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0374 PUTNAM AVENUE
_ ���. �, i �r •��.. FRIEDLINE&CARTER ADJUSTMENT, INC. 436 Main Street, P. O. Box 338 Hyannis, Massachusetts 02601 Tel. (508) 771-3232 FAX (508) 790-2344 Cl TO: (wilding Commissioner or Inspector of Buildings O Board of Health or Board of Selectmen 00 ( ) Fire Department21�- .r f t?si TOWN OF BARNSTABLE '%.n rn TOWN HALL HYANNIS, MA RE: Insured: BOUCHER, N. Mason &Anne Property Address: 374 Putnam Ave. Cotuit, MA 02635, Policy Number: HOM00349521 .Type of Loss: Lightning Date of Loss: 7/23/2016 File#: 125533 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused.copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail I C. WALLACE Adjuster. 8/1/2016 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued (,Oh / Conservation Division. Application Fee qqPlanning Dept. Permit Fee D Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 3 V` Village CO-To I T Owner Mr. + _ flop Address nTelephone .—Permit Request 'i�Ai-1-(Z.WM Z'E 0bi,: L, Square feet: 1 st floor: existing proposed- 2nd floor: existing 130proposed Total new Zoning District Flood Plain Groundwater Overlay `Project Valuation 000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new.'. Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/cp al stove❑Ybs ❑ No �; M 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 Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name GO P Telephone-Number Bq 'i;Px g) Address �oX 1 �1 License#' C-S - cfl 0s(03: Q�6 N�` Home Improve _merit Contractor# r Email � Ci. r 0�. , Co Worker's Compensation # U , 00 Q 11(a(AA A ALL CO STRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4Cew� i�J� r �cs vQ 6r SIGNATURE DATE 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION a - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i _ �o.flm�er�ga€ianr Iv �. 600 FPQslAngfonS'freet -• . BOAVY4 HA 02 I1 - Workers Compensation rnsm-ance Affidavit B Hdel-dConfra - rsl.G`Iecfi iciaas/Ph�anT�ers AppUcanf•Informafi6n ' _ Please Priuf IT Ue-`r7y -1 t Addz ;--f - u an employer?Check appro I /S— Type afprofect repaired); am a enzploytr wi$t ara1actrm and I Moyers(fM Md/or part doe).* hired the sob-c�acbacg 6. ❑New eonshaction 2.Q I am e.sole proprietor or pmtner listed on the affacbui sheet 7. Q Remodchng ship and have no employees Th� � S. Q Demoli�a a wox�g forme in my rapacity. 9, ddiiio [so wolkn:rs'CC�,mcitranrr Comp.fiMMnCrj Q Buili n a wed] 5. Q We are a corporation and its 10.Q BICCLimI repass or additions 3.❑I am ahnmeowner doing allwmk officecs have came sed then ILO PInmbmgrepaus or additions myself [No worms'caQmp. rift of t ire�dmperMGL ins�ce zeq��d-I t b•M§I(41 End We haven �'0 B°°frepans mgL)yees.[No wa±=' I3.Q Offer cmmp•;nsora ce reqnia�I *Any appTicmmtfmt chcr m bmc#I amst HIM M otcttbe mcHm brIDw gWWmg&=Wad=m.MMP=Sffb=peu,Y won. t Hnme mn=who=m ttbis Kdevk mdicatm' g 8hry axe doing RU Wmk m d Ihm hie vatiide ' ' rc zest=b=it lL=W ainaavitiaECZding=,fi_ that eheaYO&box mmt rffmAcd m additmcntl sbedshowfi6 he name oftbe mb-a�and state whcibacrnottbose difi=have employee If the sub dnxs have=apb yc-.ffiq mmSt Pm &then wo&=e—n;L PeIu y m03bm I am arc ea Obyer that is propi ffng iforkae compensation Au=ce far my unPlnyeM BdgW is the pUHq and job Site . u fanrratian; _ I =omce ComipanyName: t Policy#or Self--ins.L ic.#: F�saiicmDadz: Job Site AdciLess: C aylStaftTip: Affarh a copy of the workers'compensafiol t po&7 mhrafln*n'1 a6(shownig flee policy mnnbrx sad eo#aiioa d.at3e).. Fall=to secorm coverage asregcli atmd=Sec im25A ofMOL c.M camsI=dto the imposition of criminalpcnahies of ofm t t$$0.00a d and/or one-year>mprisonmeoi as weIl as civil pez in the fb=of a STOP WORK ORDEEZ and a fine of vp to$250.00 a day against the violator. Be advised that a copy of this sfa m=otmay be f mwm-&d to the Office of hrms6g daps of the DIA far insmaacc coverage vedfication. I do hrr by certify thepabn andp fP�y fiiat the- ormafan_ �¢ provided above u 75ue and cvr"a-cr1 'Phone 4- 1 O.07dd use only. Do not write in this area,to be complited b3'rite'or tmm n�arL City or Town: pe,„rit/r;raur�# Tss Authority(circle one): 1.Board ofHealth 2.6,Other B�diagDepattiaeut 3.CitylTaWa Clerk 4.�imII=peefor S?IambingInspec±or — - - ConfactPerson: phone� ' Information and Instructions , Massa Gc=ral Laws chaps M regorcs all employers to provide worlds'campensation fzur th=empIoyees. Pnrsrrantto this sty an anplayme is dcfined as=every person in the service of another under any dart ofhirey cqx=or implied oral orwrifiun-" An.rniplayer is defined as`pan individual,pmt3ership,assoc an,caoporaiiaa or other legal edit,or any two or more of fha foregoing aged in a joint a m-pmc6 and inchtdmgfha legal reprmm tdi- es of a deceased employer,or the receiver or trustee of an inrhvidnal,parineEship,assocaaiion or other Iegal eati%employing CMPmY=- However the owner of a dwcIlingDouse having not mtu'e than three aparime is and who resides therein,Cr 60 occqant of the- dwelling house of another who employs p=ons to do mai ateance;caotstraction or repair work on such dwelling house or on the grounds or building appurhmant$herein shall not becanse of such enuployhne t be deemed to be an mruployer." MGM chapter 152,§25C(6)also status that aeverysiate,or loraI licensing ageucpshall withho1d the issuance or renewal of a licen a or permit to operate a bIIssmess'or to construct bQihigs in the commom alth for any applicaatwho has not produced acceptable evidence of compEmce with the hmm-ance,coverage required-" Additionally,MGL cbaptcr 152,§25C(7)states`Neither file commamwealth nor;ky ofits political subdivisions shall _-. enter into arty contract for thep=fJrmm a ofpubIic wmkuntil acceptable evidence of compIianeeYMh the hm mmcd.. requaemeufa of this chaptm have been prescnted to the coniradmg anfhcdty." Applies Please fill out the workers'compensation affidavit completely,by cheoldag the braes that apply to your dtakion and,if necessary,supply sob-couftactor(s)name(s),addresses)and ph.ame number(s)along with their=tcEicat*)of insurance. Lnmitad Liability Companies(LLC)'or Limited Liability Partnerships(LIP)withno employees other than the numbers or partners,are not squired to carry workers'compensation insurance. If an LLC or LLP does have etuhpIoyees,apolicy is required. Be advisedthatthis affidayhmaybe snbmitfed to tiie Department of Indast ial Accidents for coon of insurance coverages Also be sure to sign and data the affidavrt The affidavit should be rettnned to the city or town that the application fur the permit or license is being requested,not the Department of Indnstlial Acddmts. Should you have any questions regarding the law or ifyou are regmhzd to obtain a workers' compensation policy,Please call the Department at fhe nmmber listed below Self-insured cmpmdm should eater their self-iiumrance license number on the appropriate Tine. City or Town Officials t Please be su=that the affidavit is complete andd priute d legibly. The Department has provided a space at the bottoan of fie affidavit for you to fill out i a the event the Office of InvmfVtians has to contact you regarding the applicant. Please be sure to fill in the permit icense nmmber which will be used as a reference number. In addition,an applicant that must submit nnitple P=Wlicense appEt2dons m any given yea¢',need only submit one affidavit indicating current policy infomhafion(ifn=msary)and under"Job Site Address"the applicant should write"all locations in (city or town)_'A copy of the•afffidavit that has been officially stamped or narked bythe city or town maybe provided to the applicant as proof that a valid affidavit is on ffie for fzufrre permits or licenses. A new affidavit must be filled of t each. year.Where a home owner or dtiZ=is obtaining a license,or permit notxc1drd to any business or commercial venture (i.e. a dog license or pmtmit to burn leaves etc)said person is HOT rcgmrzd to complete this affidavit The office of JuvesfigEdi=wm3ldh1mto tmmk you in advance for your coopm-a6 n and should you have any questoas, please do not hesitate to give us a call The Deparimenfs address,telephone and fax nmmbm: COMMGuWeda of Massachusetts Depa:dM'at of 1i&rt d Accadmt% ice of 11 esti&U0= 600 Vi.a*bngt Stc� &off Irk D2111 Tel.#617 7 -4900 cxt4€6 Qr 1-&77-INMSAFF, Fvr9 617 727 7749 Revised 4-24--07 m .�gf COASTLINE CONSTRUCTION INC Mr. and Mrs. Mason and Anne Boucher April 17,2015 374 Putnam Avenue, Cotuit, MA Dear Mason and Anne, Coastline Construction Inc. (Coastline) is pleased to submit this cost proposal for construction services at your home in Cotuit. The general construction scopes will include the complete remodeling of two upstairs full bathrooms. . Scope of Work The following Scope of Work (Scope) will be completed by Coastline. Any permits required will be provided and submitted for by Coastline. Demolition of Existing • Demo and remove existing shower surrounds, flooring,popcom ceihng,,select drywall, subfloor,vanities,wall sconces,vent fans,mirrors,and other materials as necessary for the successful completion of proposed Scope. • Dispose of demolished materials in accordance with local, state and federal laws. Remodeling of Bathroom#2 • Provide and install framing as necessary after demo for installation of new tiled shower. Includes blocking for installation of grab bars if requested. • Provide and install a new tiled shower with niche or comer shelf. Includes hardi-board cement wallboard, shower pan, and Hydro Ban waterproofing. Wall tile shall extend up to the ceiling.New shower shall have a low threshold, approximately 3"tall. Includes new shower valve and showerhead. Tile can be installed on a diagonal or with an accent p for t a nominal additional fee. ''��' • Provide and install water and mold resistant drywall at walls and ceiling where required. Drywall adjacent to the stairway may not require removal. Includes primer coat of paint'at new drywall locations. • Provide and install new finished-surface bamboo flooring. • Provide and install finish for new baseboards,door casing,and other trim as necessary. • Provide and install new . Includes new s faucets. Remove wall mount exhaust fan and replace with ceiling mount exhaust fan to be vented outside. Includes patching of sidewall to match surrounding cedar shake . N.O.Box 1.399 a Feast i uNy-ich. .A[A(t`>61J) o 11. (:70ti) G')I.%`_>,(ie F. (JN') GV 1.7261 oe'`�VCr,i<.rlinrma.�-�>m • <Li�i�l�4r�>;i�tlinem,�.c��m COASTLINE CONSTRUCTION INC ' Provid�plum�bing ervices�tocom;ect new plumbingfixtures and reinstall existing toilet. s . • Provide electrical services to install switches,outlets,recessed lighting,and exhaust fan. New electrical work shall be completed to meet current code requirements. • Provide painting services to include one primer coat and two finish coats at ceiling only. Homeowner shall finish paint walls and trim. Remodeling of Bathroom#3 • Provide and install framing as necessary after demo for installation of new tiled shower. Includes blocking for installation of grab bars if requested. • Provide and install a new tiled shower with niche or comer shelf.Includes hardi-board cement wallboard, shower pan,and Hydro Ban waterproofing.Wall tile shall extend up to the ceiling.New shower shall have a low threshold, approximately 3"tall. Includes new shower valve and showerhead. Tile can be installed on a diagonal or with an accent strift for a nominal additional fee. • Provide and install water and mold resistant drywall at walls and ceiling throughout. • Provide and install new finished-surface bamboo flooring. Includes subfloor preparation for installation. • Provide and install finish trim for new baseboards,door casing,and other trim as necessary. • Provide and install custom linen closet adjacent to pedestal sink and hallway wall. • Provide and install new pedestal sink and faucets. Includes moving plumbing to accommodate linen closet. • Provide and install new flush mount medicine cabinet with mirror. • Provide plumbing services to connect all new plumbing fixtures and reinstall existing toilet. New fixtures, except pedestal sink,shall be installed in the existing locations. • Provide electrical services to install switches,outlets,and recessed lighting. Includes installation of new exhaust fan. New electrical work shall be completed to meet current code requirements. • Provide painting services to include one primer coat and two finish coats at ceiling only. Homeowner shall finish paint walls and trim. P.U. Box I.iJ() • l:ritit 1-lamld), MA 026 L_, • 1). (JM)) GS11.7`86e F. (.508)61)1-_7`61 jur.�(-qua<ilinenn.cnni • (Liv lt' MeMaXOm COASTLU E QONS RUCTION INC AUTHORIZATION All work will be completed in a professional and timely manner. Any alterations, deviations, or additional work scopes to those listed above, and which require additional fees not included herein,will be executed only upon written orders, and will become a charge over and above the proposal price. Timely payments are expected. Payments not received within ten days of invoicing will incur a 5%late fee. It is further agreed should it become necessary to hire an attorney in order to collect the amount due on this contract or to settle any disputes that may occur that the owner will pay for any and all legal fees that may be incurred in the collection process. This bid is final and supersedes all previous proposals and/or correspondence written or verbal. Contractor: riiDate: 'd The above prices are as specified and conditions are satisfactory and are hereby accepted. You are authorized to do the work as described in the bid. Payments will be made as outlined above. Owner/Owners Rep.: Date: lJ *Please note that this proposal may be withdrawn by Coastline Construction Inc. if not accepted within 30 days. Also note prices valid for 60 days and may be subject to change due to continual rising construction cost. ` 411 Main St. Rt. 63+Yarnnouthport, MA 0267.5 +P. (508)74-4.I687+ F. (774)383.5297 ioe u)coasthnema.com 9 davidr�ucoastlinema.com Of WE Town of Barnstable Regulatory Services xeg Richard V.Scali,Director • Building Division Tom Perry,Building Commissioner 200 Main Street;Hyamiis,MA 02601 www.town barastable ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder -- 1 U l `fig h� ,as Owner of the subject pro ll _ _-- PAY hereby authorize ( � � `N� to act on mybehA in all ma is relative to work authorized byt.bis bail&ag permit application for. C � (Address of job) -Pool fences and alarms are the responsibility of the applicant Pools are not to be frilled or utilized before fence'is installed and all final inspections are performed and accepted. Signature of Owner o p1i[`an Punt Na me Print Name Date Q:FORMS:OWNERPERMLSSIONPOOLS '1-o`PP a oritsarnSta Me Regulatory Services - `oF relryy Richard P.Sm%Director Building bi'vmon Tom Perry,Building Commissioner IL 200 Main Street; Hyannis,MA 02601 - w VOW towabarnstable roams Office: 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EKEBeTION --- -- pteuePrint DATE: JOB LOCATIOR, numbs sirs 11 vMage liol�owNEx": name hone phone# wow phMt#< CQRRENT MAU ING ADDRESS: cityhowa stab: 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 notpossess a license,provided that the owner acts as supervisor_ DEFINITION OFHOAMOWNER 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 tD 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 Staff Building Code and other applicable codes, bylaws,rules and regulations. 1 _ The undersigned"homeowner"certifies that he/she to r_rsta,;ds the Town ofBarnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signamre ofHomeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger wM be required to comply with the Statr Bufldi g Code Sedion 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 109.11-Licensing of eonstxmction 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 nuaware fhat 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 My 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. Yon may care t amend and adopt such a form/certification for use in your community. Q:lY1PFIIESIFORM51bm7dmgpamit�mLs1EXPRESS.dos Revised 061313 Y y 1 �" '�fit,k3U! iW� i r. s �,`kt w 1 ^ Ti;!t<.(t.TtltlIt s'tlt,l If I iITil �t 1.q.!All- i t t'i pi i .tl I'm d,t h. lelll11l� t t;#,�;• -:E t a1+��ttnt,�! 4il,ttT�. att�I (tY�+. S, •{,stvf r. Tst>•.i1�t1, �� � I!°{ t(s ?f f � 4 _ r� ' re i lrE�t-�. ..st: •Ttt �,TI!€� i111llltlll �3�;It:fitttr " COMMONWEALTH OF 11J1ASS,4 CHUSETTS 2 i 66ARD Of ELECTRICIANS - ; � , ISSU 5 THE FOLLOWING LICItVsr - AS A REG .JOURNEYMAN ELFCTRIC ) AN DAV I D J BURN I E JR ' 30 WI LMAS WAY IS,� HARWIrl-i MA 02611 - �= 9��� p ' rT ' V,�� ICI �` � 4 a5:.i�ic iS.-,•.''f - �q _a try=v 'S-09036 T 9 5 U.A%'ID./ BI,RtiIF:,.IR IIARWIC'II MA 02645 _ 0511412 016 ��T'DY1 C Do heL - 5�/ o it i Y v 0 10o L .rho ivw . k i v � —�— .� cc a il8v15t4 _ cL Plxmj j,c, «f � alrr 41illct' Aff#l1rti � Misirrefis Regulation ' R P E IMPROVEMENT CONTRACTOR etgistration: 174575 Type: Expiration:. 2/26/-017 COASTLINE CONSTRUCTION INC. SupplementCf' DAVID BURN E JR 3 C IPMAN R® SANDWICH, MA 02553 t1nderserreti r4, v�. N , O N N- a RIM . ... "/.{«•t t t }�fi3,/I r !#/<'l ll�trt! �r f(f%Aai(C1EJY..df�.fi r ffiice of c'onstsnver Affairs .t Rnsine, tie�,ulatic►n License or ref istration valid for individul use 0n1\' before the e.piration date. If found return to: �. fOM'E IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation 4 F ��v Registratign. 174575, Type: 1.0 I'ark.Plaza- Suite 5170 Expiration: 2/26/2017 Supplement C; d Boston. NIA 62116 COASTLINE CONSTRUCTION INC. DAVID Sid RNIE .I+ J CHIPN SANDWICH,MA 02563 \ot valid without signature Linderseeretary 0 s a E, o � � O ^ N 00 kn TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0_:� f t` /� b Map Parcel Y _ Application # v' � Health Division 1 37 qq 0,q Date Issued �'Z' n Conservation Division ' Application Fee 1 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ( SEPTIC SYSTEM MI►ST BE INSTALLa3 arE Historic - OKH_ _Preservation / Hyannis ENVtF;,�l::.,; , Project Street Address A ` Village C%(1 Owner_ Address 6 pw/ndm r/U� Telephone �G4 d fl� Permit Request ® C �SfrLL�f a- o�(� X r 3-f�t cd l 0 014A- baAl�Mon a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation d 006-- Construction Type Lot Size Grandfathered: . ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: _ Ll Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Tape 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: ❑Axisting U new size = Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:y` ' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# m Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name r C Telephone Number 9 9.2- Address ►" 60,,�&74 License #I&I -A Ljtyj Q 2(e0 Home Improvement Contractor# Worker's Compensation # 00153 991 ,1 ALL CONSTRUCTION DEBRIS RESULTING F OM THIS PROJECT WILL BE TAKEN TO f� SIGNATURE~ -- --` _ DATE FOR OFFICIAL USE ONLY APPLICATION# r DATE ISSUED - MAP/PARCEL NO. r ADDRESS VILLAGE OWNER r ;, DATE OF INSPECTION: x FOUNDATION-.S Izi FRAME 51iCKrlATr�6 V 2�L'/�l L ?/63 ,z INSULATION ' FIREPLACE ELECTRICAL: ROUGH. • FINAL PLUMBING: ROUGH FINAL 9GAS.:- ROUGH ,: :",, FINAL :-FINAL,BUILDING- - i • t r . DATE CLOSED-OUT 4 ASSOCIATION PLAN NO. r The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations' ] 600 Washington Street Boston, MA 02111 �. w www...mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibiy Name (Business/Organization/Indivi dual): Address: g f�4st� City/State/Zip: �rl�"'5 17?8 0260 / Phone#: (60�7) -717 .9 1 / Are ,yyoou an employer? eck the appropriate box: 'Type of project(required): re 1.� 1 am a employer with aC9 4. ❑ I am a general contractor and I employees(fall and/or part-time).* have hired the sub-contractors 6. [—]Newconstruction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.•❑ Remodeling h t ub-conractors have ship and have no employees These s 8. ❑-Demolition working for me in any capacity. employes and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g p myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4)1 and we have no employees. [No workers' 13.❑ 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 state whether or not those entities have employees. If.the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ®� Insurance Company.Name: � � Pt./ 1-?®?L( //'J E Co Policy#or Self ins.Lic.#: � Expiration Date: Job Site Address: City/State/Zip: / � V A Attach a copy of the workers' compensation policy declaration page(showing the policy nurnber and expiration date). Failure to secure coverage as required under,Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c er the pains and enalties of perjury that the information provided above is true and correct. Simature: Date: Phone#: Offcial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# . Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/'Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: l ® DATE(MMIDDIYYYY) A41000R o CERTIFICATE OF LIABILITY INSURANCE 1/25/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR.ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Erica H.O'Connor HART INSURANCE AGENCY,INC. PHONE Etl: (508j 759-7326 Fa N.,(508)759-7366 243 MAIN STREET E-MAIL PO BOX 700 ADDRESS: BUZZARDS BAY,MA 025320700 INSURE S AFFORDING COVERAGE NAIC tl INSURER A: ARBELLA PROTECTION INS CO 41360 INSURED EJ Jaxtimer Builder,Inc INSURER e: ARBELLA PROTECTION INS CO _ 41360 48 Rosary Lane INSURER C: ARBELLA PROTECTION INS CO 41360 Hyannis,MA 02601 INSURER DARBELLA INDEMNITY INSURANCE COMPANY 10017 INSURER E: 1 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. ADDL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY 8500042039 01/01/2012 01/01/2013 EACH OCCURRENCE $ 1000000 DAMAGE TO RENTED 300000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ CLAIMS-MADE M OCCUR MED EXP(Any one person) $ 5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 POLICY PRO LOC $ B AUTOMOBILE LIABILITY 21662400004 01/01/2012 01/01/2013 EOaBINdantSINGLELIMIT 1000000 BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED - PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident $ (`, UMBRELLALIAB OCCUR 4600042040 01/01/2012 01/01/2013 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ $ D WORKERS COMPENSATION 0053890111 01/01/2012 01101/2013 WCSTATU- OTH- AND EMPLOYERS'LIABILITY. Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE NIA A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yas,descnbe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space is required) - CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HYANNIS,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD s V r 1 02/04/2011 16.: 15 5087754309 A►4281 P. 002/007 Tdwn of Barnstable Regulatory Services Thomas F.Gottr,Dirpoor Buildlug Division Thom"Petry,CRO 'Aal1�lgg Cgptgsicsioner 200 Win Street, HyAgt"MA 02601 www.town.barastable.ma.as Mim; 508-962r4038 Fax: 508-790.6230 Property Owner Must Complete and Sign This Section IfuSM9 A BuUder S {, ®V as 4wrlet of the subjotx property hereby authorize xo act on my beh4 in all mattrrs reAwlve to work authorized by this buUdlag permir application for: (Address of job) . Signature of O want ba tc n-1 Pout N=e . If Property Owner b appying for permit,:please complete the Homoowioers 1.kww Exemption Form on the. reverse side. C:\Ura�slderoAikV►ppUetall.acallbt�oi11R12�sey L�t�r�sot Fper�Caarenr.OuWaekIADVB'7AAz1W0'�SS.dnc Revised 072110 -19B-d Z00/100'd 921-1 9011 UP.809 HEA filed-6AOH Wd11:90 '110Z-VO-SH REVISED GROUNDWATER 6. W „a PROTECTION OVERLAY DISTRICT: AP — Aquifer Protection District � TOWN OF BARN S T 1110' , #r P ZONE: RF (RPOD) ` P 2; 2 �- Area (min.) 87,120 SF Fronts a (min) 150- Ti ms „ Width (min) no , iat Setbacks: Front 30' Location Map Side 15' TtI ` 1'=2000't Rear 15' +:b ASSESSORS REF.: Map 031, Parcel 011 tat ce� b,w/ FEMA FLOOD ZONE 3j ute P°°7/1j70 e o.,5+ , 1895 ,— A\ Zones C W Panel # 250001 0018 D E _ (rev. July 2, 1992) 75•p330� N 299.56 ' r W � r i \ 1 x ---- --1 I r •.� 1 �______-_____Grovel Drve ___ I / _ ' Atetd t "" t \ --_ — ' N Proposed Art 1 % To, t' \\` ( .Studio i i 3180 River ' \ I ' \ , o ro \� iszzsi Q: s. o \ i ; o / 1 1 67,908±SF ' 1.56±Acres y� #374 W d 2 sty w/f - `� Shed Dwelling - � � 1 NOTES: �.C-)�� ` 1.) The structures shown were located on the ground Q by conventional survey methods on (or between) 02/OCT/12 and 04/OCT/12. w 2.) The property line information shown hereon was FW compiled from available record information. 3.) This plan is not for recording and is not to be used for construction layout or deed description purposes. Sheet # CapeSury rt"Plot Plan Showing Proposed Art Studio °w9 "C798 1 7 Porker Rood At 374 Putnam Avenue Scale 1"-40 Osterville MA 02655 1 of (508)420-J994 f5 vft_ ,°r Barnstable c°tuit Mass. °ate cevesvevecoe�oanel 18 OCT 12 J67_X e cc 52 Office of Consumer Affairs and, usine-ss Regulation e— 10 Park Plaza --Suite 5170 Boston, Massachusetts.02116 Home Improvement Contractor Registration` Registration: :110609 - Type: Private Corporation Expiration: 11/3/2014 Tr# 233027 E J JAXTIMER, BUILDER, INC... _ - ERNEST JAXTIMER 48 ROSARY LN HYANNIS, MA 02601 _ Update Address and return card.Mark reason for change. Address 0 Renewal Employment Lost Card JPS-CA1 0 50M-04/04-G101216 �. Consumer Affairs& a, ss Reuclit e� License or registration valid for individul use only Office of Consumer Affairs&Bu�ness Regulation g y • HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: Type:" g (I, Office of Consumer Affairs and Business Regulation E �qg Expiration 11/3/2014 Private Corporation 10 Park Plaza Suite 5170 Boston,MA 02116 - E�J`JAXTIMER,BUILDER INC ERNEST JAXTIMER - 48 ROSARY LN g �� HYANNIS, MA 02601 Undersecretary Aot valid without signature 3 J� iVtassachusetts Dzpartment o� Puolic 5aiety Board of Building Regulations and Standards Cun.�fructiun Super�istir .License: CS-003251 nz- I r ERNEST I JAXTD ER. r 48 ROSARY]CANE HYANNIS 1VIA 02601 Expiration_ i Commissioner 01/14/2014 3 7` - �u l�rruc cc 1 AWC Guide to Wood Coasi. �setion in High Kind Areas.110 mph Wind Zone Massachusetts CheCkfist fOr COMP anCe(780 CMR 5301.2.1.1)1 Check 1.1 SCOPE Compliance i. WindSpeed(3-sec_gust)............................................_....._......._.......... ................................110 mph . . ............... Wind Exposure Category • a 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) ( stories <_2 stories _ RoofPitch ............................••-------..:-•-----•••..........--•-•----------(Fig 2) ........................................... 12 _<12:12 MeanRoof Height ..............................................................(Fig 2)................................................... /C.!)ft <_33' &/' BuildingWidth,W................................................................(Fig3)....:-•-............:----..:...........-•-...... Oft 580' ✓' Building Length, L........................_:............ -.........................(Fig 3).................:..........__:..................2e'ft <_'80' Building Aspect Ratio(LM� ...............................................(Fig 4)__._.._.__.__._.....:__................._.._.... t <3:1 Nominal Height of Tallest OpeningZ .... (Fig 4).:................................:.............1I S'-<_6'8". 1.3 FRAMING CONNECTIONS General compliance with framing connections.....................(Table 2).......................................:....................... 2.1 FOUNDATION Foundation Walls.meeting requirements of 780 CMR 5404.1 Concrete...................................... ............................... :.:.....:... . Concrete Mason 1 ry .... . .. ........ .......•........... .. .. ........................................................ _..... 2.2 ANCHORAGE TO FOUNDATIONS 3 5/8"Anchor Bolts imbedded or 5/8"Proprietary.Mechanical Anchors as an alternative in concrete only Bolt Spacing—general..........................................(fable 4).............:. _---------- 6 in., Bolt Spacing from endfJoint of plate.......................:.....(Fig 5)....................................�in 12" �- Bolt Embedment—concrete.........................................(Fig 5).................................._:--........... rin >.7" Bolt Embedment—masonry----------------------------------------•(Fig 5),-•-.........._...._.........:............_. CL in.>_15' .� PlateWasher......................................................... :.(Fig 5).................................................>_3'x'3"x'/° 3.1 FLOORS Floor framing member spans checked ............::...:.............(per 780 CMR Chapter 55)............ ...................... ✓' Maximum Floor Opening Dimension.......................:::.........(Fig 6)..................................................... t<12' Full Height Wall Studs at Floor-Openings,less than 2'from Exterior Wall(Fig 6)......................:...............1. _�• Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall................(Fig 7).................................................... Oft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8)..................................................... 5 d g •....- -( 9 )-•-----••--------------••...__...-•-••-. ••._.........._._.._... . Floor Bracing at Endwalls..:-_--•-•-----------------•-_---...-----._ ._ (Fig 9 Floor Sheathing Type ....._...-••.............................:............:.(per 780 CMR Chapter 55)..................._..._ ram/ Floor Sheathing Thickness ..............................................:..(per 780 CMR Chapter 55)....:............. .....: in. Floor Sheathing Fastening..................................................(Table 2)..ad nails at�in edge/� field. •4.1 WALLS Wall Height C Loadbearing walls_________________......................................(Fig 10 and Table 5)................_....I...... O ft <_10' Non-Loadbearing walls..............................:..................(Fig 10 and Table 5)......................_..:. L ft 5 20' Wall Stud Spacing ........................................................(Fig 10 and Table 5)............... in._<24"o_c. WallStory Offsets ........................................................(Figs 7&8)................:........................... 0 ft <_d 4.2 EXTERIOR WALLS' - Wood Studs Loadbearing walls.......................... .........................(Table 5)_•--...•-•---••.._`...........2x 0-Ift I in.Non-Loadbearing walls:..........:.. ......::.....................:..(Iable5)---:......:..._..:..._..:...:.2x - t t in. Gable End Wall Bracing Full Height Endwall Studs............................................g (Fig 10)....... ........... .� WSP Attic Floor Length...................-•-..........................(Fig 11).......................4-..: .:. C3 ft>_W/3 ✓'............... Gypsum Ceiling Length(if WSP.not used)...................(Fig 11)......................i.................... ft>_0.9W ./ and 2 x 4 Continuous Lateral Brace @ 6 fL o.c. (Fig 11)................:................. .. . .........:.............. or 1 x 3 ceiling furring strips @ 16'spacing min.with 2 x 4 blocking @ 4 ft_spacing in end joist or truss bays__&,-,'. Double Top.Plate Splice Length .......................................................(Fig 13 and Table 6).................................... ft Splice Connection(no.of 16d common nails)..............(Table 6)......................................................... �� A WC Guide to Wood Construction in ugh Wind Areas:110 mph Wind Zone Massachusetts Checklist for Comphance(78o cmR 5301.2.1.1)' 40- Loadbearing Wall Connections Lateral(no.of 16d common nails)............::..................(fables 7)........................W............................ r Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table 8)........................................................ Load Bearing Wall Openings(record largest opening but check*all openings for compliance to Table 9) Header Spans .......................................................(Table 9).................................. -3 ft G in-:5 I V Sill Plate Spans 1 ......................................;.................gable 9).................................. 7 in-.__ 2 ft I= :5 .1, Full Height Studs (no.of studs).....................................(Table 9)........................................................ . Non-Load Bearing Wall Openings(record largest opening but check.all openings for compliance to Table 9) Header.Spans............................................................(Table 9)._..----..........-•..-•---•----- T ft D in.5 12' Sill Plate Spans--.-.......................................................(Table 9)....................................._Fft_Z5 in.:5 12' Full Height Studs(no.of studs)............. .........;...........(Table 9) ................................................. Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously" Minimum Building Dimension,W Nominal Height of Tallest Openin ....................................................................... :5 6'8 Sheathing-type..............................................(note 4)......................:. 63�p Edge Nail Spacing.........................................(table. . I 10 or note 4 if less)............._.....__..._LS_in. Field Nail Spacing............. ......................(Table 10)....... _Az ------ -------------------------- in. A�— - Shear Connection(no.of 16d common nails)(Table 10)...................................... JZ . .- ............... Percent Full-Height Sheathing-------------------;...(Table 10).......................... 0 .......................�& 5%Additional Sheathing for Wall with Opening>678"(Design Concepts).................... Maximum Building Dimension,L. g2... Nominal Height of Tallest Openin ...................................................... J005......... z 6-8- SheathingType..................W..........................(note 4).....................................................(Ag:!a L Edge Nail Spacing..........................................(Table 11 or note 4 if less)....._................._ in..... Field Nail Spacing...........................................(Table 11).............................:.....................min. ✓ Shear Connection(no.of 16d common nails)(Table 11)....................................... Percent Full-Height Sheathing.......................(Table 11)............................................. . 5%Additional.Sheathing for Wall with Opening>68"(Design Concepts).................... _AZ Wall Cladding Ratedfor Wind-Speed?............................................................................................................................... 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Too[,see BBRS Website) Roof Overhang .... ._"i..........................(Figure 19).............. -------------- ft:5 smaller of Z or U3 Truss or Rafter Connections at Loadbearing Walls- Proprietary Connectors Uplift...........................:....................(Table 12)............................................U=?_Lrplf ✓ Lateral..............................................(Table 12)............................................L=!':7�ptf Shear................................................(Table V).............................................S__M pff Ridge Strap Connections,if collar ties not used per page 21.'.- (Table 13)...............................T=_Ll:;4ff Gable Rake Outlooker.........................................(Figure 20).......... __Dft:5 smaller of 2'or Lr2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift................................................(Table 14).................................s...........U=—+-71b.- Lateral(no.of 16d common nails).._(Table 14).......................................L=jtWb- Roof Sheathing Type-------------------------------------- ...........(per 780 CMR Chapters 58 and 59)............ V$Roof.Sheathing Thickness........................................... .............................................:........... in. -7/16- Roof Sheathing Fastening.............................................(Table 2)........................................................ Notes: 1,* This checklist shall.be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1 Jf the checklist is met in its entirely then the fallowing metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b- 20 Gage Straps per Figure 1.1 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft_shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. Co7vi7 160,UC, t 1411 AWC Guide to Wood Construction in Nigh Wind Areas:110 mph Wind Zone Massachusetts Checklist for Compliance(780 CM i s301.2.1.1)' 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio;determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows_ i. Panels shall be installed with strength axis parallel to.studs. ii. .All horizontal joints shall occur over and be nailed to framing. iii. On single story construction,panels shalt be attached to bottom plates and top member of the double top plate. iv. On two story construction,upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper.attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates,band joists,and girders shall be a double row of 8d staggered at 3 inches on center per figures below:Vertical and Horizontal Nailing for Panel Attachment FiYRh1H toad NKS ATfib.G , IF a n u tr all,tr n - u rr u n - u IF a N H 41 IF. n tl - n n I{ r - PF Q rt :ra r m ! o h Yl 2 hi �t IF WZ ii rt 1- - 4 a u ii Rt j tr rr� It ii 3 n r[ n WILSP'ACM Y i PANtL - See Detail on Next Page Vertical and Horizontal Nailing for Panel Attachment f AWC Guide to Wood Construction in ugh Wand Areas:110 mph Wind Zone Massachusetts Checklist for Compliance-(78o CMR 5301.2.1.1)1 Mr EDGERnavANAR z U41LP+ATTERN � PAt1Aa. PANES EDGE +p. OMME UNLEDGESIMMM DETAL Detail Vertical and Horizontal Nailing for Panel Attachment J PROJEC DAME: ADDRESS: PERMIT# PERMIT DATE: z I LIS l Z LARGE ROLLED PLANS Box tb SLOT N-- Z Data entered in MAPS-program on: BY: ASSESSORS REF.: ZONE: REVISED G OUNDWATER Map 031, Parcel 011 RF (RPOD) PROTECTION OVERLAY DISTRICT: Area (min.) 87,120 SF AP — Aquifer Protection District Fronts e (min) 150' FEMA FLOOD ZONE WidthSetbacks: in) no Zones C Front 30' Panel # 250001 0018 D Side 15' (rev. July 2, 1992) Rear 15' of rn'u•, Pot>dinsk 0 et Fnd b,w Fnd lV o Birute 113957/17 0.11i 'S.p3,30PE N2g9.56 New Concrete C( Metal 78.3 Foundation Shed Co M 0 157.7' 1 �? 67.2' o� 67,908±SF 1.56±A cres 0 s s 9 Wood Shed I i • .h0 i Q V X IP Fnd WAS�c I certify that the foundation shown hereon conforms to it�CNAitD R• i the setback requirements of UHEUREUX the Zoninc Bylaws of the. PG'�T PLAN No, 34V2 �o town of Barnstable. At 374 Putnam Avenue BARNSTABLE Pro Surveyor D to (Cotuit) NOTES: MASS, DATE: 111DEC112 SCALE:1"=60' 1.) The structures shown were located on the ground 0 15 30 45 60 90 120FEET by conventional survey methods on (or between) 02/OCT/12 and 10/DEC/12 PREPARED FOR: 2.) The property line information shown hereon was N. Mason Boucher compiled from available record information. C PO o 02635 338 3.) This plan is not for recording and is not to be PREPARED BY: CapeSurv used for construction layout or deed description purposes. 7 Parker Rood Osterville MA 02655 DWG #: C798g1 cpp2 FIELD BY WHK%MGD (508) 420-3994 / 420-3995fox TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0� Parcel'' l Application #Q:5)o 0 Health Division Date Issued Z a-3 1 Conservation Division Application Fee J� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 0 Historic - OKH _ Preservation/Hyannis Project Street Address 3��( PGvfin�m Village Owner I rd/l� k�yl���� Address 37� OG� /�1 �'L'� Telephone Permit Request XG A Alfw Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Ivy 000 lConstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) UNumber of Baths: Full: existing new Half: existing P I new ZZ Number of Bedrooms: existing _new s 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: :_El Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑existing; ❑hew size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ qommercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �JJ4Y,-nrna blsLA,&2t, JAIC Telephone Number Address License# 1 /lG0 /Y Home Improvement Contractor# (/ Worker's Compensation # ALL CONSTRUCTION DE IS RESULTING FROM THIS PROJE=)C/Z_ TAKEN TO Al S SIGNATURE DATE r FOR OFFICIAL USE ONLY u - APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 64 'm DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE 6 ELECTRICAL: ROUGH FINAL ' f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING A / - ''� DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents f--r Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): '•v• y Q Address` City/State/Zip: Q,®1.tU 5 /h!9 0260 / Phone#: (502) 1119 J�911 Are you an employer?\eheck the appropriate box: -Type of project(required): 1.[2 I am a employer with a0 4. ❑ I am a general contractor and I. have hired the sub-contractors 6, El New construction employees(full and/or:part-time).* ,� 2.❑ 1 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' comp.in # 9. ❑ Building addition [N comP o workers' . insurance p• surance. required.] 5. ❑ We are a corporation and its 10:❑ Electrical repairs or additions q ] 3.❑ officers have exercised their I am a homeowner.doing all work 11.❑Plumbing repairs or additions. myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,"§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] V *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: g61,16-6 P472KROK( IAA E co , . Policy#or Self-ins.Lic..#: Expiration Date: DI U! - _ Job Site Address: 3� (di1 AM �!p'(__ City/State/Zip: (��I' , P f Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c: 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi er the pains and penalties of perjury that the information provided bove is true and correct Si ature: Date: Phone#: Official use only. Do.not write in this area,to be completed by city or town official City or Town: Permit/Lice, e# Issuing Authority(circle one): 1.Board of Health .2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACCP CERTIFICATE OF LIABILITYINSURANCE DA031�0111 =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: N the certificate holder is an ADDITIONAL INSURED,the poiicy(ies)must.be endorsed, If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endor>sement(s). PRMCER CONTANAB: Erica H.O'Connor HART INSURANCE AGENCY,INC. NAME: . (508)759 7326 FAX 243 MAIN STREET AC Ne,(5D8)759 7366 PO BOX 7DO AAWRRI s: BUZZARDS BAY,MA 025320700 Nsu S AFFORDING COVERAGE NAIC 9 INSURER A: ARBELLA PROTECTION INS CO 41360 'Q18{IRED EJ Jaxtimer Builder,Inc - - NSURER B: ARBELLA PROTECTION INS.CO - 41360 48 Rosary Lane ARBELLA PROTECTION INS CO 4i36Q Hyannis,MA 02601 INSURER C: NsuRER:a; ARBELLA INDEMNITY INSURANCE COMPANY 10017 ., INSURER E i - @!SURER 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 POLCY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIRB&NT,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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. a INSR TYPE OF INSURANCE DL SUBR POLICY NUMBER .POUCYEFF POLICY EXPO LTR °q . GENERAL uaeulrY 8500042039 01,10112011 01101/2012 EACH OCCURRENCE s' 1000000 COMMERCIAL GENERAL LIABILITY 71mArm T RENTED $ 300000 CLAIMS-MADE ®OCCUR (Any me Parson) S 5o0dAL&ADV INJURY S 1000000 LAGGREGATE2OOD000GEML AGGREGATE LIMR APPLIES PEft TS'-COMPAP AGG20ODDOO POLICY 0. LOC _ B AUTOMOBIlEUABILRY. - 2166240DO04 01/01/2011 -01/01rz012 COMBINED SINGLE LIMIT.an! . 1000000 Me . ANY AUTO - BODILY INJURY(Per Penn) S ALL OWNED SCHEDULED . - .AUTOS L I AUTOS - - - BODILY INJURY(Per ae"mit) S NON-OWNED PROPERTYOAMAGE $ HIREDAUTOS AUTOS - - r f C UNRIRE7LAL1%i6 OCCUR 460D042040 01/0120I1 01/01/2012 EACH OCCURRENCE s 2.DOD,000 EXCESS L1AB CLAIMS MADE AGGREGATE. $ 2,000;000 am RETENTION S - - - i f - D woRl�RscoHPENsaT r OD53890111 01/01,2011 01/D1/2012 WCSTAT.0 OTH- AND EMPLOYERS L U%BILRY YIN - !d ANY PROPRIETORIPARTNERIEXECUTNE. ❑ .NIA - .. E.L EACH ACCIDENT S 500,00 OFFICERIM906ER EXCLUDED? (MandatorylnNH) - E.L DISEASE-EAEMPLOYEE S 500,006 n y�eeee desrlf6o under DESCJiPTiON OF OPERATIONS below - I - EL DISEASE-POLICY LIMB t -500,DOO DESCi"OM OF OPERATIONS I LOCATIONS I VEHICLES(Arlach ACORD 101,AddMonal RealeAw Schedule,R nwm space Is mgtdmd) - CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED"POLICIES BE CANCELLED BEFORE 200 MAIN.STREET . THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN HYANNIS,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. . - AUTHOR®REPRESENT An - ©1199888-2010 ACORD CORPORATION. All rights reserved. . ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD { 1.4 T-0 Office of Consumer Affairs and vusness Regulation 10 Park Plaza - Suite 5170 Q Boston, Massachusetts 021.16 { Home Improvement Co,dktor Registration Registration: .110609 Type: Private Corporation r ; -- A. Expiration: 11/3/2012 Tr/# 205399 E J JAXTIMER, BUILDER, INC. if ERNEST JAXTIMER 48 ROSARY LN j HYANNIS, MA 02601w j4 f s S F Update Address and return card.Mark reason for change. " Address. Renewal Employment Lost Card DPS-CA1 is 50M-04104-G101216 ._.... . ........ .. .. ... C— ..- J,J,,� .. - . ._ Of fi ce of oEumer'�'rf a-..- liifsine"-sssiegu License or registration valid for individul use only — HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: _110609 Type: Office of Consumer Affairs and Business Regulation TETI Expiration '�t(,312012 Private Corporation 10 Park Plaza-Suite 5170Bostop,.MA 02116 MER, Bl7tL13Ef ; ERNE JAXTIMER »I r 48 ROSARY LN !J g HYANNIS, MA 02601 Undersecretary Not valid without signature - Massachusetts- Department of Public Safetc ( ' Board of Building Regulations and Standards Construction Supervisor License License: CS 3251 Restricted to: 00_ —i j ERNEST J JAXTIM.ER . 48 ROSARY LANE HYANNIS, MA 02601 ; 1 Expiration: 1/14/2012 {onunissioner' Tr#` 13122. . 3e =; � b4x- CEM ]]]� 10 � .�Ps _ x I ' I �• 75 1 . s ,s 4tc 40 r d :� f 02/04/2011 10: 15 5087754303 #4281 P. 002/00 Town of Barnstable Regulatory Servim Thomas F.Getter,Dir e.M r Builaiug Division Thomas POMS COO Battfta�camra�cs►over . 200 Main Street, Ayaw MA 02601 WWW town.barAstablo,9aa.ws Moe; 508462-4038 Fax: 506-790.6230 Praperty Owner Must complete and Sign This Section If U Sum Ruder I AS {, .!G R ,as Qw=of the subject property hereby authodze to act on my behalf, in all matters relative to work authotized by this building permit application for: (Addreaa'of job) sigmat=of own« A/ /JAstJ ,t Name U propcM 0weer to applying for permit,.piease complete the Hon%"vm&rs 1Liam=Fwouptiou Form on the ravoreo soft. C:\llrorsldeco11ik1AppUamlY-ocall�liarosofllWind�l�em�aeY St�Ut'�sot FUer�CannmrOuWaoklApYtC1AAZ1��S8.dac Revised 072110 198-d ZOM OO'd 921-1 9011 W 809 HEN Vd-WObd wd11:90 110Z-b0-83d 7 ggRN>`E TOI.AS$I 306+gT7ra16e h.e� A.M. 37,12--2 , f A.M. 37-11 A,M. 37-10 ��� 'i• � 40,E j' = HS 374 era rE.- SUR-SKETCH A PERIMETER PROPERTY NOT TO SCALE LINE SURVEY IS h'L�CO�{d�tlL'�VDED. RES. ZOivg "RF" This MORTGAGE INSPECTION " is °6 FLOOD 201V .' •C" ppnix RE 15TRY OWNER �tlf.d�_&u.&.CA+T NN _a_Ifp�.41�_ �EELi ------------------,:.�_ g�]YER: B�'�YN ------ -----------ALE. ,__.50,_,..�T:- DATE: _A_Rk_-9d---------------- PLAN REF; ,K/_A.------- - - -- 1' I HERE CERTIFY TO .__ �AIJIPL�'I'AN R'�GAcmCioRp� �Or 'YANKEE SURVEY THAT THE BUILDII+TG CONSULTANTS SHOWN ON xHIS PLAN GS LOCATED ON-THE GROUND AS PAUL SHOWN AND THAT ITS POSITION DOES CONFORM A. � 409 (SUITE 1) TO THE ZONING LAW,SETBACK REQUIREMENTS OF THE H MERIVENY '^ INDUSTRY ROAD TOWN OF S8$'�.iM&Z—_._�.�.--------AND, THAT No.Um IT DOES_IM— LIE WITHIN THE SPECIAL FLOOD HAZARD Isit o IIAMONS MILLS. MA. 02048 AREA AS SHOWN ON THE H, . M P D TED_Z =B .._ ��y���1 i�N�� TTEL' 429_0055 Thur-PLA XQT MXJD! 0 ANINSTRUMENT--- 23Y71 SDS p AA -•-•-----• OT l 198-d ZOVZOO'd 911-1 90H OZb 809 HEN Vd-woad Hdll:90 110Z-VO-93d f l TOWN OF BARNSTABLE BUILDING PERMIT'APPLICATION, Map Parcel \` Application # 0 ( 0 a l Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ' Historic - OKH _ Preservation/ Hyannis /l'v Project Street Address Village Owner Address 1 l d Telephone Permit Request t U"D "Cl 61� Neck) SU-trc, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 40 (V®� Flood Plain - Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑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 Proposed Use _7Z APPLICANT INFORMATION 'S (BUILDER OR HOMEOWNER) Nam% e JA ( I rnL61Y1%_-, OIWWETelephone Number L�y� � 119.9 ' 149 1 AddressK License# ®O�oZS 4 Home Improvement Contractor# b Zfo0 1 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM T IS PROJECT WILL BE TAKEN TO SIGNATURE DATE' CS FOR OFFICIAL USE ONLY APPLICATION# 3 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 1� DATE OF INSPECTION: o FOUNDATION e').� FRAME ao y s INSULATION FIREPLACE } ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ., I 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 / / Please Print Legibly Name (Business/Organization/Individual): J. , a Address: g �Qstzr�t� City/State/Zip: 64Q,61,tV S /nlg 42&0 / Phone #: (6-02 17172 J�.9l l Are you an employer? eck the appropriate box: Type of project(required): 1.[]I am a employer with a0 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. $ 9. ❑Building addition required.] 5. ❑ We are a corporation and its l0.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their. I I.El Plumbing repairs or additions myself. [No workers'comp: right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] . *Any applicant that checks box#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. Q nn pp,, Insurance Company Name: B�'?�i�i t�tKl7 T?Qr tf /Aj S.. CQ . Policy#or Self-ins.Lic.#: 9 �� Q 1 y U / Expiration Date: Job Site Address: 7� T �� ►'l City/State/Zip: l 8 0X 3S Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi u he pains and penalties of perjury that the information provided above is true.and correct Si ature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I Acoot©® CERTIFICATE OF,LIABILITY INSURANCE °A03/o 201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER.THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Erica H.O'Connor PRODUCER HART INSURANCE AGENCY,INC. PHONEE (508)759-7326 N,;(508)759-7366 243 MAIN STREET Mc: Ei, PO BOX 700 ADDRESS: BUZZARDS BAY,MA 02532070/0 INSURER(S)AFFORDING COVERAGE NAIC If INSURER A: ARBELLA PROTECTION INS CO 41360 "INSURED EJ Jaxtimer Builder,Inc INSURER B, ARBELLA PROTECTION INS CO 41360 48 Rosary Lane Hyannis,MA02b01 NsuRERc: ARBELLA PROTECTION INS CO 41360 INSURER D ARBELLA INDEMNITY INSURANCE COMPANY 10017 INSURER'E: . - INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE aDDL SUERvim POLICY NUMBER .POLICY EFF M UCY EXP - LIMITS A GENERAL LIABILITY. 8500042039 01/01/2011 01/01/2012 EAcHOCCURRENCE S 1000000 . COMMERCIAL GENERAL LIABILITY - - GE -Ma commeml $ —.. 300000 . CLAIMS-MADE ®OCCUR - MED EXP(Any one person) $ 500d .. - PERSONAL 8 ADV INJURY $ - 10000N GENERAL AGGREGATE S 2000000 GIRL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2000000 POLICY PRO-JECT LOC S B AUTOM0131ELIABILITY 21662400004 01/01/2011 01/01/2012 COMBI,EDSI LE LIMIT 1000000 Me ce+ant ANY ALTO BODILY INJURY(Per Pam) $ ALL OWNED SCHEDULED - - -AUTOS AUTOS BODILY INJURY(Per acdderH) S - NON-OWNED - - PROPERTY DAMAGE $ HIREDAUTOS. AUTOS IF - . C UMBRELLA LIAB OCCUR 4600042040 01101/2011. 01/01. 012 EACH OCCURRENCE S 2.00D,000 EXCESS UAB rl CLAIMS-MADE .. - _ AGGREGATE - $ 2,000,000 DED RETENTIONS $ O wORKERS COMPENSATION .0053890111 01/61/2011 01l01/2012 WCSTATU- oTH- AND EMPLOYERS'LIABILITY YIN TORY ANY PROPRIETOR/PARTNER/EXECUTIVE ) NIA I OFFICERIMEMBER EXCLUDED? E.L EACH ACCIDENT - S - 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE I$ 500,000 . tt yyeeaa deserf0e under - DESt;RIPTiON OF OPERATIONS below - EL DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 701,Additional Remarka SchodWe,I more space Is required) .. _ CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY.OF THE ABOVE DESCRIBED POLICIES BE CANCELLEDBEFORE 200 MAIN STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HYANNIS,MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. _ - - AUTHORWM REPRESENT an ©1988-20+100 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i L �e & Office of Consumer Affairs and usiness Regulation 10 Park Plaza'= Suite 5170 Boston, Massachusetts 02116 f Home Improvement Contractor Registration, µ Registration: 110609 Type: Private Corporation / Expiration: 11/3/2012 Tr# 205399. _ E J JAXTIMER, BUILDER, INC. ERNEST JAXTIMER 48 ROSARY LN: HYANNIS, MA 02601 . S1 : Update Address and return card.Mark reason-for change. Address Renewal Employment Lost Card DPS-CAI 0 50M-04/04-GIO1216 . . Office ot`�o1me�&�iirsiness e� License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration dater If found return'to:: Registration: Type: Office of Consumer Affairs and Business Regulation � `" • . 10 Park Plaza-Suite 5170 Expiration tti3/2012 Private Corporation _ Boston,MA 02116 � E TIMER BUILDER / it ERNEST JAXTIMER , 48 ROSARY LN -1 HYANNIS; MA 02601 � ��J. '' Under"secretary. Not valid.without signature Nfassachusetts Deimrtment of Public SatetN Board of Building Re�sulations and Standards Construction,Supervisor License License: CS 3251 Restricted to: 00 ERNEST J.JAXTIMER a48 ROSARY'LANE - HYANNIS, IVIX02601 Expiration:, f: _ ion:•1l14/2012 (bnunissiuner' Tr#: 13122 i 02/04/2011 1B: 15 5087754808 *4281 P. 002/007 i Town. of Barnstable Regulatory Servim Tbomas F.CAW,Illre.Mr Building Division Thomas Petry.coo 'Balldtag Cdramissiouer ` 200 Main Street, HyAtri4 MA 02601 wrww.town.barasuble mama omen; 508-862-4032 Fax- 508-790.6230 Property Owner Must Complete and Sign This Section If Usi A Builder 0 V�-� R as owner of the subject PropeYty I ) h=by authorize to act on my behalf, is all matters relat ve to work authorized by this building permit application fox: T (Addreae of Jo ) yl// suture of 0== baec AJ Ptiut Nsnme if Property Owner Is applying for pennW.please complete the Aonumme rs lLw we Nwmptioa Form on the ra me slde. C:UmAd"JiLAAp busmot FgarlCaat mr.0u*omDovs7AAz\iWSESS.doc Revised 072110 198-d Z00/100'd 921-1 9011 OZb 809 HEN Vd-WOH lNdINO IIOZ-VO-SH JOB TAYLOR DESIGN ASSOC., INC. SHEET NO. OF P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY T DATE I-Z7— [ � Tel./Fax: (508) 790-4686 CHECKED BY ,j e. SCALE ilk ........................':.........................................i.......... .......... ...>.... ........ .. ...... ..... ............................ i i ....:..... .Ili.. .............:............................:..............t............................ti............._.............:........-.---'.............:. i ...... ..... ..... ...... ..... ...... ...... '..../ !�.. ' t i i i i ..........................................:......................... ..... .......... .._.... ........ c-t....��e�a ...?........ ........... .......... 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' .J ... 9_:.t _.....:. ...._$.44..._ ...................... . .V� 2,..._ ._. ........... ._3.�4..... .. _.. F T' ............... . ... .............. ..... .......................... .................. ..... ..... ..... t4 l 1 44 ? 3 a ..... . . a.._3. .............:..................... .......;...................... ...... ..... .... .. .-.. ...... ............................ ...... .... ...... 2.pt ... � �.4�. ; ...Plvv L� ' c r _.............. ....._:...... ..v..._._.:............_:.............._............,�-tom. ...: _. r.-t ........_....._w..�''.......:a. ..`... ...... �u....�. ._�_................_ ........'............. ........._-------- ......----...... ... ....... ...:......._....._......._..........._...... 1.. _ ._....1...n� .......,:...........� ............... 3 4..... '�ram: 3....g"fi....... ........� ,. . ... ... JOB 0 VG 1g G • 7 Tr TAYLOR DESIGN ASSOC., INC. SHEET NO. OF-- P.O. Box 1313 a Forestdale, MA 02644 CALCULATED BY C6 T DATE Tel./Fax: (508) 790-4686 CHECKED BY DATE 37 T (,/Cary r 1 \ - SCALE ...........................i............_i..........................'.......... ..... ..... ...... ...... ..... ..... ...... ..... ..... ...... - ...... ..... ...... ...... ..... ...... ..... ...... ...... ............. ..... ...... ...... ...`.... ....b.... ....i.... i.. ^ ` .... ....... ..... ...... .. ..... .... ...... ..... .. ....:.... ... i .................I.TG.1k'C�± ...._........_ o.P n. ..-: .......�. c...._....... S V.A. ..........es I.....-w v.p........... ...........-......_ 1. .�a..... .m.vTS. ._�Q.. ......_€.._ .�kt«....... ............................._.................. _.. ...:. ..................................................... ...... .._<._......__.............:................................... Q... _....... -._ �.�.e 11 ..........t" +'•�. .. �'! ...... _..........._.. . , . 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L ..... ..... ...... ..................................................................... . . . .. .. ..._.... .._i i i i € f F� Ga.� i p ......... ......... RaF �� 5 o.ffll l R I NA MC Qh l WK.1/P.M" - � J ` Jos I40JG41rE� K��. �i..�� J A►ieri--i TAYLOR DESIGN ASSOC., INC. SHEET NO. OF • .� P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY C—r T DATE.. Tel./Fax: (508) 790-4686 Ave- CHECKED 8Y DATE 374 T N AsM A • Com&A T EL. SCALE ............................:............:............ ft ............ .N. ie.._.44A! !sue........ -r -cn.-.:.. 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I — JOB13 evc 9 P-255 161 S pwwrfo�f TAYLOR DESIGN ASSOC., INC. SHEET NO. .7^ OF P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY e� � DATE Tel./Fax: (508) 790-4686 /� e- �" CHECKED BY DATE 3?4 pw"rNC�f"t `o?- L�,,( SCALE ...................................._.......... ' r. r x.r_�..:.._ ......... ._.LDS..�t........'c�.i.. a. 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T-wp w4.s.•? ... .........:.... ... �.r.......�..... .._ 4'� __rdr! ......D.. ........rr......_C�........._.._........:....... ............. u a.7 . ....C�no. . ... ... .. ...... ..... ..... ..... ..... ...... ..... ...... ....................... ..... . ..... .. ....;.... ........................ ...... .................. .... ...... .... ... OGMIIIT'MLt ICMb CFade1'llltt IDaMMI - Iz4J FY 400 I�f tj Q fk" f o "RD t F S � 1 xx v o'er Vv io ' I 1 UV [� YVA� .- swoop , , _ - _ _.......... -- �- _ I , �lrif•r . B�RNIE TOLASSa p.®2 AM 37--12_2 Iy oo AM 37-11 A.M. 37-10 ` 13741, l orE,- SUB�•SKE'?'Ch' A PERIMETER PROPERTY NOT TD SCALE U yE SURVEY I3 RECOM�lEIVDED. Ra ZoNE:' "RF" This MORTGAGE INSPECTION A is or Ff04D ZONEW, "C" TQWN REF: _QTMZ......-_ ------___ REGISTRY OWNERV. Y.1._mlr.A GAZ lOr _ _BOM'�41lT D DEED _�=�'k=��- _ -1�t�YER: R�'F1,N,t3N - - - -- - -AN REF: A SCALE 1��T 50' -FT_ I HE CERTIFY TO _ -�,�of - --- YAi�KEE SURVEY THAT THE ND G SHOWN ON THIS PLAN IS LOCATED ON THIw QROUNiD AS pAuL CONSULTANTS SHOWN AND THAT ITS POSITION DOES ____ CONFORM A. 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OIL' _THE 5 MERITHEW TOWN- OF 4kA&ysz;ia&f'___�_ »w.._r-_AND THAT No..U094 INDUSTRY ROAD IT DOES_,' ,_ Lll WITHIN rl� SpE651 FLOOD HAZARD MAMONS MILLS. MA. 02648 AREA. AS SHOWN ON THE � • M P DAATED_Z =B __ ��•y� ,�s TEL, 428-0055 -•D F'A 5 Af La .IA .. T DTO MADE IROU. AN IiIE 23971 SDS 198-d ZOO/ZOO A 921-1 9011 OZb 909 HBA V+lffidd Adll.:90 11OZ-VO-SH acgSF f n Taylor Design Associates, Inc. P. O. Box 1313 Forestdale, MA 02644 Telephone & Fax: (508) 790-4686 September 14, 2011 E. J. Jaxtimer Builder, Inc. 48 Rosary Lane Hyannis, MA 02601 RE: Revision to Roof Framing at Kitchen Boucher Residence 374 Putnam Ave. Cotuit, MA Dear Mr. Jaxtimer, On September 9, 2011, l met on site with Mrs. Boucher. We reviewed removing the existing roof and ceiling in the kitchen. We will provide a new open cathedral ceiling with 3 —4"x8" cross ties. The bottom of the ties will be about 9'-6"above the floor. There will be a new header spanning the 6'-0"wide area off the kitchen. The.beam will be 2—2"x10"'s and support one end of the new"A" frame roof. The calculations are enclosed. Please feel free to contact me with any questions or concerns. Since ely, / TAYLM XMICri UML R. Grego lor, Preside ' Enc. j ! Y ® 1 Pit 4: 02 JOB TAYLOR DESIGN ASSOC., INC. SHEET NO. OF P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY- �-s DATE q~ t *J^ t f Tel./Fax: (508) 790-4686 �^ CHECKED BY DA -r'vj PA. f W C. `-a Y109"T ��.SCALE �OF .. TA .... ............ .:. ................. ... s t .......... .!4.: . -. .. �41 .... .. ... ....'.. .............. _.... .. _ .... . .. ................ .. . . 1. + .... cs L �. . _.. .... ..... . . . .. c_.. = .............. '4. . ' �' .. e . �l " .....:... l.:�...... t 3e.4t Z Z 4r �$' ...= C�� P S t re. u...� " .... .. 44 Z.X�o.5 Wt71.L:..... 4- k. � '.. .... e.'i' e=i ... ... -Z..._�51 ... t ._ . t 3to.4- 4.— . -,.. ................... ._.... ...._. — -- TOWN OF BAPN F WNOV a 1 Al, �' 02 • w ' JOB TAYLOR DESIGN ASSOC., INC. SHEET NO. i'�• r OF P.O. Box 1313 Foeestdale, MA 02644 CALCULATED BY �T DATE Tel./Fax: (508) 790-4686 /� CHECKED BY DATE COYT't» ,v�7'0 -SCALE ........- l ... p : ..-.. ' ._ v !"t.�4 a.. _R.®o...t z . S ....... ............. -.. ... .. - t®. ... per .. ... ...... .. ....... .... . J ........°. .... ... TOWN OF E U DINJI'SICI, e ` r I� Taylor Design Associates, Inc.. P. O. Box 131.3 Forestdale, MA 02644 Telephone & Fax: (508) 790-4686 September 2, 2011 E. J. Jaxtimer Builder, Inc. 1 48 Rosary Laney) Hyannis, MA 02601 w RE: Second Floor Framing at Kitchen Boucher Residence 374 Putnam Ave. Cotuit, MA Dear Mr. Jaxtimer, Enclosed are the calculations to provide two wood beams to allow for a 15'-4" and 9'-4" opening in the kitchen and support the existing second floor. Both beams can be 2- 1 3/4"xl 1 7/8" LVL's with 4"x4"posts at the ends. Please feel free to contact me with any questions or concerns. Sincerely, TAVUON R. Gre Taylo Z- Presi Enc. Taylor Design Associates, Inc. ' 4P. O. Box 1313 lorestdale, MA 02644 Telephone & Fax: (508) 790-4686 ccl August 23, 2011 �.Y u E. J. Jaxtimer Builder, Inc. 48 Rosary Lane Hyannis, MA 02601 RE: First Floor Support System Boucher Residence 374 Putnam Ave. Cotuit, MA Dear Mr. Jaxtimer, Today I reviewed the framing in place. Tomorrow the final anchoring will begin. We reviewed the two W8x31 steel beams that need to be adjusted. The temporary bracing will level the beams until the steel columns are in place. We also reviewed the kitchen appendage framing. The shims for the beams should be steel plates welded together. The foundation and masonry block framing looks very good. Please feel free to contact me with any questions or concerns. Sincerely, OF / TAYLOR � Upw -+ 14a' R. Gre ayl , P. Presi t JOBS TAYLOR DESIGN ASSOC., INC. SHEET NO. OF P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY CYY7 DATE Tel./Fax: (508) 790-4686 • CHECKED BY DATE 11A UF r= -r 'r tj SCALE sl fn .....:. .. . - .. ....... kt3T Tap - t`'� .. ....... ....... ...............1....... 94. ....... . . 13 Ht 7 �•++wS.* .... aim t����.. s ®o.P K- _ .. JT — a .. ... h .. ... .... ..... .... •-i �-� 4),4 Pe 5'r ..__ � _ 33 ...._ Z �/.. _4 7 �4_l Kt{ ................ .. ..... . �s .. ...... t ,9�-;S. �z.> LE w er . 94 ....... n X............. ............. ..........1., 1+1111.1 *( . ... = Z - rot. c . ` Yl =-.... Z 33 tac•'34� ... � l '`� '.5 4 �...�;o4.Z ... �.. ...................; es®:. i `pFtME Tp��p� Town of Barnstable ' Regulatory Services BARNSTABLE. Y MASS. 1639. Building Division pTFO MPy s, 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice _ ., Type of Inspection /3 Location 3 7 y �u-�"�a,� - 7', Permit Number 0 011 O 3 �S'Z. Owner A30 C'(C e r- Builder `� �✓�x 7-7 vac--E—?Q One notice to remain on job site, one notice on file in Building Department. The following items need correcting: AT CL)r . Please call: 508-862-4 for re-inspection. Inspected by Date -0 A/ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 011 . Q Map Parcel Application # .it d 34 U c;;,,— Health Division Date Issuedo Conservation Division �L h�►�C�UJ�Y1�S/� ' '�� Application Planning Dept. a L A* a'l-a! - It F > 1 Permit Fee Date Definitive Plan Approved by Planning Board 14�-• w '` Historic - OKH AIA _Preservation/ Hyannis W& �h Project Street Address Village d OwnerzY /11 Address X0�- Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 QOC] Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.% � 1 _ ., o Number of Baths: Full: existing new Half: existing k new -3 C�l Number of Bedrooms: existing _new _ -n 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. Yet;❑ 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 Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address •cense # Home Improvement Contractor# ZD/L2?0 Worker's Compensation # / ALL CONSTRUCT ON DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Z1117V1,dJ911 3 L FOR OFFICIAL USE ONLY A APPLICATION# i } DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE t OWNER t DATE OF INSPECTION:' A powFOUNDATION 1 bcc °3 a mZLts bO(An FRAME INSULATION FIREPLACE I I. ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Y v o1 2- 1(�� I� DATE CLOSED,OUT ASSOCIATION PLAN NO. I. Q The Commonwealth of Massachusetts Department of Industrial Accidents CIE I Office of Investigations. Ind 600 Washington Street a ry r Boston,MA 02111 c www.mass gov/dia r Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumb.ers Applicant Information Please Print LeLdUy Name:(Business/Organization/Individual): Address: City/State/Zip: L jr 42110 hone #: 3 Y—L'3 F7 �O Are you employer?Check the ppropriate boxy Type of project(required): 1. am a employer with 4. ❑ 1 am a general contractorNand I 6. New construction . employees(full and/or part-tune).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees ` These sub-contractors have 8. ,❑ Demolition working.for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. El We are a corporation and aits ' required.] officers have exercised their 10.❑ Electrical repairs or additions _ 3.❑ I am a homeowner doing all work `rightof exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and.we have no 12.❑ Roof repairs insurance required.]t. employees. [No workers', . I3.❑ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of thc sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees..Below is thepolicy and job site information Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: to Job Site Address: 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.)52 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment„as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of , Investigations of the DIA for insurance coverage verification, I do hereby certify undAees e Ides perju that the information provided above is tru and correct S i ature: Phone Official use only. Do not write in this area,to be completed by city or town official .. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk. 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: . 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 Y emP to er 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 hoto�',gf au6thef who employs)iersonl toAo malnt6fiande,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 cliapter`152, §25 (67 also statei. at"every state or localJicensing agency-shall,withhold-the issuance or ,renewal,of Yji�tnse-or,permit to operate a business or to conkruct buildtngi tri'th'e.cofnivvnwealth 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 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 affidaviffor you dfiill out in the event the Office of Investigations.;has to contact you`regarding the applicant. .r .., Please be sure to fill the permit/license number which will be used as a reference nuinbei..,In addition,an applicant that must submit'multiple pefmit/license applications in any given year,need only§uf3i�ii''one'affidav t.iridicating 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. t 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,,tel`epfione mill fax number: Ramie-Co th of Massac monweal husetts - 1Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-977-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia zr � Town of.Barnstable Regulatory Services sA8%srA M MAB.& g Thomas F.Geiler,Director 1619.. Building Division Tom Perry,Building Commissioner - 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Us ing A B udder I� B �1/ , as Owner of the subject.property hereby authorize w. Uokra-r. to act on my behalf, in all matters relative to work authorized by this building permit application for: rw ;-r P 6(Address of rob Signature of Owner a Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RMS:O WNERP ERMISSIDN � 3 . r. Town of Barnstable THE Yp�y yam. o Regulatory Services t Thomas F. Geiler, atixxsusre. ,Director nse.4s. g. • �619- .� Building Division �rEDy Tom Perry,Building Commissioner 200 Mairi•Street, Hyannis,MA.02601 www.town-barristable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HO'N IE07iWER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMFAWNER": name home phone# work phone# CURRENT MAILING ADDRESS: City/town state , zip code The current exemption for"homeowners"was extended to include owner-o6ci4cd.dwe11ngs'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 HOME0 'ER Persons)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 constrq;cts 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 Ji6mi it-',(Secti'bn 109.L 1) 'w The undersigned"homeowner"assumes responsibility for compliance vrith the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies,that.ht-/she understands the Town of Barnstable Building Department minimum inspection procedures and requ43p acnts and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. H0MM0'VT,?'ER1S 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 Supcm�isors);provided that if the homeowner engages a parson(s)for hire to do such wor.that such Homeowner shall act as supervisor" Trlany homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(sx Appendix Q, . Rulers&Regulations for Licensing Construction`Supervisors,Section 2.15) This lack of awareness often trsults 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 horircowncr acting as Supervisor is ultimately responsible. To ensure that the homeowner is.fuIly aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a farm cun-ently used by several towns. You may Dare t amend and adopt such a fonn/ccrtification for use in your community. Q:fon-ns:homcexcmpt RiglitFax N1-2 7/5/2011 6:09:33 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE 0 7/0 512 01 1 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 holier is an ADDITIONAL INSURED,the pdicy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- PRODUCER CONTACT NAME: PHONE FAX )N71UTAM PALUMBO LEIS AGCY (A/C,No,Ext):' FAX ��� (A/C,No): E 4527 FALMOUTH RD E-MAIL JUL ADDRESS: (• PRODUCER COTUIT,MA 02635 CUSTOMER ID 0- 77X6R INSURER(S)AFFORDING COVERAGE NAIC N INSURED INSURER A: ACE AAIERICAN INSURANCE CONIPANY INSURER B: HAYDEN BUILDING MOVERS INC INSURER C: INSURER 0: PO BOX 496 INSURER E: COTLTr,NIA 02635 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE 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 0R MAY PERTAIN.THEINSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POUCY EFF DATE POUCY EXP DATE TYPE OF INSURANCE POLICY NUMBER '(MWDDIYYYY) (MKDD1YYYY) UMITS LTR INSR WVO GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) IVIED EXP(Any one person) $ PERSONAL$$ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE UABILM COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident)" ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY : $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC STATUTORY LIMITS OTHER WORKER'S COMPENSATION AND EMPLOYERS LIABILITY YIN US-447GP341-11 02/06/2011 62/06/2012 E.L.EACH ACCIDENT $ 100,000 ANY PROPERITORIPARTNEFUEXECUTIVE N E.L.DISEASE-EA EMPLOYEE $ 100.000 OFFICER/MEMBER EXCLUDED? (Mandatoryln NH) E.L.DISEASE-POLICY LIMIT S 500,000 I1 yes,describe under DESCRIPTION OF OPERATIONS below - - DESCRIPTION OF OPERATIONSILOCATIONSNENCLESIRESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CI-RTTKCATE HOLDER AFFEC-I•LVG W ORMtS CONIP COVERAGE, PROPERTY LOCA7101"1:MASON BOUCHER 200 PUTnLAN AVE COTUIT.B14,02635 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 ACCORDANCE 200 MAID STREET WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE HYANNIS,MA 02601 ACORD 25(2009/09) 1988-2009 ACORD CORPORATION. All rights reserved. Received Time Jul, 5, 2011 5;090- No, b752 From:Melissa Wade At:Maguire Agency FaxID: To:Bob Hayden Date:7/13/2011 10:50 AM Page:2 of 2 OR CERTIFICATE OF LIABILITY INSURANCE OP ID MP DATE(..DDIYYrr) 07/13/11 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. I the certificate holder is an ADDITIONAL INSURED,the policy s must be endorsed If SUMPUTIONIS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Maguire Agency (M.No,EKt): (A/C,No): 1935 West County Road B-2,*241 ADDRESS: DhK Roseville MN 55113 CUSTONERID*. HAYDE-2 Phone:651-638-9100 Fax:651-638-9762 INSURER(SI AFFORDING COVERAGE N.AIC# INSURED INSURERA.: Travelers snsuranca conanies 24775 Hayden Building Movers, Inc. INSURERS: Box 496 Cotuit MA 02635 INSURERC: INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CEP.TIFY TiAT TiE POLIC ES OF INSURANCE LISTEC BELOW HAVE BEEN ISSUED TO THE INSURED 4AVED ABOVE FOR THE POLICY PERICD INDICATED. NOTW'I-HSTAMING ANY REQU REMENT.TERM OR CCKDITION OF ANY CON PACT OR OTHER DOCUHENT WITH RESPECT TO WHICF--HIS CERTIFICATE MAY BE ISSUED OR MA.Y PER-AIN THE INSURANCE A=FORDED BY THE PCLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EY.CLUS1014S AND CONDITIONS OF SUCH POLICIES.L MITS SFCWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR Vy POLICY NUMBER (MMIDDIYYYY) ;MhbDDM/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X CDt✓MEP.CI.A_GENERALLIABILITY 660-866K6796 06/24/11 06/24/12 PREMI3=S(Ea o-cur'encai $100,000 CLAIVISMADE FX1 CCCUP. MED E)IP(Aiv one Gerson) $5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIAT APPLIES FER: PRODUCTS-ODVP/OP AGG $2,000,000 PO-ICY X JECT -O'er $ AUTOMOBILE LIABILITY COMBIPEC SINGLE LIA T $ (Ea accident; ANY AUTC EODI_Y INJURY(Per person) $ ALL DOMED AUTDS BODI_'Y INJURY iPcr accident) $ SCiEDULEDAUTCS PROPEP.TY DAMAGE H RED PUTOS (Per accident) $ NOW 0\MNEC ALFOS $ A UMBRELLA LIAB X cccuP EX-866K6796 06/24/11 06/24/12 EACHOCCLTRRENCE $1,000,000 X EXCESS LIAB CLAIMS44ADE AGGREGATE $1,000,000 DEDUCTIBLE $ - RETEN-ION $ $ S S O R AND EMPLOYERS'LIABILITY - TOP.Y LIIVI-S E ANY PROPRIETORIPARTNERIEXEC�JTIVE YIN IA E.L.EACH ACCIDEN- $ OFFICERAdEMBERFKC-UDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If ves,descr-be under DESCP.IPTICN OF CFERATIONS:)ely6v E.L.DISEASE-POLICY LIMIT 1$ A Cargo 660-866K6796 06/24/11 06/24/12 ACV up to $5,000 Ded. $150,000 2%Wind/Hail DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES (Akach ACORD 101,Adddbnal Remarks Schedule,I more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TWNBARI THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PRUVISIONS. Town of Barnstable Building Dept AUTHORIZED REPRESENTATIVE 200 Main street Hyannis MA 02601 J A &A, RD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD .Jul 01 11 07: 37a National Grid 1401.4670473 P. 1 TOWN OF BARNSTABLE IT JUL 9 AH 7: 5 4 D1V1 1O nationagrid . July 1, 2011 Town of Barnstable Building Department Residence of: Mason Boucher, 374 Putnam Avenue,Cotuit, Ma. 02635 Re: 374 Putnam Avenue Cotuit, Ma 02635 This letter is to notify you that after our investigation it has been determined that there is no gas being supplied to 374 Putnam Avenue, Cotuit,Ma. If you have any questions, please feel free to contact me at 781-907-2930 Sincerely, Diane L. Stevenin Customer Driven Construction diane.stevenin@us.ngrid.com 781-907-2930 781-522-1056 fax 40 Sylvan Road E-2 Waltham, Ma 02451 08/01/2011 09:33 508-428-7517 COTUIT WATER DEPT PAGE 01/01 �p oFry�. C� tuit ire Putrid • COTi11? Water PEyttrtment Mill JUL - � AM 10: 0 r � R PIRE DrgMCT 1926 4300 FALMOUTH ROAD, P.O. BOX 451 "JUV °, COTUIT, MASS, 02635 PHONE 508-428-2687 FAX 508-428-7517 L I V I 510N July 1, 2011 Town of Barnstable Building Department 200 Main Street Hyannis, Ma 02601 RE: Boucher - 374 Putnam Avenue, Cotuit To Whom It May Concern: The Cotuit Water Department will be on location at 374 Putnam Avenue on Tuesday, July 5, 2011, to disconnect the water service per our agreement with Hayden Movers. Sincerely, Sheri Leavenworth Business Manager 07/11/2011 09:50 FAX 001 E.W. Drew. Inc. Electrical Construction Phone 508-778-0723 103A Mid Tech Dr Fax 508-771-1089 West Yarmouth, AAA 02673 email ewdreweC@comcast.net 07/1112011 To whom it may concern; All electrical power/service has been terminated to the Boucher Residence at 374 Putnam Ave, in Cotuit. Any further questions please call. Thank you Eric W Drew i Massachusetts- Department of Public SafetN Board of Building Rellations and Stand t.rds Construction Supervisor License License: Cs 16161 y Restricted to: 00 ROBERT F HAYDEN 6.0 CHEOH ROAD COTUIT, MA 02635 Expiration: 91'19/201 Trs: 4275 iOffice o of men t rsfidsiness egu a on HOME IMPROVEMENT CONTRACTOR Registration: a1.06207 Type: Expiration: 2ti2012 Private Corporation H N BLDG MOVEE{�IN n F, Robert Hayden 1 '� PO BOX 496 �5 COTUIT Mills MA 02635 Undersecretary I_ l J 1 L 07/13/2011 11:03 2397329087 TAYLORED:SERVICES PAGE 01102 • ,�� •l SGµ TAYLOR DESIGN ASSOC., INC. SHEETNP, ' � _� of � P.O. Box 1313 CALCULATED BY. 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Y.. a......_.....:................... _::.._..._......... i .......i--..--•-'.......,....�......... _.................. ..... ..... ...... ...... .. _ .... _.........:..........., L. i y ! I , HAYDEN BUILDING MOVERS INC. PO Box 496 • COTUIT, MA 0.2635 SHOP 84 INDUSTRY ROAD, MARSTONS MILLS (508) 428-6380 • FAX (508) 420-6229 070 <r Yoe- .. i 33 a Q � I, To n of Barnstable *Permit Q 60(q q 4"1 PeRExpires 6 m the from issue date 1BASWAS egulatory Services Fee 7 XAe& 3 2006 Thomas F.Geiler,Director 6 F SARNSTABL Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 V"v 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 clap/parcel Number 63 0 11 'roperty Address J ? V ffIVA'yl At C Vrl/ l ' Residential Value of Work* b � Minimum fee of$'25.00 for work under$6000.00 )wner's Name&Address /145� to Vt, 31 Y A rA/ Y-,1 Oq v-L L/,7e Tar! ti contractor's Name Telephone Number -Tome Improvement Contractor License#(if applicable) construction Supervisor's License#(if applicable) - Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ® I am the Homeowner ❑ I have Worker's Compensation Insurance nsurance Company Name Workman's Comp.Policy# 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 ❑Re-roof(not stripping. Going over existing layers of roof) ® Re-side ❑ Replacement Windows. 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 sign Property Owner Letter of Permission.' Home Improvement Contractors License is required. SIGNATURE: /Y�✓ti ���2'�"'� Q:Fonns:expmtrg Revise071405 The Commonwealth of Massachusetts c Department of Industrial Accidents �fb Office of Investigations 600 Washington Street \' 4 = Boston,MA 02111 a� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers licant Information Please Print Le gib lame(Business/Organization/Individual): � J g�C I1A/Z kddress: 37 t, Pvr va^, Avg ity/State/Zip: (2a-rV1`r 0743S Phone#: re you an employer? Check the appropriate box: Type of project(required): ❑ I 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 ❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein 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.❑Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.El Other -S l y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. omeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. m an employer that isproviding workers'compensation insurance for my employees. Below.is thepolicy and job site ormation. urance Company Name: icy#or Self-ins.Lic.#; Expiration Date: Site Address: �' City/State/Zip: tach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 'lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a e 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification.. o hereby certify under,the pains and penalties of perjury that the information provided above is true and correct. mature: ��'� �9LGG/�veti� Date: one#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: sn>tivareat�. Town of Barnstable MASS. s�9• Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ffice: 508-862-4038 Fav 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 4'4'5-�J� �v subjectproperty, as Owner of the j hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: d- P>L�IyA� �DTV LT (Address of Job) �U Signature of Owner Date Print Name Q:Forms:expmtrg Revise071405 Town of� Barnstable' *Permit _ � ; A Expares b months from issue date Eas °.. Re ulator Services 9 Y f Fee..:.2 .5 Thomas F.Geller,Director y = j _., . ..._ .. Building Division. . _. _._. . -Tom Perry, Building Commissioner ^ ` E j T . 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 2005 Fax; 508-790-6230 EXPl$ SS:PEItI�$I' A' IICAI(�l� I - - -,�, - Nat Valid without Red X-Press Imprint Map/parcel Number 03? 0 / 1 Property Address L/ �V+� ��� Crj aResidential Value of Work—.y G+� 0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name- ���,�y� ��� 1 '~r Telephone Number �S �c3� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) aWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 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 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value ( ;,,,,,,„.44) "Where required: Issuance of this permit does not exempt compliance with other tDvm department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner roust sign Property Owner Let'er of Permission. e nt C rs License is required. Signature Q:Fm=:expmtr& Revise063004 The Commonwealth of Massachusetts -- -- Department of Industrial Accidents ` affre afimresoadoas 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit fedy � pam e: oCSti0i1: �a�� one [� I am a homeowner pedormiag all work myself. 1 am a sale �grietor and have no one w xn ca acitpMINION 11,111, la er providing workers compensati mY. .,P °Yee ; t ` lam an emp p• r p �42> ,•::;:<;,_:;";�� `�< � :; ' �'' tw,!.Y.; f;E%; <^�:?�;:';.�c-;:4:;Z- •,£": tt, ..,Z;n�. �.t T2k?' ,.}'i.• .:w''+. k :r �r •:its an !•n �....., �i 9ffie.::}::... rr:r:. 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''i•�''0MO,'C•. i +::r�'::'br.F::,.v?SW,s{v : r`P,S•v;v.fi ... tif' t niu' nce:co�•i>:•yx:••+:,c:::,.::n: :. ••.. �r/�3'` � 00 andloz FWb=to secare coverage as��ed mtder------25::•o[MGL IV can lead to the itap osiiioa of crisainal penalties of a floes to S1,So0. one years'imp�onment rreII c3vn penalties in the tn,-m of a STOP WORK ORDER and a tlae of 5100.00 a day against me. Itmndesstamd Own One of this statement maybe forwarded to the Office of'a1vestigatians of the DTA for coverage veiitication cop the and pe Tedury that the information p I do herebyrovided above is true sad corrtd. _ Date Signature - priut name. ofBcisl use only no write in this area to be 6mp cdal leted by city or town oifl peradt�license# ®Building Department city or town: QLisesuhtg Board 09electmea's Office checkif imrcc a response is required ®Health Depsrtzaent phone#; _ ® � contact person:. (/sys+ed 9/95 PJry UU Llt,ll Roofing & Siding Specialists Supply and Install- CERTAINTEED WINTER- GUARD: (ice &water shield) Waterproof Underlayment System Supply Install - #15 Felt Premium Underlayrnent Paper suuRly & Install - Hicks Ventilated Drip Edge where needed. supply & Install-Aluminum & Neoprene Soil Pipe Flashing supply & Install-GAF Cobra Ridge Vent. Clean & Remove - Debris from work area daily. TOTAL INVESTMENT: XTAR30 - $ LANDMARK AR 30 - $ yC'O0 LANDMARK TL - $ Payable immediately upon completion NO MONEY DOWN-NO Payment at the start or part way thru Payments accepted are: CASH-CHECK-MASTERCARD-VISA AMERICAN EXPRESS Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, ' lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$45.00 per hour, plus materials, plus 20% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the labor for 10 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for.10 years. CERTAINTEED Warranties the shingles and labor 100% for the first 5 years, and then on a pro rated basis for 30 years total if the shingles become defective. CERTAINTEED Warranties the shingles to be ALGAE resistant for a full 1.0 years. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if.not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Woran's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE; SUBMITTED BY: Homeowner Fraser-Cons ction o -� Board of Building Regula Ions and Standards One Ashburton Place Room -:1301 Boston. Massachusetts 02108 Home Improveme4f C tractor Registration y - Registration: 112536 r> Type: DBA FRASER CONSTRUCTION co i $'`, Expiration: 3/23/2007 DEAN FRASER 71 TARRAGON CIR � z i �•� COTUIT, MA 02635 '`OM•04/04-G101216 Update Address and return card.Mark reason for change. ' - ---—-----------._.. ❑ Address L 0lze boa - — Renewal Employment ( 1 LosYCard Board of Building Regulations and Standards HOME IM,PROVEMENT CONTRACTOR License or registration valid for individul use only t.. before the expiration date. if found return to: Reistran: 1�12536 Board of Building Regulations and Standards �3/2007 One Ashburton Place Rtn 130i Boston,Ma.02108 .R CONS f i FRASER IRAGON CIR��l T,MA 02635 Admtnistrator Not valid without signature \\ i #�FTHE r Town of Barnstable *Permit 3� Expires 6 utonths front issue date BARNSr,BM ; Regulatory Services Fee v MAS& Thomas F.Geiler,Director �A .q 3 1 6 a� 'E Building Division Tom Perry, Building Commissioner ��++ . 200 Main Street, Hyannis,MA 02601 X-PRESS PEA` Office: 508-862-4038 MAY ?, 5 2004 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESID§hW NS i Noi Valid without Red X-Press Imprint Map/parcel Number 0 3 7 — CI 6 Property Address r� m 37y Pa � qye Co-7-tt -r M Z 3S_ (7�Residential Value of Work <�p Owner's Name&Address �� C �fil? IF Ye Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ® I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 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 ❑Re-roof(not stripping. Going over existing layers of roof) ® Re-side 0 Replacement Windows. 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 sign Property Owner Letter of Permission. Home Improvement Contractors License is required. , Signature ��1a Q:Forms:expmtrg Revise053003 , Assessor's map and lot number ..`..-./. ZZK ...... -- C� OF THEr0 � T'lIC SYSTEM MU Sewage Permit number ..'..Ly s ` ... ,j / a com �;� ��� y c' °1 9T4DLE. � House number 4.�J.. ........................................................ V LE 5 :o MAO& ENVIR N1IATM � E NT AL COCOD ° 9.A, TOWN OF B A R N S T YWPULATIoNs BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPEOF CONSTRUCTION ..............................................................................�........ .............................................. � r_G'� .......1....1 22..G�.....................19........ TO THE INSPECTOR OF BUILDINGS: 1 The undersigned hereby applies for a permit according to th_(e_ following information: Location ......................... 1. . M.. !'�•""`.....��..\`�' T ................................................................................. ProposedUse ..... . l�. . ..... . ...... ft.e. ... ... ............................................................................I......................... ZoningDistric ... ........ .....Fire District ................. ...............................! ................. ... .. a Name of Owner 4 S`' ® �� 1 e .. ........ S........ tb. ................ ........................Address .......................................... ...��..�. .....�... .. 6,v; a * 0e 11. LV"C'6114 /21 5a C 4rI Nameof Builder........................................................Address ..................... ............................................................. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .............................`..................................................... Fireplace Approximate Cost ! 0 Definitive Plan Approved by Planning Board ---------------____-----------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee /..... ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the/�T 4f B!( s qbl eg din the above construction. .CI) v i Name ... ' Horgan, John J. No Permit for Rebuild.................. Fire D macred Dwellina ......................4..................................................... --tf-3 7Y ' Location ......u. j.n 14 V-I.. ...A . . . . ......................... ....................QQ.tjai.t;............................................ Owner ....P.Q.T1.41.0... ................. Type of Construction ...Fr.aMe......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .....Apr-i..1..4.1..............19 80 is ate of Inspection ....................................19 Date Completed .................4�ne-2....19 PERMIT REFUSED ........................................ 19 ..... ..... ......................................................... ........ ................ I.� ........................... ..................... 0 00 Ap pm%i ................................... 19 -"J s, Al 0 ............................................................................... ............................................................................... Assessor's map and lot number .......................... ... ...... u THE o 0 Sewage Permit number - ��/-r-!+`...:!� .+ SU. �...• ' .�✓!sf ev, o� ��� �/� � Z BJBH9TABLE, • Housenumber .... .......... ............................................................ 9 MAea p� ape,039. 0 '£0 MO a\® TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO R.�..t ../............. ...... .............. « TYPE OF CONSTRUCTION ..................... .. .........................................f........................................................ ....1...f.. ..,. ...................19........ TO THE INSPECTOR OF BUILDINGS:' n The undersigned hereby applies for a permit according to` the following information: Location il) (_.T ..................................................................................................................................................... . . ProposedUse � ..:J�,� ./�.�' ...................................................................................................... Zoning District .......... � ................................................Fire District ` !_ ) �E 'r �./I P iu -1 ( c 1,v Name of Owner ......,..... .............Address , Name of Builder �./ �s�v, , ' a r L✓ Address ..( ............................................. ,+ Name of Architect Address .............................................. Number of Rooms Foundation Exterior .............Roofing ........................................................................ ....................................................................... ............ Floors ......................................................................................Interior ............................................................:....................t.... Heating. .. ...........................................- ............. . ..... . ..4-Plurnb,ing ..........•.• ........................................... ........ Fireplace ..................................................................................Approximate Cost ........................................ Definitive-Plan Approved by Planning Board ________________________________19--------. Area .......................................... Diagram of Lot and Building with Dimensions Fee f SUBJECT TO APPROVAL OF BOARD OF HEALTH i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........... WeilandJQ7ald F. d, No 220.92.... Permit for Rebuild................. ..............................Fire aged..AWea ] izg................. ���PutAAm..Av.enue.......................... e 'LOCatIQrl .... � Y Y ..................CO t14it....................................... Donald F Owner .......,...................,...h7.e,],l..and............... - .; _..: . .. .. Type of Construction ........F.rame..................... ' .................................................................. ......... x Plot ......................... .. Lot ................................ : Permit Granted ,,.April 4 , g p K4 ...................19 Date of Inspection .........19 0. ........................... Date Completed ......................................19 t y{ y PERMIT REFUSED . .............................................................. 19 ..� ........... n .... ............... ...... .. ... ...(.. ...... ............................................................................... ............................................................................... Approved ................................................ 19 - ............................'.................................................. .......... ..... ......................................................... I v^' ssgssor's map and lot number ............ Sewage Permit number .. ...`.:.� . r j �l . � aFIHEro TOWN OF BARNSTABLE 1t 9AHB9TODLE, i 16 UILDING INSPECTOR, CEO YPy�`' moo E � � 1400 ) — d2. APPLICATION FOR PERMIT TO ....2 E�Op C—� . ��� -"I � .'�`4 �x'l;'�YZ I o FZ'" TYPE OF CONSTRUCTION .W.PP.P...:Fr�ti ..............19.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....77.1...(.Lo..r...!.!..).....PUTNAr1�1.../ VC..��..... .TU�.T ....M. .` ...................................... Si LiGri.a- Q,CSi ��c-1uCC ProposedUse ............................................................................................................................................................................. T ZoningDistrict .... .,. .........................................................Fire District ...............C d .TJ -1............'................................................... Name of Owner WA �-TEn- A - DC Q-AA oQ -iR•..Address 771.0 LITTL-&6j C K LIJ.� f�-(�5i�Pc�23'' ......................................... .... -,Aq-oI i! J , goosrI'Z.Jc'r, olU o x S 5 W.A.- �0.0.1.T' , !,t Jy S Nameof Builder ....................................................................Address .;3.............2-.................... ........... ... . ............................:. Name of Architect ................................................................... Address ................5: 41V1.t5............................................... Numberof Rooms ..............JIG..............................................Foundation ...................................... .�.r-................................ Exterior Roofing � �"... G$It�r�4 .as>!_ W 4�U I� ...............01 .......................................... Floors WOdj> ieR!' .1...............................Interior .................................................................................... .............................................. Heating7-fOT �f!�...... ...................................Plumbing ... .x!.5.!..!. � -............................... Fireplace ......A ...... ......................................................Approximate Cost ...... �Q .�.Q .�'.................... p ....... f /�.�.. .. Definitive Plan Approved b Planning Board - -- - 19 -- Area /.Y.41.. ..... pP Y 9 ................... Diagram of Lot and Building with Dimensions Fee .........�..�.-................. SUBJECT TO APPROVAL OF BOARD OF HEALTH hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. N �..'. UL�M wL' �........ Dermon, Walter A. Jr. x No 17460 permit for ..., remodel & s J add 2nd floor ............................................................................... Locati n ..,,Putnam Avenue ....................................Cotuit....... .. Owner ..........Walter A. Deanon, Jr . .� frame Type of Construction ; _.............................................................................. O Plot ............................ Lot ................................ ' % N � Permit Granted ........ovember 21..... 74 9......................:. 1 �.. /y/ s Date of Inspection ... .!/.1.�.. ............. Date Completed .,ll�s............ J s PERMIT REFUSEDWV ................................................................ 19 ............................................................................... sM ............................................................................... ' ............................................................................... .......................................................................... � r Approved ................................................ 19 ............................................................................... g Assessor's map and lot number /`� .. .....l::.. !�.... Sewage Permit number /l .'�.................. . ... ........... r FTNE'TO�yw TOWN OF BARNSTABLE Z BARNSTODLE, i 1NAM639. BUILDING INSPECTORam APPLICATION FOR PERMIT TO .....rZ E.M n p I W-rb C'1 ©f7-- rye.,,.,y{ C X`r;`E-tt 1 0 TYPE OF CONSTRUCTION ............�!� bD -�tZ%+�'lv1 ................................................................................................................. 4,J(o....v Z..7. , 19`14 ............ ....................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....7.-1....(...L.07 E t).... PUT N A II.1 Ar V sr., t'O�T.U.1. ;' M,A SS , .......................................... ........................................................................................... t ►.� t C 2t1 Inc h� IProposed Use .......--................................................................................................................................................................... Zoning District .....�:f. .........................Fire District �( UjT Name of Owner tL A • C>E Q-AA t�Q -1/L;••Address Tt t? E✓l'�"Z"1_CfVCC�C I.l�f•, , 2a1J f ps`;T12r)eT1 wi [3oX �.$T w C�2Uo 1 T' , JV 14 S 5 Nameof Builder ...................... .............................................Address .................................................................................... Nameof Architect ............` .....................................Address ..........................".�................................................ Number of Rooms Foundation Cc�l-j-e 2`�T ................................................... .. Exierior 1NQh ............................................................Roofing ...�•42 aw.a( Floors WOOD '� CAR tits r Interior Heating ..... Idt ?�!I fZ ....Plumbing ...PA. `.7 t W—V- Fireplace ......7 �...4. ...............................................................Approximate Cost ..........'.......................... }... �..................... .. ... .. Definitive Plan Approved by Planning Board ________________________________19________ . Area %..:.: 1...............'...�`. � .� Diagram of Lot and Building with Dimensions Fee ""�"'� .......... ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH n I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. j., I , .Ar Name_.� t`'L'(„.-7- I l t '�. ..... . .r. Dermoni, Walter A. Jr. J ✓ 3 7// No ....P7 9 permit for .....remodel & .................. add 2nd floor to dwelling .......1................................................................. Locatior_�1�Putnam Ave. ..................................................... Cotoit ............................................................................... Owner ........Walter A. Dermon, Jr. ................................................ Type of Construction frame ................................................................................ Plot ........................ Lot ................................ Permit Granted ......D1.ouemher..2b..........19 74 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ...........................................:. ............... 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... FEE ab V ✓ TOWN . OF BARNSTABLE, MASS. -2 ai m `°' 3bji.4 - - 19 0 M p to oA THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO Oq > _._......_.........................................................................................._.._...........................-_.._....._................ ..............................................................................I................. bo ......--- O .00— (PROPERTY OWNER) (ADDRESS) Ob I.a TO ................................................................................_.........__.........._...........__._..._._........... [4 y3b (BUILD) (ALTER) (REPAIR) rAa 01 (TYPE OF BUILDING) (APPROXIMATE SIZE) O O M opLOCATION ................................................................._................................._..._ ............................................................................................_.................._...--•-•----- d (STREET AND NUMBER) (VILLAGE) 2 NAME OF BUILDER OR CONTRACTOR —_....__.._..........................................._................_......................_........_..............._—._.....____._........... A d O•Q APPROXIMATE COST m tncs I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. at o Ri 0 • U= a . ........................................................... ....................................................................._................._................................................ ........... 0 (V�y (OWNER) (CONTRACTOR) V�C d Q BUILDING INSPECTOR Subject to Approval of Board of Health. fit. s r' t , TOWN OF BARNSTABLE BULK RATE COUNCIL ON AGING U.S. POSTAGE 'PAID 198 SOUTH STREET NON-PROFIT ORG, HYANNIS, MA, 02601 PERMIT NO. 2 i 1 "' / I f a A I ✓/_ it 1 '. F�•.�. . . L�nc�_.i�----moo-�v i-.�9-•/��•s-�:-.. l CZ A�M /4V L Al NDE R. , S. Bearsc kellogg- O;V' ;I�rngo--c-er-s. •. / p m c1 � �� � I `• C'r 87 , •f ez-- . 7cp AREA ACC t /ron Pipe 6.. y Sfoncs-,� X ^ t. / 1 11 - --- - - - - - - - - - - - - - - - --�I �, I i i � � I 1 i I I � I I I I 1� I 1 OY`I-)Vll tF 1 c P 6:�ztkiui �P"*}atS. Sd \A . C r Wi