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HomeMy WebLinkAbout0471 SAMPSONS MILL ROAD '{7/ Sompsods ACTIVE Cape Save Inc. 7-1) Huntington Avenue South Yarmouth,NL4,02664 Tel: 508-398-0398 Fax: 508-398-0399 8/30/18 Brian Florence CBO Town of Barnstable ` Building Division Qn 200 Main St. a Hyannis,MA 02601 CD CA RE: Insulation Permit 18-1677 Dear Mr. Florence: This affidavit is to certify that all work completed for .iam Rout has been onkiC inspected by a third party Certified Building Performance Institute (BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey , ,. Town of Barnstable BUlldln * eexxsxee»e r Past This Card Sa:That rt is l�s�ble„From the Street •_Approved:Plans Must bed, etarn'ed an lob and this Card Must be;Kept Final Ins ection Has B`eeri Made Posted Until;. p Where a Certrficate:of'Occu an is Re u retl suchBuildin'>shall IVot be;O„ccu ied urtt>I a Final Inspection fias-been made Per, mit Permit No. B-18-1677 Applicant Name: William McCluskey Approvals Date Issued: 06/13/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 12/13/2018 Foundation: Location: 471 SAMPSONS MILL ROAD,COTUIT Map/Lot: 039 149 Zoning District: RF Sheathing: S.21 � . Owner on Record: CHARMS,MARGARITA M Contractor Name. WILLIAM J MCCLUSKEY Framing: 1 Address: 30 SUMMIT AVENUE ContractorGcense: CSSL-102776 2 v . BROOKLINE, MA 02446 Est ProJect Cost: $5,000.00 Chimney: Description: Add R-38 fiberglass,.R-37 cellulose, R-28 cellulose,R-10 rigid Permit Fee: pg, $85.00 Insulation: insulation,and R-30 fiberglass to the attic.Air,seal the attic plane • and basement with expanding foam. General wea�theiizat on Fee Paid; $85.00 ,Date ,.. 6/13/2018 Final: Project Review Re Plumbing/Gas J q: •, A... Rough Plumbing: Building Official final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized,by this permit is commenced within six months,after issuance. Rough Gas: " . All work authorized by this permit shall conform to the approved application a,nd the approved construction documents for which,this permit has been granted: r Final Gas: All construction,alterations and changes of use of any building and structuresi ha[F156 in compliance with the local zoning`byaaws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical 37 The Certificate of Occupancy will not be issued until all applicable signatures by the Building and F e Officials are provided onthis permit. Service: Minimum of Five Call Inspections Required for All Construction Work:,, ' Rough: 1.Foundation or Footing 7, 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: . "Persons c acting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued 1 . 712.b4(s Conservation Division Application Fe4&50 ,(r) Planning Dept. Permit Fee j,I ' 0 D Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address '7/ V Ilage �/ T Owner � u Address Telephoner 6 J �7.3 Permit Request ``�e`j o�i fir✓ el �-�� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project°Valiaatio 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: I d Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) d Basement Unfinished Area (sq.ft) V Number of Baths: Full: existing 2" 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 811 Oil ❑ Electric ❑ Other Central Air: ❑Yes ONo Fireplaces: Existing New Existing wood/caoal stove-,,A'�'s ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ eisting 0 newize_ Attached garage:Aexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: e 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 t elehone�Number Address 4e'nse # Home Improvement Contractor# Email J 0-"J'9' Co"7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIG MAT U CE - " DATE I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. g - ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME • F INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �Z) . DATE CLOSED OUT ASSOCIATION PLAN NO. .OW10L ot-Barnstabie Regulatory Services of r Richard Y.Scab,Director °4 Building bividon r BEAM Tom Perry,Binding Commissioner .�� 200 Main Streit, Hyannis,MA 02601 WOW barmfiblenin US , Office: 508-862-4038 Pax 508-790-6230 HOAMOWNERIICEMEXEMMON Y ?/ �g_rocAnOli� 7 �i9� fob �j� iL M _ i name G ' home phone 4 WO&phe# CCJRRENT MAMNCT ADDRESS aty/bown � a� zip code _- --•—-•----- III 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_ DEFiNMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or iuutrnds to reside,on which there is,or is intended to be,a one or two- family dwelling,attujched 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 flu Building Official on a foam acceptable to the Building Official,that he/she shall be responsible for all such work performed under the bundfiz pm k (Section 109.1.1) The undersigned"homeowner"assumes responsib0ity 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 ofBaunstable Building Department mmimnm inspection pro an and that he/she will comply with said procedures and requirements. �- ofHomeowner' Approval ofBwldnig OffQal _ Note: Three4mily dwellings containing 35,000 cubic feet or larger wM be required to comply with the State Building Code Section 127.0 Constroctoa Control. HOMEOWNER'S E%E11 MON 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.Ll-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 responsbiMes 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 Myawam of his/her responsbrTitier;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/certitication for use ia, your community. Q:1 dmgpmmithmalERPRESMoc Revised 061313 • • Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division ....._.... ._. Tom Perry,Building Commissioner 200 Main Shret,l3yan3is,MA 02601 www.towmbarnstable ma.us Officer 508-862-4038 Fax: 508-790-6230 41 Ilk 1 �...: Prope4 Owner Must z' omplete and Sign ThissSe tton' } If Using;AB lder L s Owner of the subject PmPerty hereby authorize to act on my behalf; in all matters relative to work a bydh s building permit application for. (Address of ) ,"Pool fences and Msare the respons of the applicant. Pools are not to be filled K utilized before fence installed and final inspections are perfo d and accepted Signature of Owner Signature of Applicant Punt Name Print Name Date i J Q.L-V34M&OTfi\G«ii'iLWlia7a7MIMOL7 i De-pw*nent nfLWfim &Acrsdarfs 007M affiiv ons 600 Wohngtm Sfrred BesMty HA 02M wmP m=gnv/fiia . Work=' Compensation Insa=ce d_ ffid Bm-Hers/Cont-=brs0ectidans/Plm hers Aioniicant Information Please Prnzt LeEffily 4-7s�.� `- i you an employer?Cherk1he approFiatebo= ' Type ofprojecE(required): I.❑ I am a eatploper wI& 4. [j I am a geoeal cot�tradnr and I ] ca3sh=dm emp]ayees(fnII and/or part time). s have hired the mAH=mhuctom 6. ❑New 2.Q I am a sole proprietor or partner- listed on 1he attched alert 7. ❑RemndcHng sbip and have no employees Them c6o¢s have 8. []DeozoIiiiau worl�g forme m say capacity. =PIDYM and have Wmlc=, 9. BmZdmg addition Lisa wmkm'=33p•InWiMCanCC CMMP'fiLMrM t regained]�� 5. We am a corpmatim and its 11 Mect icalrmpairs or addict= [�3 I ana-a-homeowner dcdng an wank` oTm=have exercised&* IL[]p]ambingrePairs or additions xaysdt o �. .. . of1( wPQMmno U❑�f�� -1 13.❑Off= =ap.insmareqnfied-) *tsny eppTicartttmt a boxi aagt e1� oatEu:crsloa bclogt sbawmgtbca wosina' policy mf�ea tSnmwvenrawhos kisa�l `mdiatmgtgzmdoinginvP�c®dtbeabaemdsidnw�aetoaumsts1$enewafndVk;ndir gsne� a es fE�ehecicib" box naafi ate en add offiI sbctsbowmglbe acme afthe sub�ahadna�d sly wlu3ha ernottbose pia hm earplayas. =3pb y=k tbay mast pay &t5aa WMJC= comp.po&7 aamb= I am ax anph ya•that is pnnddmg tvark a eonp=affan baur =far my ra:playem Below is the policy and job site . u fornration. , Insmn m Company Name: Policy#or Self-ins Uc.#: gxphtionDem COSib.-Mdffi=— �/*• /�����f �� ( ylStatelIp: �- 7V17 d AttaJi a copy of the workers'cmapeasation policy decTasation page(sho tQmgtlu PoHry ntmaber and e3#rr ion data). Fmhm to seczttm coverage as regnard ffider Soctim25A ofUM ct 1.52 cna lead to me imposifian of crlrnmal penalties of a fee tip to$1,500.00 and/ar one-year aapris—cut as wen as civil penalties in Ste term of it STOP WORg ORDER and a fee of vp to$250.00 a day against the violater. Ba advised that a copy of fiis stahmo may be fuwm'dcd to the Office of hivmdgad=of the DIA for fimmmm covrlagm ve ifca ion. I do ha eby render the pabztti d maWes of Y � r d above is Niue and cojTrzt S' /_ -1-37 -2-'b 45--: Phone#: Q ffdd use only. Do not wry in flits area to be complied by city or tom oj7doL Chy or Town: pP,r,,►vtfr�r �. —][swing Attfhorifip(circle ono): _ _ - L Board of Health 2.BuildingDapartment 3.CRy/Town Clerk 4,Xlec[rical7aspecbor. S.PlanibingInspector 6.Oilier Cat�ctPetsoa: Phoned . S Information and Instructions Ma=d=etts Gewral Laws chapter M mqm=all employers to provide wad='campeasat=for fl=employees- . this an re is&&tined as=-every msanm.&a srrvice of a w&wuader may ca¢daact ofhire, Parsuaatto sty, �P�J' P express or fa3plied,oral or wrhm." An aFtoyar is defined as"ea individual,partneship,associaficm,cmporatiom or oilier legal cm ft ar any two or more of f9ie:foregoing mgeged m a joint eabgdv4 zmd iffi repmmt3fim cf a deceased employer,ar&e receiver or trustee.of an inch kInal,p association or otlrt Iegal entity,employing employers• However the S owner of a dwmIbg house having not mere than three aperiine�s and who resides �e occupant of$e- dwcM3ghouse'of®oSie<wlio employs pens to�." ,constra�tcn=or repairwarlc art such dwcM3ghouse or on sire or boz7dmg herein shaIlr of because of srch e¢�l.ymet�be deemed in be an employer." MGL chapter 152,§25C(t7 also states i t"every state or locsI licensing agency shaIl withhoId the issuance or renewal of it license or permit to operate a business or to construct buildings in the mun onwealth for any applic$ntvvho has notproduced acceptable evidence of cdmplianm with the hma-anceL coverage requlr - AddmunaIIy,MQ,chapter 152,§25CM states"Nei bra-the cammoaweslth nor any of its political sob.divisions shall ...... enter into any contact for the pm fmmlm=ofpnbho windmill acceptable mdeaw of ca a with the msarance.• requserae;nfs of this chap mhave Bern presented to die caIracdmg m ffi &y." Applicants , Please fill out the wm i= 'compensation affidavit completE y by rhmidng the barns flat apply to yomr sitoaiion.and,if Amy,sWply r(s)nmne(s), addresses)and ph=ntm m(s)along With their=tficate(s)of insurance. Limited Liability Companies(LLC)or Lmmitzd Liability Partataships(LIP)wino employees other then the members or partnc s,are not rega hd to cagy wadcc 'compensation insurnace. If an.LLC or LLP does,have employees,apolicy is regohed. Be advised thattis affidaykmaybe submitted to the Department of Industrial Accidents for arnfirmatam offasmimce coverage. Also be sure to sign and datethe affidavit The affidavit should be re m ned to the city or town that the application for the permit or license is being regaeshA not the Deparhneaf of lndzistriaI A ccidenfv Shouldyou have any questions regarding the law or if you are required to obtain a wiorl=s' campensationpolicy,please call the Dep I I at the m=ber listed below. Self-fnsRired cro:(panirs should miter their self-fnsrance license number on the approprfatie line. City or Town Officials Please be sure flat the affidavit is camplet m and priced legibly. Ue Department has provided a space at the bottom of iize afhdav$fur you tr fill out in the event the Office of Invesuga[icros has to confect you regarding the applicant: r ; ,Please be sure to f�l hiA6 pmmitAIcense number which will be`nsed as a refe eace nmmber:`7n a3cibion,an applicant Id mmst submit multiple permWHc;;=se applitaions in sap given year;need only kabmit one affidavit indicating cturent policy informatia m(if nxessary)and under"Job Site Address"the applicant should writs"all locations in (city or t owq)."A copy of ft aff davit flat has been officially stamped or narked bythe city or town maybe provided to the applicant as proof that a valid affidavit is on file for fieroust pmmits or licenses A new affidavit t be filled out each year.Where a home owner or d671-a is obtaining a license or permit not releted to aay business or commercial Ventre (ie-a dog license or paint to Baoileaves etc-)said pew is NOT regolred to complete this affidavit . The Office of I!avcsflgafi=wouldlilaa to thankyouin advmzce foryoar cooperation and shorldyou have MAY questions, please do not hesitate to gips us a call. The Depertment*s address,telephone and fzx number. Depa f m tt oaf lndt€s[za1 Arts mice of javesagati= Basta.MA 02111 .T-L,#61'-M-49W czt 4€l4 4r 1-&77 MA3SAFE Fa#617 727 7749 Revised4-24-07 MaS9 Pylda ,7A) 711, : ... . :. .... . .. .... �S`po I ...... ...:... e y y F `Lq 3Z � : - r- •n, r l al a .....,. .i:.... ...:... ,,:i 1 J-- y 1 - - f 40, � �° ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# q Health Division ��-3 7� 01 —eQ Date Issued Conservation Division �� �8 Iq Fee - 5-Tax Collector © �+c—"i-e-cam, r A-w SEPTIC SYSTEM MUST BE Treasurer 7 ��� 1 INSTALLED IN COMPLIANCE WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address 71 Village Owner &ke �� �1�� �J J" Address Telephone �, �' TU - 0,kyC Permit Request ,f°tA A /_'O 0.0` /fie- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new .S'L�`"t Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size A Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family j?" Two Family ❑ Multi-Family(#units) Age of Existing Structure IS 9 Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: Gull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing CP_ new Half: existing new Number of Bedrooms: existing -3 new LL Total Room Count(not including baths): existing O new First Floor Room Count Heat Type and Fuel: ❑Gas 5'Oil ❑ Electric ❑Other Central Air: ❑Yes 9P16' Fireplaces: Existing New Existing wood/coal stove: &1es ❑ No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage: 216iisting ❑new size Shed:2'elisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes CRlo If yes, site plan review# - - - Current Use Proposed Use BUILDER INFORMATION Name 0 4"f-;"e Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO --SIGNATURE DATE66 FOR OFFICIAL USE ONLY l t PERMIT NO. DATE•ISSUED f" MAP/PARCEL NO. r ' ADDRESS VILLAGE ✓ OWNER_ DATE OF INSPECTION: t + r FOUNDATION t 'g FRAME 1 ' INSULATION FIREPLACE � f x ELECTRICAL: ROUGH `FINAL ' PLUMBING: ROUGH • FINAL r r GAS: ROUGH-- `` FINAL ` FINAL BUILDING .nr �• w7a DATE CLOSED OUT . - ASSOCIATION PLAN NO. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A- DATA i ^hl f_ vo 3-A 7 v yell r t I r I CERTIFY THAT THE • � �y��,Q rev-✓ ,4 SHOWN ON THIS PLA' N_IS ' Ar o. �a�• , .°✓. '. WSJ LOCATED ON THE GROUND AS INDICATED ` RO°IN DATE REGISTERED LAND SURVEYOR 81 ELDREDGE ASSOCIATES,INC. ` CLIENT CERTIFIED P U,j)T FLAN F NEERS - LANDSCAPE ARCHITECTS J08 NO. f (: NERS— LAND SURVEYORS �,�T bo ;,7/V ;' G DR. 8Y+ P�� 889 WEST I N MAIN STREET CHICp. ®Y+ ENTiERV"' ILLE, 02632 SHE ET OFL SCALE+ DATE+ ! y V N tt'8 PORCH` _ P t 3`6 x T8 rs a's s D u 27'5 x 13' stt _ era 28,1 ,i 461 �Y/'"�li � G�.f -•7 �4�!C lop.n ` � O f If�r J 1J•t.:i y �` o_C ' r 1! E 1� �' c5 sq - ,fir" n 3$�����-_ �."� ��� �£ �� r " - 4 �-7C � •�� _ r E , �i �Ori.C �l•/J res / ob , 6,Y1 i ne j } .3 4Oct.rW f # , 1 �'r�t�f1� � "'4 •� FEE VALUE WORKSHEET LIVING SPACE (2000 sq ft or greater) square feet x$115/sq.foot= (less than 2000 sq ft) j !VO square feet x$96/sq. foot= /3 y yG (affordable housing) square feet x$57/sq.foot= (4013 or low income) GARAGE(UNFINISHED) square feet x$25/sq.foot= PORCH square feet x$20/sq.foot= DECK square feet x$15/sq.foot= ALTERATIONS/RENOVATIONS OF EXISTING SPACE 0. cost=. . . . •• 00 Total Project Fee Value Office Use Only Permit Fee N. P rojcost i F,NME ram, „uszAB� ; The Town of Barnstable . MAM Regulatory Services �'�Eo;orate` Thomas F. Geiler, Director, Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: J�P-c:J'11-1 -r-0 4/°i'"'�'� " G.L . Estimated Cost Address of Work: '7' 7l Owner's Name: Date of Application: ����/ I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied E20wner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date , Contractor Name Registration No. OR Gig Date Owne ' ame q:forms:Affidav:rev-070601 `_ _'_1 The Commonwealth of Massachusetts �� — n� - Department of Industrial Accidents Office oflnvo$tigomoas _ t 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit !� Kam- C` name location: ci I am a homeowner performing all work myself. ❑ I am a sole r Zor and have no one workin in anv ca achy %/// /%�..... to er Providing workers' compensation for my employees working on this job. ❑ I an..emp Y P.. ... .. g 'cons Isn name::; address:: , • `_ hone# insurance co. ❑ I am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have workers compensation polices: the following w :7: . ....... .P.::::::::::::.:.:: ::...:::::::: ::::::::::::.....:::::::::.:::::::.:::::.....::::.:::::::::::::::.:.::::::._::::::::......::::::::,:::::::::::::::::::::.::::::::::::::::::. com an name ..:::. . :. ........:. . addresst x. oLcv lnsnraiiee ca: sn .:name: ax _.. address. _ :: hone ciX . ...... nsnrance cti.; 17 Fafimre to secure coverage as requited under Section 25A of MGL 152 can lead to the imposition of crhninal penalties of a fine up to$1,500.00 and/or one yeany imprisomnent as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a COPY of this statement may be forwarded to the Office of Investigations of the DIA for coverage verificatiom I do hereby certify the pains and nalties of perjury that the information provided above is true and correct Si gnature Print e L�` G� G lit GC�.1�!'! Phone# �^��'-'��` •�7".Q official use only do not write in this area to be completed by city or town official city or town perndt/license# ❑Building Department ❑Licensing Board response is required ❑Selectmen's Office ❑dneckif immediate ❑Health Department contact person: phone#; -� ❑Other 0avued 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. y An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or. building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its.political subdivisions shall enter 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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns Please be sane 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 pi number which will be used as a reference number. The affidavits may be ret uriiR to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions- please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Offlce of Investlgatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 °F IME The Town of Barnstable snxNsrnBLE, ��g Regulatory Services 9. rED►r A Thomas F. Geiler, Director Building Division . Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION , Please Print O DATE: JOB LOCATION: number street village .,HOMEOWNER': LG°�- Ltr Cce/ `tG��lIG SDI 2�' U� _S�bJ- —77l name G,( e phone# / work phone# 7 ' CURRENT MAILING ADDRESS: < //` . city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedur and requireme a ure of Home er 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 s Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN 7i0 t7NR Appeadia J ti " Table J5.2.1b(continued) Prescriptive Packages for One and Two-Family Residential Buildings Heated with Fossil Fuels MAXIMUM N MINIMUM ` Glazing Glaang Ceiling Wall Floor Basement Heating/Cooling Atea'(%) U.valuer Ceiling R-value' R value° Wall �bw � Efficiency' Package R value` 5701 to 6500 Heating Degree Days Q 12% 0.40 38 . 13 19 10 6 Normal R 12% 0.52 30 '19 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13 25 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 .25 N/A N/A. 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 0.32 38 13 25 N/A N/A Normal Y 18•/a 0.42 38 19 25 N/A N/A Normal j Z Is 0.42 38 13 19 10 6 90 AFUE AA '18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart,above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a ' / V Assessor's offioe (1st floor): •.... OO� CC�� TNe Assessor's map and.lot number ..."e 1......./....7........... ..°F Toy Boards of Health (3rd floor): ' Vsewade Permit number ... .. .-.37�...........................:-:. Z HASa9TADLE, Engineering Department (3rd floor):l , , y 7/ 6K - 'o ,"b 9. House number L / ...... °'°�o mar d`e APPLICATIONS PROCESSED 8:30-9:30 A.M. and-1:00.2:00 P.M. only TOWN OF BARNSTABLE BUILDI G INSPECTOR APPLICATION FOR PERMIT TO ..... ....!.. �4..' Q ...... . ...1../`-. ?��Cl,.:.................. TYPE OF CONSTRUCTION .............................��CG.. ....... ....�.... . .. ...L ........ ...... ............................ .................,97 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...........0.( .......'C).(1 40.......... -� ,�..........................�t�? 3. ................................. .......... ProposedUse ........Roo.p....................................................................................................................................................... ZoningDistrict .....................................................Fire District ....... ...................................................... Name of Owner nu..� .. .....*•. ..rl�.�"L� .!�....LegN!?.l.Address ...K..�C(.42q.... ....nr°...7-- Name l� �� to 6eAc co-1 �j > ................................ of Builder ..................40.!?4!Q/.`C-10!.�—S...............Address O / D C C CLK .y.14 w C].. / �. .:.........Address Name of Architect ....... . ..... :0%�..(..... .......... .. , . �.... ..........�. �j p,3�aa i6 cd.�c�,e� Number of..`Rooms oo .. .... s.............FoundationQX��o..-(00%/!1�....8..i.fw./ ...... .fl.". ��q .... Exteri or,Cla�.�00IW.fit°o��:.. !..5 �!( /C.. ..........................Roofing .. �J!�( �1...._�/1../.C1��/.e .................................. Floors �t�/�S-7iC2 ('Qr Q�W LcJ00t �6.C14.05� 4?..........Interior 5f1('l�Y.,/QO ' . Cr�7C'/� Heating ' ...................Plumbing Q lJa7�/i S v lauxc�/c�....R....a..... . ............. . /1)D Fireplace �, �`��........�CXx .j.�.T.(�.U^�' `� 7 o G O .... .Approximate Cost ...........;..().....�.:....... ............................... n�mnc..� p� Definitive Plan-..Approved by Planning Board ------l�r 19 a �. Area e Diagram of Lot and Building with Dimensions ,ftJv�"" Fee ............................................. SUBJECT TO APPROVAL OF BOARD' OF HEALTH 14. U � ' �3• GG<oge \ � i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .Name .... ...1 . ..................................... ...... .............. Construction Supervisor's License �/. ... LEONARD, RANDY C. & MARGARET M. A=039-2149 ✓a 3 No Permit for ....One...$..t.Q;C.Y........ ...........S.irig .......l.....e ... ...... Location ...LQ.t...#.6.Q..........1.7.1...SAMP50.n.%..Mill Road .......................Q.Q.t'U it........................................ Owner .....RcArkd-v...Q......&...Mr.g.ar.e.t..Z......Leonard Type of Construction ..FXame........................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ......July..............9...,.................19 87 Date of Inspection ....................................19 Date Completed ......................................19 FFocTMEro TOWN OF BARNSTABLE o BUILDING DEPARTMENT Permit No. ..30•9•6.7••••• n�wa F TOWN OFFICE BUILDING Cash ,,,,,,,,,,,,,,, �ou�R HYANNIS.MASS.02601 Bond ....X.......... CERTIFICATE OF USE AND OCCUPANCY Issued to Randy C. & Margaret Leonard Address Lot #60, 471 Sampson Mill Road Cotuit, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND,IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. , Aucjust..4!... , 19......88................ ....... ... � �'1................. Buildi Inspector 01WN OF BARNSTABLE,. MASSACHUSETTS BUILDING PERMIT - _ Q � �D�AJ TIE 19 y�A��yP'�E PERM I T' N APPLICA.N •••� Lr�T / (/t��l'l/l' %/_ � P�DR ES`_= c�flii//.] ,r ==////``ffj��j'7 .) (STREET) ICONTReCENSFI t�(Jt19 NUMBER OF ! PERMIT TO (_) STORY �.— DWELLING UNITS (TYPE OR IMPROVEMENT) NO. )PROPOSE() [!SF) IN c:J. .. AT (LOCATION) 7 I _).��/���,�:il•_-..� it-�ii -(. /�! l DIOSTRGCT — ----- (NO.) (STREET) _ BETWEEN _ — AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT —LOT BLOCK _SIZE ' BUILDING IS TO BE FT. WIDE BY FT, LONG BY_ FT. IN HEIGHT AND SHALL CONFORM IN CONST.RUC'T ION TO TYPE USE GROUP— BASEMENT WALLS OR FOUNDATION (TYPE) — REMARKS: AREA OR PERMIT VOLUME ESTIMATED COST - —_ FEE (CUBIC%SCUARE FEET) - ----_-_ - OWNER ADDRESS BUILDING DEPT. --- BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR pop. PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL 'APPPC;VFD PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE' INb c f)ONS ktQU)RECi r,j;. ...I. N FERMI T,S ARE REq UIP.E.D .FOR ALL CONSTRUCTION WORK: CARD KEPT _TED UNTIE_ FINAL;NS "E: TOM. HAS BEEN EFRMIT i ARE �L=_!`UIR e ND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION N PE TI TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPEC TION BEFORE OCCUPANCY. POST THIS CARD S® IT IS VISIBLE FROM STREET. —— BUILDING INSPECTION APPROVALS �— — —PLUMBING IN:_PECTION APPROVALS ELECTRICAL INSPECTION APPROVALS L -111,,. jv r HEATING INSPECTION APPROVALS. ENGINEERING DEPARTMENT OTHER1.; --'----.._..------------------'----"----_._-_-__ ._-_-'----"--._..._._ --' .._...__� i l \VOHK SHAII NOI PHO(I.II)UNIII Hill IN:PII, PERMIT 'N!LL BECOME NULi AND V I 010 IF CONSTRUCTION IN.SPrc:lluNS INUICAJE.0 ON TEuS c.'- u CAN h;: 'OR HAS APPROVED THE: VARIODUS STAGES OF I WORK IS NOT STARTED WITH!N Sl; MONTHS OF DATE THE ARRANGED FOR BY T•.:_EPHONE OR ;VRITTEN CONSTHUCTIOP PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. __i `` �-?7° C SYSTEM MUST BE .•Asse �pr's�,offige (1st floor): _ '�i�a,4 p� �i ®® pp� THE __ ////qq r .LL ED IN C®MPLI�►NcE �� tp Assessor's map and lot number ....� .....�7.. ........ Q., �♦ Sard of Health (3rd floor): ITS TITLE 5 Sewage Permit number ... ~. ���............... 9Ng/aaL �i®®E A�°O Z B9Bd9TGDLE. Engineering Department (3rd floor): eK� REGULATIONS '�0 639 •� if House number a` APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M.only B� TOWN OF � BARNSTABLE BUILD G INSPECTOR APPLICATION FOR PERMIT TO ... . �.�'.... S �, ... .. .... .................... rtJ 6 y� TYPEOF CONSTRUCTION .............................1.. ...................... ....1.7... 1�r .... ...... ............................ .............••- . 197 TO THE INSPECTOR OF BUILDINGS: The undersigned .h]e.rebyLapplies for a permit according to the following information: Location ........4D..(.........�f1.0..........-sah!!�I-`Ah,S.......4//...../ZQ(�..�.... �.TU..!.T......� �O ProposedUse ......../YA(, e...................................................................................................................................................... Zoning District Fire District ..........Q Name of Owner 1.4G!1lJ . .c�....* . r .... �'r .!.....44?q !./�°�ddress ...�..VC(,4!7! �....L.�lne.... lJe�1�S....../."! .... Name of Builder ................... ...............Address .0...l.:�.Iev.z r...1je44isy...�/.!.... Name of Architect V.X,.... ok&,,,....-L'�C.'.........Address x..lv7 ..... Fl�-4� �.�oo i C'®rtG2 ,... Number of Rooms ..............Foundation 1 1 �oo.m.. .....Q2...&Jks.. �X 6 �.......`...���...�.i�?.... Exterior / g/ g ...... ,�......� ... `!!Zg C'�G �C1af.�.�.c�Oti��.N..�!(.�!�. ..C-�...........................Roofing �/�. - .................................. Floors .7../I�.QcA.?1.a.ac.7............Interior .S.!LC'C�.Y..�4?C�..�'./OIC(5.7.C.'/�,r............................ Heating /trJJQ�lIy !�!�....................Plumbin C ...✓�ci /LS V /G1i,��(cY/(� o g /...... g ... ............................ .... D.:..!yl............. Fireplace ............. ,t?1C.e ......C. . ./Q. .......Approximate Cost ....7./,.O..a.C?.:.. ?. ?.......se,1:............. ..... __�pp-- Definitive Plan Approved by Planning Board ___ l��___19_b . Area ..... 1... ... .7"f Diagram of Lot and Building with DimensionsJ" Feet.�r3s �./�.... SUBJ CT TO APPROVAL OF BOARD OF HEALTH - svfs 0 � a1.33 M � s 369 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 9 Name ...... .LET .........r..................... .. ...... .............. Construction Supervisor's License p ........................... LEONARD, RANDY C. & YARGARET M. ' 30967 permit for ...One Store .-.R4 ; Single Family Dwelling -.r Location .....Lot #60 , 471 Sa mpsons Mill Road J, Cotuic ............................................................................... Owner Ra.ndy... ...M.........L. eonard .... ... .. .. . ..... .. .. .... .. Type of Construction name........... ........................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ....JiM1.1�...`9.......... .........19 87 Date of Inspection ... .1�9...U�...19 Date Compl ......:.19 to .....+' . .... $�5 , ' 1 ,�twE>o TOWN OF BARNSTABLE Permit No. ..'10.9.67..... BUILDING DEPARTMENT ""'T TOWN OFFICE BUILDING Cash .Nl 'roar HYANNIS,MASS.02601 Bond ....x... . 3 CERTIFICATE OF USE AND OCCUPANCY Issued to Randy C. & Margaret Leonard Address Lot 060, 471 Sampson Mill Road Cotuit, Massachusetts r US&GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT,WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED,UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND,IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 4 August..4.,....., I9......88.1..... .. ............................. Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT _ »1°T TOWN OFFICE BUILDING rya �°� 'aJ9• �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit #.. ©.�`f:.................................................... ....................................:.................. issued to i Wes (..�n...-.`T �� '��.. L...... {�... j?��� ................................................ Please release the performance bond. 1 ` CT r s � � . .i4 1r' 3®� r L.07" b0 I f.J) N, `D � L � T3� 1 If f, 2 2- Y 1 Sr I CERTIFY THAT THE f F• f.. SHOWN ON THIS PLAN IS �,�p��^ OF �qss i LOCATED ON THE GROUND ROSIN AS INDICATED c wl O l No c"� iAftUS GATE REGISTERED LAND SURVEYOR VY & ELDREDGE ASSOCIATES,INC. CLIENT I-�o�!�>>fl CERTIFIED PLOTPLAN ENGINEERS — LANDSCAPE ARCHITECTS JOB NO._] 2-B(� sr r __Lor b0 s/9/Y�SDiv•S �'i� I2G.PLANNERS— LAND SURVEYORS DR. BY , P�� IN 889 WEST MAIN STREET CHKD. BYt_,.__._ ,- 'CENTtRViLLE, MA. 02632 SHE ET_I OF_L_. SCALE$ DATE= ,4% 8I8 y •a: . a6 Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services FA ��-�RES P 1 1 Thomas F.Geiler,Director t" �6 Build.ing.Divi$ion Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TDVVIN1 )F BARNS 1���� www.town.bamstable ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PEWM APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press.Imprint Map/parcel Number ' 1 Property Address [Residential Value of Work i Oro Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 41 +1 e L u Ca sh Nen 0< Contractor's Name Telephone Number �� �✓� U Home Improvement Contractor License#(if applicable) ! �`T 3 f o Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Ch one: [�I am a sole proprietor ❑ I am the Homeowner ❑ 1 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) 14-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/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. ***N Property wrier t 'gn Property wrier Letter of Permission. copy f the Horne Im rovement ntractors License is required. SIGNATURE: Q:Fornu•ex mtr • P g Revise061306 �y -jHE, o ; Town of Barnstable. Regulatory Services y nsass $ Thomas F. Geller,Director ►9. Building.Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 w'v'w.to wn.b arnstabl e.ma.us Office: 508-862-403 8 Fax: 508=790-6230 Property Owner Mush Complete and Sign Th s.Section 'If Using A..Bu.ilder I, :Lu k�, ..����,V►�.�•Sk as Owner of the subject property berebyaut iorize to act on rn behalf, alf, in all matters relative to work authorized bythis building permit application for: !b) Signatu>of Owner. ate •. L�k-e. Lu e� �►e�ns�c Print Name Q10PUM S:O WNERPERM]S S JON - ' The ConYlrlonweajth ofMassachusezYs Department of)ndustrial,4ecidents Offtce of Investigations 600 W ashinAlton Street Boston,AIA 02111 www.rn ass..gov/die, Workers" Compensation lasurance,Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bi Name (Business/Organization/Individual): . U WVhQ,S' Address: .d-3 City/State/Zip: 0 _m5 P TAM Phone.1t: � 1� " 46� Are you an employer? eck the appropriate box: mP y I am a general contractor and Type of project(required):1.❑ famac to erwith 4. 41a loyees (full and/or part.time).* have hired the sUb-contractors 6• New construction2. 'sole proprietor or partner- listed on the'attached sheet. 7. []Remodeling � ship and have no employees These sub-contractors have g• 0 Demolition working for me in any capacity. employees and have workers' [No workers' camp..insurance Camp. insurance.# 9. �]Building addition required_] 5. [] We are a corporation and its 10-El Electrical repairs or additions -3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions myself: [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12'D.l�f repairs employees. [No workers' .13.0 Other romp.insurance required] , *Any applicant that cbeeks box#1 must also fill out the section below sbawing their Workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and tbcn hire outside contractors must submit a new affidavit indicating such. INntractors that cbcck this box must attached an additionalshect showing the niuno of the sub-contractors and state whether ornot those entities have ernployees. If the sub-contractors have eoiployces,tfiey must providt their Workers'comp•policy number. X am an employer.that is praNt information. ding workers'compensation insurance for my ernplayees Below is thepollcy and%ob site . 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_to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of c fine up to$1,500.00 and/or one- ear t; ofP i�minal penalties of a y imprisonmen 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 Investi ations of the bIA for" verification. Ida erebyce ;rndert epatn penalti ofperjurythattheinformation provided bo P is fate and correct Sienature: / I Date: l0 Phone Offfciai use only. Do not Write in thus ,'fo be carnpleted by city or town official City or Town: Permit/Liceuse# Issuing Authority(circle one): 7.Board of Health 2,Building Department 3. City/Town Clerk 4,Electrical Inspector S.PlumbingInspectpr 6. Other Contact Person: Phone#: /r A-�",- 1Ylassachusetts- Department of Public SafetN Board of Building Regulations and Standards I � Construction Supervisor Specialty License lI License: CS SL 99138 I i Restricted.to: .RF,WS 1 i JAMES CURLEY 287 FULLER ROAD.. CENTERVILLE, MA 02632 i . . .i 1 Expiration: 1/28/2012 c Conmiissiuner'. Tr#: 99138 ✓ _ ff Boa d of Building R`aulAdDns_an.d.St9ndards—.—.. - I icebse h "gistration valic for d idul use only HO E IMPROVEK ENT CONTRACTOR. before the a iration date. found leturn to: Re stration�_f_2431110 ��--Boards-of. f din;RegfflatIC6v "z d-Sk-an•dards f iration 8tf/ gt9w~�^y'"Tr# 1 0873 4 OneAshburto PlaceRm130 g Type lndivid•al Boston,Ma.0 103 James�urley — James urley ,. 287 Full r.Rd .___ .u.._,..�. .�.r.. � . . -- -C e; A 02632 ' A m' "strator ot;yah Without h' are HIC Registration Lookup Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation Home>Consumer>Home Improvement Contracting> E ............... .......................... ...._...... . ...... E Home Improvement Contractor Registration Lookup The list is current as of Monday, June 06, 2011. You can search/filter the registration list by any of the criteria below. ' RELATED LINKS Search by Registration Number 124310 __. �. Home Improvement Contractor Search Registration Number ! Registration Home Page Search by Registrant Name Search by City F Zip Code "Search Registrants Click on the registration number to view complaint history.You can also view arbitration and Guaranty fund history. . Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION NAME INDIVIDUAL NUMBER ADDRESS DATE STATUS I James Curley Curley, 1287 FULLER RD James 124310 6/1/2013 Current CENTERVILLE,MA 02632 .. _.._. _ _.. .. ... ..... ....................._ . :.... _.._ ©2011 Commonwealth of Massachusetts 9 . http-.Hdb.state.ma.us/homeimprovement/licenseelist.asp 6/6/20.1*1 TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 11saaarAat TOWN OFFICE BUILDING � rua HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: (� An Occupancy Permit has been issued for the building authorized by © 7 1p . BuildingPer $k.................................... .... ...................................................... ................................................................................................. issuedto ...... . .. .. �. � .� �a< L �. ................................................_............»..... Please release the performance bond. o OWN OF B,ARNSTABLE,.MASSACHUSETTS e:., _ "'BUILDING: PERM1 ''J �DAATE'/ jam' ._- 19 PERRMIT ./N�O.c. >. APpLICANl/ 1f�.er /�/l'��ft)9T /�{a. .If;f'y j'� ESE ry e� � &N �Azz ,��g CJ/ ('NO..) (STREET) - (CONT.RR'S LICENSE) . NUMBER OF f PERMkT TO O STORY' DWEU_ING UNITS - (TYPE OF IMPROVEMENT) N0: (PROPOSED USE.) ZONING ,n DIST �• q g I I�/-,'x��VIL7 RICT / . - _ AT-(LOCATION) St"I' -� ti .(NOd (STREET).. '� BETWEEN AND, _ - ' (CROSS STREET) (CROSS STREET) - :LOT :'SUBDIVIS[ON'. .. - - _ ° LOT r BLOCK ...SIZE - _• BU'I.LDING IS TO BE FT,•WIDE BY FT ,LONG BY. FT.,IN HEIGHT ANDS HALL CONFORM IN GON STR UCTIUN TO,TYPE - USE GROUP -♦' - BASEMENT WALLS,-OR FOUNDATION _ .. (TYPE) REMARKS: ' AREA:.OR ._.; h •+. r'1�+ s PER MIT VOLUME '(CUBIC/SQUARE FEET);,' ESTIMATED COST .{j :,. A�_'' a -_,_ FEE _ -OWNER BUI-LDING.D.EPT.,,. - ADDRE$S._ 2: BY THIS PERMIT CONVEYS NO,RIG,HT TO O.C:CUPY .ANY-'STREE,T,'ALLEY.,OR SIDEWALK- OR -ANY 'PART THEREOF, E-IHER TEMP'OR AR I•LY OR PERMANENTLY, ENCROACHMENTS'ON PUBLI•C PROPERTY„NOT SPECIFICWLLY PERMITTED,UNDER.THE-BLICLO.ING CO.DE,' MU_ST BE-AP -. PROVED BY THE JURISDICTION. 'STREET .OR AL.LEY GRADES .AS.WE'LL.-AS DEPTH-AN,D LOCATION O.F PUBLIC SEEWEERS MAY BE;OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSU AkCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT:.F.ROM•THE C�ONDIT:ONS-•. OF ANY 6PPLl:CABL'E_SUBDIVISION'-R ESTRICTLON S.' - - - - SN F. n ncv^_-' cn 'ai A 1° MUST BF"RETAINED OtI-JOB AND THIS wHERt AF P,LICABLE SEPARA INSFE( I,UN S'nt - n'�i - Q. - .I - `- _ - _ F''FRM:TS ARE REQU'PE FOR ALL CONSTRUCTION WURK rCEF'I ., �_�:'UNIT rl �i+.. _ _ _ I. FOUNDATIONS OR FOOTiI•fG S. 'MADE.; WHE-R F_ A. CERTIFI. ATE,OF OCCUPANCY- I�-{Ft E'= AE HAr cAL INSTAi_�LA I 1 NS t 2,. PRIOR;TO COVERING.STRUCT;URA QUI;RED-•SUCH BUILDING SHALL.N;OT BE,°OC,CUP,I�,E.D UNTIL . MEMB.FRS(READY TO LATH)., FINAL INSPECTIO N HA BEEN MADE 3. FINAL INSPECTION BEFORE_, - OCCUPANCY.` t. ' P�ST.THIS CARD SO IT''IS FROM 'STREET BUILDING INSPECTION APPROVALS: PLUM8ING INSPECTION APPROVALS' ELECTRICAL..INSPEC-i ION APPROVALS �♦ _ ([��2 2 Z 2 _ ? �s HEATING INSPECTION-APPROV LS: s'; ENGINEERING DEPARTMEN" OTHER B(I OF ALI,,, --- C1 PE'RMI? 'FILL BE{OME:NULL ANL� VOID IF.CONSTRU:CT'ON" w WORK SHALL NOT PROCEED UNTIL THE INSPEC- .. ( INSPECTIONS INDICATED ON HIS ':D CAN B; FOR HAS APPROVED THE VARIODUS STAGES OF WORK 'IS NOT STARTED Wl tHIN SI M,ON-THS OF'DATE THE ARRANGED FOR BY EPHONF P`NRITIEk CONSTRUCTION PERMIT iS ISSUED,'A-S NOTED A, V€ NOTIFICATION.' TEST -PIT 1 TEST PIT 8'-6" GENERAL NOTES p ELEV.-46.6 0 ELEV._4 6" HUMUS HUMUS _ _ _ _ _ _ _ _ _ _ _ 1. ALL ELEVATIONS SHOWN ARE BASED UPON AN 811 I I ASSUMED DATUM. SUBSOIL I � 2. PITCH ALL LINES A MINIMUM OF 1/8" IFT. UNLESS 1811SUBSOIL I i OTHERWISE SPECIFIED. 24" 000000 .0 O m C00000 N _ 00 0 0 0 O @ O 0 0 0 000 3. ALL PIPES TO AND IN THE SYSTEM SHALL BE CAST i- - - - - - - - - - J' NI _0 000000 m O m 000000 IRON OR SCHEDULE 40 PVC. T 0 000 0 0 0 O ® (DO 0 0 000 to 4. ALL SEPTIC TANKS, DISTRIBUTION BOXES, AND -1 000 0 0 0 C) @ 0 O 0 0 000 ;� LEACHING PITS SHALL BE DESIGNED FOR H-20 WHEEL FINE TO / 000000 0 O m 000000 MEDIUM FINE To `C 00000 m O 0 000000 LOADINGS WHEN UNDER PAVING. SAND MEDIUM �o,� _ 00000 0 @ m 000000 5. REMOVE ALL UNSUITABLE MATERIAL BENEATH THE SAND _ —r 314.1 00000 m O m 000000 INVERT ELEVATIONS OF THE LEACHING PIT FOR 4"-01 " TYPICAL DISTRIBUTION BOX 00000 (3O 6) 0100000 A DISTANCE OF 1OFT. AND BACKFILL WITH CLAY- LIQUID LEVEL FREE SAND a GRAVEL HAVING A PERCOLATION RATE ✓I/OT TO SCALE 6'_0" OF 2 MINUTES PER INCH OR LESS. 12' 14' NOTE-' DISTRIBUTION BOX AND 1000 6. THE BARNSTABLE BOARD OF HEALTH MUST NO WATER NO WATER GAL. REINFORCED SEPTIC TANK BY BE NOTIFIED WHEN THE SYSTEM IS NEAR COMPLETION OBSERVATION . PIT TYPICAL 1000 GAL. SEPTIC TANK ACME PRECAST OR EQUAL. TYPICAL LEACHING PIT AND PRIOR To BacKFILLING. 7. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS PERCOLATION RATE= 2 MIN/INCH NOT TO SCALE NOT TO SCALE SHALL BE INSTALLED IN ACCORDANCE WITH TITLE Y OBSERVATIONS BY, NOTE' TANKS REINFORCED THROUGHOUT WITH OF THE STATE SANITARY CODE AND ANY LOCAL BARNSTABLE BOARD OF HEALTH ELECTRIC WELDED WIRE WITH 24-1/211 RULES WHICH MAY APPLY. ENGINEER: McKINNON 8 KEESE ENGINEERING EMBEDDED STEEL RODS IN TOP a BOT 8. CONTRACTOR IS TO NOTIFY ENGINEER, PRIOR TO THE DATE APRIL 3, 1986 TOM. CONCRETE IS 4,000 P.S.I. TEST. INSTALLATION OF SEPTIC SYSTEM, OF ANY DISCREP- 47x2 a a ANCIES BETWEEN TEST PIT RESULTS AND FIELD a CONDITIONS. 9. ACCESS MANHOLES TO SEPTIC TANKS AND LEACHING PITS TO BE BUILT UP TO 12 INCHES BELOW FINISH GRADE. TOP OF aoxa (FOUNDATION ELEV.=5I+5 FINISH GRADE FINISH GRADE FINISH GRADE OVER LEACHING 47X3 y FINISH GRADE OVER TANK . OVER I'D" BOX AREA ELEV.= 47+0 ss ELEV.=50+0 ELEV.= 47+8 ELEV= 47+00 EXIST. GROUND Ilx 7811x 3/411 WASHED STONE A - h 2� L T 60 INV.= 45+ 5 INV.= 44+90 T 2��. INV.=44+ ...... , ......... INV.= 1000 GAL. INV•=45+25 ................ DIST. BOX ...... .... ...... 2411x 3/411x 1��2�1 REINFORCED (TO BE LEVEL WASHED STONE Acres ...... .. . . ....... CONCRETE a STABLE) ...... ... . ....... 4789 SEPTIC TANK .••..-...- -• BOTTOM OF PIT ago (TO BE LEVEL 81 STABLE) INV.= 44+60 ELEV= 3.8+60 43X4 UTILITY BOX QS / TYPI CAL SEWAGE SYSTEM PROF( LE PRECAST LEACHING PIT / (TO BE LEVEL 81 STABLE) ha NOT TO SCALE ��• 49X, LEGEND 3 MAP SECTION PARCEL LOT ADDRESS ,►.'� EXIST. CONTOUR — _. 8 39 149 5k 1�6� 'd `�� PROPOSED CONTOUR 9� f' EXIST. SPOT ELEVATION 8 X 0 43X6 / PROPOSED SPOT ELEVATION 8+0 // PERCOLATION TEST RI ZONING DISTRICT FLOOD HAZARD ZONE \< + .�- �/� 44X3 43X6 / RF C �9 h � / ,/ OBSERVATION ION PIT m as o / ,� P` ,� x, ��OPp/ , ►� ' ^M� PROPOSED LOCATION OF DWELLING DESIGN CRITERIA g° 0 43x7 /' �/ ;''., � & SEWAGE DISPOSAL SYSTEM o / NUMBER OF BE PERSON PER BEDROOM —2_ ! ' �i�+ i;�C� �� z, , , n LOT .60 SAMPSONS MILL RD 46X6 0/� / GALLONS PER PERSON PER DAY ,55- .J9 `9fl-41t�'` +� Oil/ / LEACHING REQUIRED 30 Gf� " � ' BARNSTABLE MA so , 4>sx j/ LEACHING PROVIDED 5,49 GPD +� r ; / DISPOSAL NO APPLICANT : ENGINEER SEWER DESIGN .. e - �y or �,. THEO CONSTRUCTION ARROW ENGINEERING INC." .of ;� 24 GREAT POND ROAD 10 CAPE DRIVE SUITE B• 46x9 x X X X p YARMOUTH, MA MASHPEE, MA 02649 SIDEWALL: 2 TT ,5 6 2.5 = 471 GPD. nr•rr;•vn !;:, ; i z wo Irs�. : , BOTTOM= r-r x5 x 1.0 = 78 GPD SCALE DATE: SHEET -` 47xe / `: C �r/��'E�i �' AS SHOWN MAY 20, 1987 1 OF .1 TOTAL= 549 GPD �, � $ DRAWN BY= CHECKED BY., APPD. BY: PLAN NO. 49X3sp►, PLAN SCALE - 1"=30' SEE/SEM JTH RER 468 p8 -