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0033 GROVE STREET
�Jv ���� ���- ' v i + TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel .-`Application # ~Ld �� Health Division " Date Issued C(� Conservation Division ,_Application Fee lJ Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address 3 3 . 6 cove- 5flty•e+ Village C04-1/o�"� Owner DPrnpY +n`v5 ISa C04 e_aoes Address C0f5&_)0 I.d Avon Telephone Permit Request AAA C2it 5 4- WO roe r M 1,+ re- a (_^� C t7 rl P��j S�'1 1'n r a'nt Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay _*oject Valuation $(0040 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family.'g Two Family ❑ Multi-Family (# units) Age of Existing Structure /00� Historic House: ❑Yes 0 No On Old King's Highway: ❑Yes '11 No Basement Type: ❑ Full WCrawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new (D Half: existing new Number of Bedrooms: Z existing 0 new = ' Total Room Count (not including baths): existing new First Floor Room Count' C::" -n Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Y)o Central Air: ❑Yes ;VNo Fireplaces: Existing New Existing wood/,coal stove: gYes ❑ No 4 ,,off Detached garage: Elexisting ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing new? size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - - Name 0, e5 Telephone Number Address J__5i.4_)CDk a Q License # Avt}� , cj o(oco 1 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU E , DATE /0/1 /10 FOR OFFICIAL USE ONLY 4 APPLICATION# DATE ISSUED ,-,,aMAP-/PARCEL NO... - f ' ADDRESS_ VILLAGE OWNER ° DATE OF INSPECTION: oS M r' F.OUNDATION':f. `z o'kw ti ° f RAME s E / 0 9 ro R So �/Va'elk`� o rolerrwc� `r ,�'_INSULATIOWL J r� *� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' `;4 GAS-H ROUGH » - FINAL .iif AL-BUILDING in- Z�,N Z:,;'F= t ' ;DATE,CLOSED OUT ASSOCIATION PLAN NO. f ,1 The Commonwealth of Massachusetts r Department of Xndustrial Accidents � l Office of Investigations 600 Washington Street t� Boston, MA 0211 sy www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le� Name (Business/Organizatio(Eividual t > e mt 1 0s QCO Address: `Lt— Cotsw®�dt IA-)(;L yl City/State/Zip: Dn 0 CQC7C� Phone #: �3' �O��J Are you an employer?Check the appropriate b Type of project'(required): 4.lam a gbneral contractor and I ].❑ I am a employer with 6. ❑New construction * have hired the sub-contractors.. • eiriployees(frill and/or`part-tiri�e). - 2.❑ I am a sole proprietor.or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have . g, ❑ Demolition working for mein an capacity. employees and have workers'. Building addition g y P ty. 9. ❑ g, No workers' comp. insurance comp. insurance.$ required.} 5. [] We.are a corporation and its 10°❑ Electrical repairs or additions 3. I am a homeowner•doing all work officers have exercised their 11.❑Plumbing repairs or additions xe myself. [No workers right of e mption per MGL coinp. 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees.,[No workers' 13.❑ Other comp. insurance requued.] *Any applicant that checks box 41 must also fill out•the section below showing their workers'compensation.policy information. t Homeowners who submit this affidavit indicating,t ey,are,doing all;work and.,thcn hire outside contractorsmust submil a new afiidEMt indicating such. tContractdrs'that check this box must attached an addidonal,shect showing the name of the sub contractors and state whether.or not Ihoseentities'have f I_employees. If thcsnb-contractors have employees,[hey must provide their workers'comp.policy number f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic. #: T 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. T do hereby certify under the pains and penalties ofperjury that the information provided aboveis trice and correct. Si rat Date:. ld I t c7 Phone# ��&D 093 1 Official use only. Do,not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one); 1. Board of Health 2,Building Department 3, Cit),/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector 6, Other Contact Person: Phone#: A TYC Chide to Wood Consti-uctioii to High Wind Areas:110 niph 1,Vh1dZofze Massachusetts Checklist for Compliance (78OCNfft5301:2.1.1)' Check Compliance 1.1 SCOPE Wind Speed(3-sec. ........ ................ 110 mph ✓ WindExposure Category................................................................................................................................B Wind Exposure Category................Engineering Required For Entire Project .......................................C 1.2 APPLICABILITY -7 Number Of Stories(a roof which exceeds 8.in 12 slope shall be considered a story) CIW�'StDries :5 2 stories Roof Pitch ................................ ............................................(Fig 2) ............................................;�� 15 12:12 Mean Roof Height .....................................................:........(Fig 2).............................................41 ft :5'33- M .�4 A-C Building Width,W ................................ Z :5 0' ✓ St. ?..(Fig 3).............................................../ ft 8 Building Length,L ...............................................................(Fig 3)................................................/9' ft.:5 80, Building Aspect Ratio(L/W) ............(Fig 4).................................................. 3:1 V"!�6'8' Nominal Height of Tallest Opening2 ....................................(Fig 4)................................................ 6 1.3 FRAMING CONNECTIONS General compliance with framin.g connections......................(Table W&Z ✓ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.............................................................................................................................. ConcreteMasonry..................................................................... ................................................................ 2.2 ANCHORAGE TO FOUNDATION"'. 5/8*Anchor Botts,imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Sppcing-general ..................................I.......(Table 4)....' .........J i in. Bolt Spacing from endrjoint of plate.............................(Fig 5)........ .............. 7" in.56712-, Bolt Embedment, concrete.........................................(Fig 5)....... in.-a 7' ✓ Bolt Embedment-masonry......................:.............:....(Fig ...... ........... in .15" 5)........ —� X x 3-x 1/.- Plate Washer.................................................................(Fig.5).....7............................ t 3.1 FLOORS Floor-framing member spans checked ...............................(per 780 CMR Chapter 55)................................... Maximum Floor Opening Dimension...................................(Fig 6)................................................... n- fl:5 12' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)..*..................................... MbMmUrn Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Pig 7)......................I.................................lift 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall ................(Fig 8).......... ..................................... (0 ft :5d Floor Bracing at Endwalls.....................:::.............:......::......(Fig 9)Z A? Floor Sheathing Type (per 780 CMR Chapter 55)............................... ......................... a e" Floor Sheathing Thickness ........ ...............:................(per 780 CMR Chapter 55)..... ................. in. Floor Sheathing Fastening....................................................(Table 2).. ?d nails at_C, in edge 1, ),-t,.in field 4.1 WALLS Wall Height Loadbearing walls..............................................I..........(Fig 10 and Table 5).........................�s ft :510, Non-Loadbearing walls..................................................(Fig 10 and Table 5)..........................Kg-ft 520' Wall Stud Spacing ...................................................:....(Fig 10 and Table 5)................... 16in.,:5 24'o.c. ft :5 d Wall.Story Offsets ........................................:............:..(Figs 7&8)............................................ 4.2 EXTERIORVALLS' Wood Studi 61 Loadbearing walls....................................... ................(Table C7)...........................-.2x 6, - 7 ft,: in. ✓ Non-Loadbearing walls.....................................:...........(Table 5)..............................2-x /z ft o in.mac. Gable End Wall Bracing Full Height Endwall-Studs........................:....................(Fig 10)...2 WSP.Attic Floor Length..................:..............................(Fig 11)............................................... ft z013 Gypsum Ceiling Length(if WSP not used ....:............:.(Fig.1 1)............................................—ft a 0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c....(Fig 11)............................................................. or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays v Double Top Plate Splice Length .................:-...................................(Fig 13 and Table 6).O�n�re,, ............ ft A� (Zn1ir-P rnnnprtinn(no-of-16d Common nails)..............(table 6).................j ...... ............. Ali/C Guide to Wood Coristruktiou ill High !find Areas, 110 fiiph !find Zori%� Massachusetts. Chedd st for Compliance(7sq.Ci1'Iit 5301.2.1.1)' , Loadbearing Wall Connections Lateral(no.of 16d common nails)....................................(Tables_ 7)...... ... .. t Non-Loadbearing Wall Connections Lateral no.of 16d common nails ......:. .:.:.:.. . : :....:. Table 8 ... ... ....:.. ..... .. ........ Header Spans (r ) compliance to Table 9) 9Openings.. ... .. .. 9 ...... .. 9 openings .... ...:..;.,�ft o in.5 ill Load Bearing Wall record lar est o enin but check all o enin s for ��.:...... able 9 _ SillPlate Spans ......................................................... (Table 9)....:.... ......... ... . ........�ft c�in.51V, Full Height Studs (no.of studs). ......:. ........ .....:(Table 9) ........ ....::.. .. .. ......... ......::. Non-Load Bearing Wall Openings(record largest opening'but check all openings for compliance to Table 9) Header Spans.................................................. .........(Table 9) :.::...::.:. :.. : .:.:.:.... et, in.512' Sill Plate Spans............ ...::. (Table 9) ............ CJ ft in < 12' n fi Full Height Studs(no.of studs). ........:......: :.:.:.(fable 9).. ....:.. ::...:. .. ......::......................... Exterior Wall Sheathing to Resist,Uplift and Shear Simultaneously' Minimum Building Dimension,W Nominal Height of Tallest Opening2 ...:. . i 6'8. �.. Y—max Sheathing Type... .... (note 4)_ �u Edge Nail Spacing (Table 10 or note 4 if less) .R,.f v.�9" in, c/ Field Nail Spacing Gin a'D'' p g: (Table 10) .... ....... .�" m. Shear Connection(no.of 16d common Waits)(Table 10) � ! Percent Full-Height Sheathing. .....:. ...:...(Table 10)......... ..... .... ..... ..... .....3G. /o _xG 5%Additional Sheathi ng for Wall with Opening>6'8'(Design Concepts)..:'. ..... ... Dimension, L MaximumBuilding Nominal Height of Tallest Open s Sheathing Type. - (note 4)........................... .... u Edge Nail_Spacing (Table 11 or note 4 if less) . .. Field Nail Spacing ........ . ........(Table 11) .........$�CE�� o� ZZ in. Shear Connection(no.of 16d common nails)(Table 11) �Fr 3 Percent Full-Height Sheathing... .,:..:........(Table 1i9 ':....{...: .9 ...... .. ) !8 %, 5%Additional Sheathingfor Wall with'O enin .6'8*(Design Concepts) Wall Cladding Ratedfor Wind Speed?.......................................................... . ........ . ... ......... : .......... 5.1 ROOFS Roof framing member checked?... .::. ....2...(For fuse g A W,C Span pan/Tooi(,see JR!S We bsite) L� Roof Overhang .. (Figure 19)............. ft s smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift..... ..(Table 12) U—�Of _ Lateral:... . ..::::.. .. ...:. . .......: ......(Table 12).. ......................................... plf Shear.... '....(Table 12).. S�plf 'Ridge Strap Connections,if collar ties not used per page21 ... (Table 13)....................I... ......T= • plf Gable Rake Oudooker... . (Figure 20) .nft s smaller of 2'orL/2 . ....... ....... ......... ... . . Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift...................................... ........(Table 14). .........................................U lb. n, Lateral(no.of 16d common nails) ..(Table 14)............................... ..L Ib. Roof Sheathing Type (per 780 CMR Chapters 58 and 59) .. .. Roof Sheathing Thickness ............................�� in >_7/16'WSP - Roof Sheathing Fastening.. .......... !! rr�........(Table 2)....... . .....(fl..:.: d Notes: 1. This checklist shall be met in its entirely, excluding the specific exception noted in 2,to comply with the requirements of 780 CMR-5301.2.t.i lternA. 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 184 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 batfom,sill plate in exterior walls shall be a minimum,2 in.nominal thickness pressure treated#2-gr6de: I _ - P�olTo�y Town of larnstable Regulatory Services `JA88. Thomas F. Geiler Director .,� rass. �, � , 639• A, Building Division Tom Perry, Building Commissioner 200 Main Street,. I-Iyannis, MA 02601>: www.town.barnstable.nia.us Office: 548-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: NN JOB LOCAT number street village ,.HOMEOWNER•' b1'4.c'�la� �Sq(0V`P•4j e_S S��t9 1�_ 5 4'SPy name home phone Nwork phone N ` CURRENT MAILN6 ADDRESS: �Jm �S (.7oc � i y' ¢ r �ra T; fa'e o )' city/town state 7 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/o�'farm structures. A person who constructs more than one home in a two-year period shall riot be'considered,a homeowner. Such:"homeowner"shall submit to the'Buiiding 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) f _ The undersigned"homeowner"assumesaresponsibility 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 tiiat�he/she will comply with said procedures and requirements. -Lola Signature of Ho eown.er ' r! Approval of Building Official Note: Three family dwellings containing 35000 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 ofconstruction.Supervisws);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 cannotproceed against(lie unlicensed person as it would with a licensed-Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fullyaNGaie of his/her responsibilities,many communities require„aspart.ofthe permit application,that 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 I amend and, adopt such a form/certification for use in your community. " Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc . Revised 072110 i r THE ri * HARNSI'AHLE, MASS. Town of Barnstable i6gq. �0 �rfD Mp`l A Regulatory Services Thomas F. Geiler, Director Buil ing ]Division Tho as Perry, CBO Buildi g Commissioner 200 Main Str t, Hyannis, MA 02601 www.to n.barnstable.ma,us Office: 508-862-403 Fax: 508-790-6230 Propert Owner Must Co plete a d Sign This Section If Us ng .A. Builder I, Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this b ulding permit pbcation for: (Address of Job) Signature of Owner Date .Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the rev`e'rse sib' QAWHILESTORMSNidding permit forms\EXPRESS.doc Revised 072110 .Z �'��'/'%✓y�fer.C.'q�f ;X>r^7ef14.le ;7:;, .LOi'( %T• J,'/-' /4rzci g} d 1y f/&i e j Aew ZZ 3 , r - P i • q .. . r��.(�f� .�{dp �J� .�-.r�•�.c—.wrs�saec, ^-Clt�'� HS. , r ! l i'f Cr,' / <f/ S' v-e L y' • t i 3 G Aq Cer eo 2k60 loci /10 APB << ?L4if� IT Q Pke e) . w 411 t Ay c �I 'I Map Page I of I Town of Barnstable Geographic Information System New Search Parcel Custom Ma Abutters Map Zoom 1111111111n Viewer ize VUL l� _ ',R r: �!a �� �_ IF ® 0�-JPG Map:020 Parcel:110 020111 Location: 33 GROVE STREET on j Owner: TSACOYEANES,DEMETRIUS Location Information =122' Map&Parcel 020110 ess Location 33 GROVE STREET Acreage 0.46 acres Current Owner Mailing Address TSACOYEANES,DEN 24 COTSWOLD WAY AVON,CT 06001 03D134 - Appraised Value(FY 2010) 0321 - Extra Features $0 Out Buildings $0 J 020110 Land $207,100 033 E Buildings $91,700 f Total Appraised $298,800 Assessed Value(FY 2010) Extra Features $0 Out Buildings $0 Land $207,100 Buildings $91,700 Total Assessed $298,800 ti a as Construction Detail 0aooer o 031 Style Conventional m Model Residential Grade Average Minus Stories 1 3/4 Stories Exterior Wall Asphalt Igo. 36 Feet Roof Structure Gambrel Roof Cover Asph/F Gls/Cmp Interior Wail Plastered Set Scale 1" Aerial Photos I MAP Interior Floor Hardwood DTSCLATMFR -' - - Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v1.2.3867[Production] http://66.203.95.236/arcims/appgeoapp/map.aspx?propertylD=020110&mapparback= 10/14/2010 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION (� Map Parcel `Application Health Division Date Issued (w i r) Conservation Division Application Fee .422. __') P,/ Planning Dept. Permit Fee ' Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street s�Address J 3 G Y-D Ve, 5St, Village Owner c.tieQ/n 2S Address X VUO(< W aq !'i / A, Telephone (p7?' t053'f OLoC0 1 Permit Request ��p l: f4ct JJ01z-1)b 0 0,C da 162 F (,4(eJ-Q4 4'i ew S' !4,Ci Lae 2 ' oo d, 5 , o&,Qt e C, e-4 Az Le/t, y S Square feet: 1 t floor: existing t/ proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type woo o `:�Z ,e Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) ? Age of Existing Structure 100+ ? Historic House: ❑Yes IdNo0 On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 0 s'y. FT-1 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing I new o Half: existing ® new o Number of Bedrooms: 2 existing 0new Total Room Count (not including baths): existing _Ir new 0 First Floor Room Count 3 Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ®Other 1106C Central Air: ❑Yes #No Fireplaces: Existing nNew Q Existing wood/coal stove: ❑Yes/0 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# /14 Current Use S(4j,,, p e 1Z_ w e_P&" Use Proposed p .5 _p -W.. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) VT Name e_- Y- - aCC eQn e S Telephone Number X Moo) W -bb,3 �Vfyw- (5 00) 5q3-3sz8 c� Address COTS U"l C1 lea License # N(A Ay U r 1 , cf- <U & C)o Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO MA CDmbe,'s CO. Ma SMS Mi'l is , MA SIGNATURE .1� DATE t j FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED ' MAR/PARCEL NO. , ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: 'FOUNDATION,i FRAME ,t - INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t • - ti - GAS _ ._ ROUGH -u,' FINAL J_ FIINAL_BUILDING f DATE CLOSED OUT r r ASSOCIATION PLAN NO. .L The Commonwealth of Massa ehusetts �„ "" Department of Industrial Accidents `Office of Investigations 600 Washington Street t Z Boston, MA,02111 Y M Ly r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information x Please Print Legibly Name (Business/Organization/Individual): , �OW10"�" I�as 50,C0Cde6Xd1e_$ ' a Col-sw o l d 1n1a Address: }� _ -- Ci /State/Zi : �(1 CT ©�0 Phone #:` �' P - Are you an employer?-Check the appropriate box: Type of profect.(required)s i.❑ I am a employer with 4. [] I am a general contractor and I 6 D New construction ' employees(full and/or'pait-time).* have'hired the sub-contractors.. _ 2.❑ I am a sole proprietor.or partner- listed on the attached sheet: 7. Remodeling ship and have no employees These sub-contractors have(•, g Demolition - working for me in any capacity. employees and have worke s, 9. Building addition comp [No w e.workers' comp. insuranc _insura11, nce: 5. �•We a re a corporation and its 10. Electrical repairs or additions required.] 3.�A I am a homeowner doing all,work officers have exercised,their I I.N Plumbing repairs or additions myself:b[No worker's' comp. ,right of exemption per MGL 12.{� Roof repairs insurance required.] t c. 152, §1(4), and we.have no` employees. [No workers' 13.❑ Other comp.msurauce.required.] " *Any applicant that checks box.#1 : ust also fill out the section below showing their workers'.compensation policy information: t Homeowners who submit this affidavit indicating they,arc doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether`or not`those'entities have employees. If the sub-contractors have employees,they must provide their workers comp.policy number. I am an employer that is providing workers'compensation insurance foamy employees. Below is the policy and jab site information Insurance Company Name: _ Policy# or Self-ins.Lic.#: Expiration Date: 2 2 }� }�a Q City/State/Zip: Ahl 1� Job Site Address:3 3 �� Vey i�"`-'� / 1 Attach-a copy"of the workers' compensation policy declaration page (showing the policy number:arid 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" ftne.up to $1,500.00 and/or one-year imprisont, as well as civil penalties in the form of a STOP WORK ORDER and a fine men of up to $250.00 a day,;against the violator. Be advised that a copy of this statement may be forwarded to the Offree.of_. Investigations of the DlA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that-the information provided above is trice and correct. Si natur . -at Phone#:` Official use only., Do not write in.this area, lobe completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one); 1. Board of,Health 2. Building Department-3. City/Town Clerk 4. Electrical Inspector 5,Plumbing Inspector 6. Other ' Contact Person: Phone#: " a Information and bstructIODS �•"ti all Massachusetts General Laws chapter 152 requiy ey pio ersonoinr ' k compensationers theservicceof another under any contract flh e, Pursuant to this statute, an emplo))ee is defined Y r express or implied, oral or written." her gal entity, Or any two An employer is defined as "an individual, partnership, association,e al repres'entativeon Or ts of aedeceased employer, ooLheore of the foregoing engaged in ajoint enterprise, and including the 1 g p receiver or frus`tee 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, constriction or repair work on such dwelling house ','Or on'lhe grounds or building appurtenant thereto shall not because of such empl'oyrrient 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 onw wealthwith nor any.insurance ofits political subdrvusions shall Additionally, MGL chapter 152, §25C(7) states "Neither the comet 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 - ors names addresses) and phone number(s)along with their cerlificaie(s) of necessary,supply sub contract O O, ted Liaited Liability Partnerships(LLP)with no employees other than the insurance, Limi bility Companies (LLC)or Lim members or partners,are not required to carry workers' eompensat�on if an LLC or LLP does have insurance. of Ind, employees, a policy is required. Be advised that this affidavit mayobs,snba itdtedd{°the affidavit ntThe affidavit-istriaShould Accidents for confirmation of insurance coverage. Also be sure g wn that-the application for the permit or license is.being requested,not the Departm be returned to the city or-to ent of Industrial Accidents. Should-you have any questions regarding the law Or if y if insre uquired to red compares should enter their Compensation policy,please call the Department at the number listed below... self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Depa set o contact ooiaregar space the applicant. t of the affidavit for you to fill out in the event the Office of Investigations h Y } nse number wlricli will be used as a.referencc number. In addition, an applicant Ple"ase be sure to fill in the_permit/lice that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating(ci y or policy information (if necessary)and under"Job Site Address" the applicant should write"all locations in the town),"A copy of the affidavit that has been officially stamped or markCed b s Anew affidavi mu the city or town may st berfiJ]ed Door each applicant as proof that'a valid affidavit is on file for future.perMIts or h year. Where a home owner or citizen is obtaining a license or permit not related to any business or comriiercial venture quired to complete this affidavit. (i,e, a dog license or permit to bum leaves etc,) said person is NOT re The Office of Investigations woo like o han �� Dj�y_e cooperatinn and should you have any questions, please do not hesitate to give us a call. The Deparlment's'address, telepbone and fax number: The Commonwealth of Massachusetts Department of lndusbial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 r Tel. # 617-727-4900 ext 406'or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www,mass.gov/dia s! .:� -THEr, ti Town of Barnstable ` Regulatory Services stsutsrABc.E, , v MASS. $ Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street; Hyannis,MA 02601 www:town.barnstable.ma.us Office: 508-862-4038 Fax: S.08-790-6230 -Property Owner Must Complete and Sign.This, Section If Using A Builder • t as'Owzier of the subject property , hereby authorize 11:!!!! to act on my behalf," in all matters relative to work authorized by this building permit application for: (Address of Job) , Signature of Ownzr ate Print Name,, _ If Property Owner is applying for permit please.complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNFRPER1vfISS)ON S 3Y '� Town of Barnstable Regulatory Services swxxsr•AsrE Thomas F. Geiler,Director MASS Building Division ArED � Tom Perry, Building Commissioner 200 Main.Street, Hyannis, MA..02601. vtv.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 4 I30h4EOVNER LICENSE EXEMPTION Ple-are Print DATE: MA (/ JOB LOCATION: �`t number street village "HOMEOWNER": J V j`� � J 5� co *+ 8: ;�. . 0 ! � rname L home ZlA c# work phone# CURRENT MAILING ADDRESS:SC 1 (�/ IJ{.���1t �,ty C'� 00 statt 00pI e T)7e 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_ DEFINMON 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 cons"cts 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 mud requirements. 1 S+ titre of Homeown/cr- = 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 requirtd shall be exempt from the provisions of this scction.(Section 109.3.1 -Licensing of construction Supervisors);provided that if the homeowner engages a parson(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 Mould with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her respons5bilities,many communities require,as part of the permit application., that the homcowncr certify that he/she understands the respons,bilitics 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/ccrtif,cation for use in your community. Q:fo,rru:homccxcmpt R 4 N�G✓ uwoc.l.l9��s-% t- ��',%, � .Dao 2 �+ ,c��'z',!,'v�C ��� ,y it s:.�crc ,o,t.• r.�.¢irS 1 A�� �� • lk!1�W t���w iY o 1-fl .41 04l i/-77 71+ ,UfM,�;,��[� ��'.¢it d L �5"l'o L C,Q�,,��' /=rr�_' L� n caw r�.•g �j� ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Z Planning Dept. Permit Fee " ) Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village L.AJ-{'�t,t� Owner V6604jgco u ega Address Telephone b o' Permit Request 2" -5ew ,-V1d1.d b d Lo_" Sq are feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain //Groundwater Overlay Project Valuation �/008' d� Construction Type`4� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(soft) Number of Baths: Full: existing new Half: existing n(!W w Number of Bedrooms: existing _new Total Room Count (not including bath existing new First Floor Roo, Count__ Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other w C) Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals ALAhorization ❑ Appeal # Recorded ❑ Commercial ❑Yes VNo If �es site plan review # Y Current Use Proposed Use APPLICANT INFORMATION kl,�_ (B,aIWff-�OR HOMEOWNER) Name (w� �4 - ( Telephone Number Address Y bL ��/ License# (00"I,::a:f Now,& v Home Improvement Contractor# 164- b p Worker's Compensation #U1Gq'c052 lot ALL CONSTRUCTION DEBRIS RESULTING FROM THIS �APR�OAJ�Qf WILL� BE TAKEN TO V"Wry SIGNATURE DATE G� 'G ti FOR OFFICIAL USE ONLY ., .. APPLICATION# 'DATE ISSUED ` MAP/PARCEL NO. r ADDRESS - VILLAGE OWNER DATE OF INSPECTION: -FOUNDATION FRAME INSULATION FIREPLACE t • hk ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 2 i DATE CLOSED OUT ASSOCIATION PLAN NO. il�. •., �Da 'a'. r 3 • I 1 iNtussaclu setts - Department of Public �,afct% Board of BuiRlin- Re�-ulations and -standards (;onstrutction Supervisor License Licen�3 CS 100988 HENRY CASSIDY . 8 SHED ROW WEV '*ARMOUTH, MA 02673 Expiration: 11/11/2013 ('uuuuissiuucr Tr#: 7620• /l/c coeali/f/ c1 ,C��� /t i 69 y11 17 lG�C`1' ,1 _^)l Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/,?b14 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE _ .SO. YARMOUTH, MA 02664 ---------.._.___ Update Address and return card. Mark reason for change. Address U Renewal Employment Lost Card NGA IG zoaa-uti'i i �'��r- �f�oirrrrrr-raccnczlr�rrfC?llr;�drrc�u�c!/fJ :\ Q'fice of Consumer Alfnirs& Business t2egul�tion License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: e istration: Office of Consumer Affairs and Business Regulation 9 153567 Type: g :expiration: 12/1`5/2014 Private Corporation 10 Park Plaza-Suite 5170 Xr '' Boston,MA 02116, CAPE CUD INSULATIONsINC: HENRY CASSIDY 18 REARDON CIRCLE.' SO YARMOUTH, MA 02664 _ Undersecretary f val• wit t nat re The Commonwealth o 'Massachusetts Print Form -•-J Department of'Industrial Accidents _ ;14 Office of Investigations I Congress Street, Suite 100 Boston MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Naine (Business/Organization/individual): ej 4 Address:_ City/State/Gip: V a MA' Phone #: Are you an employer? Check t e appropriate box: Type of project(required): 1.0 1 am a employer with 20 4• ❑ I am a general contractor and 1 employees (full-and/or part-time).* have hired the sub-contractors 6. ❑ New construction �.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition, working for the in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.'insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their l l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.FIR oof re airs insurance required.] �t c. 152, §1(4), and we have no �j �e� �l / employees. [No workers' 1.3•� Othe.r W f2 comp. insurance required.] I 'Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t I lomeowners 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 urn an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site infi)rrnation. Insurance Company Naine:. Ct vl hc, C,4uvhv 1�%vaoc-I& Policy #or Self-ins. Lic. #: WCA OD 115 q01 Expiration Date: �dyPi - f bZ�� Job Sitc Address: � City/State/Zip:` *J w(�l � `a 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do hereby certify n4er the painsNnd eenalties of er'ui y that the information provided above is tr ae and correct. Signature: 22 Date: r . Phone official use only. Do not write in.this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector S. Other Contact Person: Phone#: GllefltU: 4597 GC I Iq S U L.ACORD," -------- CERTIMATE OF LJABILITY IN$URANCE UA THIS C,1' I I:ICA I 1�,IS I S:iLIF'L)A_1j A MATT CONFZ:R,9 NO RIGhT8 U N TliF--CF_m-iF'JCATF_HOLDIER.'111IS N0'J'APf-wmA-I,jVj:�Ly OR NEGATIVELY AIWAIL),EVEND OR ALTER TFIE COVL.,I:ACIZ AFFORDr-D UY Ti-111H PO CEKTIFIC�ATF I MATI-EN OF INFOTiiiAT J-11ti CL-.ffFIJr;ICA1'JZ, QF INSURANCE DOES NOTCON;j 111 It jE LICIE6 kF1*1iic".,[i1\1 I A CWt l"f1CMILIGPR ANO 1'HF,CERTIFICATE IIQUQR.A CON I_"CY BEIWEEN'l iiL 1,*��I.IING SLIRI:t K(!�),ALI I I IQKI4L0 IN, 1'10 N_AL INS UNf 1),OIL, t� 1pn.l Illay It tid(LAII,Lill )n(Ills collilicwtk'(14 O 111A cullfCr[lulwj(o(lit; 7-6p .......... 1w.l. —So. uvmwk; NAWE maiEcicl you —---------- j4(t:At(Q I;t�jNo k.l506-7 60-11602 1 F,A) t)I I I t no, MA 02G1iQ-I U0 I .......... 's ln.�wraflco 16333 cc)(( Iw;UIAt(km 11,10 IN'sum:RU:LYZI114 1oTl Illsu y lh'l� Yololouill tNsIjrEjjc -_ - ----------- I IV'I IV]A 02 i�I)I 111QUI'MICe Coljjp�kjjV ................... Lh(IF)CAIL NUMUEP%; ....... 1.1,17111 Y [HAT ll_(l HAVE BEEN(660Ep TO I I(L IM(A 71) NA W�L)AGOVL 1-t)Ft TIIC-11-01. _Ll_t lot) iPt-CI, Ti:) III(., .rol,oa) by Tti� Pouciac :1) OR MAY PV-_RI'AIN. THE MURANCL �k; ik,NY (�ONW1101,101' AIV C1,1111RACTOR OTHER DO(',U&11,N'I' WITH 1-41- illklIC1,11 MAY ffl.- 11 II h41 OR Vv _D Ia_fEIN IS SUU,IC(,I' 10 AIA. 11IF (Njj.U,AA'Ji ANO OF 5UC-1 POLICIES. LIMITS SHcvvlj Iyi, "A'19 BCzEN REDUCED OY PAID CLAIMS, COP826306", 044112012 EAGI-I OCCURRtz 000 LIAWLIV�i 1'1116QPIAL ADV IN J1.1kY .................................... 1311HU-04,AGORLMAI li: 0,1300,000 L hAl I Al"I"t-Lj�kl PIR: -NI&W_f:42w1ccc I X X All I k).'i 1,10011-V INJURY(I ,aAwal) x J111M J U I U,� Au 101 A NON-( VYNH,j ? it XONJ4535,1 14/0'1010U�410,1 IT,1.00 0.,O()U AGORIZUATL W301201-9 v t [P111, I IV9 N YI Z1, -—---------__ [N i A (U,i 6Oki NI-tj App ow.."t'. p], t:,k ------------- —- .......... W01,kc-l's comp Infoliflutlull 4-14,It VIVIV OPAVO II,fQ41111100) fl.'j Lill ji'Cl(fi(jolial j,ISLjItj(j UIILIUI 6ullulal LWOility whon ro(JUIrod by written ---------- CANCELLAT-ION G(.ILj IlleiliIJI4611,11ic �HQULD ANY OF THE A150V6 fQL.jCjkz;i 111H 1,11-,I Qk; THE EXPIRATION DATE THEREOF, NOTICE WILL 1st: UELIVhkk0 IN ACCORDANCE WITH THE POLICY MOVItAJON.a. 0'A&4 L a -,20-10 AC014D C0141`1014AIJON.All 119110 lk�"'YVkl (4 lum) 1 QC'I I h(t ACORV 11MIld 411d 1000 and rutjkUrod marks ofAGORO i OWNER AUTHORIZATION :FORM (Owner' ame) owner of the Property located at. 33 G • (Property Address) C_QAA1+ M (Property Address) e— Cod hereby authorize am CJ 1 U� (Sub ntractor) an authorized subcontractor for RISE.Engineering,to act on my behalf to obtain a building: permit and to perform work:on my prope1'ty. Owner's. Signature D KL.AII MAR 0 81015 7� a aw�c {r2 l p LIXD`At®8 tc> 6CA' 1 Z)C, Dl oFTMe,, TOWN OF BARNSTABLE 30799 .. � Permit No. ..............:. BUILDING DEPARTMENT { D°eNAS& I TOWN OFFICE BUILDING Cash .�cr�r HYANNIS,MASS.02601 Bond X CERTIFICATE OF USE AND OCCUPANCY Issued to BAYSIDE BUILDING CO. Address lot #47 285 Olde Homestead Drive, Marstons Mills USE GROUP FIRE GRADING OCCUPANCY LOAD 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. July 9 37 19................. ....... ........ ....................... Building Inspector , o'�y��•. TOWN OF BARNSTABLE BUILDING DEPARTMENT BARISTAU = TOWN OFFICE BUILDING rua 039 HYANNIS, MASS. 02601 �o r�r►• MEMO TO: Town Clerk FROM: Building Department DATE: �f���►� I' An Occupancy Permit has been issued for theubuilding authorized by Building Permit $�......3©22 _......_ ............ ....... .. _.. /......7-- issued to �-�,,Cl � �S.C��.............................................. ._ �. _ ....._w . ..._ _..__. Please release the performance bond. r. i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IMA�CC DATA TOWN OF BARNSTABLE, MASSACHUSETTS. BUILDING" PERMIT' HATE t9 PE..I M I APPLICANT AF-ORESS ')4 (CONYR'S FtCENSF) I N PEP. �RY PERMIT TO !S L r, (TYPE OF IMPROVEMENT) NO; AT (LOCATION) ,.DING 2 TR ICT_ (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILIJING IS TO BE FT. WIDE BY FT, LONG By FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP -BASEMENT WALLS OR FOUNDATION (TYPE) RLMARKS: - AREA OR PERMIT $ , i 4 0! VOLUME (CUBIC/SQUARE FEET) ESTIMATED COST $ FEE OWNER t 'C�V i BUILDING DEPT. ADDRESS J BY • pop. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS PRE REQUIRED FOR ELECTRIC,�L, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. �MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANIC 0. !tii,rALLATIONS. 2. PRIOR TO COVERING STRUCTURAL�QUIREC,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(REAOY TO LATH). I FINAL INSPECTION HAS BEEN MADE, 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS `7- 2 2 2 HEATING INSPECTION AID ROVAL ENGINEERING DEPARTMENT 17Y 11Z�_Ll /,e�z,J JAV'Q�l OTHER BOARD OF HEALTH -7 WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIOUUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION PERMIT ;S ISSUED AS NOTED ABOVE. NOTIFICATION. r S 5pA � � —'— 7 5, po N � � 6 S V\ 7.10 N �V\1 'P,�1°� 0 4� 1+ o p�_ o_ } 13.04' E t s t 1 e) I- Pre, komp' 191-e,- Ap P� Ive i1 M On the basis of my knowledge, information and �� ��,�rl�� - 4v, D�►r�; 5/is/�7 _ belief,- I -certify to Town/ o.- �,ge�ysa-,cam that as a result of a survey made on the groun on 6-112 87 , I find that: WAr1 rv1F v�/�► ►,s.���4� �°:� ��, f ti.IG. 1'he s.tructure(s) are located on the site as shown. he title, lines and lines of occupation of the ; site are as shoi-m hereon. `tw OFa 'he site is situated in Flood 'one it/ov-Nazve,0 'c o��WILU� `'omnunity :panel No. Date: M. WARWICK Date: rso. 19"1 / PA A � F�fSTER`��� fi LL [;illiam I .. ';dares' ALS 4 j -:: Aj 4u' ! 1� s4 (� rc.WF J' J. 71 �z)LA ..FiICHAF A., BAXTER .n IMP u Q G. ME % iC Tom. ME Assessor's offioe '(1st-floor): � _ Y —'y/ i� i .�' ���T��e SYSTEM ��� F THE w sses _ Assessor's map and lot number :. . ...... o� Board INSTALLED IN C® of Health '(3rd floor): { � Sewage Permit. number ........ � WITH TOTLE �: t B�9TAnLE. i Engineering Department (3rcl floor}; ;L j T i C�NVIl' NMEN Q°AI °�. .,voo NAM p l= House number °�� ' < APPLICATIONS PROCESSED 8:30-9:30 A.M. and` 1:00-,2:00 P.M.' only; - TOWN : :OF BARNSTABLE 4" . , HULDING ' INSPECTOR APPLICATION ,FOR PERMIT TOk '.:Cons•tr ct New House•, • .... ............................................ . ...Fr.. me............ t TYPE OF CONSTRUCTION .• � - June..12.,.... .... 1986. TO THE INSPECTOR OF- BUILDINGS: k The undersigned hereby applies for a permit according to the following information: Location .Lo.t.A.7_0.1de...Home.ste.ad..Drive.,....Marsacans...Mills.,. .MA:........:...... ..:.................................. Proposed Use ..S.ing.le'..Family...D.wellin.g.............:..................................................:............................................. Zoning District ..RE ''..''...••:..DD... �.. ...../.' ......................Fire District Cdn.tervil.le:. .Os.tdr.ville-M.....Mi1.ls Name of Owner _ fie €fetes— -t...................Addr.ess��.�:��o � �$ jrs Phi i�.,...MA Name ,of Builder -P a r?. .�'. .. .....:......................Address 23-0-�.Reaat.e 14" , Ma:E6.4i:e ;8...K I3 7."Ick • • r Name of Architect ..N.one.......... ...........................:..::.. .....Address ...... ..................:...................:..:................................`; Number of Rooms 7...............:... :................... .................•..Foundation ...10.'...P.our.ed...Ccin.ci.e.te...................... ..:. ., • " Exler for ....W.o0.d..Shin.g.las..............................................'Roofing ,Asphalt...or...Red...Cedar............................... Floors .H.ar.dwaod.......................:. ..Inte-rior ".... y�rcni ...................... 2 D a�.1 ........................... HeatingGas...W.Arm...Aix...................................................PlumbingT-2.......................................................................... Fireplace 1.:................... .........................Approximate`Cost $.$5.,..O.Q.Q...... .......... Definitive Plan Approved-by Planning Board Feb_ -_-5_,___-_-_ -:_--198-6 __ .• Area Diagram of Lot`and. Building with Dimension's 9 9 Fee ...1_...z.......................... SUBJECT TO APPROVAL, OF BCARD OF HEALTH t OCCUPANCY PERMITS'REQUIRED FOR NEW-DWELLINGS A I hereby agree to conform to all the Rules and Regulations ofthe Town of rnstable eg ding the above r ` 1 construction. a Name d, ......... .. .......... Construction Supervisor's .License .........• 1-....... , 3r'YSIDE BUILDING CO.. 3.0799, l:z Story No :. Permit for ......2.. .. ............... Single Family Dwelling ,r .... L #..... f 35 O�.de homestead Dr` ' Location ..tot. ....4.7.........2... + - Marston Mi11s F t T...... . ........... J. _ Owner Ba side ...Building...Co. .'....... ;� - Frame - _ •�,� - � ;` <'} .. Type of Construction .... . ........ .. ....... ,. ar .......................................w� I... .... f `a .,Plot t 'Lot Permit Granted dune. 2.,..... . ...°19 87 Date oftl'r spection .:.. . ............... ............19 t '.Date Compl ed .. :. .:. y% 19 ...... H • � xe. Town of Barnstable *Permit# C� Expires 6 nihs from isJte date Regulatory Services Fee anxivsrAAryF., z 1�� Richard V.Scali,Director o Building Division Tom Perry,CB.O,Building,Commissioner APR,.2 71011 -- -__ 200 Mai Street,Hyannis,MA 026� -- ;: -- - — _ — .www.town.barnstable_ma.us Office: 508-862-4038 f ax: 90-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 'l Not Valid without Red X-Press Imprint Map/parcel Number IJ b I Property Address ( t)4j Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address pomj <q(' oat �S T Contractor's Name ) Q i) U j7 G rK) elephone Number 676 Home Improvement Contractor License#(if applicable) Email: i�UE C h0- Ma- co14 , Construction Supervisor's License#(if applicable) Q.(00oZ,(a ❑Workman's Compensation insurance Check one: i 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 est(check box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Rn O r-h_Z ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is quired. SIGNATURE: Q:\WPFH ES\FORMS\building permit forms\EXPRESS.doC Revised 040215 SHE Town of Barnstable Regulatory Services ` BAMMBLVE p` Richard V.Scab,Director 1MA98. Building Division. Paul Roma,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 AMS4 of G«1 ,as Owner of the subject properly hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Pool fences and alarms ate,the responsibility of the applicant Pools i _ ate not to be filled or utilized before fence is installed and all final inspections ate performed and accepted. tore of Owner Signature of Applicant au) Prin aoae Print Name 2 y 2 -7 Date Q:F0FW:0V NERPERIv0SI0NP00LS I- Tlie Gotnurarrrc�ed3t o,fassercllretts Deparaneut o,f rndayhrid Acciderats OiTwe ofbn.wtfgations 606 Washariglon Street J. _ .,Boston,M4 02111 spun,massgov1dia ' — Fi6rl";Ors u, pensafiGu avi Suilders�C+antract rs�'Elec ricians(P hers - '-APp'i cant InfQrmai an— -------—= - I—I---P1 ase Print f�e� y-- ----- Na=(Bus;izw=1Ch-zmdzadianffiifivi&W_ pat)4 Iq 00,cm Address- '�c J �—rP_ ps �r CitgfSfatel lU c u+n�9 �1�. MR oa-SSZ Phase-4 ��--���(�� Are you an employer?Check the appropriate bm' Type of project(required t zvrth 4. ❑I a n a general coniractar alto€I I.El I am a employer 6. ❑New construction employees(full amVor part-time),* have hired the sub-contractors 2. a sole grop=ieta r Or partner- fisted bathe attached sheet 7_ ❑Remodeling rr ship and bane no emplayees Mese smb-conlractors have S ❑Demalsfiori w -ing for in any capacity- employees and hn a wozk=' on [Noodmrs'comp.imsu ance comp-inenran�# 9. ❑Building sdditi �, required-] 5. ❑ We are a corporation and its 10❑Electrical repairs or addit ons officers have exercised their - 3.❑ I am a bameflwner doing all work 1L❑Plumbiagrepair�or'additiems myself-[No workers' rigbt of exemption per MGL 1?❑Roof repairs insurance required-]i c.I52,§1(4),and we have na employem[No wadess' 13-❑ Other comp.insu=caeraequire&] ;Any apptfcsatd7atcbedsboa#lumstalsoEM cut the section below showing the vmaeWcumpensatiaapoycgiafficmad=- 13ameocvaers wlso sabot this trificiavu+rrz ,g they amdoing all vrm&anti rhea}tee autsi&contractois submit a new aiadaest ind�;ne sack_ fCanttactans that abed c d&boa mast attached tot additional sheet shooingthe nzmeof Nie sub-catttiscnt3 and state whe&er at nutthose eorrtEesbase employees.Ifthesub-caatractocsbave employees,rhe}nmutp3 vnide thda warken'rnmp.pGhU number I arrt au ersp r tliatispronidh i�,orkers'cou t izdtrrt iamirarzce for my enrpIgfwes Below is diarpoUcy and1ob site inforrnatiats Insurance Company NEame: Policy#or ins.Lic. EkpiratiunDate://�� Job Site Addre c5 City/State� p: 0(34 U� mach a copy of the workers'compensationpolfcl-r eclaration page(sheaving the policy number and respiration date). Failure to secum coverage as required under Section 25A of MGi,a 15 can lead to the imposidon of criminal penalties of a fine up to$1,500_OD andror one yearimprisv�f,as well as civil penalties.in the form of a SWOP WORK ORDERand a Eme of up to�fl-00 a day agar the-violatar. Be adtised t]rat a copy of this statement may.be forwarded to the Office of Imreskgations ofthe DIA for insurance coverage�frca#i� I do iter�by . �raid the 2 tdpsrr 's .f�rer�ury flrat f1le irrfan9xatzoupt otzriul abm�s is b3cs and correct Si�atnre_ I3�ater Phone OjUlc-ial use only. Do not write in this urea,to be camplete�d by�artoorn OffieiaL _ City or Town: Per�tUcense# Issuing Anthor€ty(circle one): 1.Board of Health 2.Building Department 3.C'iitylTown Clerk 4.Elect t cal Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: C /Cn ^ D �yj-1•., h CAW�l T �p O p NColo ,` •@ N r Go En X o Office of Consumer Affairs and Business Regulation `� w 10 Park Plaza - Suite 5170 a` Boston, Massachusetts 02116 O Home Improvement:.C.ontractor Registration E A o8 oc� Type: Individual .- tfi `: r, yp a gi' N o Registration: 123111 o N o DAVID A. CARROLL �� � Expiration: 12/09/2018 Q Z O a T c a 12 Frederick B Douglas Rd. a- w ,r d N E 00= E N.Falmouth, MA 02556 u o m o UFO or :'__ ;7 co jG�Z Update Address and.return card. Mark reason . U .. . sca i e'o 20M_05m - —Cy� -- ----- --- --_ --..—.�•-�t'T^ems .I�>F.,k'?��!r�.l.�.�ar2g�4n?rrn�.n#� .;1�} � >_ �e Ipa�nnaortcuealC�o�'C� da • - \ Office of Consumer Affairs&Business R HOME IMPROVEMENT,CONTRA Registration valid for Individual use only TYPE: Individual before the expiration date. If found return to: Registration Ex ira ion Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 -123111;;;; 12/09/2018, Boston,MA 02116 DAVID A.CARROLL: , D/B/A Cape Cod fRernodeling and Design n DAVID CARROLU, l' �OGdJ°O 12 Frederick B Douglas Rd N.Falmouth,MA 02556 yJ •�,�s Unders Not valid without signature 3{ 0 sC. y A . 0 Gv'OA�GA J � v v 0 v N 1P ' 9 v l cow-o� � l� `oF.HEr � Town of Barnstable BARNSTABLE. :. ...._..._ Regulatory Services '... 1639. Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice ; Type of Inspection ` wL 33 ��cy� s C ( Location �. Permit Number s Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: ° F rrzc sTo '� o /Al - �� {��Ncir1A�/ rJs ( obi Ct4Lr 1< 6eVo�ln� . � X L ro L � ,I Please call: 508-862-4 for re-inspection. Inspected by � r Date S v °FINE F, Town of Barnstable BARNSTABLE. r Regulatory Services 9 MASS. g 1659. Building Division plFO MAC a. . 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location S3 GZUU-r- Sr. C Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. r The f 491lowing items need correcting: ore F(, swop kl'e4 r � lfi� /AJ Ak W LL UC—. 7RX 7"/VIJ 15 CJLe�n� E CXJr CGS. oG'C Ct4L4LK aJ ?` N 70 430 143, L L �AJO Cti ti 7 —' tb C.'- i F � I Please call: 508-862-4 for re-inspection. I,el Inspected by Date SfZ Lo A r �� i f CAPE COD � INSULATION 2013Y ,7 All IV61111 Iq N® FIBER GLASS SEAMLESS SPRATFOAM SUSPENDED BATTS OVTTEgS MSUTATION CEIUN 1-800-696-6611OS ;Is,0- Town of Barnstable OIc Sly!�3 Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village '1661zoy Cane6 3 3 &wo- S-� cc)+U,4'f Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted 0 fA'J Ceilings Slopes ( ) 00 Floors ( ) ( ) ( ) ( ) ( ) �^4e Walls ( >< ) ( ) ( 1 o ) Sincerely hECasJr, President ion, Inc. i