TR r M w� 5 i�� L E�u,T• 1� Exi�i: � (� S�Dt �� W/A;DIOWS - Vtr•: rr, 12ky . I dU 1rJ _ u -NLAfZ6tD s1 T R ( y /3 ^ —�' aX'/_ TPP. 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