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0077 HIGHLAND AVENUE (2)
17 � � r I i t I ti s j I 312 5�13 ' I Cape Save Inc. T01% ' 0`, A � 7-D Huntington Avenue 14-63 A South Yarmouth, MA 0-06;4R 22 p , ; Tel: 508-398-0398 Fax: $08-398-0399 DIVISnrjjAj! 4/17/12 Town of Barnstable Thomas Perry CBO ; Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 77 Highland Avenue,Cotuit has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-19 cellulose & R-11 cellulose in enclosed cavity' All work performed meets or exceeds Federal and State Requirements." Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION lot Map Parcel 050 Application # Health Division 'Date Issued Conservation Division Application Fee �L Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address . 7� j 4Wa(%d vet,. _ Village C6+VL,1+ Owner �1e&.m.a r 'DerO S0., Address S 06M ei Telephone 5 . -- u 8. - 34 9 Permit Request C81 1 u,1 o5f, +O +he- cel V 1 ria A 1 �' 9 GCkkkost _`t'0 Aesi 11c . P+dd R-a o ��Il 101e -t-e +1►G knJe ewa l l s l oaas. R.r Sp k k " 6_ basexnan+ �► &AJ'r. Plana u►1�� Lxn >nd�--lrea_0 Square feet: 1 st floor: existing proposed Ind floor: existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation i 4 0 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family )q Two Family ❑ Multi-Family (# units)_ Age of Existing Structure 19 5 41, Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft..) _ Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing _ new Number of Bedrooms: _. existing _new Total Room Count (not including baths): existing new First Floor Boom Count Heat Type and Fuel: t Gas ❑ Oil ❑ Electric ❑ Other M , Central Air: ❑Yes QdNo Fireplaces: Existing_ New Existing wood/:coal stool: ❑Xas ❑ No Detached garage: ❑ existing ❑ new size__Pool: ❑ existing ❑ new size _ Barn: ❑ existing ® newt size_ Attached garage: ❑ existing Ll new size _Shed: ❑ existing ❑ new size _ Other: l E5 ,a rn Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes A No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - - (BUILDER OR HOMEOWNER) Name Willi �� v Telephone Number 50% -3 7 0 ` D3 1 Address �V+Ind,+Orl Na- License# cSnW-N, 1 im, y�,-�T�Pr o�.66u Home Improvement Contractor# _ Worker's Compensation # 7W C A f M ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ymow'I'�► SIGNATURE DATE A+ FOR OFFICIAL USE ONLY ' APPLICATION# 'C^ '^,DATE ISSUED =. s a "MAP/PARCEL NO. pp ADDRESS VILLAGE E, OWNER s, DATE OF INSPECTION: c . h FOUNDATION,i' ±""_' E FRAME F' ' z'INSULATION:1. ''T '.. E FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL R f GAS: -r. ROUGH FINAL F ,�F.INAL BUILDING `jk= ;, t A DATE CLOSED OUT ASSOCIATION PLAN NO. t z The Commonwealth of Massachusetts , _ Department of Industrial Accidents } `r* Office of Investigations 600 Washington Street Boston,MA 02111 www m ass gov/dia, Workers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers Auulkant Information Please Print`Legibly. Name(Business/organization,&dividuai): M 1 4 A E-i i I S ie e t Address-, 1t r4GrM%1 ; City/State/Zip: _ Ai2MoLA . l 'l 67,U one#s 3 g' S Are you an employer?Check the,appropriate box Type of project(required): 1.M lam w.a a employer er will) ]:3 4• I am: -_general,contractor and 1. P y 6. ❑New construction ` employees(full and/or part=time).* have hired the sub-contractors 2.❑ I ani a sole proprietor or part lcr- listed.oil the attached-shcet. 7. M.Remodding ship and have no employees F Tliesc sub-contractors-have g; []Demolition.: working for in.an capacity. employees and have workers' y P ty 9. Building addition [No workers' cotiip..insurance comp:insurances required.] 5. ❑ We arc.a corporation and its 10❑SElectrical repairs or additions: 3.Q:1 am a homeowner doing all work officers:have exercised their 6•Q Plumbing repairs or additions myself. No workers' comp. righvof exemption per MGL y [ p 12.Q Roof repairs z insurance required-]¢ e. 152, l(4),,and we have no employees.[No workers' 1.3.®;OuterS 11atA d:M comp.insurance required.] *Any applicant that checks box#11 must also fiU. out the section below showing_their workers'compensation;policy information. ' t Homeowners who submit this.atridavit 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 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 for my employees. Below is thepolicy and job site information. Insurance.Company Name: I - n ( m �.o M o Policy.#-or Se!f-ins':Luc,#: W C- 3 9 } l '1'd� Expiration Date;_ I 0 l a 1 a 01 Job Site Address:. °��,1 k ItAn Ave - city State/Zip: -coi I Attach a'copy ofthe:workers'-compensation policy declaration;page(showing:the policy Jot ei 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 mi ipiisonment,as well as civitpenalties m.thelorm 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 ceruf y under the pains and gen aloes o erjuty that the information provided above is true and correct Signature: r 4 Date: 3 Phone r _ . 1& �. 0fficial:use onlp,>Do not►erne in this urea,to:be completed by city or town official. } ' City.or Town:. Permit/Lieense# Issuing Authority(circle one): 1.:Board of Health.2.,Budding-Department I City/Town Clerk 4.;Electrical Inspect6i 5.Tlumbing Inspector' 6:Other -Contact Person.:_ phone*#: ' ® DATE(MMIDONYYY) AC40MEN CERTIFICATE OF LIABILITY INSURANCE 10/20/2011 THI;/CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CT Shannon Sperrazza i Risk Strategies Company - PHONE . (781)986-4400 1 FAXNok(781)963-6420 15 Pacella Park Drive ADDRES •ssperrazza@risk-stritegies.com Suite 240 INSURERS AFFORDING COVERAGE NAIC a Randolph MA 02368 INSURER A'.Selective Insurance INSURED INSURERB:Safety Insurance Company 33618 Michael McCluskey, DBA: Cape Save INSURER C-TechnologyInsurance Company 7 C Huntington Ave INSURER D: - -1- INSURER E: South Yarmouth MA 02 644 1 INSURER F:" COVERAGES CERTIFICATE NUMBER:CLI1102041451 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. INS DDLSUBR POLICY EFF POLICY EX LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED X COMMERCIAL GENERAL LIABILITY PREMISES TO occurrence) $ 100,000 A CLAIMS-MADE �OCCUR PPS1994480 •. 0/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 _ GENERAL AGGREGATE $ - 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 PRO- LOC $ 7X POLICY AUTOMOBILE LIABILITY COMINED ent) GL LIMIT $ 1 OOO ODO B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED - 6208200 1/6/2011 1/6/2012 .BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per dent X Underinsured motorist BI s lit $100000 300000 X UMBRELLA LIAB X OCCUR PPS1994480 0/16/2011 0/16/2012 EACH OCCURRENCE S 1,000,000 EXCESS LIAS CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ - I $ C WORKERS COMPENSATION Executive excluded X WCSTATULIMIT- —FOE EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE -, F3297972. m coverage E.L EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? I NIA 0/21/2011 0/21/2012 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,descr be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,B more space is required) i Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a'Boston Gas Company, d/b/a Essex Gas Company, Action Inc. , and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by.written. contract. y CERTIFICATE HOLDER . CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLE D BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Housing Assistance Corp 484 Main Street . Hyannis, MA 02601-3698 AUTHORIZED REPRESENTATIVE . Michael-Christian/SMS '�j " ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025mmnnstn+ Tha ARnon nomn onr)Innn era raniefararl mor4e of Ar.non ' te 0 ice of onsumer Af air and Business egulation 10 Park.Plaza - Suite 5170 d Boston, Massachusetts 02116. Home Improvement,Contractor Registration Registration: 164432 - Type: Supplement Card CAPE SAVE µ Expiration: 10/6/2013 WILLIAM McCLUSKEY = 8201 S. HOURD CT - CHAPEL HILL, NC 27516 :f Update Address and return card.Mark reason for change. - 7 Address Renewal Ej Employment F-1 Lost Card DPS-CAI is 50M-04/04-G101216 ✓lie i�amvawncaealC�z a�✓!'/�aaaae�tuQaLx6 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ' Office of Consumer Affairs and Business Regulation Registration 164432 Type: 10 Park Plaza-Suite 5170 Expiration_-10/6/2013 Supplement Card - Boston,MA 0211ti , CAPE SAVE WILLIAM McCLUSKEY X HUNTING AVE _ S.YARMOUTH,MA 02664 " Undersecretary Not valid without ' nature Nlassachusetts- Department of Public Safet} s Baird of.Buildin; Rc;,ail.�tions and Standards r W Construction.Supervisor Specialty License ' 'a License: CS.SL 102776 , rye rt Restricted.to IC R WILLIAM IM CLUSKY ri Y s 37 NAUSET ROAD . _ w WEST YARMOUTH,WA 02673 s Expiration: 6/28/2013 (`.nunisvirnicr Tr#,' 102776 . r 4 + L • TENANT/PROPERTY OWNER/AGENCY WEATHERIZATION AGREEMENT 4 1. The Rartie to this.Ag merit are (lowing: t (hereafter known as Tenant), (print your tenants name) bob _ (hereafter known as Property Owner) (print your name) In consideration of the mutual promises hereafter stated,the Parties agree as follows: 2. The date of Agency's signature will be the effective date of this Agreement 3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property located at(street, town) 7 7 416U4g 2_t�1'(lp - i"i"L'1 T unit# and currently leased or rented to the Tenant: f a) -Enter the premises for the purpose of performing s Weatherization 6inspection. b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection of the property and in accordance with the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing &Community Development:(DHCD) may further enter the property to inspect any and all work hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and inspections. The Weatherization work will be performed in accordance with the Property Owner's consent as further specified below: AL I consent to perinrfnance by the Agency and its contractors of any Weatherization work determined necessary and appropriate by the Agency as a result of its inspection of the property. I understand that the Agency will provide 4 a detailed statement of the actual work performed and the associated value at the completion of work. N I will provide a separate consent to performance by the Agency and its contractors of Weatherization work following my receipt of the Agency's inspection report and a statement of the estimated work and associated value.: u This additional consent will be sent under separate cover as Attachment A: I understand that the Agency will provide a detailed statement of the actual work, performed and the associated value at the completion of the work. *The Property Owner understands and agrees that any and all work,including related repairs for which the Property may also be eligible, will be performed at the Agency's discretion. The Agency estimated completion of the Weatherization work by the end of 201112012. 5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization work by the Agency, the Property Owner will be notified by the Agency and will be required to make the repairs as soon as possible. Except where the Property Owner receives a written extension from the Agency, time is of the essence in the performance of repairs by the Property Owner. 11. For breach of this Agreement by,the Property Owner,the Property Owner shall reimburse the Agency in an amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor performed on the premises,as well as attomey's fee and court costs. The Property Owner may also be liable for damages to the Tenant in accordance with applicable law; in such instance,the Property Owner shall " reimburse the Tenant for attorney's fees and court costs. .Without limiting the foregoing,the Agency may at its option terminate this Agreement-by providing written notice to the Property Owner and Tenant, in the`event of breach by the Property Owner or Tenant 42. 'Peft�menoe of the Weate,izabon work hereunder by U te Agency is co,Itil 19ent upon Ulu availability of funds to the Agency from the commonwealth of Massachusetts and the federal government,as well as the,eligibility of the Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of the Tenant warrants termination. 13. The Parties acknowledge that this Agreement is under'seal. It is intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the Agreement and,, shall have a right of enforcement 191 Phone: Address: -7-7 r , • Tenant Signature' Date It T .. L Agency Approved Weatherization Company C0.1 , SOL All Cape Energy .: - . ` Caliber Building & Remodeling Cape Cod Insulation Creswell Construction Frontier Energy-Solutions Lohr&Sons Peter Smith Resolution Energy Building Performance Contracting LLC ' • Niai Hopkins Builders Inc. Y Michael T McMahon&Son Inc. . Y, This agreement becomes effective as of the date of the Agency's signature. The Agency w will sign,and return copies of the agreement to all parties, upon completion of the proposed weatherization work. The Agreement shall remain in effect for one full year from the effective date. Agency Signature " _ - °Date k, 1WEi SAW Weatherization 508-3 8.0398 August 22, 2010 To Whom It May Concern:- William J. McCluskey is an employee of Cape Save. He is authorized to negotiate contracts and building permits for our.company. Michael Mccluskey Cape Satre—owner z 6 929-593-5939 cell a X Huntlpgton-Avenue,South Yarmouth,MA 02664 I s \ _ RIGHT • FRONT ELEVATI• ti ---------------- FEE FIT n■ ■■■ - n - e ELEVATIONLEFT ADDITIONREAR ELEVATION 11 . ROAD egg •• al r'ft"Ao ASPHALT SHINGLES - RIDGE VENT ON ae-PLY ON - 2XIm @ 24.O.C. IN 12 e 121 SOFFIT 17 ' VENT 2X12 121 S.FG. Ram SIDING RIDGE IN 36'HIGH WALL OR 12 2X4 I RAIL SYSTEM PER 12r 4'O.C. • (VINYL I 5•EXPOSURE y'PLY --- r 4XIm • 1!3 PT5(2) 2xlm m ib ON 2X4 3-13/4 X 5'6 LVL �' O0' i - 3'ii FG. INSUL 14'PLY ON 2XIm i 16' P.T.2Xf> 3-2XI0 51LL W. ON 3•CONC 'j-; ANC FILLED HOUSE COL BOLTS 4' O.G. ON 2'-6'SQ. X 12' W P.C.WALL FOOTING 3'amm P5.1. I 3•CONCRETE SLAB a: SECTION �j SECTION 2 SECTION T.r- Al y. - r-m• Al �L•m 1'-mm -�At J- (SEE SECTION 2 FOR MISSING INFO) (SEE SECTION 2 FOR MISSING INFO) ELEVATIONS DMA ADDITION 11 "IC-4LAND ROAD COTUIT,MASS F2aWN By °II; 6�t:K8ED DATE - GC�eILlTM6.6�+' R.aME� VpR.d _— 77 _. A2 i SZ� z� S� Lo �N Q a %Alp i� C^ �h, voofL i j ; i I R i 3 i i i I I 3 I i o . I aell� 4 � � Engineeri�i�g Dept. (3rd floor) Map 010 - Parcel :.O -J 0 Permit# �� g H use# 7 Date Issued - 27- �!, Board of Health(,3rd floor)( *3-'9:30/1:00- g.) -ZS 7 2 Fee �/tea 9 n a 899490aUifi1ce�h floor)(8:30-9:30/1:0 0,-2:00) , Li 4I�A '` 3'�P` .7aT t LOAIC- OF .P'Iam iirgl)vpt-(1st fl(jor/School Admin. Bldg.) - SEPTiC S UST BE �Definidue-W INSTALL an Approved by Planning Board ��.:`-`3 - 19 W LIANCE NVIRON TOWN OF BARNSTABL DE AND -` • _ TOWN RE L/�1TIONS � Building Permit Application ; treet Address Villa96 CZ U) Owner �]� e✓ Address g . Telephone Permit Request f o)/J 02� d 4,. IN r- First Floor 'o Q b `yl,P.r.J square feet Second Floor 2,2R-R 7wzd square feet Construction Type �..7 Q ` ` 1 Estimated Project Cost $ Zoning District FloodPlain Water Protection Lot Size , 6,-3 Grandfathered ❑Yes ❑No -7 Dwelling Type: Single Family Wi, Two Family ❑ Multi-Family(#units) ti= Age of Existing Structures G I storic House ❑Yes *No On Old King's Highway ❑Yes [�ONo Basement Type: qWull ❑Crawl ❑ alkout ❑Other Basement Finished Area(sq.ft.) 10— Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing Z New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ,b Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes U No Fireplaces: Existing New Existing wood/coal stove ❑Yes f No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name TP L V L Telephone Number -6-0 8 -Y 22 -7 323 Address �b (9 Z 1 License# A S 1N Pi---A6,34, M A-- G Z('oq Home Improvement Contractor# 1 352-- Worker's Compensation# n1 JA NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO <:Dy-WL0 '5T-�� -oN s/7-,r-- SIGNATURE �e�.e, DATE 7 / / Z q R BUILDING PERMIT DENIED FOR THE FLOWING REASON(S) '�� 7 FOR OFFICIAL USE ONLY q PERMIT NO. T. DATE ISSUED MAP/PARCEL NO. ADDRESS ` VILLAGE 6 OWNER - Y ju DATE OFINSPECTION: n r2 FOUNDATION FRAME INSULATION ' FIREPLACE ' ELECTRICAL: ROUGH FINAL _ y - PLUMBING: ROUGHn FINAL GAS: RGT FINAL t f,� ;, FINAL BUILDING.: fn ,.... m - ..' .. DATE CLOSED'OUT iT to U 6 ASSOCIATIONYLAN O. RM yt..: aih Y''wo«.r. ^+h.i a„� s dr ra, .. .{b rn'ratw .• ..a i �."-^ _+ ,+.e r-yy�r•i�w lk.�cu �': ShvldW d .aCk' :�,.. ^a 3�•. t'.'4'.- :+r ::,d L `SINE T The Town of Barnstable BARE,MASS. Department of Health Safetyand Environmental Services � °rEc►+a+a Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspections-� Location �' �,��( Permit Number �� --� Owner Builder k� One notice to remain on jobsite, one notice on file in Building Department. lThe following items need correcting: / (� .� V\A- v - Vi 1 Please call: 508-790-6227 for re-inspection. i Inspected by Date o 1�1# F 7890AR Appmuft Tabl*J&Ub(eoatianed) pnoeripdve paelraW for One and Two F=4 Residential Buildup WOW witb Foui1 Fuels MAXIMUM MINIMUM Glazing (hazing Ceiling Wall Floor 8arem= Slab EqWHeanng/Cooli Ann''(A) U-value= R valud It value' R-valud Wall pa, Pm� Efficierm xy' pie R.vafue R-value' 5101 to 6500 Hntiaa Degree Dare' Q 12% 0.40 38 13 19 10 6 Norma! R 12`% 0.52 30. 19 19 10 6 Normal S 12% 0 38 13 19 10 6 83 AFUE T 13% 0.36 38 13 25 WA WA Normal U 13% 0.46 38 19 19 10 6 Normal V is ... . 0.44 3F iv _FJA.. 1R ._�>B W is% 0.32 30 19 19 1 6 85 AFUE X 18% 0.32 13 23 NIA Normal Y 18% 0.42 38 19 23 A WA Normal Z 18•/. 0.42 38 13 19 0 6 90 AFi>E AA 18•/. 0.30 30 19 19 0 6 90 AFUE 1. ADDRESS OF PROPERTY: 77 ATE V! � I 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: `o 3. SQUARE FOOTAGE OF ALL GLAZING: Co 4. %GLAZING AREA(#3 DIVIDED BY#2): l S. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY QUI MENTS ARE AVAILABLE. ASK US FOR THIS FORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: 9-forms-f980303a 780 CMR Appendix J Footnotes to Table.15.2.1b: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors,.skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 fl of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units: center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between - [he GOnaitrOnen space ants UIV vvuL11QWU Yva uvaa v. u,v.vvA. •Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6,insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same_ R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements-are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and'an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). .4 x+ ,faar- 43 The Commonwealth of Massachusetts Department of Industrial Accidents w Olfice of1,7F8S j.F loos 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit WO arm name: 14 l location: , ` city nhone# ® I am a homeowner performing all work myself. I am a sole rietor and have no one working in any ca acity -- ---/%%%/%'///'////%=///%%%%%%%%%%%/O/%/%%%///%///%%////%%/G/%%%/G %%/%%%%/////%/�//'�//////�y/////O///�%�/ ❑ I am an emploverr providing workers' compensation for my employees working on this job. (comnunv name: i"2 J� ~ address: 1OZ�cl city phone#: insuranceco. Si7 pricy# It ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comnanv name: address• dtv phone . nlicv# cam anv name: :>:•::.:.:.:....:... address: phone .,..;.:<. . city #: ::>.,...... insurance CO. :.:.... :: . olicv# Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminai penalties of a One up to s1s00.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP♦VORK ORDER and a tine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oltice of Investigations of the DL1 for coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and coned Signature Date 42i f7v _ A Print name 1 L[.0 .L� ll�� '-7 Phone# :<O Q 717 3?/3 ofllcial use only do not write in this area to be completed by city or town ofncial city or town: permitilicense 0 ❑Building Department ❑licensing Board ❑check if immediate response is required ❑selectmen's Oince (]Health Department contact person: phone#; ❑Other (revere 9195 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers compensation for their employees. As quoted from the "law19 an employee is defined as every person in the service of another under any courts:. of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged is a joint enterprise, and including the legal representatives of a deceased employer, or the receiver. trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of rn rin maintenance , construction or repair work on such dwelling house or on the grounds o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation nd be supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regazding the"law"or if you are required to obtain a workers' compensation Policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permiVUcense number which will be used as a reference number. Tic affidavits may be returned iO the Department by mail or FAX unless other arrangements have been Tie Office of Investigations would like to thank you in advance for you cooperation and should you have any questions• please do not hesitate to give us a call. 01, The Department's address,telephone and fax member: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investleadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 �TMe The Town of BarnstabW: 3 s i � 1ARN6IABI.E. • M" Department of Health Safety and Environmental Services ri�o Mo+' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLAN REVIEW Owner: Map/Parcel: Project Address: LF `y Builder: The following items were noted on reviewing: CQ LNT Da 0 � ��' 4�E o,C�- 13 e Please call 508 862-4038 for re-inspection. -inspected by: C� Date: ` ZZ #uildinglonns:mview MAScheck COMPLIANCE REPORT I � 3 9 Massachusetts Energy Code Permit # MAScheck Software Version 2.01 � a Checked by/Date CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 9-23-1998 COMPLIANCE: PASSES Required UA = 326 Your Home = 297 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value U ---------------------------------------------------------------------------- CEILINGS 1330 30.0 0.0 4 WALLS: Wood Frame, 16" O.C. 1656 13.0 0.0 13 GLAZING: Windows or Doors 168 0.300 5 FLOORS: Over Unconditioned Space 1330 19.0 0.0 6 ---------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date I f P! N7. TRANSMISSION VERIFICATION REPORT TIME: 01/13/1995 00:31 NAME: FAX TEL DATE DIME 01/13 00:31 FAX NO./NAME 913103280336 DURATION 00:00:43 RESULT) OK MODE STANDARD ECM MAScheck INSPECTION CHECKLIST lkassachusetts Energy Code MAScheck Software Version 2.01 DATE: 9-23-1998 Bldg. Dept. 1 Use CEILINGS: [ ] 1. R-30 Comments/Location WALLS: [ ] 1. Wood Frame, 16" O.C. , R-13 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1. U-value: 0.3 For windows without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments/Location FLOORS: [ ] 1. Over Unconditioned Space, R-19 Comments/Location AIR LEAKAGE: [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure- difference and shall be labeled. I VAPOR RETARDER: [ ] Required on -the-warm-in=winter side of all non-vented framed ceilings, walls, and floors. TRANSMISSION VERIFICATION (REPORT TIME: 01/13/1995 23:16 NAME: FAX TEL DATE DIME 01/13 23:13 FAX NO./NAME 94200136 DURATION 00:02:23 PAGE(S) 04 RESULT OK MODE STANDARD � COOLING SYSTEMS: Y, Chilled water or 40-55 0.5 0.5 0.75 1.0 refrigerant below 40 1.0 1.0 1.5 1.5 [ ] I CIRCULATING HOT WATER SYSTEMS: Insulate circulating hot water pipes to the following levels (in. ) : PIPE SIZES (in. ) NON-CIRCULATING CIRCULATING MAINS & RUNOUTS HEATED WATER TEMP (F) : RUNOUTS 0-1" 0-1.25" 1.5-2 .0" 2 .0+" 170-180 0.5 1.0 1.5 2 .0 140-160 0.5 10.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- TRANSMISSION VERIFICATION REPORT S 9V d 00: 31 3 �,�_ � .< t T;T::3 FAXJ .:I i'a.i tifl TEL 77 ii. DATE,TIME;w'_, 01/14 00:30 wT ;w -FAX.NO./NAME 97711230 DURATION.`���l 00:01.03 RESELT OK___�._.__.....____ MODE !t::.:_ r�: ,.I,. STANDARD i t ji T"Aha y11O5IcVERIFICATION rTEPORl' j � i 1 T11ME: 0'1f let/`1995 00:31 NAME.• !. FAX TEL i DATE,TIME ii0: 'o FAXNC1 %NAh-lE 97711'230 DURATION 0 OK ODE SlFANDARD T is ' 4 ElC; ', w ti V' ( MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. DUCT INSULATION: [ ] Ducts shall be insulated per Table J4.4 .7. 1. DUCT CONSTRUCTION: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space,' including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer' s installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. The HVAC system must provide a means for balancing air and water systems. TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4 .4. [ ] SWIMMING POOLS: All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. [ ] HVAC PIPING INSULATION: HVAC piping conveying fluids above 120 F or chilled fluids below 55 F must be insulated to the following levels (in. ) : PIPE SIZES (in. ) HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-111 1.25-2" 2 .5-4" Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 Low temperature 120-200 0.5 1.0 1.0 1.5 Steam condensate any 1.0 1.0 1.5 2 .0 TRANSMISSION VERIFICATION REPORT TIME: 01/13/1995 23: 19 NAME: FAX TEL DATE,TIME 01/13 23:18 FAX N0./NAME 97711230 DURATION 00:01:09 PAGE(S) 02 RESULT OK MODE STANDARD I N IMF: �-AY 7 EL. .`,f`r,�JL r .. TheT own of Barnstable U � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Ccossen Office: 308-790-62Z7 Building Ca=issioz: Fax: SOS-M-wo For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT*CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL 14ZA requires that the "reconstruction, aitemdons, renovation, repair, modernization. conversion. improvement, removal, demolition, or coast, cdon of an addition to any pre-existing owner occupied building containing at least one but not more than tbur dwelling units or to structnres which are ad;acent to such residence or building be done by registered contractors, with certain ezceptions,along with other requirements. Type of work• Est.Cost R� e Din — e Address of Work: A-VE Owner's Name Date of Permit Application: 2- 1 I hereby certify that: Registration is not required for the following renson(s): Work ezciuded by law _ _ ob under S1,000 __Building not owwner6occupied Owner pulling Own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR ARBITRATION TION PROGZ.AM OR GUARANTY�DFUN PLICABLE ROME IMPROVEMENT w ORK DO NOT HAVE ACCESS TO THE ATiB UNDER MGL c 142A SIGYED UNDER PENALTIES OF PERJURY I apply for a permit as the agent of a Owner. Date Contra Name Regisuasion Na OR Date Owner's Name �� `-Tar ....V.n■1VF•ifft pan _ t $HIg8,Of1 - t sidto t�,�,,eadum 1 1 J f < � r 37 04, lu 1c q a �3 �,�,..-YG = � - it �•`� ,.r.e"' •..e+ �;,,i �..� y • ._ i 't x. .•,t \,� ��\ �\ 1\ « (,' so- t •'� � 4' \ 4.t ATER ELEV.z ` 1 E 7.42E c F•. GTE -�amvnzar�we¢�e �,,Z�� DEPARTMENT OF PUBLIC SAFETY } CONSTRUCTION SUPERVISOR LICENSE Nu®berY "^ j Expires: Restricted 1a � 88 PNIIIIP S `KEENS PO BOX 621 FORESTDALE, NA 82644 ✓7 70�'AtO1fQ l�Q�U6 UQB�I6' -HOME IMPROVEMENT CONTRACTOR k ' Registration `118352 ' Type $r;INDIVIDUAL EXPlTation � n 0302/99 °� �K� X•F�� K� Pik i's•�Si::Y. iPHILLIP S. KEENS ;=' PHILLIP KEENS 7-0 4yiiVERRE VERNIER DR ADMINISTRATOR SANDWICH MA 02264. meerin g Dept. (3rd floor) Map Parcel �j � � Permit# z(q s2-gS House# �'6 Date Iss ed /8 . 1 _9 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) l� Fees - Conservation Office(4th floor)(8:30-9:30/1:00 2:00) s Planning Dept.(1st floor/School Admin. Bldg.) SEPTIC SYST t E °"BE NSTAL I • - LED� Definitive Plan Approved by Planning Board 19 LED ; CE LEWH ' UAW . E g AND TOWN OF BARNSTABLIM0 N REGU NS i Building Permit Application , ' i Project Street;;Address]] ' �t C, j� f Ci'7 j4 . Village ( O v-1i T ' Owner c /�ry S CIL Address ' Se3 v77-e -Telephone q(o �{ Permit Request P y�,o , First Floor square feet Second Floor square feet r Construction Type Estimated Project Cost $ Fs060 a v { Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure I Historic House ❑Yes 01 fro On Old King's Highway ❑Yes Q-N-o— Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing�_ New Half. Existing New No. of Bedrooms: Existing New SP Total Room Count(not including baths): Existing �0 New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes a_N O Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) 01qo__n_e ❑Shed(size) ❑Other(size) y Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name i)ot u i d 4 (an,-6 w Telephone Number Address PC) L� License# r✓F S:Lk f-P m o Home Improvement Contractor# / a 3//l Worker's Compensation# bU C d G% (0 3 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 rl'1 SIGNATURE DATE ! Q BUILDING PERMIT DENIED FOR THE FOLLOWIN REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. _ i DATE ISSUED MAP/PARCEL NO. r `= ADDRESS VILLAGE' _ OWNER DATE OF INSPECTION:" - -• :r FOUNDATION FRAME 9-2 + w INSULATION - FIREPLACE ; ELECTRICAL: ROUGE - FINAL e PLUMBING: ' UGJ' `' FINAL GAS:. 6 FINAL`. f ct� �- ., ` FINAL BUILDING ; dim 0 ' rr t65 t ! DATE CLOSED OUT Ott ; i ! ASSOCIATION PLAN%. , I ATHE T �•� „+ � . . The Town of Barnstable Department of Health Safety and Environmental Services Eo " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commission For office use only Permit no. ' Date- AFFIDAVIT, HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, mnovadon, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est.Cost Address of Work: 141, I 0 Owner's Name P D-?1'n �e Date of Permit Application: 1� 3� I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL G 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent o e owner: Date Contractor Name Registration No. OR The Cutittiioniveafth olMauachUSe1LS Ir 1:_ Dc tritmuit n I�idiintrial.4cciflcnts Ofliceo//nvestigatlons _r;�'` 600 N achittwutt Sirect ' Bunton.Ma.u. 02111 Workers' Compensation Insurance Affidavit Appltcant information• Please PRINT F.WiW. _.._..1.. ........_.. --..._. _. - - name: U 1 �G f-M ocati n: -) -) cil%- 0-6 U+ Phone f� 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity w. —.s-•.............-r.��.�n.re....s+_7trl'T'_+.wn++/7'!+":iIT�...._•+w..7nT���.+wr�w_.. .w.._..T.. ....•.r.++_r.....w—..�.wrr,....-..__....... I am an emplover providing workers' compensation for my employees working on this job. ~r cons tanv mart•: CG Ood iddress: PO qd- - city: h I'�'S-�dc, m) PJ( � `I Phone 0- /S-�Cv 40,�)3 insurance co. o licy N J j Q6 [j I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers compensation polices: comnany nate, address: city- lthonc 0• insur-ince rn. policy t! comnamv mint•: address• rite; phone#• insurance co. nolicv>Y Attach additional sheet if necessary_ _ - __"M:r:�� ''"^` •'—�•=+- ^- --' F:tilurc to secure cttver:tt!c as required under Section ZSA of AIGL 152 can lead to the imposition of criminal penalties of a line up to 51.500.00 andiur une i cars' imprisonment:is well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to ttic Ottice of Investigations of the D1A for coverage verification. 1 clo hereht c ' r tuuler the pant nt1pe tics of perjun-that the information prorided above is truey and correct. Si=nature Date ' Print name 1 J0 111 - C( (�I/!) l I Phone>* 3 3 ' official use only do not write in this area to be compacted b%tiny or town official -� t city or town: permit/license a9 rIBuilding Department C3Liccnsing Board r 0 check if immediate response is required aSeleetmen's Office ► k 011c2lth Department ., contact person: phone tY: rlOthcr t r ICI ro.i,ea. ,• ,�.v Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the. employees. As quoted irom the "la\\- an etnpluree is defined as every person in the service of another under an\• contract of hire, express or implied. oral or written. T An enrplt rer is defined as an individual. partnership, association. corporation or other legal entity•, or ail-,, two or more the foregoing engaucd in a joint enterprise, and including the le-al representatives of a deceased employer, or the receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the owner of a dwelling_ house having not more than three apartments and who resides therein, or the occupant of the dw ellin- house of another who employs persons to do maintenance , construction or repair work on such dwelling_ ha or o» the _;rounds or building appurtenant thereto shall not because of such employment be deemed to be an empioyer MGL chapter 152 section 25 also states that even- 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 an}• applicant �--•ho leas not produced acceptable evidence of compliance with the insurance covera;e required. Additionally•. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Applicants Please fill in the workers compensation affidavit completely, by checking the box that applies to your situation and supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the cite or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law' or if you are requires to obtain a workers' coimpertsation policy. please call the Department at the number listed below. I City or,rowns v' a ace at the bottom o: Please .'it is complete and printed legibly. The Department 1 as ro tded s P _e be sure that the affidavit p p ,. P P the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple: be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questior please do not hesitate to _=ive us a call. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations :... 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406. 409 or 375 610wn -fie Vf ,. � . � �, ,, 4 ., . , • S ' z ,DEPARTMENT OF PUBLIC SAFETY . CONST.&, ON SUPERVISOR LICENSE MDe Expires: �. Nes WC* Ta 1G AVID A CARROLL yr torsw -BOX 342 FORESTOALE, NA 02644 i � fie �anv�,aruue�z� o��,/G�a�eC� HOM I MEtNT CONTRACTORS REGISTRATION Boar of Guiding Regulations and Standards , One Ashburton Place - Room 1301 Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 123111 Expiration 12/10/98 -- - ---- ---- -- -- - - - i Type - D B A �- HOME IMPROVEMENT CONTRACTOR Registration 123111 CAPE COD REMODELING AND DESIGN Type D8A DAVID A . CARROLL Expiration 12/10/98 31 PIERRE VERNIER DR/PO BOX 342 FORESTDALE MA 02644 CAPE COD REMODELING AND DES DAVID A. CARROLL 3�. PIERRE VERNIER DR/PO BOX ORESTDALE MA 02644 ADMINISTRATOR ! DRUM?Of PUBLIC Sully j CORSI ON SDFRRVISOR LICBISB Roster: Bxpires• Restricted To: 89 DAPID F noLB!! 1 17 1W DAtR RD 1 RYAARIS, bA 02601 �+ HOME IMPROVEMENT CONTRACTORS REGISTRATION �r Board of Building Regulations and Standards One Ashburton Place -- Room 1301 Boston . -Massachusetts 022108:1 HOME IMPROVEMENT CONTRACTOR Registration 1207.07 Expiration 02/22!98 7�c. TYPe — DBA HOME IMPROVEMENT CONTRACTOR Registration 120707 K D DESIGN $ REMODELING Type - DBA DAVID TREMBLETT Expiration 02/22/98 17 FERNDALE RD HYANNIS MA 02601 K D DESIGN a REMODELING DD9VIO TRENBLETT ADKMNMTMFM I7 FERNDALE RD HYANNIS MA 02601 �b °FTME Tpl,_ "�. The Town of Barnstable • NRNSTABL& • 9� '& �' Department of Health Safety and Environmental Services '°rEc n p as Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, 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: 4 F P//Y Est.Cost 1800 Address of Work: -7 7 N1<-H4 6 yP >r-f (d 7-0/ T Owner's Name CL(-'E Nf4 /l f/ea S✓4 Date of Permit Application: —2 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 12 0 2 07 Date Contractor Name Registration No. OR Date Owner's Name 1 The Commonwealth ofIllass,uhusetts - l e Department of Industrial Accidents � � .�� � OIJ�Ceo/Inyesdgal�s 600 Washington Street Boston,Mass 02111 A Workers'Compenuflon Insurance Affidavit cit • A �-� v/V 1 i It 77s-- z 9i2 ❑ I am a homeowner performin.- all work myself. ❑ I am a sole proprietor and have no one working m any capacity ❑ IN, 111=1 I am an employer providing workers' compensation for my employeess working on this job. fampany name: city: y Q 777 7 r !rt Z insurancece: 6 NUS 83/ ,,t 7�.5� ❑ I alas a sole proprietor,general contractor,or homeowner(eln to one)and have hired the contractors listed below who have the following workers' compensation polices: S�mt74nv name: nddress:. ctty: ;12bonr N= instir8rice fptntfanY natnS: address, city Rfiorip f6 aa9urance co. ISM 11 ' R011l'Y-�'•• Failure to secure coverage as required tinder Section 25A of MGL 152 can lead to the imposition of critainal penalties o[a flue up to$1„500.00 and/or one years'imprisonment as well as civil peon ' 'u the furm of a STOP WORK ORDER and a thic of$100.00 a day against ine. 1 understand that a , copy of this statement may be forwarded 1 het :a of Investigations of the DlA far coverage verification. I do hereby cerfift under the erjjury that the information provided above is true and eorma. Signature ^^ ate Te 7— ! � rY Print numc �1 9 / U �r �'I�LR-TT Phcnc# 7 7�5—` 2 51 I2- C(0:)cbeck use only do not waste lei this area to he complrtM by city or town official wn: permitiliccueec# Building Licensird if immediate respea-ac is required pSeleettafice OHcalth ment erson: phone tt; r'TOther r" freviad IM PW Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law",an employee is defined as every person in the service of another under any contract of hire, express or implied,oral or written. An employer is defined as an individual, partnership,association,corporation or other legal.entity,or any two or more of the foregoing enraged in a joint enterprise,and including the.legal representatives of a deceased employer, or the receiver or trustee of an individual ,partnership, association or other legal entity;employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of pub)ic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/]license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Uffesdodens 600 Washington Street Boston.Ma. 02111 fax N: (617)727-7749. phone#: (617) 727-4900 ext. 406,409 or 375 w.. a rf ,, � OFTME i The Town of Barnstable + BAMSCABIX • 9� 1 Department of Health Safety and Environmental Services ArFCIMA'�p Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 r Ralph Crossen Fax: 508-790-6230 Building Commissioner PLEASE FORWARD THE FOLLOWING PAGE(S) TO: TO: vZe'r � RE: '77 FAX NO: `796 937p FROM: ��1t,C� DATE: `�� /a, I gi9Y PAGE(S): APPLICATION FOR PERMIT TO INSTALL AND REQUEST Do24 -450 FOR ELECTRICAL SERVICE Inspector of Aires Wiring Permit COM/Elect is#s t# P 9 _ Town of ��S1S ��- Massachusetts Building Permit# Date �' Customer: "'�S e �`'�� on(Street#)M 77 Lot# in the village of CcT'A r,/ � /� utility pole number or underground number 2�� Customer's billing address �Z7 ��'�'� un� c- l o Temporary New installation �hange of service Starting Date Job description �'�� iti�r+ iJ�CJrc- e. t� S¢r✓;�.r Service entrance voltage ICJ 2 2'rlo Amperage 24' Phase Wire size(cu.or al.) Conductor per phase Number of meters 2 Water heater Off peak:Yes— No— Estimated load:Electric heat kw,lights kw, Range dryer Motors,l lP.&P ase Ready for first inspecti n Ready for final inspection �� Electrical Contr for Jd A^ rc, r I��# S-I is s39 Telephone# Address 3 C v ✓✓fc is v� �c.c r ///L. o c ' Additional Remarks: Do Not Write Below This Line ELECTRICAL WIRING INSPECTION CERTIFICATE G INSPECTOR OF WIRES c, INSPECTIONS DATE FEE CHARGE Temporary Service Roughing in ' Service and Meter Off Peak Meter Final Approval Disapproved' 6 9 'For the following reasons CERTIFICATE OF INSPECTION DATE 155' Q'T0 the COMMONWEALTH ELECTRIC COMPANY.The installation described above has been completed and has this day been inspected and approval granted for connection to your service. _ -� Inspec or o ires WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS.READY FOR INSPECTION Permit Good For One Year From Date Of Issue CA as-, White—COM/Electric Green—Inspector Canary—Town Receipt Pink—Inspector's Copy Goldenrod—Electrical Contractor to COM/Electric TRANSMISSION VERIFICATION REPORT TIME: 03/06/1995 00: 47 NAME: FAX TEL DATE,TIME 03/06 00: 46 FAX �10./NAME 97909370 DURATION 00: 00:50 PAGE(S) 02 RESULT OK MODE STANDARD ECM L Engineering Dept. (3rd floor) Map a� Parcel ;�� Permit# House# � �� G Date Issued Bo}�T--,.L IQ•i 5 g.3n ,, "0-4:30) Fee COU.W.a,...__ .*a ,gih igawi. ;Q.zn Q•Zn L,:00-2:00) Pla De r 19 ; B ` BARMAR& E. ` 6 q TOWN OF BARNSTABLE 'F�'�"' Building Permit Application Project Street Address 7 7 14 1 fi V r- Village C"o T✓f 7- Owner 9 LL,g N 4 'Df 20 sq Address 77 1-41(-F14/4aed 11 yf Telephone Permit Request FA/L j i/3 C (/,iy y L S'i�iiy d-F %//,�: First Floor square feet Second Floor square feet Construction Type 4 S/ �- Estimated Project Cost $ /8o O Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 0-" Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House p Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes )�No If yes, site plan review# Current Use Proposed Use 36 .- Builder Information Name Kb Telephone Number -7 75' zq I Z Address 17 Ff-z" 77/3G f i2o 4)4Z License# O Z Z r�'s � A iq Home Improvement Contractor# (Z O 7 0 Worker's Compensation# 61161; NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /4-o 7 9 O aJ a 45-9 EIa/e l/- 4 7- SIGNATURE DATE 7— — BUILDING PERMIT DE E THE FOLLOWING REASON(S) . _ .. _ _ �1f.'.tc7NYS1i'L�W14'fl,+:asfSC[�+Hswww�n�++rcr'r.ew,�-eem..�v+`••, -•••- + t�+trsra�=ew,xa'u�".sisiw.c�arer�scrv5erez;ca�; •" �*M9+rn�:ir.9RMIWt°WIU+9F. +Wyq� ' 'ANienJfft.�:s�irya;;�y�(P,�};y� ��triaLfti�►�?�ss� ,4 _-r