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Home My WebLink About0932 MAIN STREET (COTUIT) 93A -- �r '1 APPLICANT INFORMATION n y (BUILDER OR HOMEOWNER) Name vVL e . Telephone Number Address qwi r License# g ` i Home Improvement Contractor# � Email Worker's Compensation # (o 1409 0*1 wt_�_ 5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _, - SIGNATURE '� DATE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- 0' Parcel A lication Peof� _ PP Health Division Date Issued ' ., Conservation Division Application Fee Planning Dept. 1 Permit Fee Date Definitive Plan Approved by Planning Board 1 (,JirK' �J Historic - OKH _ Preservation / Hyannis Project Street Address CA Village l til Owner 6 i Address Telephone Permit Request ti Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total news Zoning District Flood Plain Groundwater Overlay vwN Project Valuation © Construction Type_ r Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting-d'ocurl*ntation. 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 ffl new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: al//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 gar age:' existing ❑ new size _Shed: ❑existing ❑ new size _'Other: i Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes _ - 1YNo If yes, site plan review# Current Use - �r�een�4 Proposed Use �n t� 11L� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name GAn'1e5 (/�'�`'�►- (� Telephone Number !-74 z 7 7 7_�y Address I - 0�- S�� License# (4 319 7 i I A/ - 14-1AV)SAIL , tM 4 0Z6-7 2-- Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r i FOR OFFICIAL USE ONLY APPLICATION # , eft DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE iOWNER s _ DATE OF INSPECTION: FOUNDATION FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ti j FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. 5 Tlie Commorrft ealth of—Vassachusetts Y Offw.e of.Invesfigations 600 Washhigiton Street J. y Bostozz,41A#2111 _ wm-v m gov1dia Workers' Campensatian Insurance Affidavit:Bugders/ContractursJElectdcians/P'lumbers Applicant Inf6rmatinu Please Print LeQitbIY Name(B,ismess�lDrganizabonlInc�dual}= � Address: LIZ S OrD c Cltyfti3tP� {/ tiC ` IIB VMCI Are you an employer?Check the appropriate boar ' Type of project(required): I.❑ I am a employer with 4. ❑I am a general contractor and I employees(full.atrdfor part-time. * Have Mired the sub-contractors 6- ❑New consfzucton 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1. ❑Remodeling ship and have no employees . These sub-contractors have g-,❑Demolition . w Q far me in an capacity. employees and have workers' nr3� yinanrarr�I 9. ❑Building additionINo worknrs camp.in urine' omP- required] 5. [ Weare a corporation and its 101❑Electrical repairs or additions t officers have exercised their 3.❑ I am.a hameoumer doing all work, - , � 11:❑Plumbing repairs or additions r right of exemption per MGL nysel£INo vuailrers F- 17_❑Roofrepairs insurance required]T c.15.2, §1(4h and we have no employees.[Nowod=s' 13_❑Other camp_insurance required.) 'elny sppbcan dot chedm box iF1 must also fM out the section below showing tlsworkere compensatiou policy inEormzdarL Mameoarnerswho submit this afhdatit=TIcatiug they are=dGmg all woof sadthenhire auwdecontractorsmast submit anewafdaeit indicatia;such. ZMmInctors t5at rke a this box must attacked sir additional sheet showing the name of the sub-cars and store whether or not those entities bxve emplMe>s. If the sub-a tracrmshace empktfee%they nmstprauide their marke n'camp.palicg number- I ant an empJrryer that is provNing ivari'cers'compensaffen insurance for my enrpLayees Betoav is tJtePV cy artd job s&e informadorL �— Insurance Company Name: A Policy,4r or S&-ins.Lic-9: Job Site Address: a 1��0L V1 r,,�U J-'04/ , City/State/74p: 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$UOD.40 andrfor one-year imprisonments as well as civil peaaNes.in the form of a STOP WORK ORDER and a Time of up to MO.0!0 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIAY for insurance coverage t2ri$tttion Ido hereby certify under the pains andpenablies ofpetjury that the irlfbmzadon pro,i&d abmv is bars and correct i�nahzre:� Date: Phone 9- �Lf Offle:iai use only. Do not starts in this area,to be cornpTeted by city ortown officiaL City or Town: Permitff icense# Issuing Authority(circle one): 1.Board of Health 2.Build Department 3.CytyiTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Iastruct ons ' Massachusetts General Laws chapter 152 rmI ices all employers to provide wormers'compensation for fheir employees. ` Pursuant to this sty,as wVL7yw is defined as."-.every person.iu the service of another under any contract ofhire, e2cpress or implied,oral or wut=L" An employer is defined as"an individual,partnership,associations corporation or other legal entity,or any two or more of the foregoing engages 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 occopant of the - dwelIing house of anofer who employs persons to do mah tent ce,construction or repair work on such dweIling house or on the grounds or building app�n t thereto shall not because of such employment be,deemed to be an employer." i MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance-coverage required." Additionally,MCrL chapter 152,§25C(7)states"Neither the commanweatth nor a'ay of ifs political subdivisions shall enter into any contract for the performance ofpublic woik until acceptable evidence of compliance with the i„gran ce.. rtqui ements of this chapter have been presented to the contracting avfhouty_" Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s) along with tlaeir certificate(s)of snnz ance- 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 regnirr Be advised that this affidayit maybe submitted to the Department of Industrial Accidents for confamaiion ofmsmnce coverage. Also be sure to sign and date-he affidavit The affidavit should be retuned to the city or town that the application for the peanh or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are regrin ed to obtain a workers' compensation policy,please call the Department at the number listed below. Self-int companies should enter their self-insmance license number on the appropriate lime. City or Town.Officials Please be sme that the affidavit is complete and printed leg3lly. 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 penma t liccme number which will be used as a reference number. In addition, an applicant that must submit multiple pennitlhDmse applicatons in any given year,need only submit one affidavit indicating current policy h:l rmation.(if necessary)and under"Job Site Address"the applicant should write"all locations in (cam'or town)-"A copy of the affidavit that has been officially stamped or marked by Aire city or town maybe provided to the applicant as proof that a valid affidavit is on file for BArtre permits or licenses. A new affidavit must be filled out each year.There a home owner or citizen is obtaining a license or permit not related to any business or commercial vent= (i.e. a dog license or peunit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investig,doIIs would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give vs a call. The Departmenfs address,telephone and fax number- Tie C_cj �tvWmjth of Massachusalts Ilepaitment caf Iiad�trial Accidents dice of ut� ktio. CQQ�ashir�tau � B astou.,MA GiI11 TtrL 1617 t727-4g00 ci t 4-06 or 1-977-MA.SaAFE Fax 9 617-727 7M Revised 4-24--D7 d - l • AFDC Guide to Wood Construction ittWigll Fund Areas: 110 mph 11 ind Zone Massachusetts Checklist for Compliance(780 CMR5301-2.,1.1)' Loadbearing Wall Connections Lateral(no.of 16d common nails).._..._..._.._.::.:.._...:.(Tables 7)........-.-_:..................__... ._....__.: Non-Wadbearing Wall Connections Lateral(no.of 16d common nails).._._..--..-.._.----..:._-.(Table e).._......._......olt.._... ce.in.......-...._. Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9j Header Spans --..—.............___..._._._:.............(Table 9).......:......___.._.._...._R in.511'. = SIR Plate Spans ......_.---_.........__.._......._._----_-(Table 9).............._:...._........... It_in.511' Full Height Studs (no.of studs)...___._----...___;._.....(fable 9)..........._....._._....._... ........._.. Non-Load Bearing Wall Openings(record largest opening btrt check all openings for compliance to Table 9) Header Spans........................... g)......._........._._._...... _ft—in.512' SiltPlate Spans...._.___.........:._....................._...._...(fable 9).:._.__:...___..._._...._ft_in.512' Full Height Studs(no.of studs). .(fable 9)........_..........._.._....._........... Exterior Wall Sheathing to Resist Upfdt and Shear Simulfanbously4 Minimum Building'Dimension,W Nominal Height of Tallest Opening2 ................................................................_..._..__5 6`Er SheathingType..................... ._..............(note 4) ._............_...._.... ...._.. Edge Nail Spacing .._--..._. „-.- .(Table 10 or note 4 if less). .........._.__... in. Feld Nail Spacing ---—-.---.....(Table 10 in. Shear Connection(no.of 16d common nails)(Table 10)... - ...�. ........._.._.....r............... Percent Full-Height Sheathing..:..._:.........:_.(Table 10).................................._........... _% 5%Additional Sheathing for Wall with Opening>6V(Design Concepts)..:._............. Maximum Budding Dimension,L Nominal Height of Tallest Openine..........I._......................................................... Sheathing Type..._...._.....__....._...._._..M._...(note 4)..................... Edge Nail Spacing.......... 11 or note 4 If less)....................... im Field Nall 5pacng.:..._............_.__....:..._....:..(Table 11)......... in. Shear Connection(no.of 16d common nails)(Table 1 i)......._..„........_.._. ....-...._. _ Percent Full-Height Sheathing--._.;.--. ....--.._(Table 11)......._...:__---.._..._......:....:.__..._Yo 5%Additional Sheathing for Wall with >BW(Design Concepts)_.......... _..:.. Wall Cladding Ratedfor Wind Speed?......... .. .._...._................_.............. ....._...__...._..._._._......: 5.1 (ZOOFS Roof framing member spans checked?.........A_...:....:..(For Ratters use f 1WC Span Tool,see BBRS Websife) . Roof Overhang ..................................................(Figure 19)............. ft 5 smaller of 2'-or L/3 Truss or Rafter Connections at Loadbeadng Walls Proprietary Connectors Updit.:.._... ..... .. ..__.r:._..(Table 12)......._.. ..... ......... ..U= pif Lateral ._.............(Table 12)...._......... ......_._....L= pif Shear._. ......__........(Table 12)............................__..... _S= ' •Pif Ridge Strap Connections,if collar ties not µsed per page 21... (Table 13).............................T= pif Gable Rake Outlooker....................... ' ............_.(Figure 20 ft 5 smaller of 2'or L12 ' Truss or Rafter Connections at Non•Loadbeadng Walls . Proprietary Connectors, able 14 Lateral(no.of 16d common nails)_(fable 14)................... . • !b. Roof Sheathing Type..... �._...._:._ .' __.....__ .(per 7$0 CMR Chapters58 and 59) .......... Roof Sheathing Thickness..........................:._. .:.....:..:.........._._........................._in.z t/16'WSP ' Roof Sheathing Fastening._........................................:(fable 2)..................:..............._...._................ . •Notes:: 1. This chadcM shall be met in its entirety,excluding the specific exception noted In 2,to comply with the requirements of 760 CMR-530121.1 Item 1.if the checklist is met In its entirety then the following metal straps and hold-downs arr.not required per the WFCM 110 mph Guide: r a. Steel Straps per Figure 5 b. 2b Gage Straps per Figure 11 c. Upliift Straps per Figure 14 ' d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 1 Be and Figure I Bb 2. 'Exception:Opening heights of up to 8 ft.shad be permitted when 5%is added to the percent ful!-Iieight sheathing 'requirements shrnm in Tables 10 and 11. 3. The bottom sib plate in exterior wads shall be a minimum 2 in.nominal thickness pressure treated P-grade. ' ATYC"Guide to Wood Construcdon iu High lend Areas:110nzph If Zone Massachusetts CheckHst for ComPantce(78o outs3oi•2.l.f)' Pf Ch,=k . Compliance 1.1 SCOPE Wind Speed(3-sari gust)-_..»_._._...»........»..._...__...».___------- »...110 mph WindExposure Category..»...._.».»......».».......____....._:_.......»...___.........._._..................:..__........ :._B Wind Exposure Category................Engineering,Required For Entire Project.......................................0 12 APPLICABILITY Number of Stories(a roof which exceeds B In 12 slope shall be considered a story) stories s 2 stories RoofP'rtd r._.»....._.._..__._...:_»...._._..._......._».......»»-_(Fig 2) ......._..-._-......._................. c 12.12 MeanRoof Height _..»...»......_._.».__.........._:_..:...»..... (Fig 2)_....».......»...___..............._._.__ft <_'33' BuildingWidth,W........»...__..»...»..:......._..._.._......»..._,..(Fig 3)_.-»-........_....--..............._:._._ft 5 B0' Building Len L ...(Fig 3 ......................................... -ft s 80' Building Aspect Ratio ..(Fig4 Nominal Height of Tallest OpeningZ »......__.._ .� .(Fig 4)_..__.__.__....:..........._....-... s SIB, 1.3 FRAMING CONNECTIONS General compliance with framing o6nnecflons_....._......._.(Table 2)........................................................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete...........................:.................................................................................................. Concrete Masonry........_..._._.__..__._........._...»....»..........___._..._......».»._ ............... 22 ANCHORAGE TO FOUNDATIONI-3 . 5/B'Anchor Bolsdmbedded or 5/B'Proprietary Mechanical Anchors as an alternative in concrete only BoltSpacing general 9-9 .................................__...:.(Table 4).....................................__ in. Bolt Spactrig from endroint of plate..-_--....._...»___-...(Fig 5).._._....»._.................... In.s 6'-12', Bolt Embedment-concrete...... ._.. ...........»..___.._...(Fig 5)......_..........._».._.:.»..�...._.._. In.z T Bolt Embedment-masonry...._.__....._..;....._»._......».(Fig 5)__.:.._.�_.......................».» in.Z 15' PlateWasher..:.......... ».._..._...._._._...__.»._........(Fig 5). ................... L 3'x 3'x K" 3.1 FLOORS FloorFraming member spans checked ..____........._._....».(per 780 CMR Chapter 55)....._...___..._.....:....... Maximum Floor Opening Dimension._:.......».._»..__.»....... r _ (F9 6).....»....._..........._......._._...._.... its 12' Full Height Wall Studs at Floor Openings less than 2'from Exterior Wan Fg 6 ..... Mhdrnum Floor Joist Setbacks Supporting Loadbearing Wallis or Shearwall...._.......»(Fig 7).._.._......• ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Wals'or Shearwall_..........._(Flg 8)_.._..........................._..._...........—ft s d FloorBradng at Endwalls..».._.._.........._.._._..._.:...»._.._..(Fig 9)__..._._..» ---------- Floor Sheathing Type ..»....__..........._..:_...__...».».._...._(per 780 CMR Chapter 55) ................ Floor Sheathing Thickness.......»..._......._...............»-:.....(per 780 CMR Chapter 55).....»__._...._... In. Floor Sheathing Fastening_.............................................(!"able 2)__d nails at in edge/—in field 4.1 WALLS ' Wag Height Loadbearing wails.-'. ... .........»»_.-»»-_-....._.._._.......(Fig 10 and Table 5).........__--..........».—ft S 10' Non-Loadbearing walls.._.........._..._. ...(Fig.10 and Table 5).......................... ft's 20' . Wan Stud Spacing ._...._.._.............:............»...._........(Fig 10 and Table 5)-----------------—In.!;24'o.m Wall Story Offsets •..(Figs 71£ ......................... 42 EXTERIOR•WALLS' Wood Studs Loadbearing YWLd ....»._............_......._........_.__.».......(Table r4................. .........2x _ft in. Non-Loadbeadng walis :(fable 5)._..._...:;.........._....2x - ft in. Gable End Wall Bracing' Full Height Endwall Sfuds.....»....»..._..»»....».»._...»...(Fig 10)_........»:...»..........__......_._._..»..;._:....... WSP•Aft Floor Length.»___.»....»_. _'..»....__..._(Fig 11)__..._»._......._.._.»........... ft kW/3 Gypsum Carling Length(If WSP not used)....:.........._..Fjg i1)»._.._»....... .»....--•--....._ —ft z 0.9W and 2 x 4 Cbntlnuous Lateral Brace Q 6 fit.o.c.»(Fig 11)............................... ...... _»..»..». » or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top Plate Splice Length ...... 13 and Table 6)........................... _ft Splice Connecffon(no.of 15d common nar'ls)........_....(Table 6).....-.»............................:..».»._.... . F • AWC Guide to !Food Corr ctructio a i i High 1 Yind Areas:j l l0 mplr 1•Yrrrct Zone Massachusetts Checklist for Compliance(790 cniR 5-3011J:i)' 4. 3. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect'Rallo,determine Percent Full-Height Sheathing and Nail Spacing requirements f b. Wood Structural Panels shall be minimum thickness of V1 W and be installed as follows: L . Panels shall be Installed with strength axis parallel to studs. 3 ir. Al horizontal joints shall occur over and be nailed to framing. ; lL On single story construction,panels shall be attached to bottom plates and top member of the double top plate iv. On two story construction,upper panels shall be attached to the top•member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. ' v Horizontal nal sparing at'double top plates,band jolsts,and girders shall be a double now of Bd staggered at 3 Inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment 5.. Glazing protedlon:a)new house or horizontal addition-required If project is 1 mile or closer to`shore(generally,south of Rte.2B or north of Rte.6) b)vertical addiction—not required unless then:is extensive nmovatlon to the first-floor c)replacement 6riridows—needs energy conservation compliance only(chap 93) 6.Wood Frame-Construction Manual(WFCM)for 110 MPH,Exposure B may be obtained from the Americdn Wood Council (AWC)website. 19 . 11 it 3, t, 11 it ► G 1 At F it 1' la m ii i7 4 i 1 an m ' 11, ;l 1 AL �< t . y , 1 I Ill ,1 u 1 + 1 FRAeArNEt - 1 ! eDSE AflsMuT£ 11 �► IL if p 1l ►tW .. 1 1 .. 1 1 WL ll41 11 1 1 t raa,sP�dNG 1 NML PATTUW PA118- RAWL E= Z noLism uALmG.ESPAcm mxL. See DaW on Next Page ' Detail Vertical and Horizontal Nailing Vertical and Horizontal Nailing for Panel Attachment for Panel Attachment �IME�° Town of Barnstable °* Regulatory Services HAMMBM KAM t , Richard,V:Scali,Director 1639. Building Division QED MA'S 6 Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038. t Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Mal . /' G ,as Owner of the subject.property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) , **Pool fences and alarms,are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant 4-1_//� Print Name Print Name �. Da e Q:FORM&OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services oxIKE Richard V:Scali,Director Building Division Tom Perry,Building Commissioner KAM 039. �� 200 Main Street, Hyannis,MA 02601 ► www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that,he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fomis\EYPRESS.doc Revised 040215 Ocean Edge Custom Homes Inc. 4 481 Depot St. Harwich, MA 02645 Phone: 774-836-5799 Email:dvdcrosbie@yahoo.com - t To whom it may concern. My.Name is David Crosbie lam president and owner of ocean edge Custom Homes inc. I am writing this letter to verify Charles Whitcomb being employed by my cooperation. Please let me know if there is anything else you may need., Signed Dated Town of Barnstable � E Regulatory Services Richard,V: Scali,Director JLL 1WMSTAB Building Division BAMSTABLE 9 DiA9& 0 uRs"io Qj 1639 1mv Thomas Perry, CBO 1639-2014 D�.�a Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.nia.us Office: 508-862-4038 Fax: 508-790-6230 December 31, 2015 Charles Whitcomb Jr. 707 Main St. Hyannis, MA. 02601 RE: 932 Main St., Cotuit, Map: 035 Parcel: 093 Dear Mr. Whitcomb, This letter is in response to application numbers 201508586 and 201507975 submitted to remodel the above referenced address. Unfortunately,the application can not be approved at this time because of the following: 1) Ocean Edge Custom Homes, Inc. does not have a valid home improvement registration as required by law. Please do not hesitate to contact this office if you have any questions. r . Respectfully, e L. Lauzon Local Inspector j effrey.lauzon(a�town.barnstable.ma.us (508) 862-4034 4 DK jINII� I DESIGNATION OF AGENTS/PROXIES BY CO-TRUSTEES On June 17, 2015 Mary A. Fiore resigned as Trustee of the Mary A. Fiore Trust dated April 18, 2002 as amended December 11, 20040 thereby effectively naming, in accordance with the terms and conditions of the Trust, Marisa F. Kelley ("Marisa") and Michael P. Fiore ("Michael"), as the suer-trustees. Unfortunately, Marisa resides in Cotuit, Massachusetts and Michael is often traveling for work and out of the area of Lake County, Illinois, making it increasingly impossible to handle emergency funds for the Settlor, Mary A. Fiore. The settlor has accounts in Massachusetts, but the bulk of her banking is at The Northern Trust Company in Lake Forest, Illinois. Therefore, Marisa and Michael, as such co-trustees appoint immediately, as permitted by the terms of the Trust, their sisters, Claudia F. Walter, of 24100 W. Chardon Road, Grayslake, IL 60030 (Phone 847-546-6434) and Loretta F. Foss, of 23232 N. Indian Creek Road, Lincolnshire, IL 60090 (Phone 847-634-1493), their agents and proxies, with full authority as though named as such original co-trustees with Marisa and Michael, to manage and administer the assets of the Trust. This Designation shall remain in full force and effect unless and until such time as the undersigned notify in writing The Northern Trust Company, or any other account holder of the Trust assets. *Dated this-day of July 2015. e Michae P. Fiore Marisa F. Kell Subscribed and sworn to before me This 2 ay of July,2015. Notary Wblic Prepared by: Andrew a. Semmelman 4 RADLEY L. JONES SemmelD1- - & inelman, Ltd Notary Public 900 North Shore Drive #250 COMMy Commission T OF ssion Expires ETiS Lake Bluff, IL 6W" My Commlaslon Expires February 06, 2020 Phone 847-234-4438 ■u=n■ Town Boundary 0351012 CND :, 035-089 Y 123-456 Parcels FY201$ •- .---, _ #1234 Address Street Numbers Buildings 6pa0misPeations of OF�_j Above Ground Swimming Pools 035-011 Qa In Ground Swimming Pools "9�413 " 035-101 ® Walkways Improved #33 '__===n Walkways Unimproved - = Paths 035-092 #916 ® Stairways - 035-090 Paved Roads Qo #910 1 G-`�y Unpaved Roads Paved Driveways •• Unpaved Driveways ` Painted Lines Q ... Paved Parking Lots ------- b 0 Unpaved Parking Lots _ /Ov 'I� ® Bridges Railroad 035-093 Fences #932 —f— Guardrails Retaining Walls <>o—m Stone Walls QQSports Areas - C�� Golf Areas Docks/Piers a Boardwalks (~ ) 2257 Jetties Streams t • — - - Drainage Ditches Marsh Areas - Water Bodies `• ! x Spot Elevations(NAVD88) 035=094 i� O Topo io ft Contours(NAVD88) ` 4'• • Cotliit ^ • \✓ Topo 2 ft Contours(NAVD88) • Bay M" Wooded Areas ? t Street Trees - -. xCatchbasins • Monuments Lamp Posts • TowersUL Manholes • OSatellite Dish Q Utility Poles 035-095 -Signs .•�Fuel Tanks; #960 - Flagpoles ®®Water Tanks Utility Boxes0 Posts " • Pilings 035 96 Town of Barxisftbie Data Source Human-made features, Disclaimer This map is.for planning purposes only.It is 1 inch=50 feet N hydrography,topography,and vegetation were Parcel lines on this map are only graphic not adequate for legal boundary determination - Feet Conservation DiViiSion interpreted from 2oo8 aerial photographs and representations of Assessor's tax parcels.They or regulatory interpretation.This map does no p 12 5 �5 50 75 l00 W E P'// htt —.town.barnstable.ma.us. may have been updated from more current are not true property boundaries and do not represent an on-the-ground survey. " sources. Parcel lines were digitized from represent accurate relationships to physical Enlargements beyond a scale of i"=too'maYZoo Main Strcct,Hyannis,MA 02601 AsBuilt Page 1 of 1 TOWN OF BARNSTABLE z LOCATIONMMtl�n ��r�t✓1 SEWAGE# ✓� ILLAGE CZ5+1 .1 ` ASSESSOR'S MAP&LOT 0 2/ INSTALLER'S NAME&PHONE.NO. a h'1 C,r&_C-1 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) CUSS eSd r (size) NO.OF BEDROOMS_ BUILDER OR OWNER Y ja i 1p k 0 f PERMrrDATE: COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist . on site or within 2W feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within alb feet of leaching facility) Feet Furnished by a / s l blJ OecK- 0 cor moo �t cov eR4o �xL C9r•�e http://issgl2/intran6t/propdata/prebuilt.aspx?mappar=035093&seq=1 4/23/2015 f 7 ® DATE(MMIDD/YYYY) A�o CERTIFICATE OF LIABILITY INSURANCE 12/14/2015 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 Christian Barber, CIC NAME: _ The Oceanside Insurance Group PHONE (AI NIJ Ext): (508)775-0500 FAX No); (500)790-7955 EMAIL ADDRESS: 52 West Main Street INSURER(S)AFFORDING COVERAGE NAIL# Hyannis MA 02601 INSURERA:Commerce Insurance INSURED INSURER B: _ Ocean Edge Custom Homes, Inc. INSURER C: 481 Depot Street INSURERD: INSURER E: Harwich MA 02645 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL15121404187 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE ADDL SU D POLICY NUMBER MMIDDIWYY MM LTR /D 1DYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED A CLAIMS-MADE ❑X OCCUR PREM SESO(Ea occurrence) $ 100,000 BDRDYZ 7/5/2015 7/5/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY, $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PRO- 2,000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: Hired/Non Owned Auto $ 1,000,000 AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT $ Ea accident) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS (AUTOS PROPERTY DAMAGE $ NON-OWNED Per accident _HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under , DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 367 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE C Murray CIC/CHRIS U ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) � oa2vnw�uuea��C'a� ul'ation Q, ffice of Cousumer-Affairs&Business Reg HOME�IMPRO��MENT:CONTRACTOy e. b Registration 14021 Individual Expiration 9120i7 CHARLES WHITCONyE t CHARLES WHIT CO'. /1ri t 707 fV1AINtTREET HYANNIS,MA•Q2601. `�-�-='' Undersecretary � 1 t�; Massachusetts -Department of Public Safety 'Board ofBuilding Regulations.and Standards � ConsGructN>rrSupEr"�isex CS-083 License. 184 y rr CHARLES A.W11 tc , B.IR PO BOX 501 02672' West Hyannisport-' Expiration 04128/2016 �i commissioner i Ocean Edge Custom Homes Inc. 481 Depot St. Harwich, MA 02645 Phone: 774-836-5799 Email:dvdcrosbie@yahoo.com To whom it may concern. My Name is David Crosbie lam president and owner of ocean edge Custom . Homes inc. I am writing this letter to verify Charles Whitcomb being employed by my cooperation. Please let me know if there is anything else you may need. Signed Dated C§2Y,/nZOnIU g Office of Consumer Affairs&Business Regulation a f L before or registration valid for individul use only f h eore the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR � P gistration• 1''$4418 Type: Office of Consumer Affairs and Business Regulation t xpiration: At'�i2 d Corporation 10.Park Plaza-Suite 5170 Boston,MA 02116 OCEAN EDGE CUST011i7�10'WIi=Si DAVID CROSBIE 481 DEPOT ST. 1 HARWICH,MA 02645 Undersecretary Not valid without signature YIV • L • r Town of Barnstable *Permit#.0 Expires 6 months from issue date Regulatory Se 'cg Fee 743 UU M"ng' 1639. Richard V.Scali,Director �� dVd ATED�,i p —— ---- ----- ----�lhi�U1H9=D1V1AO — ---- --- — -- -- Tom Perry,CBO,BuildingTo 200 Main Street,Hyannis,MA 026' R /�Dr C www.town.barnstable.ma.us ��„D`c Office:.508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ' Property Address ( AIO, �� Q�c�I Dd residential Value of Work$ IDO OW Minimum fee of$35.00 for work under$'6000.00 Owner's Name&Address Af eJ� V� Contractor's Nam C A�I��6 CUST4k 9 aWS t1"6relephone Number �7 ( S -7 q 7 l Home Improvement Contractor License#(if applicable) 1CJo q Email: Construction Supervisor's License,#.(if applicable) UUUVIILI U ❑Workman's Compensation Insurance DEC 14 20 Check one: To U 15 ❑ I am a sole proprietor t - /V OF BARIUST ❑� I am the Homeowner ABBE I have Worker'jCo ensatio s ance P YInsurance Com an Name Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Reque (check box) [ e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping: Going over existing layers of roof) D-Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑1 Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. **.*Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: Q:\WPFILES\FORWbuilding permit formsTYPRESS.doc Revised 040215 t + s .`� ?Tie Commm vveahh of-Vassachusetts DEp[El't7uP. t of Indmsfrial Accidews - © -ce o,f'. nve-stlgatlons 600 Washington Street impinniass govIdldi -Workers' Compensation Insurance Affidavit:Builders/CuntractorslEIecErlcians/Plumbers Applicant Infannation I e P ' t bI Name(B.udmm/Organizadonffiidvidud):OCLA�j 2W�, U "ORE) C s EEf of7 -T. pity/ tatpl A I% cane Ll �; S l "Y Are you an employer?Check the appropriate box: Type of project(required): I am a general contractor and I 6. ❑New construction I.El I am a employer 4. ❑ employees(fall andlor part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor arpartner- listed on the attached sheet. I. ❑Remodeling ship and have no employees , . I I These sub-contractors have 8. ❑Demolition worldng forme in any capacity. Ion andhave.wodiers' g. ❑Building addition [No vmrlmrs'comp.insurance Comp-msurance.l required-] $. We are a corporation and its 10-❑Electrical repairs or adddmm 3.❑ I am.a homeoumer doing all work officers have exercised their 111-1 Plumbing repairs or'additions m3` � myself o workers' right of exemption per 1'MIGL' - 12-❑Roofrepairs insurance required-]T C.152,§1(4h and we have no employees- o workers' 13.❑tither comp.insurance required.) 'Any Wbcamthat checks box ill amst also fill orutthe sectionbelow shnsriag their workere carapensatiaupolicy iafnrmatia3- Fiaateoavners who sulmnit Ehis affidacft indicating they are daiag all woaic and.Ifien hire outside coatractnrs amct submit a new affidavit indieatimg sacb- ICo=actars that ehea this boat mast attwbe,d m sdditianal sheet showing the name of the sub-comtmcbo-a and stale whether or nut those entities have employees. Ifthesub-cam=ctws:1mve employees,theymustpmuide their warlkers'comp.policy number. I atn an employer that isprviid trg workers'congwisaden irtsarance,fbr my employees Below is fltepofiey and job site inforrrzation. Insurance Company Name: Policy 4t'or Self-ins..Lic.k 12 KQ yZ-3, FuTirationDate: /�- q1-7 Job Site Address 1 W�pt 'A "�� OtUl`:�_OCify1State/Zi,: Attach a copy of the workers'compensationpolicy declamation page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A o€MGL c 152 can lead to the imposition of criminal penalties of a fine up to$I,500 UO andlar one-yearimpnsouine�as well as civil penalties.in the fo=of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the 016ice of Itavestigations of the DIA for insurance coverage verification Ida hereby certify under the pairs andpenabYes offer,juty fhatthe irk;formadou prot?L abMT is bare mid correct _ J Simature: Date_ Phone Official use only. Do not write in this area,to be cotnpfeted by city or town offieiat City or Town: Permitffikense if Issuing Authority(circle one): L Board of$ealth 3.Budding Department 3.Cityi Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massar husetts General Laws chapter 152 requires all employers to provide woEL-eas'compensation for their employees. � purs�this statute,an.enplayee is defined as."_.every Person in the service of another under any coact of hie, ` express or implied oral or wlfttm-" An er1pIoyer 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 - dwelIing house of anther who employs persons to do mnai„tmance,construction or repair work on such dwelling house or on th.e grounds or building appumrtena t thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct bindings in the commonwealth for any applicantwho has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the cometaowealthnor any ofidspolitical subdivisions shall enter into any contract for the performance ofpublicworkuntil acceptable evidence of comnpl=cewithm the hmza,ace._ requirements of this chapter have been presented to the co„i,�amthodty." Applicants Please fill obt the workers'compensation affidavit completely,by checl time boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone nomber(s) along with their cm ificate(s) of iasi r „ce. Lanittd LiabD4 Companies(LLC)or Limited Liability Partnerships(LLP)withno employees other than the members or partners,are i e not mqud to carry workers' compensation insurance. If an LLC or 11T dries have employees, a.policy is required. Be advised that this affdayit may be submitted to the Department of Industrial Accidents for conf=ation of mmAran ce 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 h,d,ctriaT Accidents. Should you have any questions regardimmg the law or ifyou are required to obtain a workers' compensation policy,please call the Department at the mmmbea listed below. Self-mffured companies should enter 13aeir self-;,,sr,rance license number an the appropriate at. City or Town Officials . t Please be sore that the affidavit is complete anal pm hted 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 pemmitflicense n=ber which will be used as a reference number. In addition, an applicant that must submit multiple pe>mWhcense applications m any given year,need only submit one affidavit Mdicatimmg current p olicy in.�mumation(if necessary)and under"Job Site Ad 1dress"the applicant should write"all laca#mans II ( Y or town)_"A copy of the affidavit that has be=officially stamped or marked by the city or town maybe provided to the " applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavitmust be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venire (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Of 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 Departm.=f's address,telephone and fax number Tie C�G.MmmWealtIE of MassaahmeAb ' Dtpaztment of liidmtdal AocWants �it�e r�,f�.ve�fig�tto� �Q#��ashin�Qn t Bost MA 02111 Tf,-L 0 617 727-49QO ext 4-€6 car 19T`-MA.SSAFF, Fax 9 617-727 7749 Revised 4-24 07 M gGV1dia IKE RAJMSTABM MASS. Town of Barnstable _- ----_ - ------ -- ---.._ Regulatol"y_Sel'��e�S...— - Richard V.Scali,Director Building Division Thomas Petry,CBO Building Commissioner q 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 I 1 S as Owner of the subject property hereby authorize to act on my belialf, i in all matters relative to work authorized by this building permit application for: (Address of Job) c � •- �r�%��. .;. � � _ /1` rye+-- . ; Signature of Owner Date ((( w Print Name x If Property Owner is applying for permit,please complete the Homeowners License Exemption Form_on the, reverse side. Q:\WPFHM\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services ��t rgyti Richard V.Scali,Director Building Division * sAaxsTAst.e, * Tom Perry,Building Commissioner MASS. 163q. �� 200 Main Street, Hyannis,MA 02601 ATFD ► www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: - city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. �. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 p .Massachusetts;-"De artment of Public Safety f Board of Building Regulations,and Standards a { - Construction Supervisor ' License: CS-Mi84`� j CHARLES A.WHO"'TCOMBJR "-,4 PO BOX 501 < tr n West Hyannisport]YIA G 2 Expiration 0412812016 ` t Commissioner 1, t c�fie�vo�mmzo?ureall�o�C��aeacrcluraeCta - . . e of Consumer Affairs&Business"Regulation h E IMPROVEMENT CONTRACTOR Vges istration� 6099aL�_ Type: i xpirabp 7-91 f a f 16 1f7,1 Supplement CA MARINE LUMBER OLO tN A 7 zl CHARLES WHITCO 134 LOWER ORANGE STD `° `�„ i NANTUCKET,MA 02554 1 Undersecretary ACOR" ' CERTIFICATE OF ,LIABILITY INSURANCE DATE(MM/DD/YYYY) 11.. � 1 10/26/2015 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 Christian Barber CIC NAME: The Oceanside Insurance Group PHONE (508)77570500 ac No: (508)790-7955 �E-MAIL _ - ADDRESS:. 52 West Main Street INSURERS AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURERA:Commerce Insurance INSURED INSURER B Associated Employers .Ins CO Ocean Edge Custom Homes, Inc. INSURER C: 481 Depot Street INSURERD: INSURER E: Harwich MA 02645 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1571003855 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE A CLAIMS-MADE ❑X OCCUR PREM SES Ha occurr0ence $ 100,000 BDRDYZ 7/5/2015 7/5/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,600,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2;000,000 X POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT i OTHER: Hired/Non Owned Auto $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ /. DIED RETENTION$ $ WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ N/A i B (Mandatory In NH) WCC-500-5010487-2014A 11/30/2014 11/30/20.15 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION billing@capecoastalbuilder SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Coastal Builders THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 827 ACCORDANCE WITH THE POLICY PROVISIONS. Harwichport, MA 02646 AUTHORIZED REPRESENTATIVE o C Murray CIC/MC �� m (/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 romans Parcel Detail Page 1 of 5 o e l , Logged In As: �n Pa rce I Detail Thursday, Novembery19 2015 Parcel Lookup Parcellnfo Parcel ID 035 093 1 Developer Lot Location 932 MAIN STREET(CO Pri Frontage 129 . ,•.,., -.�1 Sec Road Sec Frontage 1 Village COTUIT 1 Fire District;COTUIT 1 Town sewer exists at this address jNO 1 Road Index 0951 {qw i Asbuilt Septic Scan: � �3 0350931 Interactive Map I Owner Info Owner FIORE, MICHAEL P ET�1 Co IC/O MARY FIORE 1 H Owner Streets 3�0898 N. MANOR HILL f Streetz city GRAYSLAKE 1 state IL zip 60030 . .� 1 Country 1 Multiple Ownership Info % Owner Name Co-Owner Address 25 FIORE, MICHAEL P ET AL. C/O MARY 30898 N. MANOR HILL ROAD, GRAYSLAKE IL TRS FIORE 60030 25 KELLEY, MARISA F 30901 N MANOR HILL RD, GRAYSLAKE IL 60030 25 FOSS, LORETTA F 30901 N MANOR HILL RD, GRAYSLAKE IL 60030 25 WALTER, CLAUDIA F 30901 N MANOR HILL RD, GRAYSLAKE IL 60030 Land Info ...... ... ........... ......... .. ............ ..................................... ................................................. ........ ......... Acres 0.92 __ use Single Fam MDL-01 ! Zoning RRF �Nghbd j0119 «« Topography Level Road Paved Utilities Public Water,Gas,Septic Location Waterfront,Excel View Construction Info Building 1 of 1. Built c tG ll 86 �Sac ble/Hip w ood Shingle Living 13307 "` Roof sph/F GIs/Cmp AC e None Area Cover Type Style Colonial In Wa11 Drywall Rooms °6 Bedrooms Model R se Idential' Int Hardwood Rooms�6 Full-0 Half Floor Grade verage Plus Type Hot Water Rooms 12 Rooms Stories 2 Stories Fuel Gas Found- ation IBr�Irk Walls http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2291 11/19/2015 Parcel Detail _ Page 2 of 5 Gross 6698 Area Permit History Issue Date Purpose Permit# Amount Insp Date Comments 7/8/1999 Remodel 39588 $15,000 1/1/2000 NEW WINDOWS/FINISH 12:00:00 AM BEDROOM Visit History Date Who Purpose 7/20/2015 12:00:00 AM Tony Podlesney In Office Review 6/10/2013 12:00:00 AM Robin Benjamin Cyclical Inspection 6/9/2005 12:00:00 AM Paul Talbot Meas/Est 4/28/2000 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 3/22/2000 12:00:00 AM Martin Flynn Meas/Est Sales History Line Sale Date Owner Book/Page Sale Price 1 12/15/2006 FIORE, MICHAEL P ET AL TRS 21612/68 $10 2 5/30/2002 FIORE, MICHAEL P ET AL TRS 15207/222 $0 3 9/15/1988 FIORE, MARY A 6458/38 $1 4 10/3/1973 1 FIORE, ALFRED L & MARY A 1944/271 1 $150,000 Assessment History... ......... .... .. ..........................__....... Save Building Total Parcel Year XF Value OB Value Land Value # Value Value 1 2015 $235,600 $34,800 $131,900 $1,500,700 $1,903,000 2 2014 $235,600 $34,800 $136,200 $1,500,700 $1,907,300 3 2013 $240,900 $34,800 $138,700 $1,500,700 $1,915,100 4 2012 $245,400 $35,600 $147,900 $1,445,300 $1,874,200 5 2011 $283,200 $7,900 $149,600 $1,445,300 $1,886,000 6 2010 $283,700 .$7,900 $158,400 $1,445,300 $1,895,300 7 2009 $453,700 $9,400 $222,000 $1,605,600 $2,290,700 8 2008 $453,700 $9,400 $222,000 $1,673,700 $2,358,800 10 2007 $467,200 $9,400 $222,000 $1,673,700 $2,372,300 11 2006 $432,700 $9,400 $225,000 $1,653,900 $2,321,000 12 2005 $366,400 $8,800 $150,000 $1,653,900 $2,179,100 13 2004 $298,800 $8,800 $146,000 $1,503,500 $1,957,100 14 2003 $264,200 $8,800 $25,200 $1,344,000 $1,642,200 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2291 11/19/2015 Parcel Detail Page 3 of 5 15 2002 $264,200 . $8,800 $25,200 $1,344,000 $1,642,200 16 2001 $264,200 $9,300 $25,200 $1,344,000 $1,642,700 17 2000 $187,900 $2,300 $26,200 $574,100 $790,500 18 1999 $187,900 $2,300 $26,200 $574,100 $790,500 19 1998 $187,900 $2,300 $26,200 $574,100 $790,500 20 1997 $174,900 $0 $0 $574,100 $778,400 21 1996 $174,900 $0 $0 $574,100 $778,400 22 1995 $174,900 $0 $0 $574,100 $778,400 23 1994 $155,000 $0 $0 $559,700 $736,900 24 1993 $155,000 $0 $0 $559,700 $736,900 25 1992 $176,700 $0 $0 $621,900 $824,000 26 1991 $198,400 $0 $0 $717,600 $941,400 27 1990 $198,400 $0. $0 $717,600 $941,400 28 1989 $198,400 $0 $0 $717,600 $941,400 29 1988 $127,700 $0 $0 $430,600 $577,600 30 1987 $127,700 $0 $0 $430,600 $577,600 31 1986 $127,700 $0 $0 $430,600 $577,600 Photos k�V i V F` Ili http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2291 11/19/2015 Parcel Detail . Page 4o5 � � s . . f ° . . . .. , . � §#/%!»q 2i2#aneEp opdta/Pa c lDemƒa px?ID=2291 11/19 2015 fs -a 2 '! r . + \\C \ L 2 ti TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map:,�0 3.� Parcel_ - a� '• Permit# yy T r 0 v Health Division :,�, W Pate Issued �? die 4N Conservation Division T®� �� e` Tax Collector y.-y ' 1Y�- ''�Q�C /� t P�R��L��c Abet / NS. Treasurer. �77 CSL g� Planning Dept. ' ' /►^ t t Date Definitive Plan Approved by Planning Board r Historic-OKH Preservation/Hyannis 4 / Project Street Address C1 3 4S�T ` Village Owner &P P' 0-1 e Address PlAe SpriA� ck c.rG Telephone Permit Request —ro cAa—e eiqkA�a^ we trJa,-,S °fd �,�d o,. &;;-►dmws -rQ O�Jd �� rLc p.`z�� S �• iSu� �3e�. �v�`z ��,� c?uP RIP C'00 ' Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cos Zoning District Flood Plain Groundwater Overlay Construction Type ' C�'^o Lot Size�� !X 477 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: O Yes .dNo Basement Type: 'Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) qq Basement Unfinished Area(sq.ft) Number of Baths:. Full: existing J new Half:'existing new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing (1 new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other ' Central Air: ❑Yes l�o Fireplaces: Existing New ' Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:*xisting`❑new 'size Shed:❑existing ❑•new size Other: Zoning Board of Appeals Authorization •❑ Appeal,# Recorded❑ Commercial ❑Yes Flo If yes,site plan review# T Current Use Proposed Use BUILDER INFORMATION Name 1 ✓lS�� (a^ Telephone Number � ` Z Address `1 un'Cl` License# _ S G Nc3`wy_�— 0 2-S-3'7 Home Improvement Contractor# U Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE ?3 )f, • FOR OFFICIAL USE ONLY PERMIT NO. ;,, �• *' — -- 4 DATE ISSUED�t MAP/PA,RCEL NO _ _ � - ,u ' ' - - •; � '' � - — -ADDRESS OWNER DATE OF INSPECTION: . { -..1 'its-. •, - � _ �• .: t . -. • { .- FOUNDATION_ .� • t a 5,: _ t F , FRAME INSULATION +rri �. -- r _ `- f; ", y - .,S • ,._ y_ - t �., _ , _ t T •s FIREPLACE # ELECTRICAL:-`;.�ROUGH FINAL PLUMBING: ROUGH FINAL _ GAS: ,ROUGH FINAL- FINAL BUILDING DATE CLOSED;OUT ASSOCIATION PLAN NO. `'♦. a Building Mivision 367 Main Street,Hyannis MA 02601 9 i •� r e \ MCC: 508-862.4038 Ralph Crossez 508-790-6230 BuiIding'Commissic e- Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERBIXT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to aay pre-existing owner-occupied building containing at least one but not more than four dwelling traits 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: Q Mo Estimated Cost Address of Work: IMaLv, Owner's Name: Mo-ry -For-Q-- Date of Application: C I hereby certify that: Registration is not required for the following reason(s): Q Work excluded by law OJob 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 3za Date Connector Name Registration No. 12 OR Date.. Owner's e q:forms:Affidav 600 Washington�. .._. � Sdreet Boston,Mass. OZIII / Workers'/ Compensation Insnraace davit name: location- "I. fnleJl g - city raL,, hone 0 YIn— I am a homeowner performing ail work mpselE Q��/�soIe aronriesor and have no one zvorldn9 in anv stilly I am an employer providing workers' compensation for my employees working on this job. comonnV name: address: . . .. city- hone#s 'nsurnnce tin. �( I am a soIe proprietor general contractor or homeowner drele one and have � iavc t hired the contractors listed below who the folloi%ing workers* compensation polices: omnsny name•. 1-IN: /1--t-4- k dress: J tvVw rdd� � ,. •• .... .. :max:; _ hone#►~ IlurlInce Cfl. Len IaINv-^- : . iii�►!! ... 4 , �, �' '„�:, .::. r-nanv name- ... ... •� .':'• .. ... :. • :it�2i�s.w• ;',«a,.,`l��'�.,... ..:: :.ti:^:7vtiM:::..• d res hose .. .. �..... - .•:a.. �nrnncc CO. ...... �ri>:>"+:fd..:" + "M'•. ... .oi,,:;;tA �^c ..v..,.'.:: ::.. kvd i:rr to secure coverage as requited under Section ZSA otMGL I52 can lead to dw veers;tmprzsonment as well as dvil penaides in the form of STOP♦VO1tK ORDEQ�a ads o[SIpO.Op�o[a One up to SI.SDUD and/or v of d s statement may be forwarded to the OMce otInvndcations otthe DlA for eoverage•eeida<doa• tit ' I mrderstand that a hereby terrify under the psis and penalties of perjruv that the information provided aboae itVw mid Correa II- t name �J�f 6'tLS Phane0 - aIldal use only do not write is this area to be completed b7 eats ortowa otIIdaL tv or town: pa>mitJticros°t! - C3BuU WgDepartment check if irtt mediate response is required OLteensiag Board • • ❑Sdeeszrtm's OM nuct person: CHealth Deparanent phone k; ❑Other�� emniovees.. As quoted from the "law", an employee is defined as every person is the service of another undue:sav of hire, express or implied, orni or written. An employer is defined as an individual partnership, association, corporation or other legal entity, or any two or the foregoing engaged in a joint enterprise, and including the legal represeatadves of a deceased employer, or the:�cr-•e- . trustee of an individual , parmership, association or other legal entity, employing employees. However the==of Z. dwelling house having not more than three apartments and who resides therein, orthe occupant ofthe dwelling house o: another who employs persons to do maintenance , consCuction or repair work an sack dwelling house or an the=u:iz building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section ZS also states that every state or local licensing agency shall withhold the issuance or rere-: of a Iicense or permit to operate a business or to construct buildings in the commonwealth for any applicant who not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neid rthc commonwealth nor any of its political subdivisions shall eater into any contact for the performance of public work,,r,- acceptable evidence of compliance with the insurance regturemeais ofthis chapter have been presented to the c��_ authority. AQQlrcants PIe:se fill in the workers' compensation affidavit completely, by clung the box that applies to your situadaa and suppiving company names, address and phone numbers along with a certi =of incmance as all affidavits may be submitted to the Department of Industrial Accidents for con$tmadoa ofimmmuce coverage. Also be sure to sign ana date the affidavit. The affidavit should be returned to the city ortmmthatibe application for the permit or H=c is being requested, not the Department of industrial Accidents. Should you have any questions regarding the `law"or if:•c are required to obtain a workers' compensation policy, please call the Deparaaeat atthe number listed below. City or Towns PIe:se be sure that time affidavit is complete and printed legibly. The Depaita=has provided a space at the bat=of: dEdavit for you to fill out in the event the Office of investigatiams has to contact you regarding the applirnnt please :e sure to fill in the permittliccnse number which will be used as a rcfi=n=mmmber. The affidavits may be reu=6d to he Department by mail or FAX unless other arrangeffn have ban made. the Office of investigations would like to thank you in advance for pon cpopemdm and should you have any T=dons, ii=e do not hesitate to give us a call. I= Department's address, telephone and fax number.- The Commonwealth Of Massachusetts Department of Industrial Accidents 0liice of Imtesd0adoas 600 Washington street ' Boston;Ma. 02111 fat#: (617) 727-7749 phone #: (617) 727-4900 a= 406, 409 or 375 i DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Number. Expires: Restricted Toi 00 ROBERT . IADONISI 7 HILLWOOD WAY E AST.SANDWICH, rA �2537 ✓1m�oo�w�non�aealDi o�✓�aaaaeo%vet7 HOME IMPROVEMENT CONTRACTOR Registration 103635 Type - INDIVIDUAL Expiration 07/09/00 ROBERT G. IADONISI :!A7Sandwich Way MA 02531 ADMINISTRATOR 10 OC CIIA t ZLA 1 �t t yJ\ y Mar nevi All 4-k �� fie_ p� I �� z 1 HOP x .b . 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