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1000 MAIN STREET (COTUIT)
� © � � � ���arw ���- J ,� __ _ _ _ �. �- l Assessor's map and lot number ..... ..7.... ............. SEPTIC SYSTEM MUST BE �0i THE t01� Sewage Permit number ............................... y3 INSTALLED IN COMPLIANC // WITH TITLE 5 • House number ...C���a.......... z P. ...�....:......:... Baarnea LB•� ENVIRONMENTAL CODE A o G % TOWN REGULATIONS � pYPYpr� TOWN OF BARNSTABLE f BUILDING INSPECTOR y APPLICATION FOR PERMIT TO ........ ..... ......t>1a,=�S\ ... ................................... .TYPE OF CONSTRUCTION ....... ...... Q .................................................................................... 1fr..............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ../ 0........ LA.1k ...... ? i....... �� !�.. ...................................... ................................................................ ProposedUse ...... t4.... ...........................:.....................,a........................................................... Zoning District ........................................................................Fire District ....(2.4,j� ................................... Name of Owner ....................Address ............... �•....... Q. .. Name of Builder .. -- .. ddress ... ... � rt �¢ 'I k L � b' S2 y � g M hh�� Name of Architect ... �4a.. Y11 .. ..............Address .....M."Iv.......da�i..4 P-44.............................................. Number of Rooms ......(...........................................................Foundation .....�Sp.lJ1C........................................................... Exterior .......... .....................................................Roofing ....... �4......................................................... Floors ( ......................................................Interior ........ ......... .. Ct+. \............................................... Heating ........ ..................................................Plumbing ...... .0................................................................... Fireplace ........NO..................................................................Approximate Cost ......../PL ��.�. a. Definitive Plan Approved by Planning Board ________________________________19________ . Area .3 .. .. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH N OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............................................ Construction Supervisor's License .®�i� .............. HICKMAN, PETER No .2.8.249..... Permit for ....XMITION.............. ..................... Location ....1000.................Main....Street......... ............................ . . Cotuit ............................................................................... Peter Hickman Owner .................................................................. Frame Type of Construction .... ..................................... x. ,,Plot .......................... Lot ................................ Permit Gramed ..MguMt..22..................19 85 '.Date of Inspection ......................19 Date Completed .......... ..............19 Lr ..21, M In 171 rei I p- C, 4c M Cr rj 0 !�- Assessor's map and lot .number ...... ....i�/ . . i f of 7NE TO Sewage Permit number ........................................... d House number ....... .../t 1 Z BA"STLBLE, i Q�V.............. ...........%,•............................. y t63q L 1639 Apo, • \00 SEC MPY d' TOWN OF BARNSTABLE DUILDI/NG INSPECTOR APPLICATION FOR PERMIT TO ........f)d ...... ......... ..... s: �\ ....... ................................... TYPE OF CONSTRUCTION .......� O......n:1;14 I(Vsk..................................................................................... ....... �r 1....................19........ TO THE INSPECTOR OF BUILDINGS: r The undersigned hereby applies for a permit according to the following information; Location � ................................................................. ProposedUse ......r G/,�„r z.�G(.. . ..1 . .............................................. I.................................. ZoningDistrict ........................................................................Fire District .... .., .1...................................................... Name of Owner ... . .k':.. ....................Address ...............M �;�,.....r� ........ e Name of Builder ... P` .... .. `� ... v1 .Address .... ...... .....CF! l' ,[4.1,Q............................ FName of Architect ...,,�,�!e�,... :�!�0.. ...:�'t^. ..............Address ..... ...... .. ...........................:.................. Number of Rooms Foundation Exterior t�✓�ACSa.. " .........................Roofing ....... :5!!v. :......................................................... Floors .......... ,. ......................................................Interior ....... ..... ..l say N................................................ r Heating .. 1^I ..Ab..................................................... Fireplace ........ 1 .................................. ..............................Approximate. Cost ........X ..00.o....................::`................ f Definitive Plan Approved by Planning Board ________________________________19________. Area ........o.�.................. Diagram of Lot and Building with Dimensions Fee .............�-�......~P.................... SUBJECT TO APPROVAL OF BOARD OF HEALTH t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. {Name Construction Supervisor's License ..&O-1-7,T.............. ! BZCKMA0, PETER A~34-61 ~ � 28349 ADDITION/ No -----.. P�rmhfor -----------.. Single Family Dwelling --------------------------' - 1000 Maio Street Location —'-------------------' ` Cotuit --------^--'---------------' Peter Hickman Owner ---------------------- Type of Construction —Fru---me---------- -----'_-------------------. ' p|ct ............................ Lot ----------' / . ^ Permit Granted ������ �22 lg 85 ` n --' ' ^--- ^/ / Date of Inspection ------------lg Dote Completed ...................................... - � ~ ' F1 r Town of Barnstable *Permit# pro Expires 6 mouths fro r issue date Regulatory Services Fee LS , Y BARNSCABLE, + MASS. Thomas F. Geiler,Director 1639. �lED MA't A Building Division Toni Perry,CBO, Building Commissioner 200 Main Street;Hyannis,MA 02601 " www.town.barnstable.ma.us Office: 508-862-4038 " ;0,�230 . EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY -- Not Valid without Red X-Press Imprint Map/parcel Number ii G_l Property Address -1 o G G i [rResidential Value of Work s.c o 0 Minimum fee of$2S.00 for work under$6000.00 Owner's Name&Address 2!a E I kl r Pt IC L l c G o iM V-t- c':y T— Contractor's Name S s-.;_; -Z.*1 vt.,c-e L_.N z / 13 ?t2.S r ►-L C • Telephone Number 5c Sr - 4`1 't Home Improvement Contractor License It(if applicable) t 5-7 (e 5 Q Construction Supervisor's License#(if applicable) 4{? 9 3 ❑Workman's Compensation Insurance Check one: S PERMIT ❑ I am a sole proprietor ❑ I am the Homeowner JAN 2 7 2"1 have Worker's Compensation Insurance 2010 Insurance Company Name 43 . ('� 2 0•-•E` TOWS OF B// dNSTA . Workman's Comp,Policy#. 3TWG O ZO fC5 3 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box): ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) #of doors Replacement Windows/doors/sliders.U-Value o ( (maximum.44)#of windows *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 ,required. SIGNATURE: Q-\WPFILES\FORMS\building permit forms\EXPRESS,d.bc Revised 090809 The Commonwealth ofYlassachusetts Department of Industrial Accidents OfficeofInvestigations 600 Washington Street �E15 Boston, MA 02111 wfvm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly_ Name (Business/Organization/Individual): S 1 JE d j JJ V— rf L F I '4 V-1 U. I 7>1E 4Zf I e Address: �x (, o City/State/Zip: NT-" Z- A ©Z to 3 S Phone #: ';�d (1,1. - �' Ct � '�- Are you an employer? Check the appropriate box: Type of project(required): 1.al am a employer with _ 4.. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors. 6. 0 New construction 2.[] I am a sole proprietor or partner- listed on the attached sheet. 7. [ emodeling ship and have no employees' These sub-contractors have g• Demolition Workingfor me in an capacity. employees and have workers' Y P Y� 9. Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12,E] Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.� Other comp.insurance required.] *Any applicant that checks box tll 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. tContractors 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: G h MI M'i'� 1 S G> 2 Policy#or Self-ins.Lic.#:. ST't•.JC_ 0 Z 0 f6 -S 3 Expiration Date: ' I Z 4 t U Job Site Address: T` City/State/Zip: N,i G. T Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA'for insurance coverage verification. I do hereby certify tinder the pains and penalties ofperjitry that the information provided above is trice and correct. Signature: �� Iti-C Date: j 2 1 0 Phone#: S G U- - 7 (e 7— 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 S. Plumbing 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 this statute, an eniplo},ee is defined as "...every person in the service of another Linder 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 ns to do maintenance construction or repair work on such dwelling house dwelling house of another.who employs persons , or on the grounds or building appurtenant 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 buildings in the commonwealth for any applicant who has not produced 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 performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors) name(s), address(es)and phone number(s)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 affidavit should be returned to the city or town that the application for the pennit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. 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 submit multiple permit/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 fixture 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 (i.e. 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia �YHE T Town of Barnstable do Regulatory Services. v $" Thomas F. Geiler,Director 039. y Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 VnVW.town.b arnstable.ma.us Office: 508-862-4038 Fax: 5087790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, (N wy Fh t4 /c.I- Z7- , as Owner of the subject property hereby authorize -t 0 ---C-If L rt'&�q S tt • L D X QctpXjjdy behalf, in all matters relative to work authorized by this building permit application for. ts (Address of Job) dwtA-161 /Sc, /fib Signature of er Dat Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. 0:F0RMS:0WNERPERMISS10N Town of Barnstable F 7riE Tpk, , Regulatory Services ' Thomas F. Geiler,Director RutNsrnst.E, Building Division PIED �a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 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 and that he/she will comply minimum inspection procedures and requirements P Y with said procedures and requirements. , Signature of Homeowner " Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or lager will be4required 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 dQ 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\homrcxempt.DOC qWACQ" ., GE ICATE;OF LIABILITY INSURANCE > { 4` DATE(MMlDDiYY) = O1/27/10 PRODUCER ,THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PAYCNEX INSURANCE AGENCY,INC. HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 150 SAWGRASS DRIVE ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW- ROCHESTER,NY 14620 COMPANIES AFFORDING COVERAGE . COMPANY - - A GUARD INSURANCE GROUP NSURED COMPANY STEVEN MCELHENY BUILDER INC B P.O.BOX 460 COTUIT,MA 02635- COMPANY . - COMPANY .. D COVERAGES r 4 rtr4 t} + ham¢ 4k, P h p# 'THIS IS TO'CERTIFY THAT THE POLICIES OF INSURANCE LISTEDYBELOW 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. O TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION (Tg LTR DATE(MMIDDIYY) DATE(M=DIYY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOPAGG $ CLAIMS MADE F--�DCCUR PERSONAL&ADV INJURY $ OWNER'S✓#CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED EXP(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTO$ SCHEDULED AUTOS - BODILY INJURY $ (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per aoddent) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT . $ ANY AUTO OTHER THAN AUTO ONLY. EACH ACCIDENT $ AGGREGATE $� EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM, AGGREGATE $ OTHER THAN UMBRELLA FORM $ —--WORKER'S-COMPENSATION-AND--- ------- --- — WC 57ATU OTH-TORYI]Mrrs ER _ EMPLOYERS'LIABILITY — -- -EL EACH ACCIDENT $ 100,000.00 THE PROPRIETORI PAMERs�cunVr INCL STWC128738 01/29l10 01/29/11 ELOISEASE-POLICYUMIr $. 500,000.00 oPFlcsas ARE ®EXCL EL DISEASE-EA EMPLOYEE $ 100,000.00 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS :CERTiI=1CATE,.HOLDER �_ ., _ n � . £_�ANCELLATI®NF._:v_:r{s. F.,.s .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE THE STEVEN MCELHENY BUILDER INC EXPIRATON DATE THEREOF.THE ISSUING COMPANY WILL ENDEAVORTO MAIL PO'BOX 460' 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, COTUIT,.MA 02635. SM FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE AGORD_/.,� p -•' _. [ -�yx"t'4�r :;. r.',.�12�i�r-r � �'.,}� "'y.,,. E �. a+ r �-..,,yn ' �. 1/95 b tY 2��� h#Y "�� y r' �e »�`1�A• `+fit i'f k 4 ) �Y K T �L.--:--�...-,— �.« r... r-.�� �45x _ - Massachusetts-Department-of Public Safefv Board of Building Revelations and Standards, - x Construction_-Supervisor License License CS 47693 / Restricted to 1G y. k "STEVEN P MCELHENY ram" ` ,PO BOX 460 `,COTUIT MA 02635 K t Expiration: 9/23/2011 Conmiissioiier". .L Tr#: 6192 ff License or registration•valid for mdividul use only �annz!ynun before.the expiration'date: If found return toulation i office of Consumer Affairs'& ust CTORg I HOME IMPROVEMENT CONTRA Office of Consumer Affairs and Business Reg ' 10 Park Plaza-Suite 5170 Registratio 157699,. Tr# 288175 Boston,MA 02116 0/2912011 I Expiration*.� - i T pe; naafi ox o`�ation y z ;i . -STEVEN MCELEN BU1i D ZINC y ✓�` •4 (•. STEVEN MCE M ld- z _ g ` 56 BOW' RDA = Undersecretary Not valid without signature t ASHP.EE,MA O26 J7 j r j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee 16 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis ��v� Project Street Address 1 e o o S R Village Owner l %-i W__%_z Address 33 •2 Telephone & 1-7 -7 4 7- -�3 c 6 z Permit Request i o C c KJ S-t-?Zc&t-T- E�,J-r-Z-4 J t S;-t ;� 1A_ r- - , u C-N � c tc S:�� l i �7/� ri���Q vL-r-c ids E 60" --7c:rk/, L L /%C_ Square feet: 1st floor:existing t q0o prop sed Z.o 1 nd floor:existing I d�u proposed � Total new Z-c Zoning District Flood PI 'n o Groundwater Overlay r Project Valuation 'A 4?0 o Construction Type W o o D74Z R^-4L 4 i N) i Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporti ocumeht1ion. I% Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 3 ' y C1 Historic House: ❑Yes 9 No On Old King's H ghway: cfil Yeses qtNo Basement Type: gFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 1,64 Basement Unfinished Area(sq.ft). G-t G Number of Baths: Full:existing 3 new Half:existing d new Number of Bedrooms: existing 3 new Total Room Count(not including baths):existing G new First Floor Room Count Heat Type and Fuel: Pas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes $No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ANo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:*existing ❑new size `L7"0Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial"❑Yes ❑No" If yes,site plan review-#�- -~-~----- - - - Current Use Proposed Use BUILDER INFORMATION Name 14 rMttc,IrwxAy ?jScrnIlt. 14t_ , Telephone Number 5o % - 4-,-r - Address ry '&vw- r'�o. *+ License# CC, u A q Z4 3 Home Improvement Contractor# t t o 8S Worker's Compensation# M 16L11 -'1 -o 5.,. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO iS A re %4 s,r r,-L F_ f� &J S Ir 2r_X S 7-47)Q-^L SIGNATURE ��'~` �- DATE ��2'6�6-7 FOR OFFICIAL USE ONLY z RMIT NO. TE ISSUED AP/PARCEL NO. j ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION i FRAME Q(PUM dio40? INSULATION;id M �® �7 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' r FINAL BUILDING DATE CLOSED OUT h� ASSOCIATION PLAN NO. F �t►+E r Town of Barnstable Regulatory Services ' L►ar A M Thomas F.Geller,Director Mess . � Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 568-790-6230 PLAN REVIEW Owner: Map/Parcel: a-3 Z 40 Project Address `4Vt�.S �-t: Builder: C The foDowing items were noted on reviewing: 7 is : : . /V /cam 0 Reviewed by: .Date: Cc Q :Forms:Plnrvw Department of Iridastrial Accidents Office of Investigations• a 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Bualders/Contractors/Electridans/.Plumbers ApipUcant Information Please Print Legilbly Name (Bu=ess/Organ=tion/Individual): S;is 'E I ✓`': 15-4 4 P7zg I Ne- - Address: z a2�'S5 City/State/Zip: Co , Phone#: 11;.o s; - 4-in. - Sd et bZ- 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 ' 6. ❑New construction employees (fall'and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet$ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp.insurance. g, ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or.additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself;[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other . camp.insurance required.] +Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: ! ' t Homeowners who submitthis 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 as additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. - Insurance.Company Name: HA r-:"¢uC-17 Policy#or Self-ins.Lic.#:_ t i•C.G.t '. - n -6 S Expiration Date: �o T Job Site Address: l o cs o ✓'^ '� •�-' S? . City/State/Zip: o i� i A C* &3 S 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 cari 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 STOPWORK ORDER and a fine of uP to$250.00 a day against the violator. $e advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Si tare: ��^ W Date: Phone#: 4 7 Official use only. Do not write in this area,to be completed by cityor town official City or Town: Permlt)Ucense# 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#: information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide v'ce of another under f contract employees.hir . pursuant to this statute, an employee is defined as ...every person in the serum express or implied,dral or written." « , association,gwporation or other legal entity,or any two or more i. An employer is defined as.: indivi¢pa1,.:P MWP of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the partnership, association or other legal entity,employing employees. Howovpr:tlfe receiver or trustee of an individual, Owner of a dwelling house having not more than three apartments aa�aho�residesother wo the s�dwelling house dwelling house of another who employs persons to do maintenance, repair or on the grounds orbuildmg appurtenant thereto shall not because of such employmentbe deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence-of compliance 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 performance of public work until acceptable.•evidence of compliance with the insurance iequirements 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(L•LP)with no employees other than the ers' compensation insurance. If an LLC or LLP does have members or partners, are not required to carry work 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 affidavit should be returned. the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. Self-insured companies should enter their self-insurance license number on the appropriate line. 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 appl ict Please be sure to fill in the Permit/hcense number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"'tlie applicant should write"all locations in ____' (city or to,,,m)"A copy of the••affiidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that•a valid affidavit is ton file for:future permits•orlkenses..Anew 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 (i.e. a dog license or permit to burn 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 nothesitate to give us a call. The Depanent's address,telephone and.fax number: The Commonwealth of Massachusetts Department of Industrial.Accidents office ..f IftVesta ations $ • 600•Washingfon eet•.�'. . . 02111.. y . Boston,MA . " Tel.#617-727-4900 ext 406 or-1-877-MASSAFE Fax#617-727"7749 Revised 5-26-05 wwwma'ss.gov/dia s.,. Town of Barnstable Regulatory Services EThomas F.Geiler,Director .�'��• Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the`reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type.of Work: 10o c r> f:R A- -e �2�r u 9 Estimated Cost � :o v o Address of Work: 1 v o u ✓�` '"� i �d f�''-` ' �'"`'� 0 Z S Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): MWork excluded by law []Job Under$1,000 . []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name Q:formskomeaffidav Table JSMh(anv rued)p wcript th Fomsd P'ada' ' e PsekaEem for one and Teo-Famitr Rgddenttd Hu1td1nV Beated ld r 'h p13AXfh1UM mEmu1H We11 Floor .Hasemeat 31ab 'I�ea�nslCooling �{�g GlaxiaB cdit$ der pgnlgmaat =cleucy' Ares]V/.) U-valid Rrvalue' A value' R iaiu2 wallJU6j III° 5701 to a300 ding n nAW 13 39 l0 b N0� • Q. IZ'�• 0.40 31 b. Normal 12J. 0.32 30 •95$Xlm • R � g 12•/. 0.10 3B NIA lft=—A = 3a 13 ZS NSA10 Normal- 31 v•ti.•; 15•J, 044.- 3a 13'.. 33 NIA "'NIA '' 10 W' • Ir/4 O.SZ 30 Z '` 2S t!/A NIA orasal, 18'l. 03Z ' 38 IAA t OMA Y 18y. '' 0.42 3E {9 31 NIA 90AF{J8 Z ,' 18•/.- 0.-g {3 I9 10 33 d 90 AbZTO1. - AA 0.30 DRESS OF PROPERTY; ' 1 e v a �^►4 •'� S i 2, SQUA FOOTAGE RE OF ALL EXTE ; ' 3. SQUARE FOOTAGE OF ALL'GL.P•ZING: �. GLAZII�14 zS ' o AREA(#3 DIVIDED BY#2�: . /o 5, SELECT PACKAGE(Q--AA-see cb2rt above): X , .. IS, ©•AMR MORE WYOLVED METHODS OF DETBumcm ENERGY REQUIREMEN?S ARE AVAILABLE. ASK US FOR THIS IWORMATION. ' BUaDiNciiNSPECTORAPPROVAL: ' NO; q•factns-�g0303a A PF,endix J ` 780 CMR' Footnotes to Table J5,2.1b: lass doors, skylights, and : Glazng area is the ratio of the area of the assemblies glazing (including sliding-g opaque dcars)-to the gross wall b�ement windows if located in walls thaat enclose conditioned srp a may excluded from the V-value rec�uiremant. area,expressed as a percentage.Up to 1/o of the total glazing Y _ area For example,3 if of decorative glass may be excluded tested and doc=ea ad bydesign the manufacturer in a accordance with 3 After January 1, 1999, glazing U'values inttst test rocedure, or taken from Table 11.3,3.a. U•values asp for• , . the Nadonal Fenestration Rating Council (NFRG P , ' whole units: center-of-glass U-'values cannot be used. . a e.Cei�g•R values 3o not assume a raised or oversized fuss canstru�ulatioa man. If the y bo substituted for R,-38 ; the'exterior walls without compression, R . inskilthickness over =insulation: CeiliagR-Yal�ipr� - °n.. ted'forR=49 eat the-sum•ocavaty� in la oin®�R13� u�awon riiay be'sdbec�fu mut.b laced between . atiri sheathing(if used)';For veiitil'atad beilings,insulating Shea 1 .9 4.P insulation plus instil g , , , the conditigned space and the venh'lated portion of the roof, , if itse .Do not Include` 4 .all g,•values represent the sum.of the,wall cavity lasulat�on plus insulating sheatliiag'( d) W Fcr exam 1 an R-19 requirement could be met E1T�3ER exterior siding,structural sheathing,•and Interior drywall. F b R 19 cavity insulation OR R 13 cavity insulation plus R 6 insulating sheathing. Wall regnirexnt d.c apply'to Y wood-frame or mass(concrete,masonry,log)wall constructions,di saces(such as uucontditioue ccraw lspacces basetaants, E T ne floor requirements apply to floors over uncon spaces , or l: g��'FIQOm over outside air must meet the ceiling requirements. an th +'the entire Opaque portion of any individual basement wall walls,,Windoth an ws and lidinga depth s glass idoorse of eonditi'aned. racrt the same 'R=value requirement as above-gradeBasement doors must inept.t o door.U-value requ'uement basements must be included with the other glazing. described in Note b, . s•The R-value requirements are for unheated slabs.Add as additional R 2 for heated slabs. oit lap to'install more If the building iitllizes elgbtnc resistance heating use compliance approach 3;h;or S.�'If y P. than one Piece of heating equipment or more than one piece of cooling equipment,the'ogiiipirlent with the lowest off c'iency must meet.or exceed the efficiency required by the selected paokaga•. requirprments e closest cltY or town secTable J111a o NOTES: , . a)Glazing areas and.V-values are maximum acceptable lode structural camponenis�mm�mum acceptable•leve s. R value requirements are for insulation only and do n b Opaque doors in the building envelope muss have a U- uNe n0 P a edu�a5o Doc from the door Ufvaluo ) P and documented by the manufacturer m accordance with the U-value rating for that door is not available,include the in Table J1.5,3b,if a door contains glass and an aggregateto dermine ass area of the door with your windows and use the opaque ave oor U v-l ui greater than 35�compliance of the door. one door maybe excluded from this requirement Ei.e.,maywi c If a aet� g, ' +floor,basamei}t wall,slab-adge,at craw ea wen wted av ge R u includes great dn r equal to differeat•insulatian levels,the component complies if the ar the?,.value requiremcat for that component.Glazing or door components com yal ply if the area-weighted average U- ue of all windows or doors is less than or equal to the U•value requirement(0,35 for doors), 43 �pFIHE r � ' Town of Barnstable ' Regulatory Services i"m' �' ' Thomas F.Geiler,Director i639• ♦0 ��EoyA Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us )ice: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder f �+tf 1KL-ur- , as Owner of the subject property hereby authorize S:c.� VA-`Z t-bt ZIt 1 1>2,S 1 ke•act on my behalf, in all matters relative to work authorized by this building permit application for: l Si. Cap ; (Address of Job) i Signature of r Date m le- Print Name • . Q:FORMS:OW MRPERMISSION # 13( License OF BU-/` i NU C�/VSTRUC7.D/NG REGu` Bin�da }o S o47s 3 SUPFRV/SOR S 9/ 3f1g Xpire$`. 8 a ,� SrEV Restr 209/Z31�O67 PO$ p MCE�N lcre�,i1GTr•no: s' COTUiT 460 c Elk 0g 0 Commissioner ` • � GTE ,°���e� ��� � Board of Building Regulations and Standards License or registration"valid for individul use duly HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrati0n: 110485 Board of Building Regulations and Standards Expiration 10/20/2008 One Ashburton Place Rm 1301 TYpe pBA..• Boston,Ma.02108 GROVER&MCELHENY BUILDERS STEVEN MCELHENY x 523 MAIN ST COTUIT, MA 02635 Deputy Administrator Not valid without signat e � s 1 i I�OoM A AA�� --o 00 VVAl POACH � N z /3 ►y 4�1 Ira O --"-55 go APP,ccz. 2 Z�L " i f Eu _ o,► ld�M� ; t o 8S°42� 4-e D h � cn ` Ln to 5cc y 9I 57 30 In �' : z / PRoP6ATY WNC N 4 40 401 4011 E o " cc . 0 v 1000 MAIN 51-kcaT Z 3 COTU I T MASS. ----------- I 1 e I I I I Z _ I I i ! r- e • r I � SIF i I uP F- r.l Y-rTi Ur CT' 3LA - C> t-j 1 � r f 3 i ,� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel G 1 Application# Health Division Conservation Division Permit# Tax Collector Date Issued. tp L- Treasurer Application Fee . Planning Dept. Permit Fee 7 0!;- Date Definitive Plan Approved by Planning Board � G Historic-OKH Preservation/Hyannis Project Street Address 11pap V -V1 %-• Village Cta T- Owner S *t-i-1 14 ,0 V--`-r- Address Telephone &z-j -- 49 '3 -Z 4 G i L— Permit Request o p, Z -et-t- (s A 4z nL_/+ ie y-Z_v-i iEr-E 2 rJ!E,,J z+y !z© o-Fz, Square feet: 1 st floor:existing l` c►q proposed 2nd floor:existing i v eda proposed �' Total new O Zoning District Flood Plain Groundwater Overlay Project Valuation v. a P 0 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family r Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Po On Old King's Highway: ❑Yes PKNo Basement Type: gFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) '� S a Basement Unfinished Area(sq.ft) '3 0 Number of Baths: Full:existing new 0 Half:existing ® new 0 Number of Bedrooms: existing `� new 0 Total Room Count(not including baths):existing new D First Floor Room Count 14 'Heat Type and Fuel: ( Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing New ig Existing wood/coal stove: ❑Yes $,No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑ne',w size Attached garage: ]existing ❑new size LtO Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal_# __ _Recorded-Llz Czrf - a Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name ('s a 7E J Z ',—c E 4-tM 4E,-1 Y T;"% LJ>TZSelephone Number �,-70 k - 4Z0 m 1;3 C� Address 0 Wv-)c L4 L® License# e3 4-1 to Co T'ut i T- 6 Home Improvement Contractor# I to 4 r_ Worker's Compensation# b&r L(11 G-` -7 -cp S� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /9rrC P-1 qT-a c-;F- t A-1-i t3,-PZ ot SIGNATURE ✓�` DATE I -7 1e(o FOR OFFICIAL USE ONLY I ' ►1 PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS r VILLAGE OWNER- . <� , DATE OF INSPECTION: FOUNDATION FRAME. NK �OZ D-1 K�i4�(�BxJ�/49 .9 e INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL p FINAL BUILDING 1�-- _ Piz- DATE d ' CLOSED OUT ASSOCIATION PLAN NO.' A ' I ; ' �� 1I►V VvfIIII-VI►IrYN-►I- � rM w..Ywvl-w..v►� • Department oflndustrial Accidents 01 Office of Investigadons 600 Washington Street Boston, MA 02111 www massgov/dia' Workers' Compensation Insurance Affidavit; Builders/Contractors/Eleetridans/Plumbers App1f cant Information Please Print Legibly Name(Business/Organizstioa/Individuat): vim•c-�L t-lieJ `f 7S LL e 0;C !r's P r4 C-. Address: f7 City/State/Zip: • 0 o 7-t,, ✓`•►A 0 7-G`3S' Phone#: S o k-.4°zr, - °5 Are you an employer? Check the-appropriate boa; Type of project'(requirecl); am a 1 er with Z 4. ❑I am a general contractor and I 1, - 03' 6• N construction amp ❑Now onstra n employees (tn and/or part time)* havehired the sub-contractors 7. emodelm 2.El am a sole ptoprietar Or partner- listed on the attached sheet I � g ship and have no employees 'These sub-contractors have SS El Demolition working for me in any capacity. workers' comp/fim=ce, 9. ❑ Building addition workers' go .insurance 5. ElWe are a corporation and its �o mp 10.0 Electrical repass or additions required.] officers have exercised their 3.❑ I an a homeowner doing all work right of exemption per MGL 11.❑ Phambmg repass c rr additions myself.(No•workers' comp. e. 152, 1(4),and wehave no �,❑Roof repass •in==cc required:]t ; employees.(No workers' 13.❑ O ier camp,instunace required.] *Any applicant that ohecb box#1 avast also fill out the section below showing their workers'acmpensation pdEcyzaforrna#t t Adrneownece who submit this affidavit indicating they are doing all work andthen hire ouiaide eoatraotdrs must submit anew aSdavh iadiostiag Bush 1corbactars that check this ben Est attached an additional aheet shouting the same of the aub-eontrahan sad their wo&ae comp,policy h f'otmation. r on an employer that is providing workers'compensation insurance foamy employees. Below is the poligy and iob sits. Information, ' ' Insiaanco Company Name: �f,At 2 > Policy;or Sties/Lic.0 Job Site Address: t a e0 t%1 as.1%4 S C e9'rZ., r &A— city/5tate/Z.- ZG 3 5 Attach a copy of the workers' compensation policy declaration page(showing the policy number and Wiration date). Fa:ure to secure-coverage as required nude!Section 25A of MGL c. 152 taif lead to-the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as dvt penalties in the•fam of.a STOP WORK ORDER and a fine of up to$250.00 a day against ttte violator. Be advised that a copy of this statement may be forwarded to the Office of Iuvestigations of the DIA for fi=mce coverage verification. I do hereby cerd fy under the pains and penahies of perjury that the information provided above is true and correct. Sr tore: W`c Date: v dG Phone# Su ,k- 41a ' S3 5 I kind asc . Do M,ft mia, a Vie cmWerei 4,cit -w .sad • 4 City or Town, PermitUcewe,# Issuing Authority(circle one); 1.Board of He&,h 2.Building Depar-tmetat 3.Cityl—I own Cleric 4.Electrical inspector 5,Plumbing Inspector 6.Other 1 I Coutct Person: Phone#: Information and Instructions Massaqbusetts General Laws chapter 152 requires all employers to provide Vbrkere compensationfor-lbeir employees. r Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, ' express or implied,-6 al or written." ; An employer is defined as-"an individual,partnership,association,corporation dr other legal entity,or any two or more of the*regomg engaged in a joint enterprise, and including the legal rcpreseUtatives of a deceased employer,or the . receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of dwelling house having not more than three apaztinents and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on each dwelling hour e or on the grounds Or building appurtenant thereto shall not because of such employment bedeemedtobe an employer," MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a Beewe or permit to operate a business or to constrict buildings in the cosnmanwealth for any app eaut who has not produced acceptable evidence of compliance with the insurance coYerage required." Additionally,MGL chapter 152, 125C(7)states"Nehher file camauonweahh nor any of its political subdivisions shall eater into any contract for fe perfoMMce ofpublic work until acceptable evidence of coa=liancc wit}u the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers°compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(a)name(s),address(es)and phone numbers)along with their certificate(s)of insun-ancc, Lf sited Liability Companies(LLC)or'I.imitA LiabilityPwtacrships(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 Ibis affidavit may be submitted to the Departmcat.of Industrial Accideats for confirmation of insurance coverage. Also be sure to sign and date the affidavit Tho•afftdavit should be ritmed to the city or.town fiat The application for the permit or license is being requested,'not the Deparf rent of Industrial Accidents. Should you have airy questions regarding the law or if you are required to obtain a workers" compensation-policy.-please call,the Department at the number listgd below, Sclf-iasurced compMnC$9toU-M seater their self insurance license number on•the appropriate lime. - Cit9 or Town Oft9dah . Please be sure that the affidavit is complete and printed legibly: The Department has imvided a space at the bottom. o f�a gzyk.for you to fill omtm the e�the(Mice of Invc-A rations bus to contact you regarding.the applicant - Please be sure to fM in the permit1cense number which wM be used as a reference number. Tn addidM sir Vplirant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job.S*Address"the applicant should write"all locations in_-city or tm),"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applieantas proof ihat•a valid a0davit is on file for fatuie permits or licenses, A now affidavit mustbe filled out each ' year.Where a dome owner of citizen is obtaining a license or permit notrelated to any business or commercial ventage (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to(hank you in advance fox your cooperation and should you have any questions, please do not Hesitate to give us a call. The Department's address,telephone and firs=nber: -1le Coxnmonwealb of Massa s its Dqw�nmt of Industrial.Accidents . office of En-yeftsfim 600 Washington Street Boston, MA 02111 Tel, #617-727-4900 e t 406 os 1 o77-MASSAFL ' Fax:hl':61.7-727-7749 Revised 5-26-05 wv, xaass.gov/dia S _ IKE • Town of Barnstable SAWMAIRZ Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO 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 I, -,.as Owner of the subject,property hereby authorize_ Si TJ �f a�-. C�e-V1 fin[""/ to act on my behalf, in all matters relative to work authorized by this building permit application for: rn�� �� P �► sue. (Address of Job) 617�� Si ature of Owner. Date tSa % PrintName Q:Forms:expmtrg Revise071405 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 Alterations/Renovations $50.00 Change of Contractor/Builder $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x .0041= plus from below(if applicable) x, ALTERATIONS/RENOVATIONS OF EXISTING SPACE `� 50 square feet x$64/sq.foot I 'A x .0041= yo plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq. ft.= x .0041= ACCESSORY STRUCTURE>120 sq. ft. a >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x .0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) .Permit Fee Cl I . o Projcost Rev:063004 1` a fie t�am�rro-n�riea:l� a�✓��ac�uae�a + '$ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS O47693 B i rthdate: 09/23/1958 Expires: 09/23/2007 Tr.no: 6108.0 Restricted: 1 G.. .. STEVEN P MCELHENY' PO BOX 460 COTUIT, MA 02635 Commissioner Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:,lug .110485 Exp►ration 10/20/2006 TYPe DBA i GROVER&MCELHENY'BUILDERS STEVEN McELHENY;', - 523 MAIN ST ' COTUIT, MA 02635 Administrator ZZ oFTHE ro Town of Barnstable ti Regulatory Services + HABxSPABLE, 9 MASS. �, Thomas F.Geiler,Director �A 16,39. rEo�rp 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 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization,conversion,- improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. �Ze boo Type of Work: fey-d vJIc Estimated Cost Address of Work: i (1 G-u A--IV-A► S i Cv Owner's Name: i-L-A Ei •.N �� Date of Application: 0-I to L I hereby certify that: Registration is not required for the following reason(s): RWork excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Signature Registration No. OR Date Owner's Signature Q:wpfiles.forms:homeaffidav Rev: 060606 i ,JU I-1-Uts-Ub 1G I b..SY F'_U1 /{�f4Af1Y ! DATE(L(LIfM-rYfY) A I()RD CERTIFICATE OF LIA131LITY INSURANCE I s/5/2006 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION McShea Insurance Agency, Inc. I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, Ma. 02655 I I` 508-420-9011 INSURERS AFFORDING COVERAGE I NAIC# INSURED Steven P. McElheny Builders,lnc. INSUKckA The Hartford Insurance Company --j I P.O. Box 460 INSURERe. The Hartford P.O. BOX 460 !INSl1RER C- -- I Cotuit, Ma 02635 IIN;UHrHu i 1508-364-1926 !INSURER E _I — COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN SSUED TO THE INSURED NAMED ABOVE FOR THE POLICY DERIOD INCICATED.NOTWITHSTAIJOING i ANY RFOUIRENIENT, TERM OR CONDITION OF ANY CJNTRACT OR OTHER DOCUMENT WITH RESPECT TO VVr1:Ch I-t'S GCRTIFICATE MAY BE ISSJED OR MAY PERTAIN.THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POL CIES.AGGREGATE LIMITSSHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. c pALICY ErrECT!VC POLiGYEXPtRATtCN` LTR IfeeR TYPE OF INSURAN.F POi r-Y NUMBCR ! P __ T_:hB�NDDQATE MALDDM'1 UMliS ' rsthhKAL LIABILITY EACH OCCURRENCE . I a 1,000,000 CR ; i X COMMCIALGENERAL LIADILITY j I 7-1 ,,=REMI9CS;Ca�cw�ency.._A2 5O f 000 , �(CLAIMS MADE ! x j OCCUR I i MtUEXPIAny one person) Ff 5,OOO i AI i _ NPP916772 ` 09/22/05 `: 09/22/06 1PERSONALBADV;NJURY $ 1,000,000 CLNERAL AGGREGATE _f_ 2,000,000 ! j 8£N't AG(iRFr,ATE LIMII AYPLILS PER: PRODUCTS(-OUP/OPACG S 2,0004 OOO POLICY(..._'PECT 1 I LO^. _� t -1— ! ASITCSMORII,FLIAHI.NY I I I `COMRINFUSIAK:LE WAIT —J ANYAUTO I ' (Ei,aocice^.11 I —,ALLOWNEDAwTOS t BODILYiNJORY S ' I !SL:HFDUI F(J AL-1 JS `7 p8�EM) —i HIRF0AUI0S 1 I 1 I BODILY INJURY is j I NON-OwNtO AUTOS i i i ,(Pd acciuenl) PROPERTY DAMAGE 1 I IAUTO ONLY-EAACCIDENT '$ I GAHAC:E LIABILITY I i V ANYA 7O OTIIERTHAN FAAC i$ !--4 I I j i Ai1TOONIY; AGC S ..� CESSAJMBRELLA LLABI;ITV I I EACH OGCURRCNCC S r I I I I.00Cl1A i_!CLAU.1SAtADE I 1 A'GGREGATF :S I i `I DEVLICIIBLE ' ; I is I 1 j I RETENTION 1 i WAorwRSCONPFNSANONANO I WQ$ 87HI x 1 rORYLIMIT6, ER*: EMPLOYERS'LIAAII,ITV I C.L EAC.N A„1,10EN T'ANY PROPF.IETOIUPARTNER/EMFC'JOvE i I I r._— O OOO g'9Fr:r�RMEMbEP EYf.V(1El]'' 10816C17-7-05 09/0.1 i 09/04/06 EL DISEASE•EAEMPIOVE4$ 100,200 � i tiers elasalCeunde/ --- Y SPKiALPRDVISIONStebw iE.L.DISEASE-POLICYLIMiris 500 ,000 � 1 I !UESCRIPTKIN OF OPERATIONS+LOCATIONS;VFHICI.rS I tXC_USIONS ACDEG D'f ENDOAStmEN I i SPECIAL PRDV:.IONS i I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY Or T11E AkOVL DESCRK+CD POLI(.FB Bt CANCELLED BEFORF TKt LAPiRATIOh i Town Of Barnstable DATE THCREOF. THE;SSUING INSURER WILL tNOEAVOR TO MAIL 10 DAYS`NAITM4 j Building Department I NOTICC TC THE CENTIFiCATC`iOLDFR NAMED TO Tiir t FFT.BUT FAILURE 7D CO SO SHALL! IMPOSE NO ORIOA[RIN OR 11IJ UTY Or ANY XIND UPON THC[NSLIRFk.III AGENTS OR , i ��// 1 REP .StNTATUCS. ' - AU1 RIZEfLRFPHE �y - ACORD25(2001lpg) chi ACORD CORPORATION 1988 i _ Id o umer � O {a r� mraral vrrw � ---•• �� 7- g �m a �=7= P. � BATH.I BATH,-2e'a BREAKFABTl51TTIN6 KITGFIEN ,O - BEDROOMw -- - pp rFr r-�U FIRST FLOOR PLAN V0/y LOWER LEVEL PLAN PROPOSED SECOND FLOOR PLAN(BATHROOMS) JCC0 eg�;,��T•= a �11.F9 f3F - - � � urtunr nnaool i W j^6P'3e'��a4�.9a3J K sn.o.d anru ^41 N - W • - � W Q) O BATHROOM slBATHROOM�EVATION AA B TNROO.sl-ELEVATION B B`THROOM>I.ELEVATION G uwn q j j scnLe.ii� r-o r s fie. {> - wm rmu V VIr N . V W to c N ,o 00 �0.5 a ®. 4 -B o m _ I IN 5cmN&DETAIL =T"U u- x.w.m I ax< BATHROOM>]-ELEVATION A BATHROOM>]-ELEVATION B BATHROOM s]-ELEVATION G e . A_1 6SUED MR CMTMKTM pF(HEA The Town of Barnstable RARMAT,' LE, MASS. 9` Department of Health Safety and Environmental Services • t 1- �0 prED MPS A Building Division 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location /Qf90 AU A-1,4/ Sr ("uT Permit Number 6' Owner Builder One notice to remain on job site,one notice on file in Building Department. The following items need correcting: / v G` o� Please call: 508-862- 0,3-84or re-inspection. Inspected by Date / la _ r � Wr I ve rmTEIiA MUST BE INSTALLED IN COMPLIANCE SaZ4)-J e 2 /' WITH ARTICLE II STATE SANITARY CODE AND T ro�'Qyo�TMETO�y� TOWN OF BARNS VIT E i BAMSTADLE, i NABS.q RUILUN;G INSPECTOR 0 MPY a' M APPLICATION FOR PERMIT TO ....... .v ...........:......''............. .................. TYPE OF CONSTRUCTION ..... a.? 't..e....................................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..1.4.DD...... ..oil..-4.... .............. Q. 4�. .. ........................ .t .............................................................. ProposedUse .�Y. .. .��l.. R. .................................................................................................................................:.......... ZoningDistrict .................... ?..r.......................................Fire District ....... ................................................... Nameof Owners. ,d.Y./. off.??. ...L.k.".?.....................Address .................................................................................... Name of Builder �"...:......Address 1T/10.11 A.?±h.A,...........d�...�-�.lt.�d.l.. ....... Name of Architect yl..... .1".?'l.�l.a' . ....................Address .... .. 5. t M Numberof Rooms ............... ..............................................Foundation ............................................. Exterior ...CfJQ.O...9t.....S.f1..{......................................................Roofing .... .5 .:............................................. ...................... Floors ...sl...............................................................................Interior ... ....................................................... Heating ....i 1J.... ................................Plumbing ... .! .d. .!Z..S.:.......................................................... Fireplace "..:" Odd p©..�..................................... "...................................Approximate Cost .....�.. .........�............................................... � Difinitive Plan Approved by Planning Board ________________________________19________ . 16:)- f S . Diagram of Lot and Building with Dimensions 6-3 Gar �a �t l 1 �o?o.3G F hereby agree to confjrm to all the Ru s and Regulations of the Town of Barnstable regarding the above construction. j d 1 Name . � !T .'` :........ Luke, Dr' D&�~y Jane . t��� � No ..���� ,6.— Permit for ----- --.. single family dwelling L/ ---..~-----.------..~-----~--.. ` ' l � ~~ Main ^,~� '/�J------''''`—`'--'--^------ } � cotuit —'—''.----------------------- | � Owner ..........Dr...Ma ryIuce_____.. / . ' Type of Construction ------..�X-APp---. ~ ` . . -----.---------.------.----- Plot ............................ Lot ---�M ------ ~� \ ' ^ . , \ J�zriI 16 �� Permit Granted ---'��.��.��----]V ' ' / -� Date Date Completed �� 3��� ' � PERMIT REFUSED ' --.--.--.--..--.------- 19 ' � ^ . .___------^—^^—^---'r--'---'--' 1 ^ - / ~_----.-----.-------------,' / � ...--._------.---.------.----- / ~ ' .��--------~—..~.—...--.—..----... . / ' ' \ Approved ................................................. 19 . . � ----------.----.-----...----,, [ ` -------'~---------.--...-.....—.' / 7 _.a 3261 Main Street Route 6A Barnstable Village MA 02630 November 4, 1985 BSC . . t 0 Joseph DaLuz, Building Commissioner Barnstable Town Hall Main Street Hyannis, MA 02601 617 362 8133 RE: Sundeck Reconstruction (Our File No. 3-1608.0.0) Dear Mr. DaLuz: Attached please find a plan and photographs of the sundeck structure I spoke to you about Friday, November 1, 1985. As you can see from the pictures, the structure is in a state of disrepair. I understand from=.:our clients, the Thompsons, that 11 the structure sustained add-itional damage due to a boat being lodged against it during hurricane Gloria. The Thompsons, who have rights in the easement and deck. for recreational purposes, want to have the deck reconstructed. We have in fact made a filing with the Conservation Commission on their behalf to obtain permits for that reconstruction. A question has arisen as to whether any permit from the Board of Appeals would be required for the reconstruction. As you can see, the structure is located quite close to the lot line. Lt is, however, my understanding from the attorney for the property owner, Mr. Hickman, that the structure has existed for more than 20 years and perhaps as long as 30 years in this location.. I would appreciate knowing from you if, in your opinion, any Engineers permits would be required under the Zoning By-Law in order to reconstruct the deck . Surveyors Very truly yours, Scientists Architects BSC/CAPE COD SURVEY CONSULTANTS Landscape Architects Arlene M. :Wilsonn, Planners Project Manager Attachments: Project Plans Photographs 1AMWl Cape Cod Survey Consultants y - �� IN RFVISIONS� DAT F I(FZ*J,LIA (10 "m�k,(:4 it)%-) 0 tA_1) 0 L of o,r1_5 cot Ui t t-ccus F1+ r4 -A REFERENCES� L__C)C 3 P 0 P, 10 V0, 1?0 .A o-rE (3 101 ALj__ ELE\JH-T101QS REFER To T�iE NP�_TiONAL C) (5;-E0ZE1\C_ lt)M'T�CAL_ (_,P'-TJtA VIN �_- 0!:5 E 0 + G. S iij c, !)-T(-�7 E 5,joZ�\)r-i Cit5te., SE-1' IN P� c_0N0_?,E7E f,',ON u 0)E r-,)T \15 Cy', Z S S EL - 38,,?P_ PR("JJLC-f I-IFLE aEG P,_vc,YJ sE-, .4') PROPERT*4 LkNG �NFOQ-T'nqTION tiEREON wP�Z-) CamPtLEC FROW� L,C-C, tt�o?_ 39 3 , 6 )H PROPOSED D I T C H E S Nrbrb PL A T FORM MARSH (D <1 �? \ RACIC 01V3T8Ucr101V rb�) BARNSTABLE MA. (37, C�, b e (C 0 TUI T) 441 z 0 % PREPARED FOR : 0 C) kANK C) (NJ ff,40 dOHN S THOMPSON D4 w�. CID 10 4 C C. 16239 40 /v4 CO P The BSC Grou �y IA\ tiv tA_"_ L 10 - 0 x 4 por, c� Cape Cod Survey Consultants \0 -1261 Main Street 01,� �N q/ 34'GALV jt)11"S f L Q. Route 6A VIT5 C) Barnstable Village MA C3TA11t% 02630 T_Q���L 4� 617 362 8133 e,"Df A, It FILE LEGEND -Vjz)YE).j -rc c F,* OF DUNE Dr WRACK LINE Z.)E C_5- F= L_E;.V A-T I C)�,J L S. TOP OF DUNE NBENCH M F) RIr— HIGH WATER LINE N�_ c E) 'm 3.-7f�) QI EDGE OF MARSH CENTERLINE DiTCH 0 A jr Xj EDGE OF VEGETATED WETLAND .41 J /Y/ POST a RAIL AND CHAIN LINI�, FENCE COMB POST 5 RAIL AND 1 STOCKADE FENCE COMB. -3ALV, Qj CHAIN LiNK FENCE EDGE OF THICK BRUSH T"(r A L NJ 0-T t�� ALI IPIL�__:� AQ1D '5�)ALL C%010;11. or -1 F<e_A-1 't.V tS"� \A4 0 L)V'N L-j& , 1)f-� 3/j 130 L-7 TH N X Q, 1,1 A N It V 'Asiiitizi ALL %L-I)ILI cP 18tAx)$ 50ALL 8*_ SET >0 pf:,0 F,T I 1_\ L SCALE� 1 " 20 A,,3T-) A 1XAb"F_"ZS. 'IYE M 0 ,'Aj&LC A--- 4- G ZA FEE- loop 5 _,Y-))SIS 30AL-1- A -T C�E_ l<, -U L 7-1E, L DATE. 9 / 18 / 85 'F, < _;ALV� �70�S-T Zk )2- 0L*jL r—L- 4-o -To I- o f-- t>\j tz JZL 4 ' COIVIP/DESIG_N� 9,Pm _CHECK_�__J�PM At, e us A L Voc� ��1;_7 f— -DRAWN: TAW `�'N4 C,N N EC T I CS KI FIELD. _FtLE, NO: V t-C Y- F-Lf VAT I C,11�4 DVVG. NO SHEET 5CA,L r- JOB NO: 3. 1608.00 1 OF I