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0136 RALYN ROAD
/�6 �AZJ / iet) J 1 I`I 1 i I i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION d� I C41 TOWN OF BARNSTABLE Map Parcel Application # Health Division - will 2_9 PM 58 Date Issued Conservation Division /VWW Application Fee Planning Dept. Permit Fee ' b Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis S � Project Street Address r: C® P A�_-f r-i Villages t T Owner S�O%N P ci&7 P4A-ti m Add 7�- C"` n�0 (� �(,r►�D Telephone�?v P 0 Permit Request s-r0EL., 6 iL_yWe--no <T-Pka:A-rAkS4- 4,y0 A cE:JLA-cam Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay o� _,-tRIbiect Valuation Construction Type_ FFL-6 u cz,,,4 c,A-,aW Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure aW `- Historic House: ❑Yes 0 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 d Half: existing new O Number of Bedrooms: existing Q new Total Room Count (not including baths): existing —new C--) First Floor Room Count Heat Type and Fuel: t4Gas ❑ Oil ❑ Electric ❑ Other Central Air: /kYes ❑ No Fireplaces: Existing New 0 Existing wood/coal stove: ❑Yes 4'No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑'new size _ Barn: ❑ existing ❑ new size_ Attached garage: existing ❑ new size _Shed:kexisting ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use RE�Tr 4 t�M-t� Proposed Use MET 9 cagIt) yi-t, APPLICANT INFORMATION f^_ (BUILDER OR HOMEOWNER) Name �S b}-aq P I r4 Telephone Number rn�-ct� Address '� t.-a.LO Vi1tF L VP License # Home Improvement Contractor# Email E,5-1E64%f1c 6P, "L l cmM Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUREAL DATE `i 5 n FOR OFFICIAL USE ONLY APPLICATION # ".t DATE ISSUED ' MAP/ PARCEL NO. i ADDRESS VILLAGE ` OWNER a h DATE OF INSPECTION: i f FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH ' ' FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f#kp'G Guide to Woad Ca=tr-rrcuorr by Hr-,Ir WZZad Arm:II D szPIr end Zane • Massaffiusetts Checkligt for Co m�liance(7So cmRs3cf—i-01 1-1 SCOPE. - - VAnd Speed{3-se¢9 - i10 mph lRrud)✓.p�� DTY ..... �sg¢��nrt��t:�i Fnr�rrfir��ja•t•-f �: _ 12 APPLICABILITY - -- - -- ucnb�b€stdties ja taafivirlvdi ems B Irt:'[2 sitspe shaIl Ise a sinryy dies s siaries - - - -- - . Fief PB=t, Mean Rausf Helght (Fug z) Bung lido,W (Fig 3) Buadutg Leng1h.L. _ (Fig 3) -it s BD' BrAding Aspect Rafm(Lh►y� " (Fig 4) c 3r1 lslm*tal Height afTaIlest Dpm ingZ —(Fig 4) General aotriirance wMi frarnitig c 6nnBcgoas (Tab3e22) . 2-1 FDUNDAT1OrN Foundation Walls meermg regtm•e arft of 7 BD CMR 5404.1 _ _- • Conte.__.-__- ---_.�._.---..__..____ .._._..__---_-___-----------•--- -- ----- . lamer Masanry 22 AMLHORA f;I=TO MIND 4TIQhl 3. SIT Anchor Bofsmnbedded or Sr F tv 5tafy Medzanical Anchors as an ahenafiva in mna-ela Only Butt Sgarg-general._ —_..� (Table 4) rn Salt SFBM-9 from etwjjolrrt of plate (Fg Bolt Embedmmit-mn= (F'rg 5)_ _in_;-7- Bolt Embedment 7 masonry_ (F9 5) Plafe:usher (Fig 5) 3`X 3'X VT 3.1 FL.DORS . • Flow-fining mmnberspers dmaked (peg 730 CMR Chapb_r 55) . Maxhm4m FbOrD*e mg¢mansion - (Fig - FuiF Height Wall Sands at FloDr Dpen¢gs Ies -can 2T fmm Dior Wall(Fig 6)- hftftl m Floor 1 ist Se#fracics. SuppDrig Laadbeadng Walls or ShmmvaIf Fig 7) fi 5 d Maximum Cangovered FiDor Joists , - Suppmfr4 Lbadbaaflng Walls ar ShmrwaI! (Fig B) -MocrB adng ItErldwall- 0.9 g) Floor Sheaifiing Type (p4-7B0 CMR Mapier 55) • Floor 5featvg Thdmess '— 7B0 CMR�pt-_r'' n_ Floor Slung Fasierbg (Table 2) d rob at in edge t In field , 4J WALLS Waft Hai;ft _ Inaffmmin.g Wails - {Fg 1�and Tabu� _ft sUr . g walls (Fug 10 and Table,5) $--?Z V&I Stud Spacing (Fg 10 BDd Table S} _in.5 24 o.r- _ 1►►Fall Stuy D$sets FF9s 7&B) —.ft c d 42 IDF WA1.5= ' . - Wood ids g aid L�ufiaeatia a�raRs Re?3 — Nori4_=dbearing walls._ ---(cab)e 5) 2x --i)•-3ci_ Gable End Wal Bragg i Ftdl HelghtlndwA- ids Fig 1D) . ws;P,AtS_ Floor Length (Fg 11) 'Gypsum CeRV Length[rF WSP not used) '(Fg 11) _ft;=03W -and Zx4Cbnfn=usLaha Brain Q B ft o_r__ Fig art X 3 mrog Rabg sties @ jT spacng•n&.wMu 2 x 4 bbcfdng @ 4 fE sgaczng in end jaist 6rtntss bays DDvhie&PUM Len - (lyg 13and Table 6) - ft rn,,.rf IM r vilmnrn rraSsl._ --iTabla 51 -.._. . AWCGuide fo Wood 110 raph Wm- d Zane Massachusetts Checklist far COMp._ance Mo cmRs3ol=is)i Lcadbeating was C Racoiar m _ - Lama! (nm of 15d co na mmon rk) (fables 7) NWg-Madbs3r1ng wan Can7ec5ons L (ran.of I5d common nails) (TpbIa B) Load Bearing Wall ppenings(n�mrd largest opening but dtexiC a!1 apertings for r�tripGancr:in`i'ab}e 9) Header S� - (Table 9) _ft_in. 1t' • S11 Plate:Spans (Table 9) _ft _ FIA Height Studs (no,of sfr7dsl (fable 9) t�YaD re=d ' g btrt check all openings far compliance to Table fd) Nan-•tradl�e�ring Dpex�a�gs( �n Header SFars-.__ (Table 5) _ft_ e9 ft frt51Z" Sty I"Iate Spans-- (f abl ) — FLA Height Shi s(no.of studs) 6dariorWali S)heafhing to Resist Uplift and Sheaf 5'unn6aniDrtsfy4 NDrznir�l HD gIt ofTalfest OpenW --- sheathing Type_w(note 4) - Edge Mali Spa ih-q (Table 10 or note 4 if less) frL Field Nall Spacing— (Table 10) ShearConnecBcn(no_of 16d minmon nails)(Table 10).r Perrot Full-HeightShea$ing - (Table 10) 5%Add ffonal Sheathing for Waif wfth Opening>.TW(Design Concepts) ► mdmL to BaUrfing Dimension,L - Nominal HeliftOfTallestDpeningz— --.___.------------._—..__________... <SIT Sheafimng TypR (note 4)-- • Edge Naq Spacing (!-able 11 or nail 4 if less) li_r. : - Field Nang Spacing (Table 11) hL Shear Connecron(no. of!lid common rob)(Table 11) - _ Percent Full-Height 5heaftimg (Table 11) _% 5%Addf anal Shea ling for Wall wfth'DpeY bg>-TS'(Design Concepts) Waif Cladding - - Raied fDr Wind Speed? - - S.t pODFs _ Took see I3B Roof frami n-9 mernber-spans checked? (For Rafters use AWC Span R5 Webs) Rif p�=g (Figure 19) ft 5 smaller of 2:or LP3 Truss or Raffiar Conner5nns at I-m6 wring Walls : = Prvpnetwy ecbrs - (Table 12) s U= plF ' Leal. (Table 12)-- r= - pif . Shear (Table 12) S= -Pff. ' Ridge Strap Cbnnec:5orzs,rT catfar fies not Amid per page 21-_ (Table 13) T= pIf • Gable Rake oufiooker (Fgure,2D) .__ ft s smaller of 2'or LPL Truss Dr Rafiar Cannez5ons at NDn-I�ring Walls - - Prmpdebvy Connednrs - - Uplift_ (Table 14) U= lb. - T Lat�l(no_of it5d rnrruttan naffs)_(ab�4 f ��5B and 53). 1 - 'RDof Sheer 1lR9 YP ' irL W1W WSP RDd ifr g Thir b7 — - Roof Slheatfvng Fasfenfng (Table 2) _ — Nofesc , -1. . This dhenicEst shag be met in fts mrtirety.m=Udmg�spes>fic e�pfion noir d rn 2,fa cvmpfy u�the refit m ernes of TBD C;MR_530122.1-1 turn 1. Ifthe che6c&rs met in ft en*eiy Then TheMowing metal satraps and hold dawns am not requaed per fhe WFGM 110 mph GLfde: _ - a. Sal Sltaps Per FUum 5 b. 2D Cage:Straps per Figure I i - - - U Sltaps par gigue 14 P� d. f+tl Per Fi 1T Comer stud Hold Downs per Frgi re 1 Ba and Figure 1 Bb - _ - 2. -E=ep5ort Dpen¢ng W4ft Dfup.to B fL sfid be peimrlted When 5%s added fn the percent t dMaight sheathing -require erft sh6m in Tables i D and 11. 3- The:bDtbm sff plEit5 in e)d&iw walls sW be a mirkm 2 ur_norniiral fWakness pressmae frBateq fZ-er a • - r r -AWC Guide fo Wood I10 mph I�nxdZoaze . • Massachusett3 Checklist for Compdance gag 4. a From Tables ID and 11 and is mfion of wall string and BuUfvrg Asper#RaSo,deternvne Pelt FutF Height _ ShesfhIng and M Spacing requuernards - b. Wood Sft ichnat Panels s M be rT*ft i ihicknesss of 7116`and be►mb dIad as follows: - - _ L Panels shall be hsWad W5 sfr encgh mds parallel fn stt& L M hori mtW jofrrb shall ocrrr over and be naDed to fi Wining. RL Dn single stoiy mnsftudonr panels shall be afiacbed b botinm plates and inp:member of fhe double -------------__---- ---_ist.—Dn turQ-slaty�,,,�„��an,-trPPer-paneEs.sfsatljhe affad�ed.foAhd top rnamberzfte-upper double bp------- phda and to band jdrst at botbm of paneL Upper affachm-rit of lower paned shall be made to hand joist and iovreraftardrment trade to lowest pfafs at first fiaartwbg. - V. Hor iznrdal trail spacing at dm ble fop plays,lard joists,and girders shall be a double rgw of ad - sfaggetsd at 3 inches on cerdarpsi figures below:V�1 and HortmnW hulling fbr Panel Auachmffnt S. GFa ing profEcB=a)rew house orhorimntataddrZon—requited Fproject'IF i rde orcioserto,shone(generally,south of Rfa.23 or narih aF Rie s) . b)verfica[addffion—not requ6zd r�iiess there is�nbve rerro�on fn the lust floor c)repl mrnerft Mdows—needs eneW conswvaton tarnpGar only(chap 93) S.WDDd Frame CottsftUCUDn Manual KCM)for 110 MPH,bPosrae B may be obbi-hedfram fhe Arnerirkn Wood Council (AWC)websife. . rrs�s=d t odes 'hta-= • LL , tl 11 • t tl It l [• C� it Lt t e Q t E i - ■r I i it +Q LL t L I m R it , .L L 1 u a t I t is tl�r tLa[iS.�t nF - t E � tf tt r l 1_ • l► I s i 2 � � � ' •S t l.t [ 1 'C tr 1 t Lt= a L it •� F��. i i t t _ n 3a� - EJkE� � �4tLt'}Q'r8�hi Pl.Rrli . ti-` � r�TiracuaR B� bF314L . Sea Daly pnMerl Rage . Ver)?cal and HratimrrW hlaBm- g I Q . for Pand Aftarhrnnnt t �erIrnCat Rnd I-fo rdaI Naiimg for Fanet Atchmant - _ YIN The CammompeaM qfA&swadiuset& Depmibweut of sfriai`Acdden& 600 FFashuig=JA eet Baston,MA 02H.1 ww .mgvQ� a WarI Bins Comp ensatianInsumuce Affrrlavit-13wldL-7JC nbhrsJIIecftican b&-s APPHcantlnfu�ficm Please Print Name Ad Of V-0 M l 07 b', Phflae Are y-o-II an eniph *er?Qpecl€the app' repriat ebCMType of project(required): L El I oata employer with 4. I am a gems/contract=and I * base hkedffie sn�am�ors 6- ❑Ides won • employees(fia11 and/or pact-�ime)_ 2.❑ I am a sole pmpAetat orpartuer- fisted oathe attgrhed sheet, ?'_ RRPrn deUng ship and have no employees . Thew mb-c�tin have � Ej Demoldibn wodring fnrme is any capacity. empl and have wodoere [No Wadzew Comp.roan*+ camp- I p- ❑Building addition. -1 S. El We are a corponfim and ifs 1 ❑Electrical repairs or'a,d ns 3!Q I am.a homeowner doing all wort€ officers have eseicsed fhek 11-0 Plutabsagrepaus or adcfitious myself[No wo&s'omap. 1,0 Boofrqmirs msu==required_]E a M JI(4).andwelaveno 13 0{?ffier coma-mmma+ce required:] 'ter sir bcm Fl— g�s z sn�� 5bs � s�ra � �a�eoa�a�w�snuKMaac9i g8erRMaaiaggnWa&�d&abxe cOUtMC a�stsnhmirane�s�a cmdi sacb- $ c3�ecYtt¢5 beat must sdeIitianal sheet sbweEagthen of tb¢ �d StBfEvrbe ainat their a sb M emplo3-m Ifti:esn5-coo daeshave wplefam,&eY—F-2&thw-ad'-=P•13da anrohEL I am all srripar t�?�atispra��irTir�,g�vcrkers'avrtsrdicrtt irrsurar�cavr empf �ex Sdaev is fl�ceprrTrcy jQFa site isfarratrfranE. ' Isere ComupaMy NatMe - PaficF41or Self jM&I.ic_A piratiauDate= Job.Site Address Cify/Stafe!lp: Attach m copy of the workere compensaflon policy decFam iaa gage(showing the policy member mad erph--d inn(late). Fad to soma coverage as zequisec3 under Section 25A of MGL m 157 can head to the imsposid of Miznivial penalties of a fine up to SUOD OQ and/or one-gesrimpsi =nent,as w&as civil p-09t-s ia the facia of a STI)P WC)RIK ORDER ld a fm � of up to$250_QO a day agaiwtffieviolatar. Ee advised gat a copy of this sent maybe fxvarded to the Office of Inveskg4oms offhe DIA for imumme coverage verifkafion. Ida Ttersiry - u dia Pc&7 trey 4fperjiuy dwtiiie informadan pr ovfiW abom ig and correct S1 - U Date (c, Phone r 7 / C) 0 d use Do nat,W+rite is this Zre,4 trr be camspTetei by city artbovu o icrat L or Tarns: Permiff- &ewe# gkUffiority(eagle one): wwd of g e� 3- Dew 3.n ova c3=k 4.Electrical Easpe�r 5- hmpectDr tact Person: PhD=9: , 6 t 1 /i it 1 / I D tt ♦.._ "■n6�... -..r .....■r �.tO� 1 �RIr .•%R It .1 .- .- ••q.1�F ..,..,.:�. :..•). lat �. . :1..1. . i- •al •.nt .. la J, .=nt1i- ..• %r 11 I •�7.It�■ :� "'�' •-rR•. ,/ i. i! • - • :■.•r,r t1■. _I• ' r.I■It :. • ■■■ - ■ Ji 1I I •% ■�][!!�. : .1■ t•■■' InY rr.■ ■.�R■t1. _•l•.fYn.■ r•1 •• :..•!. •1 ■..�' ^J= ■t.t • rl .■,• ••• . n•1 _Aw.rf Y.It.n .1 .■■? -r ifln. • D!On •• a._ �+■U. ••�w .•• • tt" -1111011� ads as ' [■ .■ t.•n/It:!../■r- .,. ■ .r.•tt .1 -■.f1 "... •1. ■I 1 ■^ l.t.� ,•.w" • •.Il .• J ••n• • .of ■t■- :n•01 lit. .. l ,. •i.:■. - • • .. 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P r.■ ■O.t.1■.0 • O at .n r" ••- l . ■t u •_ / t. a ■' .1. ■a■ ■. : �.a_ ■• ■ • a. .wn• ..a- I�l . • n- �r.. ■n�■ • r- - .nn�. a ■- t u u ■ n.t n- J,r.r...m n i.- a�nu • - M.�. ■. 711.. . .1 .: ... . .....n :c .■. ..- - • 1 •. :. - �..0 �. n •.ran ••.R�.1 .nn.►..r_.m r. l • r. r.l a ��rJm.�■t - t■- ■1.1/..� l I"a •" .• I. .I �• b\II■tr.Oa:•. ■•. • i�■ t.-1 " u u _n .+. - nun.� ■n u- _u q r,,..n- u" • a . •' 1 � G■ r. a to.+.1 ■. ■] • .�■ .-r J .■- r.n..n . u _.0._ 1 .. ,. n 71 .n u u as n Yi.. . .•.�a_.n•n .. n r.nc •.. _-. .■u_ a -u, w.■ • .nn t m �... 1 n■ 1..n. na �. p J ■■ ■ �.•n Ir I.tr a�.0 It �. .rr..ti_. .n■ n■..:� •r tin- ■.,...w i.- .n■ rnl •• ■ ■P- 1• .] ■.•91 u. r . •• • ■ u n • u t... 1 t.. .. r Psft .�.\! rnn\�. u u JR7ra r .■- yl t..•■ .r - -.. - . :o•_• o .. 7 w nut. - .an. � . •1�04 •- _n a .rn. _ n .• u. - r:f■ .] r.am t .. ■:,. a ..■ •.Yn w • ►.mu.■ w_ •Pn1u. - - •. ra■ - • .Pan 1 N r■I.. " �.- P."1 ■p i?. :..I :n`. .' P./.n- _Ia. G ■Itn1 r�? .1 vigil 5 sea fail ► : . • - ■ - r � ■11 643 Town of Barnstable Regulatory Services , dF Richard V.Scali, Director Building Division ��"TM'•"�a Paul Roma,Building Commissioner `�� 200 Main Street; Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print (DA : , JOBLOCATION: 3 Co Rt � Q Gz�iV t T number n street p c village IEOWNER": ST> Tlie+ �� ES ,MC(W OJname home phone# work phone# ENT MAILING ADDRESS: U--"V 4L-e R L t!D cityhown state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A . person who constructs more than one home in a two-year period shall not be,considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection projedures and requirements and that he/she will comply with said procedures and r e ts. giea#6 of H—o-+wwffi Approval of Building Official Note: Three-familytwellings containing 35,060 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required . shall be exempt from the-provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of s a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Town of Barnstable Regulatory Services ' KAM ` Richard V.Scan,Director. Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office. 508-862-4038 Fax: 508-790-6230 Property Owner. Must Complete and Sign This Section If UsWg A Builder I ,as Owner of the subject property hereby authorize to act on my behalf in all matters relative to worm authorized by this building permit application for. (Address of Job) **Pool fences and alarm s are the responsibility of the applicant Pools are not to be filled.or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date QTORMS:OVNNERPERMISSIONPOOIS WIGGIN MEANS PRECAST CO. , INC. P.O. BOX 1507 POCASSET, MA. 02559 TEL: 508.564.6776 FAX: 508.564.6770 www.wigginprecast.com PRECAST BULKHEAD TYPE "D " 5112 s 0 o 84" 0 o I bad 55 1/2" 86" -�-- 45" 0 84" 59 7/8 72 1/4" 12 3/8' 51 1/2" 0.C BOLT INSERTS 7/8 8„ 1 1 /4" /TREAD NOSING 8-1/4" RISE TYPE "D" WEIGHT 6200 LBS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map no Parcel IM -7Application # 0 c7 (Q Health Division Date Issued Conservation Division Application Fee v Planning Dept. Permit Fee Date Definitive Plan Approved b Planning Board PP Y 9 1 Historic - OKH _ Preservation/ Hyannis roject Street Address "tillage Owner Address elephone D J ermit Request 41:frS l . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay `,.;oje�C'Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family 0 Multi- Family (# units) Age of Existing Structure Historic House: ❑Yes ®'IVo On Old King's Highway:.❑Yes ❑ No Basement Type: -❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq�) o Number of Baths: Full: existing new Half: existing ne _ Number pf Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roo Count' Heat Type and Fuel: ❑ s ❑Gas' Oil ❑ Electric ❑ Other 1.9 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_ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ame Telephone Number `7 7 4,-2!&b 0,5?6(n , ddress j � I ���� License # Home Improvement Contractor# Worker's Compensation # LL CONST UCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE O __J FOR OFFICIAL USE ONLY APPLICATION# R DATE ISSUED << µ MAP/PARCEL NO. t ADDRESS VILLAGE OWNER DATE OF INSPECTION: . FOUNDATION;._ . FRAME Ir INSULATION � FIREPLACE ELECTRICAL: ROUGH FINAL 4 - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r� DATE CLOSED OUT ASSOCIATION PLAN NO. ,, I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IF 600 Washbigton Sbwet Boston,Mi 02111 weviv.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please:Print Le- 'b ' Name(Btisihe"sts/Oavizalanl1}: City/StZgp_ — Phone# �C) b 6 Are po an employer?Check the appropriate boa: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6. [:]New construction employees(full and/or part-time)-* havee hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition working for me-in any capacity- employees and have wodws' [No�vor&ers'-comp.insurance comp-insurance. I 9. ❑Building addition d-T,_�..-.�IN 5. ❑ We are a corporation and its M❑Electrical repairs or additions -1-am a homeowner doing all work officers have exercised their I LEJ Plumbing repairs or additions myself[No workers'comp- right of exemption per MGI. 12❑goof repairs insurance required.]i c. 152,§1(4),and we have no employees-[No works' 13.0 Other comp.insurance required-] *Any spplicimt that checks bar#1 mast also fill oat the section below showing their workers'comrpemsation policy information. ?Homeowners who submit this affidavit indicating they are doimg all work and then hire cuts&contractors:mast submit a new affidavit indicating such (Contractors that ched this box must attached au additions 9 sheet showing the mime of the sub-contt"is and state whether or not those entities have emp96yees. X the sub•contsactoes:have employees,they must provide their workers'comp.policy number. lain are eenpk or that is pmi&ug workers'compensation insurance for oty en9zroyees. BeZow is the policy and job site ieafor�aatiare Insurance Company Name: Policy#or Self-ins.Llc.#: Expiration Date: 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 MGi.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 itnsttrance coverage verification. S I do hereby card&under the pains andprnaltios of payarry that the anfouweatran provided aboste _ d correct Si tune Date: r ^ Offs al use only. Do not write in this area,to be completed by cifta or town.o(j'icsat City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City1rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• ur ' Town of Barnstable Regulatory Services ` RAPNSTABM MASS. Thomas F.Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: T 1 JOB LOCA N: IV o i number street village G «HOMEOWNER":S'/C y l�L� Y ( 1 EW C:.S 1�1,�� 77 Y � V�6 S-t F a l =.71(c name home phone# work phone# CURRENT MAILING ADDRESS: - c��r`1 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies th t he/she understands the Town of Barnstable Building Department minimum inspection procedures and requireme is and that he/ e will comply with said procedures and requirements. 9iinatAg of Hom caner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 r r INWOO, W3330 W3330 W1530-R DW2430'R AV43 i BWB21 BCPO6 SSS I V - C JCn < i I I m - N I ; F I i VJ --------------------------------------- I' I I I � I ' I: 2DB33RT 2DB33RT UB3084RT —k m i— RW3615 1 o: W3330 • W3330 J I , - I I I ' --` --- - _ --- ----------------- NOISIAIO s All dimens pns e�:de i tions i Paris Kitchen design This is an original design and must Designed: 3/11/2013 •t. i not be released or copied unless Printed: 3/12/2013 i�' ai�s Ib eci O +eX on on 217 Main St. p g �� J i job site and adjustment to fit job South Paris,Me. 04281 applicable fee has been paid or job con i' � .® QI 207-743-2509 order placed. Design3 Estaphan Rayiyn.kit All(no dims) Drawing#: 1 Town of Barnstable *Permit# Expires 6. nths from issue date Regulatory Services Fee ��xttST" M' $ Thomas F.Geiler,Director Building-Division '" Tom Perry,CBO, Building Commissioner 200.Main Street,Hyannis,MA 0260E www.town.barnstable.ma.us Officer 508-8624038 Fax:5018-790-6230 EXPRESS PERNUT APPLICATION RESIDENTIAL ONLY . Not Valid without Red X-Press Imprint Map/parcel Number �� w. 1 Property Address / Ci M Residential Value of Work 3 1 .- 3 - 00" Minimum fee of$35.00 for work under$6000.66 Owner's Name&Address Ile /e-ct ee,5 ! Q 0A zq d Contractor's Name : /7 t rJ` �Ov� 00. Telephone.Number Home Improvement Contractor License#(if applicable) �I'�`� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance.. Che.,ck one: . NOV 7. 2012 II am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Z� i Workman's Comp.Policy# Zy b s � yd 76 _ �Z Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane-nailed)(not strippmg rGoing over existing layers of roof) VRe-side 4 of doors _ ' ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows detectors.4 floor p plans marked with red S and *inspections required. ❑ Smoke/Carbon Monoxide , p p q Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q;IWPFILESTORMS\building permit forms\EXPRESS.dO The Commonweakh o,f Manachusetts iepaptinent of--IndusiDial-Ac-dden& O ce erf Investigations �. 600 Washing ins Street Boston,.MA02111 . wn w.rrscrs&gov/dim Workers' Compensation Insurance Affidavit: BugdersiContractorsJLlec nip nslPlinibers Applicant Information /f Please Print Legibly Name(Busirre�(?rganizationllmdividual): �-� �'T �l�fitfzkce"fe`Ot l Q Address: S_�� G, C/I'LA 5-(VL, Cityfstate/Z p: oL` . ! Z O Phone ik Are you an employer. Check the appropriate boa: T of project r 4. I am a contractor and I Type p ] (required): , L❑ I am a employer with gent 6. New construction loyees(full and/or part-time). have hir�edthe sub-cont rs .2. I am a sole proprietor or partner- listed on the attached sheet, y- ❑Remodeling These sub-contractors have ship-and have no employees These ❑Demalitioa~- employees and have wodCers' working for pre in any�Pa�Y• �° z g. E]Building addition [No workers'comp.insurance camp-msvrauce- requited] 5. ❑ re We a a corporation.and its 10.❑Flectrical repairs or additions. 3.❑ I am a homeowner doing.all work officers have exercised their 11.Q Plumbing repairs or additions right of exemption per NIGL myself [No workers'camp. 12.E Roof repairs . insurance required.]r c.152, §1(4). and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 mnst also fill out the section bebop showing their workers'con4mm3 anion policy inforustion- 1 homeowners who submit this affidavit in+dicatiag they are doing all wal and then him outside contractors mast submit a new affidavit indicating such tContractors that check this boa must attached am additional sheet showing the'mmne of the sub-aMtractors and stare whether or not those entities have en9loyees. If the sub-contractors have employees,they must provide their Workers'comp.policy number. I am an employer that is prvviAng workm'co.r gmmation insurance for rrry enrpIoyee& Be1'ory is the padicy rind job site informifrt on. Insurance Company Name: Policy ft or Sel€ins.Lic.# Expiration Bate: Job Site Address: City/State/Zip: ` Attach a copy of the wwters'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MGL e, 152 can lead to the imposition of criminal penalties of a fine up to$1,500-00 and-or or one-year imprisonment,as well as vigil penalties in the farm of a STOP WORK ORDER and a fine of up to$250M a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the MAL for insurance coverage verification I do hereby ceWfy under the pains and penaMes ofped ury that the in�fornrat en provided above is true and correct Date: Phone#: Official am only. Do not unite in this area,$a be completed by city or tome official City or Town: PermitUcense# Issuing Authority(circle one): 1.Board.of Heal& I 1 wilding Department 3.C ityrrown Clerk t Electrical Inspector 5.Plumbing,Inspector b.Other Contact Person: Phone#- F.. _5,0 888-0354 508-728-9080 L.A.WINSHM CONSTRUCTION COMPANY Residential Commercial 'General Contracting 33 LIVINGSTON DR. PLYMOiJTH 92360 cd I/We hereby contract with and authorize you as contractor,to do all of said work, according to the following specifications,.terms and conditions below described; sw llelel� Name Mr. and Mrs. Estaphan Address 6.Elm st. City Douglas, Mass. Phone 774-280-0266 Job Address- 136 Ralyn rd..Cotuit,Mass. Specifications:' 1. With Alcoa brand custom aluminum trim in cameo- cover corner boards in rear, rakes and returns-on sides, fascia-soffit and frieze to rear and sides. 2.Furnish and install new.seamless aluminum gutter and pipe in cream to rear of house.. - 3.'Contractor to fbi-nish(building permit. •Total Labor and Materials $ 3,153.00 Deposit needed $ 1,000:00 Contractor will do all of said work in a good workmanlike manner. It is understood that the Contractor is covered by Workman's Compensation and Public Liability Insurance . Customer agrees that in the event of cancellation of this contract before work is started,Customer shall to Contractor on demand twenty-five percent (25%)of the contract price as liquidated damages for the breach: No work to be done on this job other than that specified in this.contract without additional charges. All verbal or written agreements not mentioned on the face of this contract are void,and no salesman has any.authority to change,alter or add to this . contract in any particular. . This contract contains the entire contract between parties. A copy of this contract is hereby acknowledged to be received: This contract is subject to strikes,accidents or other,delays beyond our control:. - N WITNESS WHEREOF,the parties have hereunto signed their names this..:....:.l..Gr....... . .... y of.. :...a ....:..2012 ............ Accepted: Signed. . .. L.A:•WINSHW EJOiVSTRiJGTIOIV CO Signed.................... ::.. Customer Signature per: ... . Representative or Contr or t CiC_ L _ O L,�.L �2(�Y) g�'— j,11 S i ?-r►'I w i'� �`^` c �` � � s �c: $ T. tvi. is i Q (�' 'L' Raw a . License orregistration valid for individul use only ✓� 'e �� tiv �/ if ac�u�aelta Office of consumer airs u mess. egulat�on before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR 71 Office of Consumer Affairs and Business Regulation = Registration: 1,44456 Type: fir. 10 Park Plaza-Suite 51'0 r Boston,MA 021.16 Expiration 10/4/2014 DBA W IP CONST,,C© — / LANCE WINSHIP . ++ 33 LIVINGSTON DR :� Not valid without si nat } PLYMOUTH,ma 02360 = g g [ v Undersecretary Ma ssachuutts-.Dcp:utmutt cif publicSafctN 10- masBoa tl ot• Buildin" Re�llulationS and Standards 4 Construction Supervisor License License: CS 69916 ' s 6. LALI A.WINSHIP A"g ... a .' .. - ,• 33 LIVINGSTON DR �' a PL`?MOUTH;MA 02360, `` r Expiration: 4/6/2013 I M Tr#: 15471 f,� Town of Barnstable aP it(P L2 IT Q„ Fapires 6 months from issue date Regulatory Services Fee BUM snxxsrna�e, 1639. Thomas F.Geiler,Director �A Building Division Tom Perry,CBO, Building Commissioner �°l1• 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number t Property Address `,.�(o Q OV(.._yN R n C c,— u CT— i [ Residential Value of Work. 7 000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address G�.rvl '► i O/ 1CA Contractor's Name N Iry Telephone Number 77 yL2jo Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance ,, '�x Check one: PERMIT ❑ I am a sole proprietor �., ® � I (� I am the Homeowner 2011 LJ I have Worker's Compensation Insurance F - O BARNS l AB r Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) �$( Re-side l � #of doors _ Replacement Windows door sliders.U-Value (maximum.35)#of windows --- *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is e uired. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 _ The Coninionwealth of Massachusetts Department of Industoal Accidents lt�,JV- Office of Investigations 600 Washington.Street Boston,MA 02111 wdww.mass:g v1dizr Workers' Compensation Insurance Affidavit: Baders/Contracturs/Ek-.c.triciansfflumbers APpficant Information Please:Print Legibly Name(Budm flF7z ftovbdivld=0: 1 Address: 13 (L✓�-L.`>ry {Lo City/StateJZip: 1T,— MIA,- Phone##. 7 C) CZL-L Are you an employer?Check the appropriate boa: Type of project(required): 1.❑ I am a employer with 4- ❑ I am a general contractor and I employees(full and/or peat-hime)- s have hired the sub-contractors 6- ❑New construction 2.❑ I am a sole proprietor or parer- listed on the attached sheet: 7- ❑Remodeling ship and have no employes These sub-contractors have g- ❑Demolition working for me in any capacity- employees and have wodoers' [No workers'comp.insurance comp-insura mi 4- ❑Building addition required] 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions 3X I am a hameowrter doing all work ollioers have exercised their I L❑Plumbing repairs or additions myself[No workers'comp, right of exemption per MGL 12_❑Roof repairs insurance rewired..]1 c.152,§1(4X and we have no employees.[No workers' 110 Other comp-insurance required.] Any apphc=that checks boat#1 0"aLo fill out the section below showing their vioskets'oomtpensatiompolicy infonmiam. Hommviners vrho submtit this dEde;rit iabcatcag they are doing all woik and then here outside contactors m avt subunit a new affidavit iedicatmg such rContractors that check this bo E must attached an additioad sheet shoves the nave of ibe sub-co=acmors rind state whethEr cram those entities have emplayees. If the sub-contsctois have employees,they must,pmvide their watkers'comp.policy number. I am an employer that is provid g workers'cougmusatfon inwrance for my eurploswe& Below is the policy axed job site iuformatieta. Insurance Company Name: Policy 0 or Self--ins.Lic.#: Expiration Date: 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 2.5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisorment,as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day aft the violator. Be advised that a copy of this statement may be:t'onvarded to the Office.of Investigations of the DM.for imummce coverage verification. I ado hereby certa;� the rta�es a�f peayak►y that the infou nzatio proW ded a.bosw b tnwandcorrect Signature:. Date: Ploane#: 77L1 Official use only. Do not write in this area,to be completed by city or tmm offl" City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Town of Barnstable Regulatory Services RUMSTABa MASS. Thomas F.Geiler,Director 16,jg. 1� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: gA t . AJ (1 0 number street village "HOMEOWNER": N7F�? name home phone# work phone 4 CURRENT MAILING ADDRESS: 6 e5l_wl r T° DouGuA-s nna- 0fr/61 city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 1.09.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable.Building Department minimum inspection proced r an requi a en and that he/she will comply with said procedures and requirements. Signat ofHom owner Approval of Building Official Note: Three-family dwellings containing35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions,of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. ` To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 ;4 oFtKKE r� Town of Barnstable erm�"P i Dqq Expires 6 months from rss date �3 Regulatory Services Fee * r r • BARNSTABLE, * . 9cb 9. Thomas F.Geiler,Director iOlEv Mar" V"Building Division g Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 01,;�- f 0 1� Property Address R Q(_yN IZ-0 A 0 Residential Value of Work 30 13C> ,-Q6 cJ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S��QM}�1� P - 'Zc� J1°�, (E�S __Ty' l 44-J Contractors Name ly A Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) X-PRESS, ❑Workman's Compensation Insurance Check one: T 20py El am a sole proprietor I am the Homeowner TOWN OF BARNSTABLE ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) Re-side 4._ilii�ty l4�,la�t -1:ip o i= D^Izso �lcufl,5l' ct. i #of doors fUr Replacement indow /doors/sliders:U-.Value S J�VOR_L4"((maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is �e ire SIGNATURE: F C:\Users\decollik\AppData\Loc icrosoft\Windows\Temporary Internet Files\Content.Outlook\4STGU5QO\EXPRE.SS.doc Revised 090809 4� �4IN The Commonwealth of Mcissachlls'etts De a titient of Inditsuial Accidents i� P. U. Office of Investigations ^_ 600:Masiliiington..Street Boston,,M4(I.�III f twit.inass.gosldia Workers' Compensation Insurance:at ffida-vit: Builders!C-ontraCttst's.'Elect-ieians,°Plufiib rs Applicant Iuftltmat on p Please Print LegibI3 Name(Busines,3iOrgm izationlln&tidual): c�i ��e'� i `es tW Address: 13 G R.4tY/V Gity'State,'Zip._C d i� I -% M 4 c> Phone,: .SZ) Arr you an employer?Check the appropriate box: T�ge of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I � �New jeccont(required) employees(full andloi part-time).* have hued the:sub-contractors 2.ElI am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling: _ ship and have no employees The:e sub-contractors have 8. ❑Demolition working for ine in any capacity, employee,acid have workers' 9 0 Building addition [No corkers'comp.insurance comp.incuxran>ce:� ' ❑ Ne.are a corporation and its 14.❑Electrical repairs or additions required.] 5. 3 I am a homeowner doing all ivork officers have exercised dies 11.Q P1umhiag,repairs or additions myself. right of exemption per i�•iGi ? 1£.�o workers a 12.❑Roofrepars, insurance required), c.152,y 1(4);,and we have no employees.[No workers.' 13.0 other comp.insurance required.] •.dap appti:atrt taa?checks bo%� #1 must also compensation polio.information- 1 Homeowners who mbrart tshis affAnit in&csting:they are doing_all rots and t'aeakre outside contractors nrim stihmil a nets affidat•at indi.catiae such. =Cautracroes that check this box m-uM attached an additional sheet shoirs'ng.the miarne of ttte sub-co=mctors smrd state srl:ether or not those eatitie lave employees. If the sub-contractors have employees,they mustpiovide their workers'comp.policy number. I aemt am emnmp aver€lent izprt7i'itlitng ifrRr er:Sr C'Ot)tp@ffS(llLpft IfiSIIY(f11CB 0Y ilfb'e►mataIrrtxE;ers. Below is the pvlicY grid job site itmfornrmrntionm. • Iw rance CompanyNarne: Policy w or Self ins.Lic.R: Expiration Date: Job Site Addre-ems: C tate Zip: Attach a copy of the workers'compensation policy declaration page(shoning the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the impo,ition of criminal penalties of a fine up to.$1-,500.00 and`or one-year imprisonment,as well as&M penalties in the:form of a STOP 1,11ORK ORDER and a fine of up to$250.00 a da_y against the violator-_ Be advised that a copra of this statement may be femarcded to the Office of Incest gatiorms of the DIA for insurance coverage verification. I do hereby certif a 1der the p 'ea ned pr*nnaltmes of petj terty that the in►forniatiare provided above is trite and correct. Simature. ��}, Date: /O v Phone : SDI(�' (� �X6 Oricial.use achy.: Do not write in,this area,to be completed by city or tosvit official: City or Town.: - PermitlLicense># Issuing Authority(circle,one): 1.Board of Health ?.Building Department 3.CitvrFoi%u Clerk 4l Electrical Inspector 5.Plumbing Inspector fi.Other Contact Person: Phone?l: °Ft ►°,,, Town of Barnstable Regulatory Services " BAMSPABLE, ` Thomas F.Geiler,Director y MASS. g 059. ,` Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 77r JOB LOCATION: / J(P Rv-ri.. N R D GOTV cr m A number street village "HOMEOWNER": SZ1G�N 'C"1�I �S7 �t 77 y,Z80 O 2.6 SW i9®J71(o ` n m home phone# work phone# CURRENT MAILING ADDRESS: S T— oL) L-A:R-: cry 01 ��?� city/town - state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow' homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section, 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The u de ig ed"ho er"certifies'that he/she understands the Town of Barnstable Building Department minimum inspection proae requi s a -hIfis'he will comply with said procedures and requirements. i Homeo r Approval of Building Official " Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code• . Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION ; The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner ; certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community: C:\Users\decollik\AppData\Local\MicrosoR\Windows\Temporary Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 a oZ oFt►+etOw Town of Barnstable *Permit# Expires 6 months from issue le Regulatory Services Fee A l g 2-.aj + BARNSTABLE, /� v� t639, MASS. 9 Thomas F. Geiler, Director Srb�a wO��- o--loLL AlfD MPt eh Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number_ _C)2,0 01-7 Property Address f 3 / VOLI I ( n P Y —[��lra V� I VG1 j' CC� C> y'1/� ❑ Residential Value of Wort. UUU Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address :51e e_1/l �q hQ Lf C/� Contractor's Name rNrj�� �1G�� I vC.- t�tn �iJ/. Telephone Number I lome Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable)�.� 6 M / C ❑Workman's Compensation Insurance ®PRESS PERMIT Check one: NJ I am a sole proprietor APR 2 8 2009 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BARNSTABLE 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 -gou;rt'L e, L �� ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. `Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: �r ✓' Phll.LS\F0fZMS\building permit forms\EXPRESS.doc Revised 100608 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): r/_ �(�{ co Address: �_ L-rr(J L'tR City/State/Zip: t Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I employer with . • 4. I am a general contractor and I 6. ❑New construction ployees(full and/or part-time).* have hired the sub-contractors ..2: I am a soleproprietor or partner-' listed on the attached sheet 7. .0 Remodeling ship and have no employees These sub-contractors have 8.'0 Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'•-comp.-insurance comp.insurance$ required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEJ 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. *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-contractor;have mployers,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: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure fo 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 covers a verification I do hereby certify under the pains•and penalties ofperjury that the information provided above is true and correct Si e: Date: Phone Official use only. Do not write in this area,to be completed by city or town off-ciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and In Atuctions 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 engag m a�our n rpris` eta =inEd— gtlie leg-represehifa7ive-b�f- deceasezi�mpi rthe=._--- - -" '--- receiver or tiustee of an individual,partnership,association or other legal entity,employing employees.-However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a'business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C( )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 inraqce requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),-address(es)andphone number(s) along with their certificates)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be'used as a reference number. In addition,an applicant that twist submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all-locations in - (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for fiiturE permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtainer a license or permit not related fo any business or commercial venture (i.e.a dog license or permit to born leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Dgmrbment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext-406 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia aoae.aaslulwpd f; 09£ZO Bw'HinOIN ld .- aan;e Is;noq;ln�pile^ION \2�p NOlSJNIAII£E _ Mdl --- -- ----- `E'�dIHSNIM 30 R bOASNOO dIHSNIM i �Lb8t7 adli SOLZO'eI4i`UO;SOg LZ09LZ #11 0WZ/4/ l�uoge�idic3 IO£i WH aaeld uo;anggsd aup 99b441e�3sl6aa spaepue;S Pug suol;eln2ag Sulplrng;o p.aeog NO.Lo IN001N3W3AOHdWl3WOH :oI uan;aa puno3lI.'a1nP uol;elldxa aq;aao;aq sae ue us spoge n2a Sup �n Oq 8 Cluo asn lnpinlpul ao;pge^uol;ea;s1Saa ao asuaalZ e� oy Public Safe"" Massachusetts- o Re- l t ons and Standards Board of Building Re a isor License Constru6ton Sup 69916 Ljcense. CS e 3 Restricted to �� Y �1 R LANCE A WINSHIP 33 LIVINGSTON DR PLYMOUTH MA 02360,p ;t Expiration: 4/6/2011 Tr#: 14331 ('ommissiuner . I 988-0354 1-800-287-0354 �X L.A.WINSHIP CONSTRUCTION COMPANY Specializing in Vinyl Siding-Custom Aluminum Trim Residential Commercial Home Improvements General Contracting 33 LIVINGSTON DR. PLYMOUTH 02360 CONTRACT I/We hereby contract with and authorize you as contractor,to do all of said work, according to the following specifications,terms and conditions below described; Name Mr.and Mrs. Steyeq Estaphan Address 6 Elm St. � City Douglas,Ma.ffe/eil Phone (774)280-0266 Z Job Address: 136 Ralyn rd. Cotuit, Ma. No Additional work shall be done, except as herein specified and expressly agreed to in writing by the Contractor. Specifications: 1. Remove all old roof shingles from complete roof and remove from job site. Cover complete roof with an ice and water rubber underlayment. Repair lead flashing around chimney. � l ' Furnish and install a Tamco brand 30 yr. roof shingle in 0i ....! ..... to complete roof. Furnish and install new vented aluminum drip edge and ridge roll vent. Total Labor and Materials $ 10,400.00 Payable: 1/3 to.start 1/3 half complete 1/3 at completion �r3-466-9A• �J�, Contractor will do all of said work in a good workmanlike manner. It is understood that the Contractor is covered by Workman's Compensation and Public Liability Insurance Customer agrees that in the event of cancellation of this contract before work is started,Customer shall to Contractor on demand twenty-five percent (25%)of the contract price as liquidated damages for the breach No work to be done on this job other than that specified in this contract without additional charges. All verbal or written agreements not mentioned on the face of this contract are void,and no salesman has any authority to change,alter or add to this contract in any particular. This contract contains the entire contract between parties.' A copy of this contract is hereby acknowledged to be received. This contract is subject to strikes,accidents or other delays beyond our control. IN WITNESS WHEREOF,the parties have hereunto signed their names this..................:..... ...... y o . . . .....:: .. ....2009................... Accepted: Signed.. . ..... ..:........... ..... ........ LL.A.WINSHIP CONSTRUCTION CO. Signed....:...........................................:.............`... Customer Signature Per............................................................................... Representative or Contractor / / 7 FEE 1.516 c� �b v csdw ° + WN OF Al yawm d a)o 52 S/. 19 p 4)) pq o� � THIS IS TO CERTIFY THAT A PERMIT I� HEREBY GRANTED TO � o r IPROP[RTY NER)Y I IADDRE981 10, To O N (ALT[R) (REPAIR) W (BUILD) . .03 _ .G O (TYPE OF' L G) (APPROXIM [ 19) N~ SON Vyb O LOCATION (BTR[ET AND NUMB (VILLAGE) �wP4 D. NAME OF BUILDER Oft CONTRACTOR i`APPROXIMATE COST ____ >.22 OLD y N 00 ad Mw I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN r~ oM c.5 OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. W Q cis CO 93 . R " I (OWNER) ICONTRACTOR) O ~Oi V 4! -1 BUILDING INSPECTOR Subject to Approval of Board of Health. e S -• SEINIOR CEIuTER TOURS AhD TRIPS FLOWER SHOW -- Thursday, March 1$. Cost: $10.50 (includes bus and admission . Bus leaves West End Municipal Parking Lot, corner of North Street and Bassett Lane, promptly at 9:00 A.Fi. Standby reser- vations only. WASHINGTON D. C . CHERRY BLOSSOM SPECIAL -- April 1 - 4. Cost $189.00 double occupancy, includes 6 meals and sightseeing. Standby reserva- tions only. 'BOSTON BUS TRIP -- Tuesday, April 20, 1982. Cost: $7.25. Bus leaves West End Municipal Parking Lot promptly at :C�, .0 A.M. Leaves Boston at 4:00 P.M. (Please note change in time due to Bridge repair) . 'Y Call Center for reservations. Tickets must be paid one week in advance. z °0 q IiWuaa XH MAP U IP JAFFREY NEW HAMPSHIRE -- Thlg� Cos4jVj ? vMgO&imS1uqes bus, guided tour of historic t visit tgsPgnXqphnsonts Sugar House and luncheon at sZI000 Woodbound Inn -- choice of Yankee Pot Roast or Bak il llilgHggdMk� ) All taxes and gratuities included. Call Center for reservations. TEN-DAY CRUISE -- S .S.ROTTERDAM -- Flay 4, 1982 to Charlotte Amalie, St. Thomas, Philipsburg, St. Maarten and Bermuda. Cost: $1425 .00 per person. Brochure available at the Center. STURBRIDGE VILLAGE , Thursday; May-120. Cost: . $24.50 (includes full course buffet, admission _and •bus)'. __ Call- Center for reservations. WORLD--IS FAIR KNOXVILLE TEhhESSEE -, June 7. r . Cost $499. 00 double occupancy; ,. 449.00 triple; and 29:.00 single. - At this time, standby reservations only. NEWPORT, RHODE ISLA11D -- Tuesday, June 22. Details next bulletin. NOVA SCOTIA� AND: PRINCE EDWARD ISLAi4D ,June 27. Six days., Cost:j 349.00 . ouble occupancy; 319.00 triple; 4449.00 single. Deposit of $25.00 per person due March 12. Standby reservations only. Due to the tremendous..response, there is the possibility ofiasecond bus . ,. TFUTURE TRIPS are being planned to the. ISLAND OF HAWAII 'and to IRELAND. provided enough interest is shown. V S