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0026 LEWIS POND ROAD
J,e6uIS "Po r)C( eOcec), 1 i Town of Barnstable Building : .. g $ Post,T'i Cdrd So That it is Visible From,the Street-�Approvecl Plans;Must be Retained orijob and this Ca cl Must be,Kept Posted Until Final Inspection Has Been Made. .j °iWhere a Certificate of Occupancy is Required,such Buldin',g shall Not be Occupied until a Final Inspection has been made Permit .. . ti ... .. , Permit NO. B-19-3776 Applicant Name: Keith Cliff Approvals Date Issued: 11/08/2019 Current Use: Structure Permit Type: Building-Stove Expiration Date: 05/68/2020 Foundation: Location: 26 LEWIS POND ROAD,COTUIT Map/Lot: 020-016 Zoning District: RF Sheathing: Owner on Record: DANNHAUSER,STEPHEN J &JAMES F,TRS Contractor Name" ,,.KEITH A CLIFF Framing: 1 F Address: 49 PUTNAM AVE Contractor License CSFA 058557 2 COTUIT, MA 02635 2 Est, Project Cost: $2,467.00 Chimney: Description: INSTALLATION OF APPROX. 16 FT. OF 6" DIAMETER STAINLESS ., Permit Fee: $35.00 ; p , STEEL FLEXIBLE LINER INTO FIREPLACE CHIMNEY FLUE FOR USE Insulation: Fee Paid:, $35.00 WITH WOOD STOVE. Final: Dater` 11/8/2019 Project Review Req: FLUE LINER ONLY. IN COMPLIANCE WITH MANUFACTURERS SPECIFICATIONS. 29sy�— Plumbing/Gas -' Rough Plumbing: Building Official. Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months-after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for whichrtthis permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structuresshall,be in compliance with the local zoning-by-,laws and codes. This permit shall be displayed in a location clearly visible from access street or roadand shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by Build' by and Fire Officials are providedson-this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection ryz - � ,, �� - Rough: 3.All Fireplaces must be inspected at the throat level before finest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in.MGL c.142A). Fire Department Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: or F�►au s E.�� Ts PJ 5 " ir4.�w--• lk PILOT, pt 'SC1�L41r T&A :TNT FL)- �`�lET3A�'bC `7EQU1'KE�4cb.,tTS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ,b TO Parcel Map �pplicatio.n #OU l� I OF BARN$TAB 2015 U�� `. Health Division t 3 in _.f E�; j I: DDate Issued $ mlls Conservation Division Application Fee Planning Dept. E �pum Permit Fee ��•� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address ` o.c .��S �o AJ a A 02 621- Village C 03 ,x, p Owner SAksMA �frtiA_A\ Ak Address Telephone O — 5Y.00 MA Permit Request lit c- CvG `Cy -IN <,4d I `�I:�.e - (2 3 a 40 C�O� S G c VN-Sti�( ���!�i�� -�a �i 0 `FCIL.OY� G quare feet: 1 st floor: existi�g proposed 2nd floor: existing proposed Oe —Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a� Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished.Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ 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 0 Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ' Name .lys�e� 4_ 1, L, I4i-rt) Telephone Number( J �'� �' `r Address J :�k>, ���1 �� License # k O -7- t kM A- Home Improvement Contractor# Email o- ri cIt v Worker's Compensation # LA ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATEa r � FOR OFFICIAL USE ONLY ti� t APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ti ` GAS: ROUGH FINAL i s FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. • 3 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Ivfiorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): eAyo ,�y15.. �»► Address: P n 13 c)c 10 City/State/Zip: 03JI I Phone#: ,��''eJ �/ /0 J_0 Are you an employer?Check the appropriate box: Type of project(required): l.�am a emplover with 1(� employees(full andlor part-time).* 7. New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 3.M I am a homeowner doing all work myself.[No workers'comp.insurance required.]'' 9. El Demolition 10 Building addition - 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions 1 proprietors with no employees. 12.❑Plumbing repairs or additions t S.a I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.QRoof repairs �. These sub-contractors have employees and have workers'comp.insurance.t 6.[J We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: S AZ4,(- Policy#or Self-ins.Lic. #: d��S_(20 I Go Expiration Date: JA Job Site Address: o l�C� I City/State/Zip: ��`�'t�l " " `� va4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).. Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct Si nature: Date: P hone# 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#: S , Client#:317787 RETROFITIN1 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 8/05/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS , CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: HUB International New England PHONE 978 657-5100 FAX 978-988-0038 (A/C, /C No Ext: A/C,No 222 Milliken Blvd EMAIL Fall River,MA 02722 ADDRESS: 508 235-2200 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Star Insurance Company 18023 INSURED - INSURER B: RetroFit Insulation, Inc. INSURERC: PO Box 105 - Seekonk,MA 02771 INSURER 0 INSURER E: • INSURER F: 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. INS ADDLSUBR LTRR TYPE OF INSURANCE NSR WVD POLICY NUMBER MM DDY� MM/DD/YYEYYY - LIMITS GENERAL LIABILITY -EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE 7 RENTED PREMISES Ea occurrence $ CLAIMS-MADE 17OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC0845201 OO 8/02/2015 08/02/201 X WC STATU- oTH- AND EMPLOYERS'LIABILITY _ ORY ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $� OOO OOO OFFICER/MEMBER EXCLUDED? � N/A (Mandatory In NH) • - E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) -- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY'PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1432002/Mi432001 RB004 Office of Consumer Affairs and Business.Regulation 0 Park Plaza - Suite 5170 - R Boston, Massac ipetts 02116 Home Improvement Ct *or Registration Registration: 180461 Type: Private Corporation .G RETR INC. �" �' '� }::,,_.:. Expiration: 7/29/2016 Trn 252915 OFIT INSULATION n - �a,; ' JOSEPH REILLY �� b P.O. BOX 10S . r "SEEKON Update Address and return card.Mark reason for change. sca 1 (10 20M-05n1 ,E] Address Renewal o Employment Lost Card •�e�oammvo�uuaa/C./i,of'�.era�ac�ua�ll.� ' _ r Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR • before the expiration date, if found return to: Weiiatratlon1 61 T rp ss Re ulationiration: 7 �2b18 g 4, a Private Corporation 0 Park Plaza 5 70 Affairs and Business i • Boston,MA 02116. . . RETROFIT INSUTATI�'SN II�(� .._.',, - _ .' JOSEPH REILLII 1 111. _ r y 644 RODMAN ST• `� _ai•::''..' FALLRIVER,MA 02721 �.._ Undersecretary of alid without signature ` Mmiald PW -MGM of - Publlc$ate oaf x • ,��'• - �iidi��Ragtd' eta and�ruaarft C'onstruchibn S%!Wrricor cialtp low 1 ;K IPO.Bo:lAS Seekonk1slow l°aef" l Ulm Town of Barnstable R , Regulatory Services NAM Richard V.Scali,Director 1619. Building Division ,. Tom Ferrq,Building Commissioner ' 200 Main Strut,Ilyannis,MA 02601 wvrw.town.barnstablc:ma.ns.' Office. 508-8624038 Fax: 50&790-6230 Property OwileirMUSt Coriviete a S:ig i-d This Section If Usin6 A RuildLx I, Sandra J. Dannhauser 2011 Revocable TrI . �wner of the sub ecr(iroperty 1 tic rcby ataorirx f�2`�- VIS(j 10,t1 d to act on rn}•behalf, Y -U in all matters rclativc to work authorized by this builciing perrnit_application for. 2610W'is Pond Road Cotuit_MA,Q2635 M (Address of j�b) Pool fences and'alanns are the responsibility of the applicant. Pools are not to be-`filled or utilized b care fence is•installed acid all fi ial .nspecaons are perfomaed and accepted. jams danr hauler(Ju131..2015), - Signattire of Owner Signature of Applicant Print Name Print Name Date r�1:FORh1S:OR 2>'FRYEIWISSIONPWLS Federal ID#05-M5629 RISE Engineering y RI contractor Registration No 81166 - MA Contractor Registration No 120979 A division of Thielsch Engineering 1 CT Contractor Registration No 620120 5 Dupont Avenue,South Yarmouth,MA 02664 • C^���A�T ' 508-568-1926 X-6197 FAX 508-%&1933 V IV1 f R S Page, 1 PROGRAM . -, .. .TH{4 eONTRACT al Baum'tNTO BETYYEEN RISE CLC-RCS EROMEERINO RM THE CUSTOMER FOR WORK As ENGINEERING DESCRIBED BELOW CUSTOMER - PROkE i 'DATE - • _ - cum t WORM ORDER Sandra J Dannhauser (508)420-5580 0.7/16/201.5 186088 00002 SERVICE STREET - - - BILUW STREET • - 26 Lewis Pond Road PO Box 2016 SERVICE Cm,STATE,LP ._ SUM Cm,STATE,ZIP » - Cotuit,MA 02635• Cotuit,MA 02635 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 of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor au quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (6)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will:occur,but the actual - number of cfm is not guaranteed. , $462.00 AIR SEALING:Provide labor and materials to seal heating and/or cowling ducts within designated unheated areas. This work will be - performed at the rate of$75 per man per hour,which includes materials. (4)working hours. : : ATTIC FLAT:Provide labor and materials to install a 9"layer of R-30 unfaced fiberglass bates to(100)square feet of attic space. $192.00 ATTIC FLAT:Provide labor and materials to install a 12"layer of R42:04ss I Cellulose added to(1400y square feet.of open attic, space. $2,044M ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thermax board.Weatherstrip the ;perimeter. • A _ _ $42.50 VENTILATION:Provide taborand materials to install(1)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom f ih(s): - y '$116.10 VENTILATION:Provide labor and materials to install ventilation chutes in(66)rafter bays to maintain,air flow. $230.34 VENTILATION:Provide labor and materials,to install(12)4"X 16"rectangular aluminum soffit vents to increase ventilation in ' attic areas.Specify color:White or Gray. $346.92 BASEMENT CEILING:Provide labor and materials to install(144)linear feet of R-19 unf iced fiberglass insulation to the peririretcr of the basement ceiling at.the house sill. '$315.36 INCENTIVE:RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed.only the Net.amou Currently;for eligible measures; m he Cape Light.Compact offers 75%incentive,not to exceed$4,000 per calendar year,and an [.m.� incentive of 100%for the Air Sealing measures1� (� For the safety and health of your home's indoor air quality,we will be conducEing a blower door diagnostic of the available air flow. your home both before the wcA is begun,and after the.weatherization work is complete.We Will also conduct a full assessment of - the combustion safety of your heating system and water heater.This has a value of$90 and is at no cast to you. 2 ►f L i $90.00 1.�: { Federal ID$05-MS629 y RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thielsch Engineering, CT Contractor Registration No 620120 5 Dupont Avenue,South Yarmouth,MA 02664 t CONTRACT CZ 508-568-1926 X-6197 FAX 508-568-1933 � Page 2 R I S t PROGRAM TWS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING CLC-RCS'` ENGINEERINGAND THECUSTOMERFbR WORK AS DESCRIBED BELOW CUSTOMER - - PRONE +DATE" CLIENT) WORN ORDER Sandra J Dannhauser - (508)420-5580 07/16/2015 186088 00002 SERVICE STREET - BIWNG STREET - - - 26 Lewis Pond Road PO`Box 2016 SERVICE CITY,STATE.LP BILLING CITY,STATE,LP - Cotuit,MA 02635 Cotuit,MA 02635 1 , JOBRDESCRIPTION' = F TOW $4,139.22 Program Incentive: $3,317.41 { ` Customer Totals $82T.W WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH AsovE SPECIFICATIONS;FOR THE SUM OF - ""Eight Hundred Twenty-One 8L 801100 Dollars $021.80 UPON FINAL INSPECTION AND APPROVAL BY RISE ENCtiEERINO.CUSTOMER AGREES.TO REMIT AMOUNT DUE IN FULL:,INTEREST OF 11A WILL BE CHARGED MONTHLY ON,ANY. UNPAID BALANCE AFTER 30 ft.SEE REVERSE FORNPORTANT INFORMATION ON GUARANTEES;RIGHTS OF RECISWK SCHEDULING.AND CONTRACTOR REGISTRATION..- / DO NOT SIGN THIS CONTRACT IF TH E ANY BLANK eAlCES AUTH W / E.Ena Mp QWTCjAlER ACCEPTANCE' NOTE THIS - CT MAY BE WITHDRAWNBY US IF NOT E% ED ECIJTVVITHIN - DATE OF ACCEPTANCE • ' I • . - �- ACCEPTANCE OF CONTRACT-THE.ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE +_ 30 SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTIWRI2E0 TO DO THE WORK DAYS. - q8 SPECIFIED.PAYMENT YISLL BE MADE A9 OUTLINED . s ' -.: .. '•� _ .. III f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0� Parcel elf G` Application # C / �,� Health Division Date Issued Z' L Conservation Division Application Fee )1 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis M� Project Street Address Lr-yy F'S Village Cd+& Owner _T%/c4-- Du of w IICS.0 S Cl- Address "al p©co-d Telephone p� Permit Request �-�r fly�� � i/���t Sn I ac M'fsk4,t tx tµfi �l ZS I✓� A C4 plu c M -21_'IM kX-0 t)Av -,��rs a SY: ;�ze— I;353"k L4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z2i 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'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 Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/.coal stove:,_❑Yesi ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑:9.15ting q new :Size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ee Commercial ❑Yes ❑ No If yes, site plan review # r, Current Use . Proposed-Use-_ --- --- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name co, f VA l I a� Telephone Number Address PO I7� �y License # V 6 Co� ri 02 05� Home Improvement Contractor# 416 276 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SlJr_ 4�al_ SIGNATURE J DATEI� f I FOR OFFICIAL USE ONLY y APPLICATION# F DATE ISSUED MAP/PARCEL NO. 4 C r ADDRESS VILLAGE OWNER j 'C DATE OF INSPECTION: I FOUNDATION z FRAME F i INSULATION FIREPLACE { ELECTRICAL: ROUGH FINAL b PLUMBING: ROUGH FINAL { GAS: ROUGH FINAL FINAL BUILDING / DATE CLOSED OUT ASSOCIATION PLAN NO. F. t F The Commonwealth of Massachusetts Rjmt Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 - Boston, AM 02114-2017 www.massgov/dia. Workers' Compensation Insurance Affidavit: Builders_/Contractors/Electricians/Plumbers Applicant Information / I Please Print Legibly Name(Business/Organization/Individual): C,o kd 5o la r L L C Address: le 0, 9901- '('et City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.[5I am a employer with 1 Z- 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 8: Demolition working for me in any capacity: employees and have workers' 9. Building addition [No workers' comp. insurance comp..insurance.: required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself o workers' comp. right of exemption per_MGL Y � P 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no r V r employees. [No workers' 13.�Other Sa1a� ►�S comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees_ Below is the policy and job site information. Insurance Company Name: -Fo,-�(lf ,,�., Policy#or Self-ins.Lic.#: U F-' _q V 0 {� X b y Expiration Date: Job Site Address: 2.� ��;,✓ &orb a City/State/Zip; C d yj . 0 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 ce _-r the p ins and n ties oury that the information provided above is true and correct Si ature: _- Date Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4,,Electrical Inspector 5.Plumbing Inspector 6.Other. Contact Person: Phone M nigntixax D.L—L Y/Yi GV1"t / :G.7:.Lo a vi rt�%si. 4.1 vvlr_ i'ati vct rr_J. ' -0 DATE(MMODNYYYI CERTIFICATE OF LIABILITY INSURANCE FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERZFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,'EXTEND'OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THISFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE 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 and endorsement A statement on this certificate does not confer rights to the certfficate holder in lieu of such endorsemen US- PRODUCER CONTACT NAME: DON BUNKER INS AGCY PHONE FAX 51 MILL STREET BLDG F (A(C,No,ExW. (AFC,No): EMAIL HANOVER,MA 02339 ADDRESS: I 73JCD INSURER(S)AFFORDING COVERAGE NAIC tI INSURED INSURERA: TRAVELERS INDEMNITY COMPANY OFAMERICA- COTUTT SOLAR LLC INSURER B: INSURER C: fINSURER D: 3800 FALMOUTH RD NSURER EMARSTOId MIL LS,MA 02648 NSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER- IMIN 6TOCERTFYTHATTHEPOLICE.SOFUMBANCELiSrED=1HAVEBEENISSUEDTOTHEP1SUREDNAM@ ABOVE FORTHEPOLICY PERIOD INDICATED NOT1N WANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VATH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HESH6 SUBJECT TOALLTHETERMS,EXCLI1SIONS AND 00WHIONSOF SUCH POLICIES.LIMITS SHOWN MAY 14AVEBEEN REDUCED BY PAID CLAIMS. - INSR ADD SUB POUCYEFFDATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY HUtdBF.R (MDMIYYM iLOMIYYYYI LIARS GENERAL LIABILITY [ERAL CURRENCE S COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. TO RENTED S ❑ S(Ea o=irrence)' {Any one person} S &ADV INJURY S GEML AGGREGATE LIMIT APPLIES PER AGGREGATE S POLICY PROJECT❑LOC S-COMPlOP AGG S AUTOMOBILE LIABILITYDSWGLE S ANY AUTO LIMIT(Ea accided) ALL OPINED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY 1S NON-0WNEDAUT0S (Per acident) PROPERTYDAMAGE S (Peraccideffi) . UMBRELLA LIAB OCCUR. EACH OCCURRENCE S EXCESS LJAB CLAIMS�MADE AGGREGATE S DEDUCTIBLE S RETENTION S S A WORKERS COMPENSATION AND / WC STAMORY OTHER EMPLOYER'S LIABILITY YIN U649BBP8�14 03J262 12[Y1 014 03/2fi5 LIMITS L ANY PROFERITORIPARTNEWEXECUTIVE E L EACH ACCIDENT S OFFICEFWIEMBER EXCLUDED? N/A 500,000 (Mandalary In NH) E.L.DISEASE-EA EMPLOYEEI S 500,000 It ym dcsafm undtt DESCRIPTION OF OPERATIONSb&w E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VENCLEedRESTRMMONSISPECIAL rTEMS TRM REPLACES ANY PRIOR CEIrFMCATE MUEDD TO THE CER7MCATEROLDER AFFECTING WORKM COMP COVERAGE CERTIFICATE HOLDER CANCELLATION CONRAD GEYSER SHOULD ANY OF 7HE ABOVE DESCRIBED POLICIES BE CANCELLED 3800 FAL.MOUTH RD BEFORE THE EXPIRATION DATE THEREOF,NGTICE1MLL BE DELIVERED IN ACCORDANCE VIITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT'_VE MARSTON M UI.S.MA 02648 i#a ; ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 198E 2010 ACORD CORPORATION All rights reserved ,, b P iN , ,'Am Cotuit Solar LLC Project: System: 5.35 kW DC (STC) Site Plan Sandra Dannhauser 21 Polycrystallyne 255w Modules O Bo 8- 9 26 Lewis Pond Rd. 21 Enphase M215 Microinverters Revision: December 15. 2015 P PO Box 8 Cotuit, MA 02635 Scale: COTUIT SOLAR Cotuit MA 02635 So4FR .Mao�cE .�.� PRegear(t. TSE po�09 CLA-MP SGk�A4l4z-1J.0. -C N1To RhE . $� A. TYFXc ►1� o , C s M ovNYsrJb phNEs ti ` James A.Clancy,PE o - 601 Asbury Avenue A PR - ', National Park,NJ 08063 - Massachusetts PE Lic#46775 21 solar modules lag bolted into rafters every Oft. Roof is of truss construction on 2' centers. [ Cotuit Solar LLC Project: System: 5.35 kW DC (STC) Attachment Plan Sandra Dannhauser 21 Polycrystallyne 255w Modules 508-428-8442 Revision: December 14,2015 i• 26 Lewis Pond Rd. 21 Enphase M215 Microinverters .tee' PO Box 89 Cotuit, MA 02635 Scale: COTUIT SOLAR«` Cotuit MA 02635 Technical Data Photovoltaic Modules Conergy PE 240P - 260P conERG!:J -7i` _ � � . framed �•. t .` . I. ,-Nominal output- "-(P . ' r �'� '�% � �° +� '�k` fides •AL 4 , � s } �� No of cells �. •& ,,.�, R � '� � if 60 n Aw Cel type a polycrystallrne Module weight -4iv„fir 3 ry SS.J� Al M i - �' y =18 5kg 1340 7 Ib ; The Conergy P-series solar modules offer a high level of module output at an attractive price/performance ratio.They are equipped with efficient cells �4 :=1 ;perand have proven their worth in practical applications over the years.They are characterised by high yields and a long service Iife..Their production is certified 5,400Pa in accordance with ISO 9001,ISO 14001 and OHSAS 18001 and meets the high �. quality standards of Conergy.Solar modules in the Conergy P-series are-also -- available with monocrystalline and polycrystalline cells in other power classes F 'Warranty zz and different module dimensions. -= Benefits: - 3 10 years Y_ High salt corrosion and humidity resistance—complies with IEC 61701: Salt Mist Corrosion Testing. Outstanding performance in low-light irradiance environments -anti-reflective and self-cleaning surface reduces power loss from dirt and dust 100% EL double-inspection ensures modules are defects-free ��PTfFz�Q $ f 'CO NE'RGY PYCYCIE` 1g,z 4VA��� In accordance with IEC 61215 Ed.2 and according to 4 Conergy AG's current installation manual. 2 According to Conergy AG's current warranty conditions. Technical Data Photovoltaic'Modules oQ� Moo Co e gy PE 240P 260P eongomi Mechanical specification i Module dimensions(Lz{NzH) r 65x39x157,in (1650x991x40mm) h -....F�n�w%a.aa.�3. i,u:`.`s.,"":..�a»i++a-�».•«.. ��'-.» �w g�,,.��..�aw .a�w .....•.ww<k,te� e sna�,hu-.�.dr�,.,.sous.e4;...e:.a.:.. -w.,.--,...�,..sx` Cell dimensions 156 x 156 mm No.of cells w. ,,.a jL _ a w Fa Cell type Polycrystalline cell;3-busbar technology -°�...'.,r�•"`'£ '�' a � � "'x+ NOCT' 47 �w.......«....,w�..,c�1�';x�k-wz F..,�k1!a3.d���=�.is�..Yt`w:i" _ l^..,s'f d...-rivkw+�w �.�... .m..ew+.a.....,;.=.o..d...x��<.. .�. ' 5400Pa/113psf-Front side(long side`mount) Maximum permissible toad 4 2400Pa/50psf—Front side(short side/corner mount)—Details in Install Manual t 2400Pa/50psf Back side (negative load/wind) Front covet type h*' " a.+ ap t Tempered solar glass 3 2 min thickness t I �..6 .>r=..�s�..»s..�.......5...•..:w3.�.......��-.s+`.�r.. ..e�wp-�v...�v"'�.��..a.���„': Junction box Tongfing TL-Box026;Protection class IP67;90 x 91 x 16mm tion 2m ICable U..,_,mm Y- . _ Plug type Tongling TL-Cabfe0l (MC4 Compatible) Frame material Anodised aluminium(black frame avadable) si Module weight 40.7 lb.(18.5 kg) ° Certification ` H 's `IEClEN 61215 Etl`2 IEC/EN 61730,(NCS fS0 90g1 2008 ISOx - .,, � x ;`, :;. .140012004 OIiSRS18001 2007 UL1703(USantlCanada) Product warranty s 10 years FPerfor � .; �, � � �� ineamance warranty s x year 1 z 97%of nominal pouver output g a a Year 25 >80%of nominal power output ` -.,�._. .+.,,, ,..,......,w,.,...�==—.,w,...�-..-,.�:.•,`-.�...,..._.,- -.axe,k °=!:s,.. ._.+a�s.M..ap<..� .=....wa.,e.-,..-�v,as.,...a.n...,,ea. ,,,,s.�..x���,.e:.as�:�K...,mF.....-.F �.....-�,��„�....�..�'.. Maximum permissible system voltage 1000vdc Reverse current loadabdity(IR) ''# 15A �' 991 Linear performance warranty for•Conergy's P-series modules 100 97.0 94 94.2 0 c' 90.6 CO 88 87.1 .°4.2 6 E 83.5 a) . Q 82 80.0 .14z9 76 " 3 +14',s LL 70 1 5 10 15 20 25 4° year.of operation 3 Nominal operating temperature of the cell at.800W/m2 irradiation,20°C ambient temperature,wind speed of 1 m/s - °In accordance with IEC 61215 Ed.2 and according to Conergy AG's current installation manual. According to Conergy AG's current warranty conditions . i Jan 15 15 O2:2Op Cotuit Solar LLC 508-428-8441 p.3 E- r 'owe n of Barnstable ./r r fit oti `�: i .Regulat®ry Se -vice • WxvSTAttLF 4:,z- attics Thomas F. (.eiler, Direcinr - Foutn�� -Building DiViSiOD Tom.Perry, Huilding COmmissiUncr.. 200-Main S1rc.ct; HYann;s,NIA 02631 .. ti »^w^w.town.br�rnal�t+Ie.r»a.cts: Offieo: F-x.: 503-i90-6 >0 t - a Pro er - Cw�rrxe.r Allisr.P '. �Com'Elctc Arid ,Sit .r`i: This Scctior� f, Using A Builder . KI ::cY Of the subject Pion etrs `• --r- l --_�— 'a act on t e' 1f, 1_I I?:atter; rr_�a4 vC Ln Nvork auth or,Y,t.-d In i.his 1 rJ-1 it g periruU :L-I!P! ca4urr ic3r id-res r,f t��t� ( ) Zr- o :1 if Property. Oztncr is appl�ia Forpf,crnit ptra_sc eorn Ietc tIre HoMcOw*zir I.icr_n�;z, Fxcmptivu Forizt un.thi= revcrsc side. J ti Massachusetts -Department of Public Safety S Board of Buildinq Regulations and Standards Construction Superr Nor License-, CS-107947 "E ,'"► JOHN VREELAND` c. 48 QUASEINET ROAD" ' Mush pee MA 02649 } r 3 s- " 1EXPifation 04/25/2018 Commissioner 0f ce of Consumer Affairs/UdBusiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improveri%rentContractor Registration Registration: 146276 " r.. Type: Supplement Card Expiration: 4/8/2015 COTUIT SOLAR JOHN VREELAND _ �� 3800 FALMOUTH RD. MARSTONS MILLS, MA 02648 Update Address and return card.Mark reason for chap. SCA 1 0 20M-W11 " F] Address Renewal Employment El Lost( _Office of Consumer Affairs&Business Regulation License or registration valid for individul use only --' ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation t Registratio.n:_14627&" = Type: 10 Park Plaza-Suite 5170 o ExPiration 418120-75 Su lenient Card i PP Boston,MA 02116, COTUIT SOLAR JOHN VREELAND , P.O.BOX 89 COTUIT,MA.02635 Undersecretary Not valid without signs ure TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4 Map OgA.0 Parcel O l to Application Health Division Date Issued Conservation Division ���' Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ` Historic - OKH _ Preservation / Hyannis 1f Project Street Address a.6 Le—w Y S ?or1CA 20014 Village C`.0�'V► Owner Ca, Address Telephone (��. Permit Request U o — IJ 0_(X iq Z 0 Square feet: 1 st floor: existing t proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation S 5 D Construction Type UCK Lot Size • y Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family S Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes No On Old KirP7'r,HighwaW ❑`t 4 No rZZ Basement Type: ® Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq ft) Y Number of Baths: Full: existing_ o^k new �&L Half: existingw Number of Bedrooms: existing Anew Total Room Count (not including baths): existing l�o new First Floor Room Count i R Heat Type and Fuel: ❑ Gas ® Oil ❑ Electric ❑ Other Central Air: 14 Yes ❑ No Fireplaces: Existing 1 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 Uk<o__ If yes, site plan review # Current Use Proposed Use kes APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Fi w P -d uCc'1.3►v1.c c. Telephone Number 6008) Address 739 R%up,^ (Lct License # 0J76o3 Home Improvement Contractor# t oa 9 8 7 Email Worker's Compensation # a1/A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Town n� I.�GII•i�S�u.Iol� `�rUvtS��r StcciG�l SIGNATURE ' DATE AA�3 mI i(d i ` FOR OFFICIAL USE ONLY APPLICATION# BATE ISSUED ; MAP/PARCEL NO. . t ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 5 5oij bs 2 FRAME r6i 0114 INSULATION FIREPLACE j r, ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL '> FINAL BUILDING DATiE—CLOSED OUT °k AS`SOUTATION PLAN NO. r i the i_ummunweann ojlriassacnuserrs DeparbueW of Industrial Accidents -f Office of Invesfigations 600 Washington Street Boston,h1A 02111, www.mass govhHa Workers' Compensation Insurance A�tdavit:Builders/Contractors/EIectriciaus/Plumbers kVJ Applicant Information Please Print Legibly Name(Business/OrganizafioagadMduaI): .--- Address: ?3 B t2, e e- 2e4M aR c o -s tfM 11 M Jp1 City/StateMp: Phone#: Are you an employer?Check the appropriate box: Type of project:(required): 1.❑ I am a employer with 4- ❑ I am a general contractor and I employees(full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.Eglam a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-cm ractors have g. Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance . . comp.insurance$ 9. ❑Building addition - reT*ed.] S. EJ We are a corporation and its 10_❑Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work: 11.0 Plumbing repairs or additions lf se mY [N workers'' P. n p right of exemption. MGL comp. I2.Q Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required_] *Any.applicaut that checks box 41 must also fin out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all wodc and then him outside contractors must submit a new affidavit indicating such. lContractws that check this box must attached an additional sheet showing the nzme of the sub-contractors and st afr whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy nnmher. I am an employer that is providing workers'compensaizon insurance for my employees Below it the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.# Expiration Date: Job Site Address: 2 to Lc uw S•'--eta ry<1 -P—d City/Stalx/Zip: C o*u it) M b Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dale). 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 forR*arded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepaba andpenalfier ofperjury that the informafion provided above is true and correct SLU.ature: Date Gov c 9t�,ZD1 Phone# Official use only. Do not write in this areg to be completed by city or town official City or Town: -PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.PIumbing Inspector 6.Other Contact Person: Phone#: ` Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to Ibis statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto sha l not because of such employment be deemed to be an employer." MGL chapter-152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not prodneed.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfu ance of public work until acceptable evidence of compliance with the in sw-ance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the %members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidai�t 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 Departmed at the number listed below. Self-insured companies should enter their . self-insdranGe license number oathe appropriate lime. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant '• that must submif multiple pe mit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le,a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents office of lowestiptiml 604 WashizL9tau Street. ' Boston,MA 02111 TeL if 617-727-4900 e)d 406 or 1-877-MAS8AFF, Revised 4-24-07. Fax#617-727-7749. vmass_pvfdia t Town of Barnstable Regulatory. Services BAR� 'SS.. � Richard V.Scali,Director 1639. �0 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder ,as Owner of the subject property' hereby authorize mod" 4��L! O�Co r.»GL�.. to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) . ' **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are perfonned and accepted. Signatur�of �er Signature of Applicant Print Name Print Name. , D to Q:FORMS:O WNERPERMISS IONPOOLS Town of Barnstable Regulatory Services TKE roicyy Richard V.Scali,Director Building Division t IRIAIRINsxAs Tom Perry,Building Commissioner �$ MASS. 200 Main Street, Hyannis,MA 02601 pT�O �a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print - DATE: -- JOB LOCATION: number sheet village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes.&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 ' • ;W Massachusetts -Department of Public Safety Board of B*uIlding Regulatiobs and Standards License: CS-017603 i f EDWARD R OCO�TNE. PO BOX 84/RiVLR r Marstons Mills ma ' Expiration ' Commissioner 02/06J201S aJrtuPc left rrr�/ c /Irr;.r<rr�rrcfZi _'M:` L Office of Consumer Affairs&Business Regulation" License or registration valid for individul use only iM�110ME IMPROVEMENT CONTRACTOR before We expiration date. If found return for t��!-Registration: 104987 T ype: Office of Consumer.Affairs and Business Regulation _ Expiration 21161201-6 DBA' 10 Pork Plaza-Suite 5190 . E.R.OCIONNELL,BUILDER _ Boston,MA 02116 Edward O'Connell ` PO Box 841738 River Rd w Marstons Mills,MA 02648 Undersecretary Not valid without signature ' r - - d .. .r , Asses"sor's of Me(1 st.Floor): Assessor's map and lot number C p c*TH E to Board of Health(3rd•floor): ]T Sewage Permit number I• ? 22 %/N `3_ n ��S'� r,C Sys-'e1 e Engineering Department(3rd floor): ( 0'v TALLED 1N � 9TAXLL 1 �; 'A' CO House number E� irH T•"„ MPL� �io•6���' Definitive Plan Approved by Planning Board ~19 ��RON 5 MAI APPLICATION PP0RCE�SV� 8b10-9:30 A.M.and 1:00-2:00 P.M.only + ! ®WIV AL COpE q Barnstable Conservation�oOWN O F B.A�R N S T A B L� �� �-5�`. `ate I L D I N G [N-S? E C T 0 R Signed APPLICATION FOR PERMIT TO ���` e� kj #PPzjjZ A) TYPE OF CONSTRUCTION �✓/"'� �' e9S1 Qc N 1 74 ., 19 -l l 1 7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ,747 Location le ,-✓ Proposed Use ��l A � Zoning District Fire District Name of Owner 4r f C Address Z Zl1 w 2 J /�e(_ �o� . 04/ T Name of Builder / f Address Name of Architect Address p n Number of Rooms Foundation 0 r 0� i III coliC Exterior ` 0 . � Roofing Q fi — —� Floors Interior Heating Plumbing ` v — �SFireplace ��-- Approximate Cost Area < �L Diagram of L t and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barns egar i the above construWtiy Name Construction Supervisor's License`*" 011kno PERRY III, WILLIAM_H.,+ " AinitionNo' 34448 Permit for - Single- Fan'Ay`Daellin -? 26 `LT�ws Pi d -Road r ram' �� Location U W 11 Owner i ain ;H. ,_.Derry III ., Type of Constructions ( "Frame k LZ Plot Lot - .Ip ' 'Permit Granted .=July -11 , '�' '19 91 Dat6' f.lnspectionl c J 19 , T Date Com leted— ,19 ..t 71 We f .� �� �� �,. -� � { ' It � k t ,.• , � $ ■ i t y t - i G7' �i { �. ) Cry, � `• !. k _ ` i � - k 4 J } S, 01 ilk- i� l yD�c7 � Sr2f2 ec h N 9D '� DEPARTMENT OF PUBLIC SAFETY 3 e '> COMMONWEALTH OF 1010 COMMONWEALTH A%S - MASSACHUSETTS BOSTON,MASS.02215 LICENSE 200M.2-a7•aia2s APP IN 4 f • Assessor's, map and lot.:number ....!.! `..... .......... SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Sewage. Permit number ti .......' WITH A`dTICLE If STATE SANITARY CODE AND TOWN �FTHE T �.f ? ,TOWN' OF BARI IA-WRLE 88SHSTADLE, •T. M3a::� �"i6}q. BUIL'DING * INSPECTOR - '£0 MpY a' t J; APPLICATION FOR PERMIT TO . .... LTA...... (!? :...... ©..Y ...................................... TYPE OF CONST RUCTION ...T .`1 .......... ............................................. .......... .....19 , TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... I!�l........ ..v.V,..�........l...l... ......... Q.. .vll...................................... ................................... ProposedUse ...... ... ................................................................................................. Zoning District 1.(..©./....1� ....... .... .........................................�.............,../........p.Fire District ............ ................. 4V/L�..f/ :.../. ...� JFNA....�"7address 4% nwi? .AP C. P. v�.�.. Name of Owner .. ........ ...� ................ ..... ..... .............. Name of Builder ......./ �. �.f ..Address .... ®.Y.. :.,Sr © U��................F=. Name of Architect //#O w...V.r.... I..K!.�� ........Address !.<l e5.77 .S /W 7.................... Number of Rooms � C........�.. J ..........Foundation .1..l14!4... Cc. !Bjq. J Exterior'..... ..LYI!v©Q.��..-.... , / .:-.1.�I.............Roofing ...../...!. i7.1 ............................................ Floors '. QN1.F�Q...S`! /Q .......Interior ......... .T:. .............................................. Heating ......�'r... . M...../`t.I. .......................................Plumbing .....a4.. ` 1�. 17 s................................................ /fI.7°f. Fireplace ..........® ..............(....)................................Approximate Cost ....... c �!® ® 120 ^.. Definitive Plan Approved by Planning Board ________________________________19________. Area ........................................... 0 Diagram of Lot and Building with Dimensions Fee ..........••• 7 SUBJECT TO APPROVAL OF BOARD OF HEALTH - //O. O0 IOXC 5 7f fr it�F ��r�NcE�:9ooff /6d F,4C.,z:-3 � \o 8 10 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. -- Name .. ...... .. _ I Perry, -William H. III No°': 19209 one story s .. Permit for .................................... ; single family dwklling i . .ti.. .. .oz�...Lewis Pond�Road..................'.. - � � - -•- - - � . Location ...................... ..... .......... r' Ccloit - Owner William H. Perry, III ' Type of Construction frame - , .•••°,•.•,•°••••.°°••.•.......••.•.•••••••••••.••............................... '' •�l' _ •, • L - Plot .......................... . Lot ... ......................... Permit Granted ..:.....May..16...............:.:19 77 Date-of Inspection .(2. .Ill.:7� .�.......r.19 r Date Completed ? . ..............J 9 i 'PERMIT REFUSED - • ^ -, :�� •............................................... ....... 19 17 ..................... .......................•. n................... . • t `/ ;' Y` f . ' • _ f. _ , C ' ' •.•.............................. .................. .................. .� a - t 'r •. •. •' ' . _ .................... . ...'..................../..................... I y • , • . .. ........................................... ................................ ' • f• �• - - • « Approved •..... 19 ✓ , ..................... ...................................................... TOWN OF BARNSTABLE BOARD OF APPEALS BARI s639.1 397 MAIN STREET HYANNIS, MASSACHUSETjTS 02601 July 9, 1974 #1974-7-37" Mr. & Mrs. Thomas T. eureka 19 Old Oyster .Road Cotuit, MA 02635 Dear Mr. & Mrs. Pureka: RE: Appeal Application Number 1974-40 -ll serve as official notice that the lot, This letter subject of appeal wi. application number 1974-40, is a legal. building lot having been in separate title at the time of the. Zoning change in Cotuit and, therefore, falling within the category of protected lots under Section 5A of Chapter L 40A of Massachusetts General Laws. Therofgre, an application for variance is not necessary for either the'sale of this lot or the subsequent issuance of a building permit on .that lot. %his being the case, the Board. of. Appeals has decided to refund the $25 filing fee even though "a legal notice has already appeared in the news- paper. . You should be .receiving this refund shortly. Should you have .any questions, please feel free to contact us. Sincerely, Joseph A. Williams Chairman JAW: nsf cc: Planning Board Building Inspector s l Ott i�''. •J V_laCv/�n o WZ? • � _, t F. r • • � s •; to.�O` "'s •� .ova O' F '#`2 v j A M ts C. TPJ PP ol 12 S .a q tSS.ov Tz O a�oK Z'7 3� t'Ac a's ?' REcoRpED P A i Co • . F-V P, 4 LID Ct� d - , .~ihJf 3 m •i i h y� �< ��• tE6Z'I"1F 1�L'7 p trOT FP'L.1��1 az s LOCATlot�t. TNAT" THEG�%Nl7Pl� I✓_�t �'St�o�+u1�► P�_A�.J R�F'c2ct.iG N E��1 Cc�MPt.�lS �L/IT{-1 TWG Lor +94.1a ' SET$AC6G �EQt'tZeAA wTe, 01=. TNT -Toµ Q ot= '7-2 �iA C�c. 3p.) i BAXTE1Z t,� uY� t..ic._ cze&tsrcZaD L.Auc) SuZv���Qs C7t_AI-.1 t5 JOT 8�►SE� O►J AW OSTE2ViLL,E © �rCaSS. OUJLD #I,A,s ....^b---R�iT...ita,Y�,^+'Pyic'.,�^-x,•.I"...�- .,y,....-"r-.. ^+.1-r•+.t`'""iw*.,rl.,r'lr"�;+;...i�7'�'�i,n.,:>k.['r�.l"•Jr`.wina3_e:lT3x+'Pt.Cf'�`ry-�,�;'�rrwn"�SwT�'-rs.,.n:,•q,.`�'"�r,i'-"'-"'R.�'`".�,'r�.wS'�.�r^w*.--....•..-,c->.+^•.;::.I Assessor's office(1st,Floor): Assessor's map and;lot number 0� ' of THE to Board of Health(3rd-floor): _ �kDO)rlOn)Of=1 iriltG Sewage=Permit number / : Engineering Department(3rd floor)`: to%;( O+J DAHasTULLriva House number Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF B,ARNSTABLE 3$18UILDIHG INSPECTOR APPLICATION FOR PERMIT TO ���,� �/ A?V rTJ/Y �V TYPE OF CONSTRUCTION �b 19 —/ 4 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: Location Zew.1 ` ,.D k ewaOe:lnr 9 6 Proposed Use t r At ( rn v Zoning District / 1 Fire District Name of Owner / c Address � zo1.L'(� Name of Builder f d Address Name of Architect Address Q ,r r 77 C10� Number of Rooms � Foundation Exterior Roofing `' Floors �?�✓YI'�1 Interior Heating F44- Plumbinge- Fireplace. K Approximate Cost Area ` Diagram of Lot and Building with Dimensions Fee V, Lit OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barns egar in the above constructioyl Name Construction Supervisor's License � � � ' I PERRY III, WILLIAM H. A=020-016 0 -Cy/ No 34448 Permit For Addition Single family Dwelling Location 26 Lewis Pond Road Cotuit Owner William H. Perry III Type of Construction Frame 1 ' Plot Lot ' Permit Granted July 11 , 6 19 9 L Date of Inspection 19 Date Completed 19 Of �-, :5,. Assessor's map and lot number ........ +.......... ......... ...... 77 lt. z Sewage Permit number .......................................................... WQ�Of?HEr��o ;ti TOWN- OF BAR�NSTABLE Z BAS$3TADLE, � ,,.j "b q�;e�� BUILDING INSPECTOR CFO ixY a' d , ,� �- r APPLICATION FOR PERMIT TO .:.......... �.1........�.. .................... .................0...... ..............................,......... F TYPE OF CONSTRUCTION ................ ......... .................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to nthe....... following information: Location ...ZEkzll � ...... . IIfT�'.....1 ��........ •,/ 11 .7 .................... ..................................................... ProposedUse ...... T..V .T.C...........1. r...f� ..............................................................................I......................... Zoning District ........................................................................Fire District4 / .................... .. ................................................. Name of Owner ��L..� ,/.�I //. FAddress .✓!S rr3�tl,t7.•rk� ., � TC/� �................ Name of Builder �` ��`" .� �. /..Address ......:�. ..... � ����� .................. .......,................ ........ ........... .......................... Name of Architect !/;�/ �..d... ry p .........Address / 11—L s Number of Rooms / �.�� :......!... ....................Foundation .6. 4.....................L_ z4k � .,..../....... j ........... .......................... 77 Exterior ......!„ W,©n. ......... .1�" //.............Roofing � i ................................. Floors �'��M ..s l �11 ✓................................Interior ... Y i �J Z / A,} �7 � Heating !'L'¢� / s / Plumbing a� a . ' .....:................................................. .................................................................................. Fireplace ..........©!�!� �................................Approximate Cost ....................: ....�:.. `�.... f Definitive Plan Approved by Planning Board __________________________ ------19--------. Area .......................................... Diagram of Lot and Building with Dimensions Fee � °c /•.......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH //0- ©O _ 1 �. s No )FOA.D I hereby agree to conform to all the Rules and Regulations,of the Town of 'Barnstable regarding the above; construction. Name .. . Perry, William H. III A=20-1 l9,2O9 one story � — ............ Permit for .................................... n1mgIe ^ � . ���1�� ��el}�� ' .......................................................... _ ��~ Pon - � �«y�fa �qod Road ' � Loco�on �r.----______________.. � Cmtn1t ..'—.----..---.----..----..�—.. . � Willi Perry III NY �/"vne, . _ frame K/ Type of , ` � Plot ' ~ - . . � � 0May � rern`/, Granted � CompleteDate � � ' . . REFUSED � .PERMIT � --.---_... := .-----------. lq ^ ' ---'—^-------^'' —`------- / ,�»- . . —'-4�»��- ��--'4� --}^��.�..��� U � '' r........ ` ...—..~--.—.--...~.--...—~..--'--.— . . /[ '---'------^^--------'`''^~^'---- / . . � Approved ................................................ lQ � ' . -------------------.—.---..... ` � . ................ ........................................................... , � � r E-xP t C . ^� 4 R - `. - !q. 1 y' .. ww � ��i F � 3• rT3A'T't-. 7 1 1 CV-zz-r:t- T14A-r T1-1C-:'- F EDA Ti?;,15"o%o►,l -OAAPL..�(S WIT" TWG State. -j"s✓ Ab.1►7 SE:TBtC-.4G VE-QL11ZEMcl�-ATS 0i' T4tF-- L �► . PATt~ a l ff^i y ! _� "� ►'7, �" .�ahi 's`}�i - - _ BZEGlSt�2�D LAs.tp Su?_V�Ya2S ly T"l S V L.A W I S Q oT BA.S E't� O 1-4 A�.1 O SZ E V 1�t.E a Art A SS. 1,-461-QUAAEt--1 ScJ2V��( ` Tt�E UFCS�r'S ;i40UJLZ> APPt_1GA�T �bT lB r-- � To D t~r G ZM 4,14& L O-r U We S u �'9C. 26 Hardware notes'"' "*' • L �,,,a, Joist Hangers` 2X10. LUS 28.. Concrete Piers tp Grt. Strap ties HPAHD22. Ledger to Box sill 1/2" X 6"GaIv Bolts 18"Centers i Lateral Bolts ~' ,4 EA Dlr'W w/Galy Threaded Rod i 1 S rib 6 Eck" E Z:-0 (j _ .. r T e 1 - : I MY) Al I I i1 l0 Tu