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HomeMy WebLinkAbout0138 GUIMQUISSETT ROAD /3 LA.; n h g�.�c;�s I i I • � � slzoll� �.►� T Town of Barnstable Permit#a 66 U Expires 6 mon14 from issue dal Regulatory Services Fee sARNSTABIX MAW v� 1639. .Richard V.Scali,Director �DMPrA Building Division Tom Perry,CBO,Building Commissi erPRE 200 Main Street,Hyannis,MA 02601 SS PERMIT www.town.bamstable.ma.us AUG ' Office: 508-862-4038 � : 508-79M230 EXPRESS PERMIT APPLICATION -- RES1'( ' "" / TiL BL Not Valid without Red X Press Imprint L Map/parcel.Number Property Address f. t 0 l M 610 1 0 1 / ❑Residential .Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address r(/ �✓ �� �' � Y IF W74'T6e T ) /1/- 77 Contractor's Name MY,-ICs_ -? V L,L j A2 Telephone Number��j' Home Improvement Contractor License#(if applicable) 1(fi P Email: m u t- L(y R r'I ft) G 6 C ai(p Construction Supervisor's License#(if applicable) ( P q L 7 l2 EV/Vorkman's Compensation Insurance Check one: - ❑ I am a sole proprietor �am the Homeowner [�'I have Worker's Compensation Insurance Insurance Company Name 7- V l C 7 Workman's Comp.Policy# ((r4 z `t)�', btu Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) �/ ire d �—�/ d� �'J')(� [�Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to /�' 4l/ % 0 � `l r ❑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. 4 ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. F SIGNATURE: �� � C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doe Revised 040215 77ae COninio Yttieakh r�,f Massachnsetts Dgoarttnew of Industrial Accidents Office of larestigadorrs WJ600 W ashington'strew .Boston,M4 02111 go Idia Workers' Compewation lusurance Affidavit:BuildersJContracte l tticLins/P bers Applicant Information __ P e.Sse Pr;nt;Iegibl�,� Na 1�1: k .rY1 lG L L- 1 A&hrss : 7 Al LA q Are.yo an eml :Check the appropriate boa: 6_� NEW jest r �� p°F RT of project(required): I am a employerwi 4. I am a general contractor and I employees(full and/or pant-tom).: have hated the sub-ccai�mctors ® On 2.® 1 a m a sole proprietor or parmer- listed on the afitached sheet. 7. 0 Remodeling ship and have no employees These snub-contractors have S. 0 Demolition for me in an c c employees and baste worlteas3 working y cap city. t 9_-®Btuldmg addition [No workers'romp_inm�nce comp-msu ante required.] 5 We are a ocaporabon and its 10.®Electrical repairs or additions 3,❑I arm a bom- counter doing all wok, officers have exercised their l I.[]Piumbimgrepairscs or additions if(No wort comp. right of esenption per MGM 12.®Roof repairs in=ance required.)l c. 152,§1(4),aand we have no employees.[No workers' 13=0 Ether comp instrance require.] 'Any apgiE=that checks b=al amp also fill an the section below showing their tomes°can g usetion policy imf m2dim iw +s�b$ait hsdatnt iadi•rotea� y a doing all vporY sa d 7�ere ovffide¢aastars tit as Ismat new aldaset itoa,4 sty tCanncam fti cbeea rids box mW ansched an addidamal d oet dwwtM dw tuts or the a b-ccuuK4on and am wkt v or not thm yes bove employ m U the€tab-caasactots b2w eqW ees,that tut Provide ih"uwkml toty.paltry number. I ann an rrrrpdoper drat is prmidiiW workm°co"q;ensadon ansaranco for niy enipftrynees; Belviv is fhe,palic.,4 and job site anf®rrrta�e� Ins Company Name-, 2 cJ G Poky or Sclf ins.I ac. ��(J �� 3� /�Expin tion Date: Job Site.Addms- IF �,(� d �'�62 U S .S�'�r% �City/Statel o: C_te,' (J Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration slate). Failure_to secure coverage as.required endear Section 25A aaf?AQL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 asWor one-year i rims ent,as well as civil penalties in the foam of a STOP WORK,ORDER and a fnt of up to S250A a day against the violator. Be advised that a copy of tdkis statement nsay be fort wided to the Office of luvestigationms of the lDIA for inmrance coverage verification. I do hereV certify under Me paints andpenaWas o pnpuy that the inforination,pros ided abm-e is tnnte and surfeit Pbmne.�_-- - _8' 22 t = lJfeiat use only. Do not evrite in this area,to be campfated by city or tovu officiaY City er Town Per�it/�itertse i# ' Issuing Authotity(corals`one): 1.Board of Health 2.Batdding Department 3.Cityaovm Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Coutact Person: Phone 9: - - - -- __ -- - -- - - (- A� CERTIFICATE OF LIABILITY INSURANCE ��( 5/1/)15 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: K the certificate holder is an ADDITIONAL INSURED,the policy(es) 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 enxlorsemen s. PRODUCER CONTACT NAME: Margaret J Grassi Ins Agency PHONE 508) 295-2007 FAx N (soa) 291-1707 1188 Main Street E-MAILADDRESS: debm' ins@comcast.net West Wareham, MA 02576 INSURE S AFFORDING COVERAGE NAIC# INSURERA:Atlantic Casualty Insurance Co INSURE INSURERB:Zurich Insurance Mark M Mullin INSURERC: , 7 Connemara Way INSURER D: West Yarmouth, MA 02673 INSURERE, INSURERF: . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE I R VwVn POLICY NUMBER MIDDY MM/DD/YYYY LIMITS A GENERALLIABILIT L117002080 2/26/15 2/26/16 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED C PREMISES occurrence). $ 100,000 CLAIMS-MADE OCCUR , MED EXP(Anyone person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 " GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMITAPPLIES PER PRODUCTS-00 MP/OP AGG $ 1,000,000 POLICY PRO--JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT a accidert) $ ANY AUTO BODILY INJURY(Per person) $ ALLOWl,ED SCHEDULED BODILY INJURY(Per socident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS _AUTOS (Per accident) $ UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 6ZZUB-2E59306-8-14 11/18/14 11/18/15 WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/ExECUTIVE Y/N E.L.EACH ACODENT $ 100,000 OFFICERIMEMBER EXCLUDED? �' N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yyes,desrfibe under DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Sdredule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS..+ AUTHORED REPRESENTATIVE Debra Martin ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: MULLINROOFING@GMAIL.COM Massachusetts -Department of Public Safety Board of Building Regulations and Standards - , 9 , Construction Supervisor . License CS1O4a76' r'r.ti MARK M MULLI$ 7 CONNEMARA WA, ' West Yarmouth MA 3 Expiration Commissioner 09/07/2015 aanleuBis;nogjIm pllen;ON faetaaaasaa�un a. - - - £L9i;6.t/W'H1f1OWbdl M 'tl .Vi M VdVlN3NNOO L QNl018 UNb 0NI=10Oa NniniN 9IIZ0 vw`uo;sog OLIS aamg-sZeld)I»d'01` i� d13d' 9lOZY6£/ u`egeaadx uol;u n$a ssaulsn ulisiie aawnsuo o a�� ` :ad�tl t8ZL3l uol;ea�slo 1 2T fI P, 33Y O.! U10 :oz.uan;aa punoj 3I '.ajtip uoijsaldxa ay;aaojaq aOlovNIN03 1N3W3nOMO, 3W o 4 asuaalZ uoptiln�ag ssau�sng saie3JV aawnsuoO3o aa93O ,fluo asn InplA[pul ao; pllVA uoitgaIS12a,1 �:Y' �.cn�r.�z�ncrmnn�n•2�»rinir�le�r2uncin�h �zi� i MULL EN ROOFING & SIDING INC. CONSTRUCTION.CONTRACT ' This Construction Contract (the "Contract") is made and entered into as of 8-12-15 (Date), by and between Alexandra Somers Lahr (Name, hereinafter called the "Customer") and Mark M. Mullin, DBA Mullin Roofing and Siding, Inc. having its principal office at 7 Connemara Way, W. Yarmouth MA 02673 (hereafter called the "Contractor"). Property Location: 138 Guimquissett Rd. Cotuit, MA In consideration of the mutual promises hereafter set forth and intending to be bound hereby, the parties hereto agree as follows: Contractor's Obligations. Contractor shall complete the following Project herein described in and shall provide supervision necessary to commence and finish the Project expeditiously, in a workmanlike manner, in accordance with the "all applicable codes, laws ordinances, rules, regulations and orders. a Description of"Work". Contractor shall do all the work in accordance with the terms of this Contract, as described: Remove existing roofing shingles from the roof while protecting the home and landscape. Nail down any loose roof decking to ensure a solid roof deck. Remove and replace up to fifty square feet of roof decking included.if necessary. Install new Velux venting skylights on the front of the roof. Install ice and water shield on all eaves, valleys, walls that intersect the roof, around skylights, and around pipes that penetrate the roof. Install Diamond deck roofing underlayment by Certainteed over the remaining roof deck. Install new drip edges on all eave edges. Install Swift start starter shingles over the eave and rake edges. Install new Landmark Pro roofing shingles to factory specifications byfactory•certified installers employed by, and directly supervised by myself. Install new ridge vent over the ridges. Hand nail Shadow Ridge ridge caps by Certainteed on all ridges to complete the roof. After completion of the roof I will register your roof with Certainteed for the four star-Sure start warranty. Remove existing clap boards from all cheek walls, stain new clap boards with stain provided by the homeowner, and install the new clapboards after the roof is completed. 41 Contract sum. In consideration of the performance by Contractor of its duties and obligations, , hereunder, Customer shall payto contractor the sum of '$95,000 Payment schedule: Owner shall pay the contractor 0% of the contract sum upon signing the i} contract,50% upon start of work, and the remaining 50/ upon completion of the contract work. ! Contractor's Responsibility. Contractor is an independent contractor for all Work to be. performed hereunder. The detailed manner and method of doing the Work shall be under the r control of the Contractor.All employees of the Contractor performing Work under this Contract shall be and remain the Contractor's employees. a. The Contractor shall supervise and direct the Work,.using.its best skills. Job Safety. Contractor shall be responsible for initiating, maintaining and supervising all safety precautions in connection with the Work. Permits, Fees and Notices. The Contractor shall secure and pay for all permits and governmental fees, licenses and inspections necessary for the proper execution and completion of the Work. Such permits and licenses shall be the property of the Customer and shall be delivered to the Customer upon request. The Contractor shall give all notices and comply with all applicable codes, laws, ordinances, rules, regulations and orders of any public authority in connection with the performance of the Work and the Contractor's obligations hereunder. Insurance. Contractor acknowledges and agrees that Customer or Owner shall not be , obligated to carry any insurance in connection with the Work for the benefit of the Contractor. {, Contractor's Insurance. Contractor shall at all times maintain and keep in full force and effect, at its expense, any and all insurance coverage which is prudent, necessary'or desirable for the protection of the interests of Contractor. Contractor shall furnish to Customer certificates of L insurance for the following types of insurance. a. Commercial General Liability Insurance; b. Workers' Compensation Insurance to cover full liability under the Workers'. Compensation Laws. r All waste associated with this project will be removed from the property and disposed of properly. f IN WITNESS WHEREOF, the parties hereto have executed.this Contract as of the day-and year first above written. y Custo a Contractor Company By: By: M Print:Alexandra So ers Lahr Mark Mullin, Mullin Roofing & Siding, Inc. 7 Connemara Way, W.Yarmouth MA 02673 508 2218591 w Address: 57 Palfrey st. Watertown, MA 02472 Date: 8-12-15 Date: 8-12-15 Y Phone number: 201-563-4006 License No. CSL# 104076 HIC# 167281, ; Email address: 'Email address: ' r mullinroofing@gmail:com asomers@alum.wellesley.edu 1 . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' f _ f Map Parcel ,,.'�( Application 00/6 60 Health.Division Date Issued Conservation Division Application Fee , Planning Dept. - Permit Fe ' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 12-9���Mq0 S S�e_`" ew Village Owners —Addressf �- Telephone d-77: 7_1 ,!57 3 Permit Request Y MILVIOZ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuapo �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'srghway:=0 Yes ❑ No ,.n.= Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ; Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing _ a new.,,, Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil, ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ 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 Name Telephone Number Address �^ �'1UY�f. License# e Al ' _Q?21 Home Improvement Contractor# 6 V f� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ATE L4 ;Z� ' CJQ 1 FOR OFFICIAL USE ONLY APPLICATION# la f DATE ISSUED r r4 :,,MAP./PARCEL NO. ' ADDRESS VILLAGE OWNER , I DATE OF INSPECTION: ` a FOUNDATION:- ,I FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:fl c , ROUGH FINAL :.FINAL BUILDING 3. .DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents z Office of Investigations d I Congress Street, Suite 100 ,Wy Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): M.T. McMahon and Son, Inc Address: 19 Fieldstone Way City/State/Zip:Plymouth , Ma 02360 Phone#:781-831-1234 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 9 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' Y p tY• 9. ❑ Building addition [No workers' comp. insurance comp. msurance.1 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 I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no Weatherization employees. [No workers' 13.■❑ Other comp. insurance required.] *My 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. lContractors 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:Aim Insurance Policy#or Self-ins. Lic. #:VCW-100-6014109-201 Expiration Date: 12/08/2015 Job Site Address: 138 Guimquissett Ave. City/State/Zip:Cotuit, MA 02635 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: -1�1-CCU Phone#: 7818311234 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CITE(NMIDG'YYYY) ACOad CERTIFICATE OF LIABILITY INSURANCE L 12 9 1.a THIS CERTIIS FICAI"E IS ISSUED AS A MATTER OF INFORMATION ONLY ANDEND OR ALTER T NO IGHTS UPON THE CERTIR HS COVERAGE AF ORDEDAS TE TOE POLICIESCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, lrXT BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT HONSTI UTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERrIFICAT5 ,subject to MPOR A o I the cart cste holder Is an AIDDITIOeNALLIIN5URED;-die pdolrse(meenm A t l statement nIL3 certificate does not cAIIA0rl hffi 40 the the terms Land conditions of the popsy,CarCfi p0 Yrequire certificate holder In Ilau of such endorselnen s. PRODUCER PHn t701) 335-0792 Thompson insurance 7 -1890 and Financial SLarvicss JJTins Camoast:.nst 389 Union street 1N9UR8R(9 A,�PPORDIt COVEFt/►08 — NAIC@ wa_ymouth, xk 02190-319 MT McMahon and Son Inc. INeUREi?f� �E �rri Worldri- -r$n 19 Fieldstone way Insurl �--- Plymouth, MA 02360 1 sAffil — INSUR P; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED 70 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 PERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIDCLCLAIMS. TYPEOPIN®URANCE OU U E MMl N R1n1 I.IMT@ �+ CIeNFRALLIA®ILITV N8S�820248d 9/16/14 9/16/15 EACHOCCURRENCE COMMERCIAL GENERAL LIABILITY 10ggMZ �- E 000' CLAIMS.MADE OCCUR MED (A one aeon rB pER30NAL&AOVINJURY 9 _ ENERAL AGGREGATE 8 0 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-00MP/OPAGO 8 0 POLICY F7 P 77 LOC o A AUTOMOBILE LIABILITY SA 2CS82729 8/81/14 8/31/0 eeeel nt ,- BODILY INJURY(Per person) $ ANY AU10 AUTOS PED x AUT08 LED BODILY INJURY(Par saaldant) S NON OWNED PE i X WIREDAUTOS AUTOS - 9r S UMBRELLA LIAS O(CUR 8031,3LS4OALI xi/2a/1a 11/24/15 EADHOCCURRENC6 @ 11000,000 11011188LIAE CLAIMS-MADE AGGR4°6ATE S 11000,000 ORD $ KMOMPENBATION VWC-100-6014109-201 12/@/14 12/9/15 toBYUM X AND EMPLOYERS'LIABILITY ANY PROP )RMARTNER,/EEXECUTIVE YIN .L. C 500 00 OFFICEWMfiMBER EXCLUOED9 NIA .L 5 0 0Q_ (Msndseoty In NN) gird des ftU ®AEMTIONSbtlE. DISEASE-POLICYIY I 500 O00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101,Addltlonal Remarks Sahodule,If more specs is ri lred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE GE60 1300 POL10198 BE CANCELLED ISSFOiR6 THE EXPIRATION DATE THEREOF, NOTICE WILL BE D)3LIVERED IN BZ�At4K ACCORDANCE WITH TH6 POLICY PROVISIONS. AUTHORIZED REMSS9NTATIVS John a. Thom o oIn m .............. •w�.ww Iw atw,.,nn•w•,�rr •n r9rvrr.r»........, Office oGConsnmer aiiarrs STusioes�'2eguiatiun r - :'?TOME IMPROVEMENT CONTRACTOR : egistration: �161816 Type: Expiration: 11/2412016 Private'Corporatic NNrHAEL T.MCMAHON&SON-INC. MICHAEL MCMAHON - 19`FIELDSTONE WAY PCYMOUTH,MA 02360 Undersecretary ± t Massachusetts -Department of Public Safety Board of 3uitding Regulations and Standards Comtruction Supm i—r Licenser CS-068111 MICHAEL T MC ``•- '•� I I EQ—� IyAHON-- , 19 FIELDSTONE:WAYt PLYMOUTH MAY 02360` " Ex(�iraEivtt Commissioner 08/17/2016 , 1 , .,.1 y y �r .. • a �r t COMMONWEALTH OF MASSACHUSETTS DEBRIS DISPOSAL IN ACCORDANCE WITH THE PROVISIONS OF MGL C40, S54, A CONDITION OF BUILDING PERMIT NUMBER IS THAT THE DEBRIS RESULTING FROM THIS WORK SHALL BE DISPOSED OF IN A PROPERERLY LICENSED SOLID WASTE DISPOSAL FACILITY AS DEFINED BY MGL C 111, S 150A. LOCATION OF FACILITY CONSTRUCTION SITE ADDRESS SIGNATURE OF PERMIT APPLICANT DATE G+6 Federal ID 0 05440b629 I RISE Engineering RI contractor Registration No 8106 MA Contractor Registration No 120M A division of Thlelsch Engineering CT Contractor Registration No 620120 5 Dupont Avenue,South Yarmouth;NIA 02664 CONTRACT 508-568-1926 X-6613 FAX 509-568-11933 R I S E Page AROGRAftit Tm CONTRACT a am um wo 68TTVm am ENGINEERING CLC-RCS ESCI ED a�►oxsRr woaRAs MAW CUSTOM P"M CAM CUEWS we"on" David Lahr (617)275-3299 03/:13/2015 190483 00002 SERVICE 1%TREEr __�-...._....._._ memo BUM 138 Guimquissett Avenue 57 Palfrey Street SERVICE MY.ViAm J�P 9IUJM CRY.aTAMZW .._„,......1 ....�.__....,...�..��--..--- - Cotuit,MA 02635 Watertown,MA 02472 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use ofspecial tools and diagnostic tests to assure that your home will be ieft with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary area for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows am not generally addressed.) (20)working hours. At the completion of the weatherirntion work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the solely of the indoor air quality. St,540.00 ATTIC FLAT:Provide labor and materials to install aV layer of R-31 Class I Cellulose added to.(970)square fat of open attic Space. S 1,280.40 KNEEWALL SLOPE:Provide labor and materials to install R-19 unlaced fiberglass to(315)square fat of wall. Then install I" rigid board insulation. Scal all scams with FSK tape. S 1,234.80 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(245)square fect.of knccwall area. S810.95 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. S42.50 ATTIC ACCESS:Provide labor and materials to install(1) new,finished plywood,knecwall span access hatch.The hatch will be Insulated.wilh code compliant 2 rigid Themtax board,weather-stripped,and held closed by eye hooks. (Wood surfaces will be unfinished. Prime coat and/or paint is not included.) $I20.00 A7MC ACCESS:Provide labor and materials to insulate(1) back of the kttcewal(hatch with 2*rigid lltermar board,and scat the edge of the hatch with weatherstripping. S42.50 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fus(s). $232.20 VENTILATION;Provide tabor and materials to install ventilation chutes in(153)roller bays to maintain air flaw. S533.97 GARAGE CEILING:Provide labor and materials to install 8"R-30 densely packed Class l Cellulose insulation to(528)square feet of garage ceiling located below a heated floor area;by drilling holes in she ceiling from below. Holes drilled will be plugged. Plugs will be spackled and left in arelatively smooth condition.Finish sanding and touch-up priming/painling will be the customer's responsibility. $1,045.44 RISE Engineering will apply all applicable,eligible incentives to this contract You will be billed only the Net amount. Currently, for.eligible measures,the Cope Light Compact offers 75%incentive,not to exceed$4,000 per calendar year,and an incentive of 100%for the Air Scaling measures. Federal ID 0 064406829 I RISE Engineering Ri Contractor Registration No ales MA ContrBotar RegisMon No 120979 A division of Tbietsch Engineering CT Contractor Registration No 620120 5 Dupont Avenue,South Yarmouth.NIA 02664 CONTRACT 508-MB-1926 X-6613 FAX 508-568.1933 t R i S Page 2 PROGRAM C-RCS AM ranTAM C091PAO IS ENTERED We°ETIAM K CL AS E NCIN EERINC OUCRISED BVLOW CUSTOIO'R .�_•.._ PMaN& DATE etJFMA YTORROPDFJt� David Lahr (617)275-3299 03/13/2015 190483 00002 ;mv=anI» .. aaLnLo aTHEHT 138 Guimquissett.Avenue 57 Palfrey Street OMMICs Cm.$TAM ZW ^- 11MANb CITY.STATE.LP l •. Cotuit,MA 02635 Watertown,MA 02472 JOB DESCRIPTION For the safety and health of your homies indoor air quality,we will be conducting R;,blower door diagnostic of the available airflow in your home both before the work is begun,and after the weatherirstion work is complete.We will also conduct a tall assessment of the combustion safety of your heating system and water heater.This has a value of 390 and is at no cost to you. $90.00 i i Total: $6,972.76 Program Incentive: $6,630.00 Customer Total: $1,342.76 WE AGREE NEREtY TO FURNISH SERVICES=COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATION&FOR THE SUM OF ""One Thousand Three Hundred Forty-Two&761100 Dollars $1,342.76 UPON FpNLUOPWM AND APPROVAL aY RME 0660 URM CUSTOMER AORM TO RUM ARiOUNT WE IN FULL B TERIMT of RY WALL OR CHAROED UW MLY ON ANY lalPll�BALANCE APTEII700AYa. FOR afPORrANT PtFORMATIDN ON OUARANTEEO.MOM C P RE MXK 50MADM.AND MOSTRATOK DO NOT SIGN THIS CONTRACT IF THERE AR 1111 PA S 4"'� AUTF"Ma TURF �Fi,SI Y COS ANCIE NOTE 71SS COMI1AACr MAT RR NM OR MI N W uS tP NOT�CUTEO WITHN DATE OF ACCEPTANCE I ACCEPTANCE OF CONTRACT.TIRE ABOVE PAMM,8KCW?QATIM AND CONDITION ARE SATAFACTORY TO US AND Ann RMUM ACCWrTBD.YOU ARB AUTNORID T000 TWO vim DAYS. AS SPECRUD.MUM WaL U MADQ AS OULOWO ARM 1 I RISE Engineering Program Completion 4 CLC-RCS DaA division of Thieiseh Engineering Client# Certificate 5 Dupont Avenue,South Yarmouth,MA 02664 190483 R I S E 508-568-1926 X-6613 FAX 508-568-1933 Work Order tlNCINEEE1Nl: 00002 Page 1 Contractor: 0075 M T McMahon&Sons Contract Date Start Date 4/22/2015 Address: , Primary Contact: David Lahr Phone: Alt.Phone: Auditor Service Address: 138 Guimquissett Avenue Patrick Golarz Cotuit,MA 02635 Home Phone: (617)275-3299 Work Phone: Cell Phone: FAX: Start CFM50 End CFM50 BAS CFM50 Worst Case Depressurization pascals CAZ Limit pascals Spillage: Yes or No Draft Failure: Yes or No CO Levels: Pass or Fail The following areas were sealed,as directed by RISE'Engineering: Attics Kneewalls _Attic Hatch _Kneewall Hatch _Attie Ducts Dropped Soffit _Top Plates _Chimney Chase _Plumbing Gaps _Wiring Gaps. Basement Crawlspace Sill Plates =Open Bottom Plates _Plumbing Gaps _Wiring Gaps Duct Register Gaps Basement Door Door Weatherstripping e Door Sweeps Ducts Joist Transitions Exterior Areas Sealed: Other Areas-Sealed:. RISE Engineering. Program Completion ` CLC-RCS :�AA division of Thiclsch Engineering Client# Certificate 5 Dupont Avenue,South Yarmouth,MA 02664 190483 R I S E Work Order 6NCIi16glINC 508-568-1926 X-6613 FAX 508-568-1933 00002 Page 2 AIR SEALING:Perform(20)working-hours of air sealing.To include(check one): Final Blower Door Test Combustion Safety Test _X_Combustion Safety&Blower Door Test 8 HOURS ATTIC FLAT, I HOURS KNEEWALL TRANS.(OUTER,INNER OVER GARAGE), 1 HR BSMT SILL ATTIC FLAT:Install a 9"layer of R-31 Class I Cellulose added to(970)square feet of open attic space. KNEEWALL SLOPE:Install R-19 unfaced fiberglass to 315 square feet of wall. Then install 1"rigid board'insulation that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all seams with FSK tape. KNEEWALLS: Install 2"FSK faced-semi-rigid fiberglass board insulation to(245)square feet of kneewall area. Tape all seams and edges with FSK tape. ATTIC ACCESS: Insulate(1)attic hatch(es)by installing 2"Thermax board.Weatherstrip the perimeter. ATTIC ACCESS: Install(1) new,finished plywood,kneewall space access hatch: The hatch will be insulated with.2"Thermax,weatherstripped and held closed by eye hooks. See sketch for installation location and any further instruction. (Wood surfaces will be unfinished. Prime coat and/or paint is not included.) IN MASTER CLOSET ATTIC ACCESS: Insulate and seal(1)kneewall hatch(es)by installing 2"rigid Thermax board. VENTILATION: Install [21 insulated hose(s)and roof mounted vent(s)to exhaust existing bathroom fan (s). Each hose must be securely fastened at both ends with zip ties and screws. The outer vapor barrier must be sealed at both ends with quality air barrier tape so the fiberglass is not exposed. NOT DUCT TAPE. VENTILATION: Install ventilation chutes in(153)rafter bays to maintain air flow. GARAGE CEILING:Install 8"R-30 densely packed Class I Cellulose insulation to 528 square feet of plaster ceiling located below a heated floor area,by drilling holes in the ceiling from below. Holes drilled will be plugged. Plugs will be spackled and left in a relatively smooth.condition. Finish sanding and touch-up priming/painting will be the customer's responsibility. I confirm that the measures listed above have been completed to my satisfaction.l have received a copy of the Certificate of Completion and hereby authorize the release of any final payments to the Contractor.1 understand that this Authorization of Completed Work does not in any manner void any warranties provided to me by the Contractor. Inspector's Signature Customer Signature DATE DATE 4/23/2015 3:41:36 PM a Town of Barnstable Regulatory Services ' ° = Richard V.Sc4 Director aws Building Division Tom Perry,$uUdk g Commissioner 200 Maio Street,Hyannis,UA 02601 w ww.town barmtable.ma.us Officc: 508-9624038 lax: 508-79M230 Property Owner Must Completc and Sign This Scction If Using A Builder --,as Omer of the subject prolxrry hereby authorim r/Q jM( W J 4- �Rn A)S to act on vW behalf, in all matters relative to work authorized by this building permit application for. G VI-AA gg���(5 _!�U , � C) V+ Qz63��- (Addnslf job) �r "*Pool fences and alarms are the responsibility of the applicant.P<x3lc are not to be Sled or uti zed before fence is installed and all f ul-d inspections perfcltated anti accepted. mature of Owner Sipature of Applicant �0.U't� �r V4�✓' - Print Name Print Name Date Q FORMS O%?TRPFm'AIS5}DNmLS i t i. COMBUSTION SAFETY PROTOCOL CLIENT Lm%I, CLIENT# 190 � PRE-TESTER DO�n/t 2��� DATE -13-IS START 37�' CFM50 R I'S E si+ciaeeirNc BARRIER TO BLOWER DOOR: BASEMENT DOOR CLOSED: > Asbestos Wood Stove Pellet Stove Other: CFM50 PRE-TEST: _ A5 _FAIL 1 Zero CO meter outdoors.CO detector present in home:1 NO FINAL CFM50 2 AMBIENT CO PAE POST Living Areas Kitchen CAZ 1 CAZ 2 3 COMBUSTION EQUIPMENT Boiler Furnace H2O Heater Fireplace oodstove Other Comment if any are in poor condition: PRIMARY HEAT FUEL: OIL GAS PROPANE ELECTRIC OTHER DHW FUEL: OIL GAS PROPANE E ECTRIC OTHER 4 QUANTITY OF VARIOUS EXHAUST EQUIPMENT: Air Handler(Heat and/or AC) "" Central Vacuum IGtchen Exhaust s Whole House Fan Bathroom Exhaust ' Attic-Exhaust Fan Clothes Dryer Other 5 PERFORM WORST CASE DEPRESSURIZATION TESTS: (Set up house to"winter"conditions,all combustion appliances off:) PRE POST Record Baseline Pressure: All exhaust equipment ON-adjust doors as needed: Air Handler AND all exhaust ON-adjust doors as needed: -- Air Handler ON only-adjust doors as needed: Record the actual WORST CASE depressurization number: (Adjusting the highest pressure difference by the Baseline Pressure). CAZ Depressurization Limits(you must circle the proper.11 1 Venting Condition Limit Pascals Orphan natural draft water heater(including chimneys on extenorwell). -2 Natural draft boiler or furnace commonly vented with DHW -3 Natural draft boiler or furnace with vent damper commonly vented with DHW -5 Individual natural draft boiler,furnace or Individual water heater with a properly sized vent stack such as when a new chimney,lining has been Installed. Mechanically assisted draft boiler or furnace commonly vented.with DHW -5 t; Mechanically assisted boiler or furnace alone,or fen-assisted DHW alone -15 Chimney-top draft inducer(Exhausto-type or equivalent);: High static pressure flame retention head oil burner, -50 Direct-vented appliances/r Sealed combustion appliances,. 6 PERFORM SPILLAGE TESTS(Performed with CAZ in Worst Case for Depressurization) Monitor ambient CO in the zone throughout the test If two combustion appliances are vented together,start wit smaller appliance.. Is there evidence of Flame Rollout? YES y if s'NO work until corrected. Does the flame distort when the Air Handler fan starts? YES WO If YES the heat exchanger is cracked and the system must be laced before weatherization work. F' r 4 Under Worst Case,after 60 secoms operation,check for SPILLAGE: / PRE-TEST SPILLAGE POST-TEST SPILLAGE Smal a pliance Larger Ap ianos Smaller Appliance Larger Appliance YE NO YES NO YES NO YES NO If SPILLAGE occurs with Worst Case,repeat under Natural Conditions: After 60 seconds of operation under natural conditions Is there any spillage? Pre-Test YES NO Post-Test YES NO 7 DRAFT TESTS PRE-WORK POST-WORK DRAFT PAS /FAIL DRAFT PASS/FAIL Heating System 2nd Heating System Water Healer Other PRE POST _ Record lhe.approximate outside temperature: �� , Acceptable Draft Test Ranges EFFICIENCY Outside Temp(degrees F) Minimum Draft Pressure(Pa)' Q a -2.6 10.9 (Outside Temp 140)-2.76 >90 -0.6 DRAFT LIMITS PRE-TEST ^a� POST-TEST 8 CARBON MONOXIDE TESTS Measure the undiluted flue gases and the ambient air in the zone(s). PRE-WORK POST-WORK Undiluted Flue Ambient CO Undiluted Flue. Ambient:CO Gas CO in tbo zone. Gas CO in the zone Heating System 191 F r 2nd Heating System. Water Heater Gas Oven Gas Stove Top Other CO CONCERN: If ambient reaches 35 ppm cease tests,open windows,Inform HO and evacuate until dear.If the CO in any appliance is measured greater than 100,or if ambient CO in the home exceeds 35 ppm then appliance clean-and tune must be in the scope of work. Combustion Safety Test Action Levels CO Tes exult Spillage and.Draft And/Or Tes Its RETROFIT ACTION 0-2fi ppm .And asses Proceed'with work 26.100 ppm And Passes Recommend that the CO problem be fixed Fails at worst case 26.100 ppm And only Recommend a;service call for the appliance and/or repairs to the home to correct the,problem 100-400 ppm Or Falls under natural STOP WORK:Work may not proceed until the system is serviced and problem is corrected conditions >400 ppm. And Passes STOP WORK:Work may not proceed until the system Is serviced and problem is corrected l >400 ppm And Fails under EMERGENCY Shut off fuel to the appliance,homeowner should.call for service immediately any condition -CO measurements for undiluted fluer gases at steady state 9 CONCLUSIONS Circle the appropriate results and retrofit actions on the Client Form. Discuss health and safety problems,concerns,recommendations and'resolutions. Obtain client signature and leave a copy with the client. IMPORTANT PR _POST It Return hot water lank to normal settings •Turn fuel switch on. -Make sure heating system is on/operating. Oct-14 a 3 I 1 CLIENT.NAME: LAHR FILE# 190483 RISE BUILDING AIRFLOW STANDARD FNLINCERWG Please enter the information as requested to describe the house and your measurements. What is the type of Heating System? E=Electric G=Gas O H= Heat pump P= Propane 0=Oil W=Wood GT= Geothermal heat pump K= Kerosene Is the house Air Condioned? Y=_Yes N=No N How many stories is the House? 1, 1:5, 2, 2.5, or 3 2 Enter the dimensions: House Length House Width. Average height per story This is the estimated volume of the house 0 cu.ft. OR...If there are additions or other reasons why the actual volume is different, calculate the total correct volume by hand and enter here: 38736 cu.ft. What is the actual number of occupants? 2 What is the total number of bedrooms in this house? 4 Calculated LBL"N"factor 1`4,985 What was the Blower Door Measured CFM50? 3789 CFM50 Present ACH 0.39 The Building Airtightness Standard for this house is "E �� CFM50 This BAS number cannot be decreased,but can be increased:based on auditor's observations of household conditions, and to ensure that combustion safety house depressurization limits are not exceeded. New ACH 0.35 flat any,time the final blower,door reading is below fhe SAS you,must take one of these actions:You must recommend:ventilation capable of continuous operation if the reading is above That ventilation must be capable of supplying to the living spaces up to r"" bZ5 c m of fresh air. If you are performing shell measures, you must install ventilation capable of continuous operation if the reading is at or below: 236 CFM50 That ventilation must be capable of supplying to the living spaces: ilCTM OT freshair. Customer#:_190483 Housing Type: CAPE/CONTEMP Siding: CS Roof: asphalt brown Condition: Good Vents: gable—vented drip edge Imo--- 26' f n 'l0'- H r --22 "—'I I 14'__� 14' (Garage Under) 24' i 30. (Garage Under) 20 HOURS AIR SEALING—8 HOURS ATTIC FLAT, 11 HOURS KNEEWALL TRANS(OUTER, INNER OVER GARAGE), 1 HR BSMT SILL 9" CELLULOSE—970'ATTIC FLAT 2" RIG F/G—245' COMMON WALL+ KNEEWALL OVER GARAGE R-19+2" RIG—315" KNEEWALL SLOPE+CHEEKS INSULATE AND SEAL ATTIC HATCH ®INSULATE AND SEAL KNEEWALL HATCH ..INSTALL FINISHED KNEEWALL HATCH (IN MASTER CLOSET) (153) PROP—A—.VENTS VENT(2) BATHROOM EXHAUST FANS THROUGH ROOF(BROWN) 8" DENSE CELLULOSE—528'GARAGE CEILING:(NOTE 10' CEILING) ti �.- !' �Y ` ` 1 _ ` _ -h��'KQ.N.iz wf� __ '��, �� t f '` 4 �� 1 � y � :�� ,, "'� ' ^� �1 �r •� �`, •� ,� r,.Ji _ �� {i � �1 \\� 1 � � � � �� • .� : ' r Page'I of'I 20-15-04-30 17:33:33(GMT) 17742839,906 From: M.T. McMahon&Son b E k ;I� 1 ' - 3 7 :;,;�i:;�::t:.azz"."•� :.�='.r,„,,,x;..•-:; ._�-� I I ''� � �. n.� ���c`G't''�ztttrlcxrr�arr��v�'��xtaror�v�;��r Maio iv ¢+ ° 11 G+3icc�P C�timar ess ryaaa. Licensor� �> .� �'Sara � atiDZ- a �Yl3:.r�L� ""'' i'���t�i'�459 � g�l.�b`�$YL�Ci� . 4�1818 T p0' ae apt ' ' oip *9iclti °�IQA�4&i�`�"�',�� ti]' I • � �`, ; lr�iv�{f3~GI. ..........d��+i�: 6 I`J-'!_XA 3010MFf - i cLVr,+IIL?kJTr'f.tJt,406E1: e7dsa3ers �r,Y : Ell Z r i 1 • � �y �-,y�y'�•�, w',,.,� ...✓t c +w` .s�i.`-•L<a..✓:»u4i e.e:nt ar¢�•w.s tzar 35, s � cw� 3 . x At f L .lS J12w'�11.�VMS �AY'lRZ Y •�''r i �, y �t�aC nq'YP OP ii'a liAd E �i'di35Gk•1:I „�j •.�..n�' .Y2':5S Z�" ;e,tv #'..�, •-i . are .. ftsrrgnc�s3cn sa 4 Ira �t3uR�tin�Caaf�"i6 r�. ." - apS�j��tt>�iatarr•�ar�,sib wvruav�ss,+�a.l�S i,i � -- --- s 1 1 . � 9 c a •'.I 4'� 1 S ;' ' r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 01 9 Nzak, Parcel 11'0 O Permit# Health Division Date Issued, Conservation Division Feed Tax Collector h Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis nR Project Street Address Village c7 ' Owner 5L�si4- PLICA MO ct� Address Telephone Permit Request tZVZ.00P c3-Y6E F_-K .-�� Le3� i=2o1-, - 4:hcZ 69 t"{A-csoo� B�t�t l 2 its 2Acz+"1�(2S- 22 WA" Ar°�A 3 r.�° �ao� �mac' �. . %&AA4.+& "AtA_- f:A+Y152 of Square feet: 1st floor:existing i 45o proposed 2nd floor: existing i&� proposed Total new Estimated Project Cost eo Zoning District Flood Plain Groundwater Overlay Construction Type lI re4+46 Lot Size Grandfathered: ❑Yes --Mo If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure e 2 V ON. Historic House: ❑Yes ANo On Old King's Highway: ❑Yes ail No Basement Type: $l Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) /.co Basement Unfinished Area(sq.ft) o� Number of Baths: Full: existing 2 new Half: existing — new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing �4 new First Floor Room Count 4- Heat Type and Fuel: ❑Gas N Oil ❑Electric ❑Other Central Air: ❑Yes t§No Fireplaces: Existing .► New Existing wood/coal stove: ❑Yes 29 No Detached garage:Cl existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size Attached garage:)A existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes A No . If yes, site plan review# Current Use gas,DS11kc-E Proposed Use _ BUILDER INFORMATION Name_ Affi7ic Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY = E PERMIT NO. DATE ISSUED n i - MAP/PARCEL NO. ADDRESS z:. VILLAGE + OWNER DATE OF INSPECTIOI`T: : FOUNDATION FRAME T INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL �• PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. i • (ti a commonweaun he Department of Industrial Accidents ,� =-= _ Office of/aseS9021fons A. 600 Washington Street =- 1 Boston,Mass. 02111 Workers''Compensation Insurance davit name: P,e.� location cl c Ae ;d Ca au+;,Pir Awl city G: '�,�' t {' phone f S-06^ 4Za-0112 ® I am a homeowner performing all work myself. ❑ I am a sole Proprietor and have no one worlds in any capacity , am an em 1 roviding workers' :. com any naiue.. address. . cites :::>ohane•#' ;. X. insurance co. :..< plies►#.. ;::::<.;�:::>:< ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who havthe e 114� following workers.' compensation PPolices: - :: ccoinany name: > :.: ::•:::: : ::::::... . ........ ..:.:,..... ' :ii:iJ.�.�v:iii:;:.{:':':•..:.....:v:n':v::{:{Si•i:i:�{iii:if::^::::.:.•�::::.. :: i(:'i'iiti?:::':` '!:iii:ti:::iivv'+':f.:i:i:::':iiiv:}:{4titi??tiviti:'iiii::::�:'::::'••. ::; ...........:..... .... . ::: >:: :::>:; ci r :•.{•.,{ . •:.:::vtii::::v:-is}:?{{'i:i}:?"':ii;-i:•:;:$..:': j;::;::iijiiii{i:iY:'i {::f:i:{?:::i!X:}ii•isi;::j•:{:.:ry�::niX:{::n.�-w:::::::::::::::::•.................. c any name: address: .. ...... ..... ........ ... :v::.�::n:n�:::::w::. :..- i':�:{;:j{_1-?:i^::ii:4:{:4ii:<•i:•i:'::{::i`iiY{{•iiii:.�::i::i?{{iti}:{L!•i:?{^i':•ii:^: ::::::::.:::::.:...........:::.:..�:.:.::::::•::::...::::.:..::.:{:,,.; hone:#. ....:.. :.:.. city.... _- ..... ...... ......... ............ .. ..... ..................... ..........Mamie :?:{v::::i}i:{fi::•n.......:•:.�:..n................ .' n:_.:�::::.:}i::•::•...}.teoiiev#Failure to secure coverage as required'order f MGL 152 can lead to the n of erhniaai peaatieof a ane up to siS0o0o and/or one years'imprisonment as well as civil penslm of a STOP WORK ORDER and a Sae of 5100.00 a against me. I m�derstand that a copy of this statement may be forwarded to thvestigations of the DIA for coverage verification. I do hereby certify, th pains and n • gpe4ury th the information provided above is&w and coned Signature Date Print name Phone# ofncbl use only do not write in this area to be completed by city or town offlcisl city or town: perndUUcense# • OBnading Department Ojicensing Board ❑check if immediate response is required OSelectmen's Offle e OHealth Department contact person: phone#; OOther---,--_ ([ensca 9195 PIA) oFTMe ram,_ . The Tow_ n of Barnstable KA ¢0 Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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: e—*&OT- e+v�s¢. Z-�s'�d� s�•;e;. s. Estimated Cost 900.0 Address of Work: 13 !K (-:�v t U I �S r �� � U1+ Owner's Name: ��c �gv-dl f U5g n ? l e^ -e— Date of Application:_ 2®_ I hereby certify that: Registration is not required for the following reason(s): Work excluded by law J34ob Under$1,000 Building not owner-occupied pOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. DateOwner's Name q:forms:Affidav i Building Division aMMSTAW.M ' 367 Main Street,Hyannis MA 02601 9 MASS. �* t619• Office: 508-862-4038 Ralph Crosser, Fax: 508-790-6230 Building Cumr.:izs_ HO\IEOWNER LICENSE EXEMPTION Please Print DATE: 4— 2oa� JOB LOCATION: S&r!56e - Aig .raOTL ►r number street village "HOMEOWNER": R A name home phone# work phone# CURRENT MAILING ADDRESS: 4W l393 Qcsi city/town state up 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 BuiIding 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 BuiIding 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 prooccee 'es,d require nts. 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 to amend and adopt such a form/cer ification for use in your community. Q:FORMS:EXEMM'N ` Asset', ,n p and lot number ..................//..... SEPTIC SYSTEM MUST B �OFTHEt��y Sewage Permit. number ....... .... C� .,,..,.T% ... < INSTALLED IN CO�IIPLIAN o� WITH.- - TITLE 5 /.3 F ENVIRONMENTAL CODE A = BASHSTADLE, 4 TOWN REGULATIONS M aY ''�o House num r ...:... ................. TOWN OF BARNSTABLE BUILDING INSPECTOR :��7 APPLICATION FOR PERMIT TO C°�.�!� :'7(Z C�l 0 \' Y".�..I.................. .............. TYPEOF CONSTRUCTION ............ ..........-JW1!AA TE............................................................................ a... ..........................191S. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. ✓iJ.�.. at..........: 1'�1'�'�C u 1SS.4. ..:... •`1.............. �itl%A................hA.. ...�.�?3S`.�............. ProposedUse ..Sw.ck.....ii : !1`.WT. ........................................................................................ ................................. ZoningDistrict ............U.......................................................Fire District ......... .............................................. Name of Owner ...�k�.....U�XR......................................Address ...1 .. q� .......clomu.f..j..................................... Name of Builder 7) YF.t .. .....P-.y............................Address ..... ........ .......................... Name.of Architect ..................................................................Address ..............�.................................................................... Number of Rooms .Foundation ....�.lr1 ...................CmwcF� Exterior ... t1...... .....sll(l /2 :� ` .................................................. ....... ...................................Roofing ... ....'f�. .. ....�............ Floors C4 �.......................................................................Interior .....SIA.I�vv '- Heating .....Q K .............................�..:..Plumbing ...... ........................................ xFireplace ........ ........................................................................Approximate Cost .... ......................................... Definitive Plan Approved by Planning Board ---------------_---------------19________. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH _v 4 s • OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... .............. ....... 41-if • 1 Cons ruction Supervisor's License LOCKE, AMY J-0 5 2 5 Two Story No ................. Permit for ..........................1........ 1,4., Single Family Dwelling .................a...................................... . . ............ .. . 7- Lot#21 , J-S Road Location ............................................. Cotuit 138 Gw MCfUIS5C--+-F-Rd ...................................................................... Owner ......AmV..Loke .... ........c.......................................... Tx Type,of Construction .........Frame......................... ....... ................................................................................ Plot ............................ Lot ................................ March 18 06 7 'Permit Granted .............................. .........19 Date of Inspection ....................................19 Date Completed ......;07nr7. ON ti owl 31 co 60 0 u A. . Assessor's map and lot number ....... .. ."'.....�.................... -=-- - _ Pao � E Sewage Permit number ....... ....., ��6.......T/ti'... 1 e Z BBHBSTADLE. i House number, ...... ./ .......................................... so rose ° 0639.Or��� `i YPY TOWN OF BARNSTABLE BUILDING-- INSPECTOR APPLICATION FOR PERMIT TO �.,VI �T CZ�-t tl Oh TYPEOF CONSTRUCTION. ............ ........ .......................................... .............................. . ... .�........................19 .5. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...........� U1�G�i� is�. �.......�2\).............. . ................ !Ya....... ..35.................. ProposedUse ...::?..���.! ..... :..1,(, !1�.��` ....................................................................................... .................................... Zoning District ............��........................................................Fire District ......... .............................................. Name of Owner ...a'l.G"1 �OC��,,......................................Address � �` Name of Builder :) ! ...'2.. JP,.2!!tf? ............................Address Q hl� �'oa(a �...1. Nameof Architect ..................................................................Address ...................................................................................... Number of/Rooms ..............�.�........I.....................................Foundation ........./.'.�:...................... ..........�........ Exterior�(�i !� .. !!......�.....�. i fF1' I2 Roofing ...r. �rtf Floors C4.... .0.-- I. �� kr ^ �CC,L_ ..................... .............................................Interior ......-:.........l.......'�...................................................... Heating .....�. . ...................................................................Plumbing .. Fireplace ` ..Approximate. Cost ....�. .� � Definitive Plan Approved by Planning Board ________________________________19________. Area .... i ....11.. ................. Diagram of Lot and Building with Dimensions Fee ��V..�" SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 r• h � a 1 � jjttr . d, OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... Cons ruction Supervisor's License LOCKE, AMY A=19-160 r.� No 3 0 5 2 5 Permit for , rwo S torY.......... Single Fami.ly _Dwelling. C Locationl'.gt...#2.1.r..................... .. act Cotuit ............................................................................... Owner ...... Amy Locke .........................:..................... Type of Construction Frame ................................................................................ Plot ............................ Lot ................................ Permit Granted ......March ............19 87 Date of Inspection ....................................19 Date Completed ......................................19 t. a 1 w .A, y;.:�;w;,<...,.,i.,,,i•,�e..;. ,.. qe;. r.�- ,. �.:yh:.wd:c-^^.».�inr ,nJ' "."MF!awt '"t it�'1��t'�"RaY"'."'.'�'A"""'�_s°.�S'Ni'r .'..++"'^*3A."`w�p.. w. . THE>o TOWN OF BARNSTABLE Permit No. . ,30525 BUILDING DEPARTMENT aaaan TOWN OFFICE BUILDING Cash ................ aML "anent" HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to AMY LOCKE Address lot #21 138 Guimquisset Road, Cotuit 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 5 = 89.......... ...........4. ' Building Inspector THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IM ^� , C DATA TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING PERMIT ERM1T gPPL -ANT ` DATE- - 19 " -PERMIT A D D R E S S PERMIT T ($T If C T I -•-y-�x.�-�C?r 1, ICON TR'$ LICE NSEI _. (TYPE Of IMPROVEMENT')' STORY _ '': - NUMBER OF 1 "0.'.;. -' -'_'�`-"_`-`--'--=•"� f DWELLING UNITS 11 PROPOSED"'L'SE1 AT (LOCATION) (NO.) L..._�'i ZONING (STREET) r--- DISTR ICT_PT-' BETWEEN (CROSS STREET) ' AND — --- SUBDIVISION (CROSS ----`-- LOT----_-BLOCK LOT . -------SIZE BUILDING 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 REMARKS: AREA OR - + ono VOLUME '...) ,.... (CUeIC $0 U4RE EEETI -- ESTIh1AT MATED COST ).L�l.,i y `)!,J,11 , QI1 FEEMIT 120. 50 OWNER ADDRESS BUILDING DEPT. r„\ By I ;r r k'OFI'T'Ht'U E H'AR I ME N I Uh HUHLIL WORKS. (FI I;' 'Y OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. SUANLt OF THIS HF P.M17 DOE$ NOT'RELEASE THE APP'EICAN'Tf-'R�(a"'I"(�`�"C OFf1SIYIONS- MINIMUM OF THREE CALL '---- INSPECTIONS REQUIRED FOR APF%ROV ED P ALL CONSTRUCTION WORK; LANS MUST BE RETAINED ON JOB AND THIS WHERE AppLICgB'LE SEPARATE CARD KEP'� DOTED UN'iIL FINAL INSPECTION HAS BEEN E REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE. WH :RP_' A CERTIFICATE OF" PERMITS ARE 2. PRIOR TO COVFRI.NG SS RE TRUCTURAL ELECTRICAL, PLUMBING MEMBERSIRE ADY TO LATH). QUIRED,SU 'I BUILDING SHALL NOT BECOCCUP N CED NCY IUNTTIL S RE- MECHANICAL INSTALgTIONS,AND 3. FINAL INSPECTION BEFORE FINAL INS1= :_!_? OCCUPANCY, - ION HAS BEEN MADE. COST THIS CARD 5® IT IS VISIBLE FROM STREET _ BUILDING INSPECTION APPROVALS - PLO)-ABING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVAL 2 --- --- �' �I O to ��.Q�• 2 v ) j 4 i i I Hb1TING INRPLCI"TUN APPIiOV/,,.. + ENGINEERING DEPARTMENT ct UTHEf? � BOARD OF I'?EAI�I H vbDui SH 1!.L NOT PROCi El)VNTIL I He IP tiPl•;; °E R,�!I T itiR HAS APPROVtD THE V•NI?It)UUS T (I_�; t LL COME NULL AND V —` (.UNsil+Ucnl)N WORK IS '.,)F;, ;RTED WITHIN VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE PERMIT IN SIX MONTHS OF GATE THE ARRAN(;FD FOR BY TELEPHONE OR WRITTEN ISS`LEL AS NOTED nRUvE, . • `'� NOTIFICATION. e t , a i yQ& 0 ^ 0 .r R ,4at 26,000 5.F, L b SO E/c✓= s e t9 s h •• .. •-_- .- N , . . . . ..... .. . . • .. .... � � � '... TOE. ' 30 ­ 31 ••T : O /GL•�S 0 4Z •+ I .'CF-R- I: pY • T•HATTHE�- AE3OV'E '`F' 0 U N 0 A 71 O 1�OES NOT L_ = E7 W I T IN 7HF F- L_ OD Z:Q NE . TOW Nd: co rui T SGA1.E 1"-4a' DATE 9 /0 8S R E F, PL B 1C 165 PG 91 Of FOUNDATION LOCATto1.1 I CERTIFY THAT'INE ABOv6 FOUNDATION IS LOCATED ON THE s� PAUL G� ' GROUND AS SHOWN AND THAr IT' DOES tLOT COMFo" TO THE TOMM'S c' ' MERITHEW SETBACk MrGULATIONS AND,ALSO THAT THLS LOCATION WAS yo No. 32091 'FERs°ORMED I14 -ACCORDANCE: W%TH THE TECHNICAL STANDARDS AS' ' �,r �fCIS1Ea� � AVOMED 9Y 'THE MA S5{ACHUSETTS'ASS0C-IATION OF LAND SURVEYORS �oM� tpK�S ' hQ AND CIVIL•,ENGINEERS,, .. . ... , •. .. . .- •• .••. . �(� �