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Home My WebLink About0551 OLD POST ROAD 1 �,�, Town of Barnstable Building PostThis Card So That.it is Visible From the Street-A ,roved;Plans Nlust,be Retained on=Job and this Card Must be Kept MARWPosted Until Final Inspection Has Been Made. ' pe1'm7 � Wh�re'a Certificatefiof Occdpancy�is'Requmed�such Building'shall`Notibe=0ccupied until a'Final Ir`Ispection has been.ma�de � Permit NO. B-19-3230 Applicant Name: MICHAEL DELUGA Approvals Date Issued: 10/15/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 04/15/2020 Foundation: Residential Map/Lot: 054-019 Zoning District: . RF Sheathing: Location: 551 OLD POST ROAD(CT& MM), COTUIT � Contractor Name ` MICHAEL DELUGA Framing: 1 Owner on Record,: TAYLOR, MARJORIE P W& PILE, MARY S W Tom• "Contractor-mLicensQ: CS-050234 2 Address: 65 ELMST Est. Project Cost: $35,000.00 Chimney: y COHASSET, MA 02025 Permit E e: $228.50 .. Description: Remodel Kitchen, bath,laundry, New kitchen cabinets, bath fixtures Insulation: Fee Paid:°` $ 228.50 new floor in laundry i Final: Date., 10/15/2019 Project Review Req: I Plumbing/Gas Rough Plumbing: �\,Building Official final.Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months aftehssuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. r Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the work until the completion of the same. "§ r Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Buildingand Fire Officials are provided on this,.permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection . g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). - Fire Department Building plans are to be available on site � Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT'N Application Number.... ..�. .:-.. .t ..?. w SABNBTA»+1r. p Fp Permit Fee. .. �c ,i.i...................Other Fee........................ SF p MASEL ll,A,•• 1 D9 Total Fee Paid........................\ TOWNOF BARNSTABL qqq, Permit Approval by.............................. ..on........................... BUILDING PERMIT Mv.......0 Ll.................Pam. ......... . ................ APPLICATION Section 1 — Owner's Information and Project Location Project Address Village bJb Owners Name 5it&,,Y-1 OwneistLegal Address City State - Zip Owners Cell# E-mail Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet C ❑ Single/Two Family Dwelling iEI Section 3 -Type of Permit ❑ New Construction ❑ Move/Relocate ..❑ Accessory Structure ❑ -.Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ - Fire Alarm 1 Rebuild ❑ Deck Apartment ® Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Ii El Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description IZAAAQ +� tJ W Y . T act imdatEd!2/9/201 S Application Number..................: ................................ t� Section 5—Detail *' h5 w` h Cost of Proposed Constructio T Square Footage of Pro - ct C� Age of Structure lob g � l, Dig Safe Number tit # Of Bedrooms Existing Total#Of Bedrooms(proposed) . 110 MPH Wind Zone Compliance Method M'MA Checklist ❑ WFCM Checklist 0 Design Section 6—Project Specifics Id Wiring ❑ Oil Tank Storages ❑ Smoke Detectors [Plumbing - ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply 1:1 Public ❑ Private Sewage Disposal ❑ Municipal f ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation a Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section 8—.Zoning Information Zoning District Proposed Use. Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage. #of Dwelling Units (on site) Setbacks Front Yard Required Proposed ` Rear Yard Required Proposed- y�� Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last undated 2/9/2018 Commonwealth of .Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstrpitAt1 ilpervisor , o CS-050234 E*pires: 07109/2020 - MICHAEL DELUGA 668 SANTUIT AD f COTUIT MA 02646 2 Commissioner C L rv�r flri�ar�r!�r1/c office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration x_gIgIfion 105548." 07/16/2020 MICHAEL DELUGA DB/A.VILLAGE CRAFT BUILDING&REMODELING MICHAEL DELUGA- +� 568 SANTUIT RD, COTUIT,MA 02635 Undersecretary Registration valid for individual use Only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation One Ashburton Place-Suite 1301 " Boston,MA 02108 Not valid without signature The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Flease Print LeLribly Name(Business/Organization/Individual): ljv Address: City/State/Zip: 0 - 0A 55� Phone#: Are you an employer?Check the appropriate bog: - Type of project(required): 1.❑ I am a em to er with 4. ❑ I am a general contractor and I P Y 6. ❑New construction' employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling These sub-contractors have Demolition ship and have no employees - 8• ❑ _ workingfor me in an capacity,. employees and have workers' Y 9. El 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 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per,MGL 12.❑Roof repairs insurance required]t o. 152, §1(4),and we have no employees:[No workers' 13.❑Otner comp.insurance required.] *Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state vyhether 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: J ff �Z' fh5° Policy#or Self-ins.Lic.#: G�i Expiration Date:AV Job Site Address: � City/State/Zip: L 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. m I do hereby certify under the poi an penald of 'ury that the information provided abovq is truepnd correct Signature: Date: Phone 46 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): LCoBoard of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing InspectorOther ntact Person: Phone#: 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,parinership,.association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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 ce of public work until acceptable evidence of compliance with the insurance enter into an contract for the performance p P Y P 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 certificates)of insurance. Limited Liability Companies PC)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 retained to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. 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 permittlicense number which will be used as a reference number. In addition, an applicant t multiple ermit/license applications in any given year,need only submit one affidavit indicating current that must submit P policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT,required to complete this affidavit. cooperation and should you have an questions, The Office of Investigations would like to thank you m advance for your p y Y� please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Iudust dd Aoddents 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.m=,gov/dia WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 40959 POLICY NO. I WCC-500-5006114-2018A PRIOR NO. I WCC-500-5006114-2017A ITEM 1.. The Insured: Michael Deluga .DBA: Village Craft Building&Remodeling Mailing address: 568 Santuit Road FEIN:**-***2146 Cotuit, MA 02635 Legal Entity Type: Sole Proprietor Other workplaces not shown above: 2. The policy period is from 12/23/2018 to 12/23/2019 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated ' No. Total Annual Of Annual Remuneration Remuneration Premium INTEA 000355380 INTER SEE CLASS CODE SCHEDU E Minimum Premium $500 , Total Estimated Annual Premium $3,474 GOV GOV Deposit Premium $899 STATE CLASS MA 5645 State Assessments/Surcharges $3,122.00 x 3.8300% $120 This policy, including all endorsements, is hereby countersigned by ��—'� ^ — 11/26/2018 Authorized Signature' Date Service Office: Malcolm & Parsons Insurance Agency Inc 54 Third Avenue P 0 Box 527' Burlington MA 01803 Stoughton, MA 02072 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. Application Number........................................... Section 9—.Construction Supervisor Name Teleph e Number d �r Address r/�✓� City �`� State Zip License Number License Type Expiration D Z Contractors Email �J l UUy e'� ' c ll# U�j ol0�`J7 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building C de I understand the construction inspection procedures,specific inspections and documentation required by 7 CMR a Town of Barnstable.Attach a copy of your license. C Signature Date l J 1 Section.10—Home Improvement Contractor Name , Telephone Number • D � a'�JG� q Address�'�� s�,Na�{fb City fate r� Zip Registration Number Expiration Date A� I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 78 CMR Town of Barnstable.Attach a copy of your H.I.C... _ G� Signature Date 9 o l J Section 11,7 Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date "PLIC T SIGNATURE Signature Date Print Name el/ tr 07 Telephone Number v509r Yo)-T o�7-5 E-mail permit to: G�� Cry T.,..�.....i..as.i. mnni o Section 12 —Department Sign-Offs Health Department © Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ , ` Conservation ❑ F For commercial work please take your plmu directly to the fire department for approval Section 13—Owner's Authorization L $U at , as Owner of the subject property hereby authorize v to act on my behalf, in all matters relative to work authorized by this building permit application for: ®f d L)V� (Address of j ob) r� 1 7Z /I Signature of Ownerdate Print Name ' _ ,} �• ' Last undated:2/92018 Barnstable Bldg. Dept. 51P - Approved by; �J CS � d� - Permit #; — —3-7 7- Q5 174tt� 10.2 ft2 PanttY Linen Clos 2.1 C 00. -. Fridge 0 �+ She Ives om Fridge lWasherfdry Stove17 Shelves 4 . o �s)essA office Ost floor):. SEPTIC SYSTEM M Assessor's map -and lot number Board of Health j(3rd floor): Sewage Permit number . ... .. .c1 �.. 7•'c s'1"H TITLE ' 0 Engineering Department (3rd floor): �� ENI) iRONMENTAL C Baaa9fADLE, ,5. House number ..................................... ...':.�... TOWN .............. ... YPY Definitive Plan Approved by'Planning Board ----------------______------------1.9________ APPLICATIONS PROCESSED 8:30-9:30 A:M, and .1:00-2:00 P.M. only y4 ASP P R O V E gWN :OF B.ARNSTABLE p8 le Con erv*' -• ILD�LHG INSPECTOR . � c BAeaAPPLICATION FOR PERMIT TO" �' � �`J �t t��-...... ..��. . �. .. TYPE OF CONSTRUCTION �1 ./.1>— - . ............................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..�.�JT.... .........0.. ....@.� .&Dr.....6.1 !.F... .:.../,Ou/� ot✓ �l !••.icloaPl.. Proposed Use. :...� � ' II ....... ....1.�L..................... '............................................. .. . ...................... Zoning District ' Fire Di"strict .... ... .................................. ' 7 .... ......Address SSL...O P Name of Owner ...... N �%..r ........:................ 4.D.pay.Aa:... .. . (1... ..:........ ............... Name of Builder'..Y! !n /?� ..��c /�v�,d�v/, i;L uwELG. Address �f1��./l�!A ....Q�� !1-.....:��.."• ........ / .... fln �� .................. ..•••.••...••... X Name of- Architect•............................ . ...Address ' Number of Rooms ...�............. r...............................................Foundation .. ES:.."...��J�I!! .. JcC/C1� 2� - TA � .....................Exte ;............Roofng : > ...Floors :.1/.:/�i . ..... ............:....::..........:.......:.:...................Interior ... !c ✓...!!�41. -C. ............................................ / f� i. Heating � � -�............................................,Plurtibing .....�J:. ...' l.0 ... .... ... .... G� �5.... Fireplace ..............................................................:.....Approximate Cost-........000Y� Area 6�U............... .. Diagram of Lot, and Building with Dimensions Fee ... .... ...............:....:.... . OCCUPANCY- PERMITS REQUIRED FOR NEW DWELLINGS .I hereby agree to conform ,to all the Rules and Regulations of the Town of B ble eg rding the above construction. Name; ...... .. ........... ............................ ` Cons tion Superv's is License ..; �.�J .. .cf........... EDDY, ERNEST A. JR. tv r 1' Bui ld:Addition ` No ..�2:�Q. Permit for .. : ................ - zy. Location Lot rB, 1551 Old.Post Road .cotul,t` OwrT.......................................Ernest' erA Edd , Jr:: .... ..................a a Type of Construction 1. .... r .............................,A . .. ...... .. .. .......... Plot.... . • ....... ^. Lot ......~..................' - , Permit Granted. .....December,.. , •:19 88 - >' .: fllnspection ..... 1�.........:......1,9 r 4 Date Completed ..... °5. ...... ......19 r rr ma's �, 6•� � J' r �� •• �.• c �4'S. .� rRz In' „ f i I I I Cc i FAM I L- I � i i 7L I T_A-U-N--D:R Y_A R..�:A.. I . I I � �E.DRDaM I � w ' I i 1 77 � i --------- --- Ll ---- - . �a�� yam•, ,:�.. , i -- -- PIE, ---_ j , i i - j • - ..._.....- l _* _I.- A Sketch 11.lan o� ,(awl in Cotutit, r;,a. ..�. goy Sdd y - Se inc -Cot c,, ahown on a ptan tecotded in bh 104Pq 17 £tewc�,t c•ona. ate on an aj,. Pwd datum, • �, +. XVh O F 414S J EDW'ARO t r I �� 1 '!ONALy� L A J. 40.3 I { J -6 ��G rl p a t 44.3 '100 m s i S e ''-SO I' \iJ/2 atone I date 1 I-I-88 111 \\2014 ' . t -` 1 \ 392 cdpd I ; I \ \ 34 abed AtC Cape j49 ��a2Uo4. \bad I I \ \.. Pt0O0St O�� . • �. I_ /4ganna4., Md. 0260/ i A III , r SPe�J is !?eyfCn 41;3 .4 , E. No. Ce lu oo►s� 2 I —� Ji4poacJ KO t til aee,p�uwitr83-1029 to ima te.d 4 Pow 220 �p cC 11-9—e 3 u a area 2011 d J Ex 1 s r. f. ; : 1 frSri' + , s' ?�eae�wa 204 a } 1 Capacit,�,f 392 d �} 1.... ( 4ad j r f I . `1h OF 0JOH y j 4 32490 i Nn la i I , J _ . co twit ray . . .� n SA Mn 1000 141 pit M ry 111� t- � 1 .. _. �' t— /j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � Y6 9 IS Map Parcel Permit# Health Division 3 `� Date Issued - D -0 3 PJq Conservation Division 4YOe', W' �6/�Z Application Fee Tax Collector by Zs y°1 Permit Fee �/D 70 /Y Treasurer / p VISION G // a 3 SE SYSTEM M ST 0E Planning Dept. IASTALLED IN C0V?LIM wa Date Definitive Plan Approved by Planning Board VATH TITLE 6 ENYIRONMENTAL C®bE ANL Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address j f 6 Village CJ Owner if r Address Telephone 67 Permit Requester �Jr, o� �� Son ha A r i , Square feet: 1st floor: existing proposed 2nd floor: existing proposed "� Total new Zoning District Flood Plain Groundwater Overlay ' Project Valuation Aft d 6 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 1AI Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: 0 Yes t(No On Old King's Highway: ❑Yes VN o 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 Bedrcroms existing new _-ToTal-Reem--Count(not including baths):existing 6 new�_ First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil N Electric ❑Other Central Air: ❑Yes tr No Fireplaces: Existing New Existing wood/coal stove: ❑Yes a No Detached garage:❑existing 0 new size Pool:❑existing 0 new„size Barn:0 existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# ti, Recorded 0 Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use / BUILDER INFORMATION `WX Yf A-P` 6 3 19 Name 6i1 Z Telephone Number 4E- ` Address �� a License# ✓L r Home Improvement Contractor# Cd 5_5Y8' Worker's Compensation# o7, — ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE 6 t , FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP,/PARCEL NO. 71 I I Fr ADDRESS VILLAGE OWNER rx+ A _! DATE OF.INSPECTION: FOUNDATION . �Ai! FRAME INSULATION CJ "O3 f FIREPLACE ELECTRICAL: ROUGH -•FINAL ` IOU [o� PLUMBING: ROUGH his FINAL + ! GAS: e ROUGH -1 5 FINAL � • r , FINAL BUILDING - .. r DATE CLOSED OUT TJ ; i i, f , •' ASSOCIATION PLAN NO. t. J ; f i 1 `pFtHEfp The ToW of Barnstable BARNS-r -MA-A- .LE.0p Department of Health Safety and Environmental Services 163 Y M5 �EOMP+p Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 �J PLAN REVIEW Owner: 4A o✓L/a, j5ioIg— Map/Parcel: 65-Y o/ g Project Address: 5-Y1 ©G-Tj A s-r16-67V1% Builder:/J- /Gffrg.o� D&L.L,,�* The following items were noted on reviewing: 1 ®u H b T/G N . lHe Y/fawti?ru�— ��,Sld,rrs /ZL T %�A6& D ��/7��'�/ �1✓L f"t G G cL�/`��r/!rj U.� �.rZ�L ��'I ��/r�C !Od2�G� .�/7-� WOD /t 6l)6kT JG/z rz elq �i26VA43> 3o r7'a,V OGC O!Pe M RdRCCW- 'q Reviewed by: Date: RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 5 U Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/s .foot= �(eQi x.0031= q q iPlus from below if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x 64/s .foot= x.0031= q $ q plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >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.0031= 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 n Pool Above Ground Swimming oo $2 5.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee /Q 7. (.q projcost • ✓�ee �anvmaruuealb�i o�✓f/L'aaaac`u,�aelta BUARQ:OF BUILD NG REGULATIONS License. CONSTRUCTION$ PERUFSOR Numbe� 050234 Bi[t e*�1i962 -- 4 Tr.no: 28018 . NF.f,CWArEL ©,E@h1a� / - j Sfr8°S�s�NTIkI�T,t�,RDsti��\`•-��/j'' l "�'�°,.• CO*TUIT, M� i)2f35 � s Administrator i � ..� : . �/ie -��ireaiuueull/ a��,aaaac`ucaeka. Board of Building 4%Wations and Siandards HOME I,tp�ROVEMEN+CONTRACTOR R r�tltszr� = 0�57i548 " a rgT2L24 j 12004 VILLAGE CRAFTl1 �r Diu 0 a '� ° 568 SANTUIT Rib: C01'U7, MA 02635 '' —• 1(11n,in str.Mr The Commonwealth of Massachusetts Department of Industrial Accidents Office of/Qyestioatioos _ t 600 Washington Street Boston,Mass. 02111 '�- Workers' Com ensation Insurance davit � name. ✓ k- 1 locatio Old P s� n: city hone 4 L203 9)3 ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one worlds in ca icity/%% //�%%/%% //%///%%/% %%%%/G%%%%O%/%/��%��%%/%%%%/%%/%//G/�%/%�%�0��%/I%/O//%%%%% an era 1 er rovidin workers' compensation for my employees working on this job._:.}:.} :};:.Y:.>:.?:•;}:•:{•:{;:} <:::<:>•::::j:j j: ,::,>:,,>:<:>_«;: . om an'{.name.... . ... c :}'i'< ��<) :!+;.;.• ::r::.?}.::::Y,4:isti:.:.ss:y�� `:!}:}�;;;`?:::�'�?�:::Y?'+ v.•::{;iti{•}:;?:::{{.>:{?{•ii'{i;: ..�...:..:::::::�.>Y:. :: :.. :.. :. .::.::::.:.:::::::.............. .::...;::..:.::::,.::..; ,.,..:::.:>;::>:.;:G.Y}::.?::;:;: :� :•`}'sin :{:�:;�.'••':�;:::: S:�� ::ii�3::?::� :�:::%>{%Y::Sr:�':;;: :';::i'::i::i:::::::`:%%::�:::::::�::::ii>:r:`: ::;: r�:�:::': :: ::::;:;�::: ;;ji;y%;:2;<:;•:y::: {ilF� ...... ............ ..r...• ....-......n....., .}:•.. ........... ...........::::•Y.�::YY:y:y:•}:y:y::?<i ;iG: ..... ............. •r.}'.{;.,.. .............:::.................v...:::..... ...... .... ..... .... ... .... ..... v. .. ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have n workers' co ensation olices: :............:.:..:::::::::::::::::.:.:.Y:.:{:::{«•>.>:<.}:G•:;.};}:.::.}:.}::.::.}:{.}}:•}}:.}%.}:<.:<.;>:.};:<{.?:«y>..:,:..:::�;: .?,r.%;.;}:.Y:;.; the follows g mP.................p...:.:...:.:::::::.::::::::.:::.::.,.....::..::::::::....:....:.::::::......... :•?:e `': r< > ?< `}":5 ;;;+ ? 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Tnoure to secure coverage a,required raider Section 25A of MGL 152 can lead to the imposition of erbninal penaltin of a fine ap to S1,500.00 and/or one yam'imprisonment as well"civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day again me: I underrb that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify under thv pas r of pedury that the information provided above is irup and carted Date Signature Print name Phone# official use only do not write in this area to be completed by city or town official city or town: pemdt/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; - ❑Other UrrAod 9195 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter any� chapter have the been presented to the contracting e of public work until acceptable evidence of compliance with the insurancerequirements P authority. Applicants Please fill in the workers compensation affidavit completely,by checking the box that applies to your situation and supplyingcorn an names, address and phone numbers along with a certificate of insurance as all affidavits maybe company submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and ;_ date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The.Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the piiruit license number which will be used as a reference number. The affidavits may be returned'to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents amce of Investlgatlons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: 617 727-4900 eat. 406, 409 or 375 °FIKE,°s� Town of Barnstable Regulatory Services 1AMSPABLE, " Thomas F.Geiler,Director 7 MASS. eny Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 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: AM / Estimated Cost F� �f --- - Address of Work: rl. Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reasou(s): ❑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 p t as the age At of the owner: Date Contractor Name Registration No. OR ✓Se*1 P i'y �e, AW4) Date Owner's Name r MCMRAppamft/ Table dS.ZIb(continued) Prescriptive Packages for due and Two-Family ResidentW Buildings Heated with Fossil Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Bascmcat Slab Heating/Cooling Arm'(4) U-value= R-value' R-value' R-values Wall paimefttEquipment Eflicieney9 package I R-valul? R value' 5701 to 6500 Hating Degm Days Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 129/9 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 25 N/A N/A 85 AFUE FUE W 15% 0.52 30 19 19 10 6 85 r X 18% 032 38 13 25 N/A N/A Normal rmal Y 18% 0.42 38 19 25 N/A N/A Normal Z 18% 0.42 38 13 19 10 6 90 AFUE AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: l PO 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: JT.✓ • - 3. SQUARE FOOTAGE OF ALL GLAZING: �� Yi 4. %GLAZING AREA(#3 DIVIDED BY#2): (2 17 5. SELECT PACKAGE(Q--AA-see chart above): _ NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303 a 780 CMR Appendix J Footnotes to Table J8.2.1b: I Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 fl of decorative glass may be excluded from a building design with 300 ft of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table 11.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling.R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. The floor requirements apply to floors over unconditioned spaces (such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. Tl:e entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement &scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece,of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1a NOTES: a) Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested o dure or taken from the door U-value documented b procedure and docum y the manufacturer in accordance with the NFRC test pr in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 Barnstable Assessing Search Results Page 2 of 2 Total: $22,076.48 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 1.69 Year Built 1790 Appraised Value $ 1,774,500 Living Area 4250 Assessed Value $ 1,774,500 ReplacemOnt C'ost`$-291;847 Depreciation 25 Building Value 131,300 Construction Details Style Cape Cod Interior Floors HardwoodVinyl/Asphalt Model Residential Interior Walls PlasteredDrywall Grade Average Grade Heat Fuel Oil Stories 1 1/2 Stories Heat Type Steam Exterior Walls Wood Shingle AC Type Central/Half Roof Structure Gable/Hip Bedrooms 5 Bedrooms J Roof Cover Wood Shingle Bathrooms 4 Bathrooms Total Rooms 8 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value FPL2 Fireplace 1 $2,300 $2,300 SHED Shed 100 $700 $700 FPO Ext FP Opening 1 $600 $600 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.barnstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 1/9/2003 ,,Barnstable Assessing Search Results Page 1 of 2 w � A r I g f /y { Home: Departments:Assessors Division: Property Assessment Search Results —back to search SSI OLD I' �T RC). Owner: TAYLOR MARJORIE P W TR& Property Sketch Legend Map/Parcel/Parcel Extension �, F„ 054 /019/ Mailing Address ¢ , TAYLOR MARJORIE P W TR& %WILLIAMS, MARJORIE C 20 BRAEBURN DR ST LOUIS, MO.63124 - k �. Assessed Values: � 1 Appraised Value Assessed Value Building Value: $ 131,300 $ 131131,3300 � Iq Extra Features: $2,900 $2,900 Outbuildings: $700 $700 ' Land Value: $ 1,774,500 $ 1,774,500 Interactive Property Map: aP requires Plu in: 4,� i� �a�. Totals:$ 1,909,400 $ 1,909,400 1 have visited the maps before . Show Me The Map Sales History: Owner: Sale Date Book/Page: Sale Price: TAYLOR MARJORIE P W TR& 3/15/1996 10091/317 $ 1 WILLIAMS, MARJORIE C 10/15/1961 1135/224 $0 WILLIAMS, MARJORIE C TRS 5/15/1970 14711/166 $0 Tax Information: (Tax Rates:-{per$1,000 ofwaluatiM);� Town Tax $ 17,948.36 Town Fire D i-s-t rT c-t-R-a-t-e-s-7 Other Rates 9.40 Barnstable 2.88 Land Bank 3%of Town Tax Cotuit FD Tax $3,589.67 C.O.M.M. 1.54 Cotuit 1.88 Land Bank Tax $538.45 Hyannis 2.89 West Barnstable 1.96 http://www.town.bamstable.ma.us/tob02/Depts/Administrative Services/Finance/Assessing/A... 1/9/2003 � j►� �G,��'. PATIO DOOR HEADER . "0'9' 7 r 0 60 3 Pcs of 1 3/4" x 5 1/2" 1.9E MlcrollamOLVL TJ-Beam(TM)6.05 Serial Number:7002003607 User:1 1/16/039:12:41 AM Page Engine Version:1.5.12 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED Member Slope:OM2 Roof Slope70M2 ❑p 2❑ All dimensions are horizontal. Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width:3'6" Primary Load Group-Snow(psf):25.0 Live at 115%duration, 15.0 Dead Vertical Loads: Type Class Live Dead Location Application Comment Uniform(plf) Snow(1.15) 105.0 70.0 0 To 6'7" Replaces MAIN ROOF LOAD 30/20 3'6" Uniform(plf) Snow(1.15) 90.0 60.0 0 To 6'7" Adds To SHED ROOF LOAD 30/20 3'0 Uniform(plf) Floor(1.00) 75.0 30.0 0 To 6'7" Adds To CEILING LOAD 25/10 3'0 SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 3.50" 889/553/0/1442 L1: Blocking 1 Ply 1 3/4"1.3E TimberStrand®LSL 2 Stud wall 3.50" 3.50" 889/553/0/1442 Ll: Blocking 1 Ply 1 3/4"1.3E TimberStrand®LSL -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s): L1: Blocking ` DESIGN CONTROLS: Maximum Design Control Control ` Location Shear(Ibs) 1369 -1113 6309 Passed(18%) Rt.end Span 1 under Snow loading Moment(Ft-Lbs) 2139 2139 7333 Passed(29%) MID Span 1 under Snow loading Live Load Defl(in) 0.073 0.313 Passed(U999+) MID Span 1 under Snow loading Total Load Defl(in) 0.118 0.417 Passed(U637) MID Span 1 under Snow loading -Deflection Criteria:STANDARD(LL:U240,TL:U180). -Bracing(Lu):All compression edges(top and bottom)must be braced at 2'8"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. -Design assumes adequate continuous lateral support of the compression edge. PROJECT INFORMATION: OPERATOR INFORMATION: VILLAGE CRAFT Andy Shakliks EDDY RES. - Mid-Cape Home Centers COTUIT MA Route 134 PO Box1418 So Dennis,MA 02660 Phone:508-398-6071 ext4987 Fax :508-398-4559 brubel@midcape.net Copyright (D 2002 by Trus Joist, a Weyerhaeuser Business MicrollamO is a registered trademark of Trus Joist. .� PATIO DOOR HEADER TJ-Beam(TM)6.05 Serial N��02 0360 3 Pcs of 1 3/4" x 5 1/2" 1.9E MicroIIam®LVL User:, ,n e2:a2aM Page 2 Engineine Version:1.5.12 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application, input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code BOCA analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S/BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: OPERATOR INFORMATION: VILLAGE CRAFT Andy Shakliks EDDY RES. Mid-Cape Home Centers COTUIT MA Route 134 PO Box1418 So Dennis,MA 02660 Phone:508-398-6071 ext4987 Fax :508-398-4559 brubel@midcape.net Copyright GT 2002 by Trus Joist, a Weyerhaeuser Business Microllams is a registered trademark of Trus Joist. Town of Barnstable Permtt# ' '° Py O Erpir s 6 inonN om i date Regulatory Services of f S. ' BARN 2014 . Thom ,F 1 as . Get er,Director. �e w , 0 �p 39- � . 1'® ® 0. Building Division ISARNSIABLE Tom Perry, CBO,. Building Commissioner ' , 206 Main Street, Hyannis, MA 02601 www.town.barnstab 16.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION , - RESIDENTIAL ONLY Not Valid withoul Red X-Press Imprint Map/parcel Number l Property Address D Residential Value of Work 15/106 Minimum fee of$35.00 for work under$6000.00 dp Owner's Name &Address', 2. 1 Contractor's Name ii; / Telephone-Number ) T Home Improvement Contractor License#(if applicable) 6 ' Construction Supervisor's License#(if applicable) 00c�3q ❑Workman's Compensation Insurance Check one: w ❑ I am a sole proprietor ❑ I am the Homeowner a ❑ I have Worker's Compensation Insurance Insurance Company Name / a Workman's Comp.Policy# (� Copy of Insurance Compliance Certificate must acco'nipany each permit. Permit Request(check box) }' PM Re-roof(stripping old shingles) All construction debris.will be taken-to U , Re-roof(not stripping., Going over existing layers ofroof) FT.Re-side #of doors ` ❑ Replacement Windows/doors/sliders. U=Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with oth6 town.department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must''sign'Property Owner Letter of Permission. , A copy of the Home jinprovement Contractors License& Construction Supervisors License is required SIGNATURE: Q:IWPFILESIF0RMSlbuilding permit formslEXPRESS.doc I �s The Commonwealth ofMassachusetts Department of Industrial Accidents. Office of Investigations t t;/ 1J / 600 Washington Street Boston, MA 02111 ' www. ass ov/m dia g Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information lease Print Le iblY Name (Business/Organization/Individual): ,. Addk Address: City/S ate/Zip: C'��y Phone #: 7 Are u an employer?Check the appropriate box: a „ Type of project(required): 1. I am a employer with 4. ❑ I'arrr a general contractor,and I I .6. ❑New-construction employees(full and/or part-time).*. have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 17. ❑ Remodeling ship and have no employees These sub-contractors have e S. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and,its officers have exercised their ]0.❑Electrical repairs or additions required.] of 3.❑ I am a homeowner doing all work'. right of exemption per MGL I LEJ Plumbing:repairs or additions, myself.[No workers' comp. c. 152, §](4),and we have no - 12.❑ Roof repairs insurance required.] t employees.'[No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors And 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.. j Insurance Company Name: �Gfjo . i b ,e Policy#or Self-ins. Lic.#: Lou L�01� Expiration Date: Job Site Address: ,7 `7 6 oDk City/State/Zip: 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 venfcation. I do hereby certify under t ains agns e Ities of perjury.that the information provided above is truejend correct. Sipmature: Date: Phone#: O Official use only, Do not write in this area, fo`be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department .3. City/Town Clerk 4.Electrical Inspector 5:Plum bing Inspector 6.Other 4. ,Y Information and Instructions Massachusetts'General Laws chapter 152.requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as "an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and.including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, 425C(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 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 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 future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (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 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 Reviced S-2fi-fly _ .,. i,f1 .iz. .. 1 3 -• r J y';fy Y}� re . _: .�"�. ;Y: �µ � y 1. lax vMassachusetts •Department of Public Safety Board of Building Regulations and Standards{ Construction Supervisor License: CS-050234 }� MICHAEL DELUVA 568 SANTUIT RD= ' COTJIT MA 02635 � • 3 ✓,•�. - �i t%0 Expiration 07/09/201.4 . Commissioner V/ec3�uJnb�gos¢tueu��o�'C�l�iru�nc�ruel�d � Office of Consumer Affairs& Business Regulation ME IMPROVEMENT CONTRACTOR gistration: 1Q5548 Type:r xplration 7/17/2014- DBA FA t VILLAGE CRAFT BUpING&�FjE ODELING Michael Deluga 568 SANTUIT RD• '+.`: `; tr!y '•' ��. --��.E'�. _- COTUIT,MA 02635 Undersecretary ; License or registration valid fpr individul use only i before the expiration date. If found returp to: Office of Consumer Atfali and Business Regulation , 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid witf7oitt slg�pIttuf4 1 ' dF Reg-datory Services t Thpmas F.Geller,Di=Wr - „ � Building Division Tom Perry,Biffidmg Commissioner .200 Main Street;Hymmis,MA 02601 ivww.pwn.barnstable.ma.ns. Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the sub ect' , p ro a .P=J- . hereby authorizeIF J tb_act on mp behal. in all mattets relative to work authorized by this bu>7ding pet7nit (A.ddress of Job) t ' Pool fences,anal alarms are.the responsibility of the applicant. Pools are not to be filled of utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QFORMS:OWMKRPERMISSIONPOOLS 62012. gal ry Services t sa F Thomas F.Geller,Dn vector : ,,•� Building Division . Tom Perry,Bading Commissioner 200 Main Street Hyamiis,MA 02601 WWWAown.barnstabI=&us 6ffice: 508-862-4038 Fax 508-790-6230 :. HOMXOWNM LICiE n EXEMPTION Please Print . DATE JOB MCATION: number - sb=t. 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 dwellines�of s�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. • „ .�*� - DEPINTITON OF HOMEOWNER _ P erson(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•Buildi ag Official on a fowl acceptable to the Building Official,that he/she shall be responsible for all such work performed Under the building p=ait-{Section 109.1.1) The Undersigned"homeowner"assUmzes responsibility for compliance with-the State Building Code and od= applicable codes,bylaws,rules and regulations, t The undersigned"homeowner='certifies that he/she Understands the Town of Barnstable Building Department minimrTm inspection procedures and requirements and that he/she will comply with said procedures and• regurements. - Signature of Homeowner Approval of Building Official Not-,: Three-hmily 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 FXEWTION The Code states that "Any homeownerperforauag work for which a building peanut 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 persons)for but to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unawar a timt 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 w when the homeowner hires unlicensed persons. In this case,our Board=Motprooeed against the unlicensed person as it would with_a licensed Supervisor. The bomeowner acting as Supervisor is ultimatrnly responsible. To ensutt that the homeowner is fully await ofhis/her responsibilities,many communities rtquirt,as part of the permit application,. . that the homeowner certify that hcJsbe rmderstands the rtspomsrbilities of a Supervisor. On the last page of this issue-is a form currently used by seperal towns. You may cart t ammd and adopt such•a fotrnlcerl fication for use in your community. Q:farms:homeexcmpt - , 01120/2014 15:00 Malcolm&Parsor s Ins. Agency TAX) P.0011007 WORKERS COMPF-.N;ATIOWAND EMPLOYERS LIAL3ILITY INSURANCE ?OUCY INFORMATION PAGE Associ Med Employers Insurance Company r' 54 7hfrd Avi roue, Burlington,Massachusetts 01803-0970 (800)876.2765 NCCI No 40959 POLICY NO. WCC_500_5005114-2013AI PRIOR NO. V, lCCgvG6l laUi20 12 _ ITEM 1. The Insured: Miohaa! De:luga DBA: Village Craft Building 8 Remodeling Mail?ng address; 568 Santuit Road FEIN:'*•"``2146 . Cotuit,MA.02635 Legal&roily Type: Sole R'oprietor LiJ 7` Other workplaces not shown above: 2. The policy period is from 12/23/2.013 to 12/23/2014 12:01 a.m.standard time at the insured's rtiiaKng addrs s. 3. A, Workers Compensaticn Ineuran(e: Pam One of the policy applies to the Workers Compensation Law of the states listed here: NIA B, Employers'Llabllity In:wrence:r art Two of tha policy applies to work in each state listed in item 3.A. The iimile of lia6iii-ity under Part 1 wo are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ —� _506,wo policy limit Bodily injury by Disease S �_ 100,000 Each emplvvee 0. Other States Insurance: Covere)e Replaced by Endorsement WC 20 0$06 A D. This Policy includes these Endo,soments and Schodulm SEE SCHEDULE 4. Tha prernium for this poiiov wilt bed(termined by our Manuals of Rules,Classifications, Rates and Rnti:ng Plans. All Informatlon required below Is subj act to verification and change by audit. Glassifioations Premium Basis Rates Coda I Estimated Per St 00 Esnmatad l No. i Total Annual Of I Anrn.1,31 i ! Remuneration Rvrr,uwat;cnL ! Premium INTRA 355380 INTER SEEICLASS CODE SCHEDU�E I ! i Minimum Premium $5G0 Total Estimated Annual Premium 51,5 2 - - - V— DepocO PremiumGOV STATEiCLASSI ' MA 5645 MA.Assessment Chg. --- $4,209.00 x 3.4000`Yu $143 T;W!�z poitcy;including all endorserrionts,is ha!sby countersidned by ulhorlaiid Signature Serfice Office: Malcolm.&Parsons Insurance Agency Inc , 54 Third Avenue. 6 Freeman Street-P 0 Box 527 Burlington IAA 01803 Stoughton, MIA 02072 wC000001 A(7.11), " wcwd"cnsyrlghtod matorial of Inc Natlonat Council,n Compencatton insurance, uaesd with its p®rmineion. p1HE'T Town of Barnstable er ., # o gt,, P� Expires 6 month from issur d Regulatory Services Fee • BAatvsrwsc,E, MASS9cb $ Thomas.F. Geiler,Director AlFD MA't A �V Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY I Nor Valid withoW Red X-Press Imprint Map/parcel Number Property Address cAoo�, Residential Value"of Work Minimum fee of S35.00 for work under S6000.00 Owner's Name &Address ( � �p ✓ �� ..�� Contractor's Name '��+ ' WVicot. Telephone Number o Home Improvement Contractor License#(if applicable) 5 Construction Supervisor's License#(if applicable) °� I r� PEA .�I OT ❑Workman's Compensation Insurance01_C 11. 20 11 Check one: ❑ I am a sole proprietor TO� Ji4i , K ,1 ?I,.ri` ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance , Insurance Company Name21 _ � L�3>v Workman's Comp.Policy# !/t/C�� E ,�J /0 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 ❑ Re400f(not stripping. Going over existing layers of roof) -side #of doors Replacement Windows/doors/sliders; U-.Value :�(� (maximum .44)#of windows *Where required: Issuance of this permit does not exempt"compliance with other town department regulations,i.e.Historic,Conservation,,etc. IT ***Note: Property Owner must sign Property Owner Letter of Permission. A:copy of the.Home Improve ent Contractors License & Construction Supervisors License is required. SIGNATURE: �:\WPFILES\FORMS\buildine permit forms\EXPRESS.doc NThe'Commonwealth of Massachusetts t I Department of Industrial Accidents t; Office of Investigations 600 Washington Street s Boston, MA 02111 I www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Q Name (Business/Organization/Individual): Address: v City/State/Zip: - Phone #: � � } Are ou an employer?Check he appropriate box: Type of project(required): 1, 1 am.a employer with 4. ❑ I am a general contractor and I 6.' ❑New construction employees(full and/or part-time),* have hired the sub-contractors : 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 ?• ❑.Remodeling ship and have no employees These sub-contractor's have 8. ❑ Demolition ' working for me in any capacity. workers';comp. insurance. 9. [-]'Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical-repairs or additions 3.❑.I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4),and we have no 12,E Roof repairs insurance required.] t employees. [No workers' 13.0 Other COMP. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the.name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insura ce for my employees. :Below is the policy and job site information.. / Insurance Company Name: Policy# or Self--ins. Lic.#: �• � /! �� I6 Expiration Date: W. �. Job Site Address: [ dio City/State/Zip: � b 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 has 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 copy of.this statement may.be forwarded to the Office of Investigations of the DIA for insurance coverage verification, j I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.` Signature: Date Phone#: ; Official use only, Do not write in this area, to he completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector:5 Plumbing Inspector 6.Other s � r 1 Information and Instructions Massach use tts"General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is.defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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-contractor(s)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 maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department-at the number listed below. 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 future permits or licenses. A new affidavit must be filled out each year. Where a home ownet 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 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 Reviceri S-26-(15 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company Burlington, Massachusetts Nf NO 40959 �k (800) 876-2765 CC POLICY NO. I WCC 5006114012010 ITEM PRIOR NO. I WCC 5006114012009 1. The Insured Michael Deluga dba Village Craft Building&Remodeling Mailing Address: 568 Santuit Road Cotuit MA 02635 (No. Street Town or City County State Zip Code ® Individual ❑ Partnership ❑ Corporation. [].Other FEIN 04-3182146 Other workplaces not shown above: 2. The policy period is froml2/23/2010 to 12/23/2011 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 10 0,000 each accident Bodily Injury by Disease $ 500,000 policylimit . Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium'for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating plans, All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated Total Annual of Annual No. Remuneration Remuneration Premium INTRA '355380 SEE EXTENSION OF INFORMATION PAGE . Minimum premium$ 500.00 Total Estimated Annual Premium $ 2,924.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 3,099.00 ® Annually ❑ Semi Annually ❑ Quarterly ❑ Monthly MA Assessment Chg. $2,577.35 x 6.8000% $175.00 This policy,including all endorsements,is hereby countersigned by C—��J� 10/25/2010 Authorized Signature Date GOV GOV KIND PLACING CLAIM NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP Malcolm&Parsons Insurance MA 5645 7 1504 Agency Ific WC 00 00 01 A(11-88) 6 Freeman Street-P 0 Box 527 Includes copyrighted material of the National Council on Compensation Insurance, Stoughton,MA 02072 used with its permission. i i ilttmcnt of Public Sufct) ,�. Nil ssuchusctts- Dc�`I,ulutiun� ;uYt1 Sla�ul;u tls i o BuurtJ-ut' Buililin,. ervisor License., , Construction Sup Licenser CS 50234. Vi MICHAEL�'tIiOF U 568 SANT;�1�iri1 �5h4f.. iui 71912012 a,1 Expiration 31394 r . Office of Consumer Affairs&Business Regulation, HOME IMPROVEMENT CONTRACTOR Registration:;M 5548 7 Q Type; :r . j — Expiration; _7/17H2O>a2 DBA I •VIL GE CRAFT, ILDR ODELING Michael Deluga 568 SANTUIT RD. COTUIT, MA 02635 Undersecretary cegsg.or r istration va Fbffice lid dfor individul use only eforethe expirationdate. If found return to: of Consumer'Affairs and Business Regulation I 10 Park Plaza-Suite 5170 Boston,MA 02116.' Not valid will t signature 'THET - Town of Barnstable ` Regulatory Services rBARN STAB Thomas F. Geller,Director. _.. �Eoyg- '�� Building Division Tom.Perry;•Building Commissioner 200 Main Street; Hyannis,MA 02601 www.town.barnstable.ma:us Office: 508-862-4038 r •,. FaX �508-790-6230 Property Owner Must , Complete and Sign This Section If Using_A Builder I r'v' t as Owner of d e:sub.'ect ro e i J .P P mY• hereby authorize IG!"- ✓ to act on my behalf, in all matters relative to work authorized by tbi.s building permit application for' (Address of job) i � Signature of Owner D to LU Print Name if Propedy Owner is applying fo . en iit pleas6 comp lete the Homeowners License Exemption Form on the reverse side. i Town of Barnstable *Permit# Expires 6 months jron,issue date Regulatory Services Fee c;)S. 6et5 IE .PERMIT I Thomas F. Geiler,Director OEC 1 1 2009 BuildingDivision Tom Perry, CBO, Building Cornmissioner TOWN OF SARNSTABL-E 200 Main Street,Hyannis,MA 02601 www.,town,bamstable.ma.us 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 � (/* C tJ i �, / b ❑ Residential Value of Work /— �f Minimum fee of$25.00 for work under$6000.00 Owner's Name&Addresstl� G -� �.,,,�, Contractor's Name Telephone Number Home Improvement Contractor License;#(if applicable) I Construction Supervisor's License#(if applicable) L ),3V v ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor �❑ am the Homeowner (�1 1 have Worker's Compensation Insurance Insurance Company Namely ; Workmen's Comp.Policy# zxlc Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) e-roof(stripping old shingles) All construction debris will be taken to kfR ' ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders: U-Value (maximum.44) `Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must§i roperty Owner Letter of Permission. A copy of the Ho rovement. tractors License is required. SIGNATURE; Q:Forms:cxpmtrg Revise061306' ,R ;5 The'Cammonwealth of Massachusetts Department of Industrial Accidents OffIce o Investig ations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Ple e Print Legibly Name (Business/Organization/Individual): . Address: 4 City/State/Zip: Phone.#: �� - �� Aree u an employer? Check the appropriate box: Type of project(required) 1.LJ I am a employer with_� 4. ❑ I am a general contractor and I . employees (full and/or part-time). * have hired the su.b-contractors 6. ❑ New construction . 2.❑ I am a•sole proprietor or partner- listed on the'attached sheet. 7. ❑Remodeling ship and have no employees "These sub=contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' insurance.$ 9• ❑Building addition [No workers'comp. insurance comp. 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 11.❑Plumbing repairs.or additions. myself: [No workers' comp. right of exemption per MGL 12. Roof repairs R fr rs c ❑ P t . . 152 1 4 and we have surance se uire no uz d. , § q ] ( ) . .13.❑ Other employees. (No workers' comp. insurance required.] , *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached amadditional sheet sbowung the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must pravidt their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is.the policy and job site, ' information. ' Insurance Company Name: Y Policy#or Self-ins.Lic.#: /J 6�( jl� ,�� Expiration Date: Job Site Address: ��l cv 'City/State/zip.. 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 31,500.00 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:ender th and en ties of perjury that the information provided above is ue a correct: Sienature; Date: . Phone #: Official use only. Do not write in th-is 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 CIerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: t. FE3-24-2009t;TOE) 16: 11 MALCOIBI & PARSONS INSURANCE (FAH 17313941d?5 P. 002/003 - DATE WWCOlYYYY) '�� CERTIF ICATE ®F LIABILITY INSURANCE 02/24,/2009 Pl;ooucER (781)344-3200 FAX (7 B1)344-1425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Malcolm & Parsons Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE »r 6 Freeman 5t. HOLDER,THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 527 Stoughton, MA 02072 INSURERS AFFORDING COVERAGE NA1C# rvsLR� M1c'�Fae-FD-eluga - INSURERA: Associated Employers Insurance ; -- DBA: Village Craft Building & Remodeling INSURES S68 Santuit Road INSURFR.c. - COtU1t, MA 02635 --------^--- INSURER E: - - COVERAGES _ THE POLICIES OF INSURANCE LISTEC BELOW HA%:BEEN ISSUED TO THE�NS'UREC NAMED ABOVE FOR THE POLICY PERIOD iNDICATHD.NOTWITHSTANDING ANY REOJIREMENT.TERM OR CONDITION OF ANC CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR NAY PERTAIN,THE INSURANCE AFFORDED BY TH:POLICIES DESCRIBED HEREIN IS SUEJECT TO.ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICiES.AGGREGATE LIMITS SHOW J N-.Y HAVE 3EEN REDUCED BY PAID CLAIMS. INbR .DID' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY - EAv+OC(:URRENCE 5 CA`AMERCI.All_GENERAL LiAe.ILITY D4iA3E TO RENTED S :LA143Id1A.DE or_'UP. MECEX?(A',f ono Gers a) - S-------- PERS�r4.L 8 AD'V INJURY GENERA.LAGGREGATE S— GEN!AGGREGATE LII.^.I`AFRJES'�ER _ P?CDJCTS-'LIMP/OPA.GG S POLICY I 2EC0 ---- AUTOMO5;LE UABILITV tiOta NE08Pb3!c LIMIT ANY.AUTO (F.a aC:Ww1t) S AL!OWNECAU'05 - uODILY HJURY ! SCHEO(jLEDN_TOS (PerPe;Son) HIREAUTCS BODILY Ifa)URY- NON-OWNED A•,;TCS (Per ecc dePo) PROPERTY OAMAGF. S -- (Per ecc dent) - DAR4,GELLA51LtTY A.:?,?ONLV-EAACCIDEfIT S AN!A'J'O OTHER THAN, EA 4CC ALITOON Y: i EXCES3/UM'?RELLALIA.BILIT- EACH OCCURRENCE S j OCCUR ❑CI-AIMS Mi,C'E AGGREGATE $ — _ DEDu-T6:,E RETENTIJN �WORKERS CCMPENEATION AND I k:C500611401-20D8 12/23/2009 12/23/2009 VIC STATU• �H- eM0LCY.RS'LIABILITY JY. E•- ---- _ _ A 'AN°PRC•PRIETOR/PARTNER;E;iECUP','E E L EACH A: DENT S 100,00 OFFICER;N NEZIR.EXCLUDED? FAOiSE.ASE-EABMPLT(E S 100 QQ :f yka aescrice tinder SPECIAL PROVISIONS below - E.I. 011SEAS'c.W!iCY UA'!T 5 -50Q QQ I OTHER I I DESC{RIPTX)N QF OPERATIONS I LOCATIONS I%'EHiCLES I EX:WS!CNJS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Residential contractor Michael Deluga is excluded from Wcrkers. Compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY Or THE ABCVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER'NILL E14DFA'VOR TO MAIL DAYS WRITTEN N0110E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT BLiT FAILURe TO MAIL SUCH NCT:CE SHALL IMPOSE NO OBLIGATION OR LIABILITY Insured's Copy OFAN�KINDLUPONTHE INSURER,ITS AGENTS ORREPRESENTATIVES. Evidence of Insurance AJTHCRQ:DREPRESENTATIVE Irving Parsons ACORD 26(2001108) ()ACORD CORPORATION 1S88 f �'. •: .,a x a •3 idt - r `4a� tF'1� r ` . ;/die VJ47�7/IYLO� nJ StandarJs„ � • . , Board of Building Rcgull�ipns a I HOM �MP OVEMENT CONTRACTOR Registration\105.5�.4.8 Ez lrafion 7(17/2010 Tr# :27197 ;` LIN 1'ODELIt�G UIG� C1111AGE CRAF �.- ,�ael i17 4 e n M . p t1�7UIT'RD 5 i Adnunustrator f> k CC� 11T•MA 02Fi3 t-a. ' _x'73�++• + �, V#_I ' N nT 't XT . F !I Wrm II I 1— 1+�' Mass - Department or Public Safch ' o t_ N Bourd'tit'Buildin; Rculutitins.und StandardsNTAx"Z`y�= Construction Supervisor. License. : ca; �'0D ti y $ �• . d m ZAPS- u ° I License:,CS 50234 r t, Y y rr Restricted to 00 .. ', l L ;.MICHAEQT,}DELUGA' ;a 1 : v ;a y N y O r ` h+ ° 568 SANTUIRD "COTU IT, MA 026 5#�I ` it Expiration: 7/9/2010 C�inunissiuucr, Tr#: 30003 i PR v 7. gyros Expiratio 11 /2098. w' E xE G RAF T 8, 1`LL7 t G E Rt DELING r J Massachusetts- DeparUnent of Public Safetl 1` Board of B ' dinly Rellulations and Standarils Constructi n Supervis r License License: CS 502 ,r. Restricted;ito00 �� _ r "MICHAEL .DELUGA I ; •.� 568 SANTUIT°,RD COTUIT, MA,02 Expiration: 7/9/2010 ('umiiiissiuncr Tr#: -30003 °Towwof;Barnstable Regulatory Services '� 4 BARNStAS "+.; �iE Thomas F. Geiler,Director �Fo 39. Building Diyision Tom Perry,Building Commissioner. 200 Main Street,Hyannis,MA 02601 .,.a www.town.barnstable.ma.us r r f M, R rri Office: 508-862-4038 Fax:. 508-790-6230 Property Owrier Mu"st Complete and Sign This Section_ If Using A Builder I, d`� `' `� as Ovrner of the subject property hereby authorize ja V :to,act on my behalf, in all matters relative to work authorized b this building pen-nit application for 7 ; Y g P PP 5P &1 � _ h (Address of job)__., _ /L Signature of Owner bate Print Name , If Property Owner is applying for permit please complete the Homeowners License Exemption Form'.on the re`ve.rse side:`; QTORMS:OWNERPER.MISSION. Town of Barnstable *Permit � �- Expires 6 months from issue date . s Regulatory Services Fee" -FRCS%� PERMIT Thomas F.Geiler,Director 0 C T 1 8 2007 Building Division �G Tom Perry,CBO, Building Commissioner TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601 t� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number © zO/ Property Address Residential Value of Work V v l/ Minimum fee of$25.00 for work under$6000.00 Owner's Name&AddressZA Contractor's Name I/'p W &,q4 Telephone Number, ��.. 7 " Home Improvement Contractor License#(if applicable) ` Construction Supervisor's License#(if applicable) 4/1 L � ❑Workman's Compensation Insurance Check one: 0 I am a sole proprietor J I am the Homeowner d [] I have Worker's Compensation Insurance Insurance Company Name ��l•/� U�P��°� '"� Workman's Comp.Policy# ale, '50, W/ 1 0 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) " ❑ Re-roof(stripping old shingles) All construction debris will be taken to 0 Re-roof(not stripping. Going over existing layers of roof) [ -side Replacement Windows/doors/sliders. U-Value ®J (maximum.44) 'T l✓ `� *Where required: lssuarice of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property.Owner must sign Property Owner Letter of Permission. A copy of the Home Improve ent Contractors License is required. ; SIGNATURE: r Q:Forms:expmtrg ' Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street �< Boston,MA 02111 y www.mass.gov/dla Workers}Compensation Insurance Aff davit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leelbly. Name (Business/Organizatiovbdividual): . r • Address: City/State/Zip: C4 r Phone.#: Are you an employer? Check the appropriate box: :Type of project(required):. l:�I am a employer with�_ 4• ❑ I am a general contractor and I 6 ❑New construction . employees (full and/or P - e) * ' have hired the sub-contractors 7. Remodeling listed on the'attached sheet ❑ 2.❑ I am a'sole proprietor or partner- These sub-contractors have 8. ❑Demolition ship and have no employees e employes and have workers' working for me in any capacity. 9, []Building addition comp,insuranca,$ [No workers'- comp.insurance 10.❑Electrical repairs or additions required.] 5, ❑ We are a corporation and its officers have exercised their 11.El Plumbing'repairs or additions 3,❑ I am a homeowner doing all-work . right of exemption per MGL myself.[No workers'comp. 12.❑Roof repairs insurance.required,]t c. 152, §1(4), and we have no 13..❑ Other employees, [No workers' comp,insurance required,] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. . 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. m an Name:__ ��r''� `f/' �!'►0 � �S �h�� Insurance Company Policy#or Self-ins.Lic,#: ,� /� �/ Expiration Date: f Y Job Site Address:_ �ev City/State/Zip: 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 WOo the and.a.fine ORDER of up to$250.00 a day against the violator. Be advised that a copy-of this statement maybe forwarded to the Office of Investi 7atious of the DIA for insurance covers e verification. I do hereby certify under the at •and pen f perjury that the in providedWaboveru and correct. Date: — Si attue: Phone#: v [0ther only. Do not write in this area,to be completed by,city or town off ciaL Town: ' permit/License# hority(circle one): Health 2•Building Department 3. City/Town Clerk 4•Electrical Inspector 5..Plumbing Inspector rson: Phone#: aoF- goy Town of Barnstable. Regulatory Services t �ABI'E' ` Thomas A Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 50$-862-4038 Fax: 50$-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder `I YYJk- , as Owner of the roe subject . J P P riY hereby authorize k J-Z4- �e�� . to act on my behalf, in all matters relative to work authorized bythis biulding permit application for . l (� V. t?-k Co4z�4- V� (Address of Job) c 07 Signature of Owner `. Date Print Name QFORIvIS:OwNERPHRMTSSION db^7 ram+ Y s r} {.; y :7 , '+ m" i 6, r .r'. HOfyFE�iN4PgJVE14tENT, OtiN,TkZA+ TO�2 � � � �,r.:,�is2ration validfor i#tlwi�lu� r ,. �y�yat • .r fi� 't�i Mkt x cite the ezlrir on'dR>e tf"r"- �retnr o m S 4 amklTBu11dm RP uIRT1 Ex 0gS 8ntl Std i+ �` piration r q, aka � 17/2008. � One-Aslibiii�ton PIRce�Yii P3('1 � € "�w Boston Ma 21:@� 41, l�y. Y. A E CRAFT BU[EMING&REMODELING l �. ` ` ;;JT' I;RD '3r ; A-02636 to Sir gpARD OF BUILDING REGULATIONS,r ckense CONS RUCTION.SUP€RVISOR a n Number CT 050234 'Birthae`- -- `i 07/t]9120Q8` Tr no ,29204 A, rya c fi r R es-I `�axMIGHAEL`DELUGA', yr i-,UiT RD err t�568 SANT 4 r COTUIT MA 02635 } ;'Commissioner710 PROJECT 1 C NAME: r 1 �+ J UV► ✓_ c� �D�c ADDRESS: PERMIT# 3 PERMIT DATE: M/P: LARGE ROLLED PLANS ARE IN: BOX SLOT - P Data entered in MAPS program on: 16 BY: i q/wpfiles/forms/archive a � .5+.�W.,. v h _ tirY'" a •� f:r ..�.. s,�i .r k'ir 1`+f4.L,L`•rr a$•�:s'+ .. ..rY. .a - - - Assessor's office .(1st floor): THE o Assessor's map and lot number Board of Health (3rd floor): _ d Sewage Permit number ..... ....... �1.�. �1.. 2 BaaasTnnLE, Engineering Department (3rd floor): , �o N o i, House numbe ......s l ��S v 0 ....................................... .......................... �0 YAT O Definitive Plan Approved by Planning Board ________________________________19________ a APPLICATIONS PROCESSED 8 30-9:30 A.M. and 1:00-2:00 P.M. only. TOWN OF BARNSTABLE fUILDING INS P ECTO•R APPLICATION FOR PERMIT TO ......7ra...,J!.!� �� !ti!iL,,;•, L/ c- TYPE OF CONSTRUCTION ....... ST lti.!` I� 1{:�:.- ....�lU l „••. ?�Zt!� U�!/; TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...;6-0 ........7'...:. . �?I�...9.��T.N.I.I�:......a.f. !7.....f �..��OWM/ o`✓ �G/iN/ �l{IOtiPIED..............................?/.l. ............. c4........ ProposedUse .... % .................................:.................................... .................................................................. Zoning District ............/�/ .....................................Fire District ............r..`-� L ................................ �. Name of Owner .. &we. ..:>�:a..��.-�..A:......................Address 4w o4{p P/tS%�C►a. // ��!��. ........................... i L l?. Name of Builder Iat57avy,BevM!44� E46.....Address .� ../�.%,.�aq..... lz f,W Sr /L...... /d ..................... Nameof Architect`..................................................................Address .................................................................................... Number of Rooms ....... ... . . ......Foundation ..... �c1Ut1��N3 C 4UC-1L4,z, Exterior' !.'. `. 1 T8 ��, ................... .................................Roofing .. ... .5 ............................:............................................ Floors ......vm!��t................................................................Interior ... ail, i2-*AG ; ............................. Heating :..: /le�! f�' .....Plumbing L� 2 .. ... C,- ! ........ U c Fireplace .../V©hiE....................................................................Approximate Cost QCJ' .. Area � Y.... .-77/ f ) Diagram of Lot and Building with Dimensions Fee .... '? ✓... .... / A .............. L r .. t f r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barns able4eg rding the above construction. Name .....;�...`:.................r................................................ �� ,•' jai r Construction Supervisor,s license ..��1..... .. .............. EDDY, ERNEST A. JR. A=054--019 No .325.01 Permit for ..Build Addition ,.,,Sngle.._Fami.ly..Dwelling Location ....L.Qt...#AL...... 1 Qld Road ......Post............... ........................CS?.tu?t....................................... Owner ......B-:KXM5t..A.t.... ddy.,...Jr.-........... Type of Construction .........FV. ne.................... ............................................................................... Plot ............................ Lot ................................ Permit Granted December 14 ,...19 8 8 ............................... Date of Inspection ....................................19 Date Completed ......................................19 Town of Barnstable *Permit# Expires 6 wondtt from issue date s t Services Fee MUM Regulatory 9eb K►s 16796 Thomas F.Geller,Director �e Building Division Elbert C Ulshoefer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w ®� m �7 Office: 508-862-4038 v REST ' Gifu P�2 ,eNiC Fax: 508-790-6230 �� 9 y MAR 0 6 2001 EXPRESS PERNUT APPLICATION Not Valid without Red X-Press Imprint , OWN OF BAR 1N S I AB L Map/parcel Number Pro a Add j �r Pox P rtY ress Q residential OR Commercial Value of Work o Owner's Name&Address of 1 1"2 f Contractor's NameL/yc"/ Telephone Number 496 — / Home Improvement Contractor License#(if applicable) / 0 7/ Construction Supervisor's License#(if applicable) 3 a 7Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ` rq V tit/ ' have Worker's Compensation Insurance \� Insurance Company Name / // Workman's Comp.Policy# Z/C- I f9 7 7 Permit Request(check box) [2--Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows. U-Value (maximum•'4) ' Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg +!y r•;r, '•'i ''%r'' f••�••, �•ia''4 ` - :.1_ '� :ti.'r tt' e( .,• ., ,Ij�• ,-1' .... _ —.—.-.._...-.._.,._ _ -.-_ w •'r' a'f .i�. t'�vri:•�:•- ''f,�-.' �� +• 1• .�'• 1 '•'S•V '],y S•ti�, , __""_:- __.._�, ` ` N ,r :%'• L�•.^, _r.. .. , IV '+�'`. .a„ '.I .,r '! ( .• •i ,err. '_' \,_ 1 • `�r r ",..fit,lY.+�`il 4 ', .'t r,,+ ,•.'+r.r t .1 r ,'r -:•'..,S' '�''iT, --__-.---....,�, --._ f - ---- . • • r•� r.�.� 1 � r '•\•. t fl •r_ _..,• '=••r�Jt` ti.' - .. - :s '' 1 { _ ,. _ ,;r: •' i, '• J*L Il ',•� s- •M i �.i+.L.4I I Y `l`s , ', \ \ •J''q '' •r'•r, �L•..• !. 1': 14 f'�'a+• E "fl'•.! Y•!. '•5�1 '�r• r n f•av Z •--•--_`_._•____.-_...__-._ 1 � - 'tt •\ �1'( 11r r J,.' � v �+,' i.�"��r�iit R ;c `"rC. ':'.,a. •. W �I __: �C '/,`�l `\ '•i/`, l •'1r7 '.�` •Lyre �..'•'�'•,� .� ,.,,,H.: . ,"" $ .li'. . /a%, ..-,r 5„ o _.._:'::::�.�;�:_�-..�. - / p\N� R 7 •' ,. �.1_..-z k:�' =' ;:,�;;,• _�.:.�:,;.., _ . - I ,.. t.. ;r_y .t...�y•14 ,-. ...•. �/ `i 11• ', 1• ,1r y .' (' •ri•: ."r•_ , 1�4 �:,'rr ' _:._.-___.=....._...--•y- _._.___...._ 0..____.__•Q__/c'�♦'-•• _ 4•-....__ ' \ t� \c N r 1 r••.rrvt?�.'•r'l'r!5'Y.,'�'� ii�,:',1�+,rti';a'*�-fX•'7.'f. KQ�:t+ •' .�,`y ;-;•'�....a:• .4J,f`i RES ,•�,iC�T'.•.. • "iN .. �:,1 t :irg '�'' _., '•• 1 RESTRICTED ��i REA 8 I ' s�'a`• CB DH ►� , c - AREA D. �.._.._��'ly __ ---- o /' 1C r + = 1 N V ;-,~�:•' ; •�,,9: • r�� .:,t _ . t,` r�:_._.... _ 4 ,� :4;` •:_,; , _ . ' R '(R I I EL 4 .8 G D PLBK. 104 - _ , %` 00. LOCUS MAP w SCALE 1■ - 2000' •• , Its V06 (Expires: July 30, 2005) \ OVA , \Ste• \ \ 1 0 � / TIMBER RETAINING \ + + y� \ WALL \ WN / _ _ / O �, \ \ ` ` ' `• ' � LP '� . � PROJECT DATUM . N.G.V.D. 'L, � !,• -,-_ � / ,; j � - PROPOSED WORK 11MIT + ! TK FND / �"'' / / RESTRICTED \ \ \ sof� , �0 % --�_ \ AREA E ! 'ep �\ \ \ \` `•, ''', 345:, 1 RESTRICTION LINE ��, J! 117 •� ZONING DISTRICT : RF & A.P. PG. 125 > >� O O • \\ \B/DH FND 1 ' r N �' i• I i� �� A• r • \\\ `� , `'� o N i w / / /r ` FRONT YARD = 30' SIDE YARD = 15' REAR YARD = 15' CD 1.61 OD y •. \ \ ..? .TH.WAY. -. I r� { TONE' -`_ t , 'L \ \ ', ! 0+ , i ,..�• -• •• _ ,. ;il.� '',.' cv�- �- / • • s ; ,.••••• ,' •••••�=- "�: ' ,,' `' ' •�•.. . < • ,,, ;, ;: /L� .-'-• .-• -� �„ LOCUS PROPERTY IS COMPRISED OF . LOCUS DEED REFERENCES \ , •'•• •% O� Ul STK SET O •' _ •�< •STEPS . ASSESSORS MAP 54 - PARCEL 19 BK. 10091, PG. 17 1 1 ,' a r;+ r,,��" DO PLAN REFERENCES MAP 54 PAGE 19 ` '`� PL. BK. 104, PG. 17- PL. BK. 117, PG. 125- PL. BK. 123, PG. 131 • ` j STAIR WAY ! j / /' . 1 25.. ^� \ WOODEN 'S ;,r';� ; ,�' i rri i ''% '/',/.// % • HOUSE # 55 1 GK t I PROPOSED WORK LIMIT / ,% r'i%!� i'' '�' PARCEL B COMMUNITY PANEL NUMBER 250001 0008D • t :STK SET ' -' f,: j / EXIS• / PL. BK. 104 PG. 17 THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONE V1 1 ;DWECLING!�';,j'j ;,,r'i' `%' \ ,. l ELEVATION 9.0 • , ; , ' ` 1 { ! 1 1 r / _ /%.i, '�r�: ,•�, /',r�/ �`; % ./,,� : % / / !.f`r /; AREA TO MEAN LOW WATER ',`' ', \ •' '1 r ' 1 / + ,r / ji'al�J'rr�' �• f i'',/,/ /�i r "i•�%'`r�' //fi ii'' 78211±SQ. FT. (•_. I '' \/ � ••• \\ ,', :' \\ •'•,, 1 ;,, � + , �� - :• i''i1•/-/ •/' -�; /- i ,' " % %� • 1.80E ACRES LOCATION OF UNDERGROUND UTILITIES ARE APPROXIMATE AND ' �� ', ' ', 1 l ! f , ;, % -;/• �'�,,• SHOULD BE ..VERIFIED IN THE FIELD BY THE APPROPRIATE UTILITY COMPANY PRIOR TO ANY CONSTRUCTION. O \ DECK �'%` /i%' • \ t N/F W I L L I AM S THIS PLAN IS BASED ON AVAILABLE RECORD INFORMATION AND • , '. { - LOT B PLAN BOOK 104 PAGE 17 � ` , l l' '', `, ', '+ '• i '+ APPROXIMATE TOP OF 10 PLANS AND UTILIZES THE TOWN OF BARNSTABLE GIS TOPOGRAPHY. • ' ' + + 1 COASTAL BANK �� - k s ' + PROPERTY OWNERS • ` ', _77T ♦1,', ti t� ,, `t `� �, ��` `_ _ - ro 0 Z \ Marjorie Powell Williams Taylor & Mary Susan Williams Pile ,�,` ,` ,� ,�1``,y • ` , � • \ N 20 Brae Burn Drive St. Louis, Mo. 63124to:a ' \� ; , � ', , � K 123 PG.131 °' o .� 'S , ';` `,\ .�-r area PL.B C restricted _�_ 551 Old Past Road 1 , 5 1 39 S03•43!rW '� 2 7' 3 4.0 iw Cotult' Massachusetts �, �� ! , ',r.L•=+� , `,, ; `, i •�"'r / "-- �_ PREPARED FOR ,...., , l � PLBK. 23 P 1 .�-- _ / Marjorie Powell Williams Taryfor restricted • , , , , .» , t• , MAP 54 Mary Susan illiams Pilo 'Sb�• 4'3 ; ; 18 j W Y"•w ', `! ! = _..._-- ,' \` �� ®posed Addition / Westland r�1�■� 1:,1 BAXTTER, _ \ ` , ` ` '! , t \ f �.\\'',\\,\r, •• \\''', ` — , \� \ \\ Registered Professional -�N OF P,'1f3s;� 1 :t , ` ` +` \ ', , ' \ ! `.,`•,'\,�; z�.`� � I PL. BK. 123 PG. 131 y / � `,` Engineers and Land Surveyors o`a� 9�\ 44,000 SQ.FT.f ►• �\\\\ `, g� y TEPHEN �G \ \ \``�','.,`•. �,_ 812Main Street, Osterville,•••, :� , \\, •�'+. ' ., '',`, ., ,• , ,.,\ , ,; .♦ ,,\, ♦\♦ ..- ..-- , , , � - - Massachusetts 02655 , \ `, \ ` ,`�'`•'. `' `' \�,' \ ,`\ '' ` Phone (508)428 9131 Fax - (508) 4' ONAL SCALE IN FEET ,D \ \ ■W 375.96 " _ DATE: NOVEMBER 27 2001 \, •' 03'47'35 SCALE: 1 20 r 1 , 1 ` �, ,�`, \�, � REV. DATE: REMARKS 5 30 02 PRO. ADDITIONS 4n, �j ',,Ep \ • ' UPDATE TOPO. '" 2. 6 12 02 EDIT TEXT ? \ 715 3.54.35 3, 02 CHANGE ADDITION 4 + DRAMNG IIUME0 \ •'', ,` � .,, •� •,\ .,•` \,` ,♦ ., �..� 4. 9 06 02 ADD PORCH H: 2001 -80 surve worksht 2001 -080ws3.dw ,