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HomeMy WebLinkAbout0338 POPONESSETT ROAD 33� �d��o��ss�` �� 1 ,� z .y;�� : ...,...r,�wt.r�.�..... * ,,,,/,� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I Parcel o N� iOcation # — ' �(J 4`l-v g Health Division Date Issued Conservation Division NOP& ,application Planning Dept. VsT4199,e snit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis EMS. s Project Street Address 3_,Ms Village Owner �M r 1 k Cal Address At® �w�c�s ao fL;Ssl ��Q o Telephone �ba— !Z�L, - O4 G,1 Permit Request 21 oawraEe �� t � 1 �-�e c� `� ,,� „&4N gyp 1 3�4 1,,t- man.. Iva Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size L -ftr, Grandfathered: ❑Yes ❑ No . If yes, attach supporting documentation. Dwelling Type: Single Family er/ Two Family ❑ Multi-Family (# units) Age of Existing Structure -Sb Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full Yi/Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: Z existing —new Total Room Count (note including baths): existing 5 new First Floor Room Count Heat Type and Fuel: 0`nGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Rlo Fireplaces: Existing V/ New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use -?,Qs\c1LQ_v\c Q Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number SOt ��kob Oq(,,-1 Address \ o &-o', V N �r�, License #� w Home Improvement Contractor# Email SrR%5*A�p f-\I eA- - QQc%, Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY t APPLICATION # f + DATE ISSUED } MAP/PARCEL NO. ADDRESS VILLAGE r OWNER DATE OF INSPECTION: 't FOUNDATION '. FRAME 'INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t c, .7z Commonweal&afMassr drsetts RePartrimit crfrn.d-zistrid Acddergg Offi-ce•aflM.Aeslfgatiam. ` 600 Was,�turgiort J eet -=Y Bastion,?FIA 02HI • ft.�fvtt:arcrssgtrv�riin - Workers' Campensaifan I> mmnce Affidavit Stilders/CantracturslElectrkians/Phi�nhers AIiUUcant lufa=atian Please Erinf f.eai�llY ��3I1IB ,nc;rrREc, r�t/Cnr�'cc�dna7- - A.d&ess c ,�Sx Plane g .� Sco co- 0 9 b7 rt eyou an employer?Check.the appropriate ba= Type of za ect r . ' am a general confractar ant€I p 7 :L❑ I am a employer uitk ElI b New consfzmrfiosx employees(HIamXorpait time).* liave hired:the suit-contracta�rs G_ ❑ e 2.❑ I am a sale proprietor arpartnw- fisted on,the attached sheet 'F_ ❑Remodeling ship and have no employees. `iese sub-•confractom hzm g- ❑Demolition wod-Ing forme in any capacity employees andhat:ewodcere ad3hi�oa END t�arSmrs'camp_assurance comp.insurart�_l 9. E.uildiag ' required] I ❑ We are a zorporaam arrd ifs 16❑Electdcal repairs or ad Taus I am.a home-or"mer doing all wont of-racers Rase-ecercised their 1 L❑Plumbsagrepai s or additions myself[No workers'comp- rigU of ememption per MGL fry_ Roai'i epaim;nnnnce rer mmd]Y c.15Z,§IM andwe*lave no ❑ employees.[No WaAM& 13.❑'Otber comp_insurance required.] 'gay apg�csv�ffiat cber�..shos�l�.�aLsa SIlvotth�sectFoabcTowshatdag ihe¢zuo$cels'camperse5aapeT�cgiafo�s�an. �E�ameovraers�rhosabta€t�is�daiain�uzlmgti�eya�•do-ia�gtF�va�c��8iealuxeoat9dgr,,,,+,••rc„rsamstsnbnutanewaffid�Yt'"��rnrfi . ICaatmnbest3�t checYthss boot mast attached�.9�3i6aoai sfceet shocvmgtl+en�+�of the sala-cossamd stye�rhethes arnat t7�nse eafi�eshst� ' e�9o1Res.7ftLesahtQa�si�seemPIofersitbe3'm�stgxus�tfi�s srark.�s'romp.gaI'icga�re� Ian[an errigIayRr flint is prauiding n�rkers"corrtpertsafr'an arsruarica far }*enrplvl�ees $elory is t7tRga£iry•rrrrd j ab site . irtfarmcrfivrL ' Insumnce Companpi"Eame: Policy 4 or seff-i sls_Iic-4- ��pifatiou Date: Job Site Address= 33g �a one s� k city/staterzp:� dz� Y Attach a copy afthe workers'compensafloapaIic_decIara&oa page(showing the policy,mrmher aztd�espsation date). Fadnre to secmm coverage as req*ed.under S=Eion 25A of MGL a M can lead to the imposition of r*j-;,n:d peoalfi es of a fine up to$1,�a0=U0 aryd for one yearimpFisor as well as civil peaslties in the form of a STOP WORK ORDER and a fine of np to�0.0.a clay amiast the violator_ Be advised that a copy of this statement sway,be fxvwded to the Office of Iuvesttatiaus of1he DIA far h2sm nce cavmge vacation. I rfa&ere€ry cartx �ria the pains pe afpediu7 fliattlis irrfarazaflQrtgro1,*ed abmw!s liars and correct: C Si�atur� Date- ', Z 3 L Phase rc Offal rrse vnFy. ilia not wrAe indib area,tit ire crrtrsp&dd by diy artoji7f ajoicial My or'I'own• Permitff kense 9 Issuing of -ordy(circle one): L Board of$ezltk I BuiTdmg Departmea{ 3.Citj--ffown Clerk.4 Efectrical hmpwtar a'.PlEm-bmg insgecter b.Other Contact Person: Phone#: Town of Barnstable Regulatory Services Thomas F.Geiler,Director MASS ,� Building Division. Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.as Office: 508-862-4038 ` Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 0(il -aaE ?wJOB LOCATION C 4�` CUI-lams 5&p,�p street / viha n "HOMEOWNER": �VL/ � 2� 113 i32 name home on�ej' work phone CURRENT MAILING ADDRESS: e cityhown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwelling of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildingpermit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other = . applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum' ecdon procedures d requirements and that he/she will comply with said procedures and requir Sign4t of Hom weer Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware tlist they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot.proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFIL.ES\FORMS\homeexempt.DOC Town of Barnstable Regulatory Services i A�pN4��Rf.V. f W p Thomas F.Gei7er,Director i639. �i Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Prope Owner Must Comp lete and This S ction If Us' A udder i I ,as Own of the,subject property hereby authorize to act on my behalf, in all matters relative to work authorized this building permit app ation for. ddress of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNEUERMISSION j ti n r I a ^� z { i _ f 1 . i 4 Iq Cf-l`F.T 1 { �A-t-W v 33F p6pp0tj W-b' `ctvctv"seo arr�,,, 229722 :, 79brri9 00, n3z iybnh o �; ;, :, -. _ ,. .. f s� M el. �r,, tip, F � ,����� �, ,f ' _`�_ �� 4''� ,��.a, K�{ [1�2�9hn ^ M I I i f �1f1�u.eera ._ L �' kr r. �. _.. ' _ --.�I!� �+�°� i} �`."`>: _.-i .jam, �,�iT.,: �:�.,.. i i 4 rt hh 110/000 i IF y � �w � t wa a N ` K IS _ E t _ • '7 I� L : i I f ink 000 I � _ l Tow oF�gR�sr�e cF i j 1A- i !��,�� /� �Q� ���`�� �o�A tio�� �-�a,6s T ���sr �el� V Boise Cascade Do 1- " ��Double 3/4 x 9-1/2 VERSA-LAMS 2. 1 P® 0 3 00 S Designs\131301 Dry 1 spa, No�cantilevers 1 0/12 slope _ Friday,June 24,2016 BC CALCO Design Report- US 16-00-00 OCS Build 2258 File Name: BC CALC Project Job Name: Botello Description: Designs\RB01 Address: 338 Poponessett Rd Specifier: ; City, State, Zip:Cotuit, MA Designer: Customer: Company: Code reports: ESR-1040 Misc: �c 12 1 b I a 80 08-04-00 B1 Total Horizontal Product Length=08-04-00 Reaction Summary(Down/ Uplift) (Ibs) Bearing Live Dead Snow Wind Roof Live BO, 3-1/2" 570/0 1,063/0 B 1, 3-1/2" 570/0 1,062/0 Live Dead Snow Wind Roof Live OCS Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 160% 125% 1 roof Unf.Area(lb/ft"2) L 00-00-00 08-04-00 15 30 08-06-00 Controls Summary Value %Allowable Duration Case Location Disclosure Pos. Moment 3,038 ft-Ibs 18.9% 115% 4 04-02-00 Completeness and accuracy of input must End Shear 1,208 Ibs 16.6% 115% 4 01-01-00 be verified by anyone who would rely on Total Load Defl. L/1,394(0.068") 12.9% n/a 4 04-02-00 output as evidence of suitability for Live Load Defl. L/2,142 (0.044") 11.2% n/a 5 04 02 00 particular application.Output here based on building code-accepted design Max Defl. 0.068" 6.8% n/a 4 04-02-00 properties and analysis methods. Span/Depth 9.9 n/a n/a 0 00-00-00 Installation of BOISE engineered wood products must be in accordance with %Allow %Allow current Installation Guide and applicable Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide or ask questions,please call BO Post 3-1/2" x 3-1/2" 1,633 Ibs n/a 17.8% Unspecified (800)232-0788before installation. B1 Post 3-1/2"x 3-1/2" 1,633 Ibs n/a 17.8% Unspecified BC CALCO,BC FRAMER@,AJSTM, Cautions ALLJOISTO,BC RIM BOARDT^^ BCIO, BOISE GLULAMTM SIMPLE FRAMING For roof members with slope(1/4)/12 or less final design must ensure that ponding instability SYSTEM@,VERSA-LAM@,VERSA-RIM will not occur. PLUS@,VERSA-RIM@, For roof members with slope (1/2)/12 or less final design must account for Rain-on-Snow VERSA-STRAND@,VERSA-STUDS are trademarks of Boise Cascade Wood surcharge load. Products L.L.C. Notes Design meets Code minimum (L/180)Total load deflection criteria. Design meets Code minimum (L/240) Live load deflection criteria. Design meets arbitrary(1") Maximum total load deflection criteria. Calculations assume member is fully laterally braced. Design based on Dry Service Condition. Page 1 of 2 y ®Boise Cascade Double 1-3/4" x 9-1/2'' VERSA-LAM@ 2.0 3100 SP Designs\131301 Dry 1 span No cantilevers 1 0/12 slope Friday,June 24, 2016 BC CALCO Design Report- US 16-00-00 OCS Build 2258 File Name: BC CALC Project Job Name: Botello Description: Designs\RB01 Address: 338 Poponessett Rd Specifier: City, State, Zip:Cotuit, MA Designer: Customer: Company: Code reports: ESR-1040 Misc: Connection Diagram Disclosure ,►I b r �--d— Completeness and accuracy of input must be verified by anyone who would rely on a • r• • \ output as evidence of suitability for particular on building pcode-accepted design based properties and analysis methods. Installation of BOISE engineered wood •1 • products must be in accordance with current Installation Guide and applicable building codes.To obtain Installation Guide or ask questions,please call a minimum =2" c=5 1/2" (800)232-0788 before installation. b minimum =3" d = 24" BC CALC@,BC FRAMER@,AJST-, Calculated Side Load= 191.3 Ib/ft ALLJOIST@,BC RIM BOARD- BCI@, BOISE GLULAMT-,SIMPLE FRAMING Connectors are: 16d Box Nails SYSTEM@,VERSA-LAM@,VERSA-RIM PLUS@,VERSA-RIM@, VERSA-STRAND@,VERSA-STUD@ are trademarks of Boise Cascade Wood Products L.L.C. Page 2 of 2 s r yw Ir yAW 1 i - r f _ p f I'� rzcq6 �1VK%„ Town of Barnstable *Permit# Expires 6 months from issue date �T Regulatory Services Fee d anxxsres o M" Richard V.Scali,Director Building Division AfAr Tom Perry,CBO,Building Commissiq e 200 Main wStreet,"Hyannis,MA'02601 OF O'/�R��r� ww .town.bamstable.ma.us, / Office: 508-862-4038 Fax: 5 8-90-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY - Not Valid without Red X-Press Imprint Map/parcel Number a'/ Property Address p ❑Residential Value of Work$ ��, 0,0Q, D U Minimum fee of$35.00 for work under$6000.00 _T Owner's Name&Address �hD ,(l� U��v�R Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: , ❑ I am a sole proprietor jZ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) "❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Lo Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. ' *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy the Home Improvement Contractors License&Construction Supervisors License is requir SIGNATURE: V1_ Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revised 040215 The ammenxlerilth OF, :MiZSsI7&Jue#s ' A a�rtment rr,f In�ustriat�cc��ler�cts- ', Ole of rnvestgatio s b(#(!'N'asllmg[rni,SYreet Boston,MA 02111 WWW.maSLgov/dia Workers'Compensation Insurance Affidavit;BT Kiwrs/C,6zrhikctorsfElectricians/Plumhers Applicant Information . \ Please FTlIIR �Y Nane(,BtitR1/ I41im8}: Cit7/Statt,:/MP7 oe'� .. . Are you:an employer?:Check:the appropriate baz, 4_ Iama, conttactorandl, .Type of project(regiured) L❑ I un a e�Ployefwstfi ❑ �:: & ED New Cori.. haver hired the sub9ractars employees(fall andlor PiszL-time)-s . 2_❑ I ata a:sole tuturietnr or patter Lsted c�the attached sleet` ?. ❑R l g 1lpese cab-eitractors haue ship and have no a plcvyees: 8. ❑Demohoork watking for.me many capacit and have workers' e [ATa workers' msuraiice utldmg aildttion . crimp:: comp mstYatx>e 1 B... regnir S ❑ Je are a tton and its 10❑Elechzcil repairs or additions ed corpora tl�cets have ea errased their I etas homeowner dfltrtg all wtxir :.: l I❑Plumbing repairs:or adttions raysel f[No wvrl4e s'comp.: right of esemptit�rt per IkiGL 12❑Roof repairs insivance repute&]7 c 152,;:§1(4},andwe:havens employees.:(No workers. n❑Other comp:mstusuce sequel-]. ''Amy appbcam that decks box#I m also fill out the rection below.shove*their gets'comFeltalion Pelic9 inibrm d6m.: I Home mien wl.sabmit this.dEdsvit indicating they are doing all vial and dum Lae outd de ca=a+cnus mast sabmit a new affidavit indicating sadL ` tccatraztmflist check this box lust 9ttaelie .as additional sheet divining them Hof IM sub-ccmtrvetoes.and sure Whets eF not liLm mwties ba« employees..If the sub-conw=m have employees,thug must provide,ter workam'comp.policy number. I am an ong7lgw that is providing nvrkers'conTensadan insurance for my empf Uwm Below is the poficy and jolt site information. In un=e Company Name- P©icy#of Set€ius I sc # : Exguattozi Job Site Ad&eii :. CityJStatt>Zip Attach at spy of the;sorlers'compensation policy tletsIurattan:page{slmng the policy nn�ber aad:esprratian elate) Failure to secure coverage as i erluised under Sects 25A of MGL c, 152 can lead to the i�osition of cf rntaai Pena,Ih of a fine up to$1,300_00 and/&one=year tm}utsotngeut as wellies cs peualttes m tie fornx of a STEP j,VOR {?RISER and;a fate cif up to 250 00 a day againstdte violator. Be advised that a copy ofthis:sWement map be ftravvarded�'idle Imce of fimestigalions of ffie DIA:for i�coverage on I do her sfiy cerkjv a the peen rtafrces afPerjur}'f��ttlte mfatahan pt�auid abaue.is hue and corm Si e: Bate- phone# �,�`tcia!use.tpnI� :Dv t�f�yrits ii fftis Brea,to fie coritpleted b;�:iafy or totwt o,,�t'ciaL. . -. Clap or Town d. Per�ttlLicease# . -Issuing Authority circle ones ri - 1:Board flf.HeAlfh 2.BW-Iding I}eparfinent : Cityl'Totvat fork 4.Electrical Inspector:S:Pluniblttg Ini*tor.. 6. Corttact;Ferson.. r Phone# BARNSTABLE, ,.� Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO' Building Commissioner_ 200 Main Street, Hyannis,MA 02661 , www.town.barnstable.ma.us , Office: 508-862-4038 f Fax: 508-796-6230 Property Owner Must Complete and Sign This Section If Using A Builder' -, 3 ' as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date ' y i Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the' reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services 4 °Ft rqy Richard V.Scali,Director ti Building Division syszns[.F Tom Perry,Building Commissioner Mass. 039. �m 200 Main Street, Hyannis,MA 02601 ArEn ww'I a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION I ®I I Please Print DATE: `� Q � �T� I— 'n n /� JOB LOCATION: c 36 Po poo��`�� R oo{ ;C-0- L&(' L 1 1'V 1 A 00 0 J number I street n village ..HOMEOWNER": name—r^ �y home phone# J work-phone CURRENT MAILING ADDRESS: L �l� A&ffl R A fYla� , MA , oo-cvgq city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling;attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one . home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The under ' ed"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedur d qu s d that he/she will comply with said procedures and requirements. a e oYHonk6vFner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section.1127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner,shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp Parcel Application # O> Health Division Date Issued l� Conservation Division )Application Fee Vim/ V Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address 3��s Pnrsscf �� Co ,+ '�' fJ Z(0 Village rA b�- p Owner Pe Oct Address 3.3g roaDnn��se DZ� S Telephone�,_ ��& .2 t130 1¢ Permit Request �E'�k r� � rn� �� \Dc..4 T ti Su A-ION Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �cf*7db� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) d t Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kin Highwa� ❑des ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other p1"% `'' Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing a new Number of Bedrooms: existing _new _ rn v, Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size — Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ i Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� r'r ��- Telephone Number Address a��j Lg, k< RsA License OZCo Ll q Home Improvement Contractor# 7 a Worker's Compensation # Div .o ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE�`�� DATE a FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER - DATE OF INSPECTION: • v FOUNDATION FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` 5 GAS: ROUGH FINAL--' FINAL BUILDING r • ry DATE CLOSED OUT ASSOCIATION PLAN NO. +� r the Commonwealth of Massachuseas Department of Ind usoial Accidents _. Office of Investigations 600 Washington Street Boston,h� 02111 wnw.wa=govIdia Workers' Compensation Insurance Affidavit Builders/ContractorslElectrician 44ambers Applicant Information Please Print Lezbly Name m ioraffvidnal): Address: Cl/S.1&7,ip: ���e s �Q�� c-�. Phone ?(-P Are you an employer?Check the appropriate boa: I am a general contractor and I Type of project(required): 4. L(N I am a employer with ❑ g 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 sheep 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have ems' 9. ❑Building addition [No workers' comp.insurance comp_insurance./ re1r&ed] 5..❑ We are.a corporation.and its 10..❑Electrical repairs or additions 3.❑ I am a homemarner doing all work officers have exercised their I ❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.❑Roof insurance required.]t c. 152, §1(4),and we have no repairs employees.[Nq workers' 13. Other comp.insurance required.] *Amy appbc=that checks boot#1 nmst.also fill out the section below showing their worker€:compensation policy information. I Homeowners who submit this affidavit indicating they are doing all woad and then hire outside contractors mast submit a new afi9d2viEt indicating such kantractors that check this boar must attached au additional sheet showing the name of the sub-contractors sod state whether or not those entities have employees. If the sub-contractors hsve emplcyeesy they must provide their workers'comp.policy number. lam an employer tltat is providing nwrkers'congmtisadon insurance for my enrployeeL Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: S Job Site Address: V.WC9Y, re T �� CitylState/Zip: C(>Iwo,i I"CQ w Attach a copy of the workers'compensation policy der laration page(shoving the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition ofcriminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in time 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 maybe forwarded to the Office of Investigations of the DIA fDr insurance coverage verification. Ida hereby certifrnthepains d penalties of perjrtry that the irtfarmatron provided a e' true and correct e: Date: Phone#: Of}zcial use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense!# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityNown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 CERTIFICATE OF LIABILITY INSURANCE 3 7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS -CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this ow ificate does not confer rights t0 the certificate holder in lieu of such ems). PRODUCER CONTACT ArtiwrD.Caltee kmsuralmce Agency,Inc PNONEraw5ow FAx NB 4574715 W W W.Cpitesinsurallce com E YAK 1nSllranCB.COM 338GiffordStreet INsu AFFORDING COVERAGE NAK:A Falmouth MA 02540 INSURER :NDAhland Insurance INSURED INSURER e:Acadia lawn um Lahr Home Improvement 23 Grand Oak Road I RER D: . INSURER E: Foreeldale,MA 02844.1229 I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. III LTR TYPE OF INSURANCE L SUIBN POLICY N BIER POLICY EFF POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000 000 A X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDWMI 00,000 CLAIMS-MADE x0 OCCUR WS180232 05J012013 05►0 rM4 MED Ev one s 000 PERSONAL&ADV INJURY $1 01A000 . - GENERAL AGGREGATE s2,000,000 XGENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $2,000 0070 POLICY AFCTPRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accKWd) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS E UMBRELLALIAB HOCCUR EACH OCCURRENCE $ EKCESS LIAR CL AMASMADE AGGREGATE $ DED I I RETE $ WORKERS COMPENSATION x WC STATU OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXEC Y/N EL EACH ACCIDENT $5110 OOO A OFFICERAY�®EREXCLUDED? N� N/A WC20 04035" I2M3 ONOM4 (MwxWery to NH) E.L DISEASE-EA EMPLOYEE SISKOW M desaibe OwM Rl OF below E.L.DISEASE-POLICY LIAR $500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEMKx ES(Arch ACORD 101,Addtlorol Ramada Sdwdtd%N maa apex Is-Wd—d) General Weadierlistion,I ulad n,Window and Door RepiacemeMs i CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dep (tent ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street IM Hyannis,a6li 1 AUTHORIZED REPRESIENTATM <EPMD I� ©19BB-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010M) The ACORD name and logo are registered marks of ACORD { I or registration valid for mdividul use only he expiration date. if found return to: ., 'Consumer.Affairs and Business Regulation .?laza-Suite 5170 oston,MA 02116 Not vali without signature t Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-053 61/ SCOTT A LOHR 23 GRAND OAK RD . FORESTDALE NIA 0264.4 J54--� � Expiration Commissioner 06/09/2015 l Office of Consumer Affairs&Hus:ness Re11113r:ii ` ME IMPROVEMENT CONTRACTOR P egistration 172172 Type: ^ xpiration 5/31/2014 DBA °" LOklR MO%ME IMPROYWMENTeE- t SCOTT LOHR CRAND OAK RD FOR ti:,MA"C26�.4' Jndercecretar� i.. - 40rHousing ® IT < cv io*## Assistance lu f L� RECElRfEDcawGed f ' Housing AsslstMA-!"' 1 JOrp "On J HOME OWNER WEATHERIZATION WORIZ PER IT& FUEL RELEASE: PLEASE FILL OUT AND SIGN THISFO'RM IF YOU ARE • TH E APPLICANT HOM E OWNER. r hereby consent to and-agree that weatheriration.work may.b6... done b�the d then ion grogra of Housing Asdstance Corporation (herein after referred as. "AgenW.)on the.property located at: ,� r < The weatherization work done will bebased on programmatic priorities and availability of funding and it may i ncl ude al l or some of the foil owi ng measures Weather-stripping& caulking of windows and doors, insulation of,atticA sidewalis& basements,alff and posibly replacement of badly deteriorated windows In consideration of theweatherization work to bedoneat my home I agreeto thefollowing 1. 1 4vepermission to the"Agency" its agents and employees to travel onto or across said property with such equipment and materl all s as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect thefuel or utility bill for the weatherized unit on an ongoing basisfor no morethan five(5)yearsafter the weather!zati on work isoompleted. I have read the provisionsof this agreement as listed and freely give my consent. r Home Owner: (Sgnature) Datsi — -.261 t Agent: (signature) Data HAC approved Weatherizaxion Company : live learn work grow 460 West Main St. Hyannis, MA 02601 hac@haconcapecod.org 508-771-5400 fax: 508-775-7434 _ i 10'-0" 0 UTILITY AREA, EXISTING IN STEP DOWN I W302 W1�30 o Pnf ahnvv're TRr O) ` Al TUB/5HR NTR I STE DOWN BD 15-3D t ( ( ) } 36" LAZY SUSAN 63 30" RANGE 73 03 ro r W BATHROOM MASTER BEDROOM 5' 0" DINING AREA KITCHEN O O uj o �— 00 - U IT N � z ANEL C L5 UJ J fireplace, existing U V J 0 n uj CL5 C L5 LLJ (S .� 9'-0„ W C� 0 LIVING ROOM W � 1 (V 0 0 GUEST BEDROOM D .... . - z 0111 co CL ENCL05ED PORCH co NI &22. 2016 17'-010