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HomeMy WebLinkAbout0115 SANTUIT ROAD //� ��irrn��T �� - - ,R` � __ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map li l Parcel' v Application #olo Health'Division Date Issued Conservation Division Application Fee Planning Dept. _ Permit Feel != Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address ! 1 -- Village CIA,, - Owner M.e cfll, C, (;Od Si —Address t I Telephone Permit Request \110 C i(O, \�End tee. fiy �lti�vP C� (: Si, Square feet: 1 st floor: existing proposed 2.nd floor: existing proposed Total new Zoning District — Flood Plain Groundwater Overlay Project Valuation : > )_=Construction Type Lot Size __ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family it Two Family ❑ Multi-Family (# units) Age of Existing Structure _ Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other _ Basement Finished Area (sq.ft.) Basement Unfinished Area (.sq.ft) Number of Baths: Full: existing new Half: existing newer_ A} ,kw CD Number of Bedrooms: _�_i existing new x g, Total Room Count (not including baths): existing new First Floor Room Courft" 73 �J Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other f _0 Central Air: ❑Yes ❑ No Fireplaces: Existing__New Existing wood/coal stove: ❑des ❑ No Detached garage: ❑ existing ® new size Pool: ❑ existing ❑ new size _ Barn: ❑'existing .,® neva size_ rw.a Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _. Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ?DO S C, Telephone Number 3 Address License # C 5 Ce,4,,y'S k4.- Oa,L, 3 Home'Improvement Contractor# �r 0 '11 $'b Worker's Compensation #Q) 0 y'1' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ®ATE 3 FOR OFFICIAL USE ONLY APPLICATION# t DATE ISSUED <£ 'MAR/PARCEL NO.: ADDRESS ' VILLAGE r OWNER ' a 1 DATE OF INSPECTION: i$ t FOUNDATION ''•., ;r (' FRAME _A]NSULATION3°�� o <3 N �s-� FIREPLACE !, ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS; •_'}f ROUGH?' ..,s•. FINAL r _ )' - - DATE CLOSED OUT ASSOCIATION PLAN NO. 4 The Commonwealth of Massachusetts D a ePrtment o f fnrlustrzal�4ccid ena Off ce of Investigations 60.0 Washington Street Boston, MA 02I11 www mass.gov/rlia Workers' Compensation Insurance Affidavit. Builders/Contractors/Electricians/Plumbers -Applicant Information Please Print Le 'bl Name (Business/Organizstion/IndMdrml): 06 S, 1- Address: P �J City/State/Zip: Q SA .C`U i V QX L Are you an employer? Check the appropriate box: 1.❑ I am a employer with 4• m ageneral contractor and I lype of.project(required): 2.❑ employees(full and/or part-time).* have hired the subcontractors 6.- ❑New construction I am a sole proprietor or partner_ listed on the attached sheet. 7. []Remode-Iing ship and have no employees These sub-contractors have working for me in ray capacity, employees and have workers' g` Demolition [No workers' comp. insurance comp.insuranceJ 9•. []Building addition . 3.❑ required.] 5. We are a corporation and its 10.0 Electrical repairs or additions I am a homeowner doing all work officers have exercised their myself [No workers' comp, right of exemption per MGL I I'[]Plying repairs or additions insurance required,]t c. 152, §1(4), and.we have no 12•❑Roof repairs 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 iafnnnatioa. ^ t$omeowners who submit this affidavit indicating they are doing an work and then hire outside contractors must submit a new $Contractor that check this box mast attached as additional sheet showing the name of the sub-contractors and state whether or not those entities have affidavit indicating such. employees. If the sub-contractors have employees,they must provide their workers cam p,rap,policy mrmbet. i o an employer that is providing workers'compensation insurance for my employees. Below is the policy and 'oL site information. l Insurance Company Name: L ni n• e S Policy#or Self-ins,Lic. (A-) C, o is , Expiration Date:. t I,1 Job Site Address: Attach a copy of the workers' compensation policy declaration City/State/Zip:Wirt Failure to secure covers a as re page(shouting the policy number and expiration date). g attired 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 farm of a STOP WORK ORDER n e to $250-bons 0 t day against the violator. Be advised that a copy.of this statement may forwarded to the Office o f a a e Investigations of the DIA for insurance cove rage verification, I do hereby c under thl pains and penalties o , fPerjury.that the information provided above is true and correct Si tore . Phone# � Dfficial use only. Do not write in this area, to be completed ci ty ity or town official City or Town: Permit/License# .Issuing Authority(circle one): L Board of Health 2.Building Department.3, City/Town Clerk 4.El Inspector 5.Plumbing Inspector 6. Other g Ins p for Contact Person: Phone#• �1"E Town of Barnstable Regulatory Services t ► iARNN6fABLE, + . . KAM � Thomas F. Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 0.2601 www.town.barnstable.ma.us Office: 50.8-862-4038 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the ro subject l P Pay hereby authorizeu- to act on my behalf, in all matters relative to work authorized by this building perrmit (Address of Job) **Pool fences and-alarms are the responsibili of the-a lic tY pant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signa e f:Owner qature of pplicant Print Name , Print Name Date Q:F0RMS:O WNERPEFMSSI0NP00LS �THE Town of Barnstable Regulatory Services « BARNSTAKE, « ` Thomas F.Geiler,Director fo yg. h 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: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied 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 minimurn inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official 1 1 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. Q:forms:homeexempt use :'�' L�oense�X reg�slrattoa•��hd,�ox.u[ " ►ration ate i,If fb�"jagCf!I Al , befe� he&xP Off 4f�lnsuii►Er riftairs andnlfiTs ion 10azkiPlazy Swte 5�aai4k 7 „ u soy Notyaiitl vv�thoi slgnatute - Office of Consumer AffR�rh ss Reg a. HOME IMPROVEMEUT',M'NTRAC !OR -O Registrationy118030,8u-0 TYPe• �.. Exp�ratiCn � �/2013 f 3 Individualgc i — AM B AWYER fERVII,LE MA 2f3 p y: rats s 7.77 - Massachusetts- Department of Public Safet' i Board of Building Regulations and Standards Construction Supervisor License i License: Cs 44124 Restricted to. .00 ROBERT W SAWYER 59 POINT OF PINES_AVE _ CENTERVILLE, M; 2632 Expiration: 2/9/2012. Commissioner Tr#: 15629 ,:�. CC3<1 C p f ro ot OL PL S,A C� R ltC��ae� �� aG 1 0 5-,C� 1Cg i •;¢^�- i'.ni,�. .,.M1;'9"�C�tiE7'�'.°s'j"".�?-''�"',t¢'ak,'.Tx.+j,�t"�iab'w�!�,.,,'ff,L�sr'-..��E31P"�fi":'�''�`'T.A�a-F''f���.�^�}'`se5°r,:.�";.u�^' :",�S'tGt�vs-rmr'�'�'.TM.�.^�r�C'..�.-...-� + _...... „-ems^...-....T t,�4'.'r j OF THE Tp TOWN OF BARNSTABLE 30739 � Permit No. ................ BUILDING DEPARTMENT { '"81 ! TOWN OFFICE BUILDING Cash ■"a �tEev►� HYANNIS,MASS.02601 Bond ........... CERTIFICATE OF.USE AND OCCUPANCY Issued to James Barger Address Lot #3 3, 115 Santua t 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. .........peril..?�.►..... 19..... ........ 1� Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT _ 11ARISTAIM �u�r : TOWN OFFICE BUILDING �g i6J9. HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit,-$...... v..:„!!!` ...................................................................................._..................._......»».........». .......»».» issued to ..................„ 0/Vj...... » ............ ....................................»..............................................».... » .....»».........»..»»..»»».... Please release the performance bond. < t i,4>r•. e:';�3 !;�„rta "�+,�oYBUILDING ,4• a r,il vt ..�` ..:� f..h!t'"t�,¢� ;• ,,:'r.A ro"`Nv�#iL.�:Sy}SC a TO�dN OF BARNSTABLE MASSACHUSETTS �! ' BuILD'N�,\ " �' 02c`j, say 13 �19 �� }.. 't t r re gg PERMIT71 APPLICANT �WTZG'r. xs Y� t ADDRESS " I ft k x `mr€"tq (STREET) .((CONTRr LICENSE( PERMIT TO l3LLil.d'dW@Z.�I.Z't (J'Fi)4�STORY .T't „+.^ ° E17U3.1V CIG7CZ.J:�Yli{ NUMBER OFF, (TYPE OF._IMPROVEMENT) �,2 �4 - NO.IN jy•t:: i � (,PROPOSED USE) DWELLING UNITS 1 .'� .. .'ZONING j ATn(LOCATION) a,:`x�Ot 33 . lIS .SAnit it`>-Road, COtuit }ZF (STREET)-`-.,.' DISTRICT �.r BETWEEN AND - - ,(CROSS STREET) , (CROSS. ST REET) . SUBDIVISION / LOT BLOCK gO. BUILDING IS TO BE FT. WIDE'BY `FT LONG BY FT. IN HEIGHT AND'BHALL'CONFORM IN�CONSTRUCTION ^ M♦ - _ .., ,,�. � •_; .. ` saw>. Y i TO TYPE USE GROUP. BASEMENT WALLS OR FOUNDATION w {. 1•: - (TYPE) s, REMARKS: - ,, - - se-wa.g #87-131 AREA OR a f t. BOND VOLUME ` IZ9G �q• ESTIMATED COST 90 QQU FEE MIT $' 03.50 (CUBIC/SQUARE FEET) lames."BarAei 'OWNER I1P\" 4 Road, Utu t .BUILDING DEPT. ADDRESS'' 9 BY sYa: tr THIS PERMIT CONVEY S.NO RIG HT Tb,OCCUPY ANY STREET ALLEY OR SIDEWALK OR ANY PART THEREOF,.EITHER'TEMPORARILY OR ® PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY,,NOT `SPECIFICALLY PERMITTED UNDER THE BUILDING CODE YMUST:BE AP- t.. PROVED, BY:,THE JURISDICTION.--:STREET.'OR;ALLEY GRADES .AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS-MAY'! OBTAINED FROM THE DEPARTMENT OF PUBLI,CFWORKS THE.,ISSUANCE OF THIS PER DOES NOT-RELEASE THE APPLICANT.FROM THE CONDITIONS .'-. OF. ANYA,PPLICABLE SUBDIVISION-^RESTRL 1.CTIONS:':.* ,. I` y- 9 MINIMUM)-OFF THREE aCALL r gPPROVED:il: S MUST BE; RETAINED=ON JOB A(JD;THIS, .WHERE APPLICABL�E SEPARATE INSPECTIONS REQUIRED FORS - .-h .,yrt ar y,y, rx _ r ALLyC ONSTRUCTION WOR K:?g "` CARD KEPT-�POSTE,Q UN'Tll:,F•IN A..L IN5'PECT�IbN.HAS'E3•E_EN- PERMITS-ARE.,REQUIRED FOR fir':t `+ MADE WH,,EftE��A-CERTLF'flGA�TE ;O,F�O�C BAN'. V ; } IELEC,TRICAL,. PLUMB'ING.`$�j AIJDi w 1.�F OUNOA..T,IONS-`OR'FOOTIiNGS - s ` ! c, , }Jr x „C IS.,RE MVHANICAL INSTALLATIONS ', rY 2. PRIOR,TO"C0V.ERING€STR',UCTURAL t _ Q411RED $UCH BUILDING S'HALLNOTBE'.00CUPdED:UNTIL ^MEMBERS�IREADYTO LATH) + .�.+, v j 3: FIN AL:INSPECTIONVBEF'ORE � (FIN4L INSPECTION HAS �EENXMADE ° `� :OCCUPANCY +w '''1^Fe+`1`�k;r..c r ::°' :> s T >t.xd 'LZ = �'c.. ,. r, A r`- ,�� POST.TMIS CARD SO, IT. IS -VISIBLE( �RONI STREET`' �k r * 3+BU DING'I ECTIONAPP VALS'( * ?TPLUMBING INSPECTION APPROVALS.--, ;:.:ELECTRICA4•INSPECTION:APPR a ey f t xt Fi art �,•k 1�, <S it-. .+r L� R1�. ./� �\"' � I.I. � � ,�t: ��: ^:,�dl�x I.41 �{ti. a ��y..r% �� _ ,f 7• 1' lA`ry(f J P. y 24 f1 I Y ar A 2 - y/ 2. +, 5�• 4 }t.r�'k�1 6k•J��C� �ti��� F N` '�` -t i fkEx �HEATINGINSPECTIONAPPROVALS ENGINEERING DEPARTMENT F 4 � ` T It gyr , r R t �Y ). QTHER Q BOARD OF HEALTH t Y 3 rQ'0` y , e vo WORK SHALL`NOTPROCEED UNTIL THE INSPEC-' PERMIT W!LL.BECO.ME,NULL ARO,V=F- STRUCTION ' TOR HAS APPROVED THE VARIODUS STAGES OF r WORK IS':NOT 5TARTED WITHIN SPY GATE THE INSPECTIONS INDICATED ON THIS CARD CAN BETRI CPp4 ti PERMIT i5'`I"SSUEDAS NOTED ABOVE NOTFCATONOR BY TELEPHONEOR WRITTEN�" _ ., 0. ! -r 125.00 j LOT 33 d f 20, . 000 S. F. rf) b ti EXISTING M. FOUNDA TION } a rasa 3S0 t 2.IV 27.03 125.00 ! S 22'10'42"W SANTUI T POAD PLOT PL AN ND E OF L A � TO THE BEST OF MY KNOWLEDGE, THE FOUNDA TION L OCA TED .IN SHOWN ON THIS PLAN IS AS IT ACTUALLY EXISTS AND BA PNS TA BL E — MA SS. THAT IT CONFORMS TO THE TOWN OF BARNSTABL E ZONINfs` ?a4, REGULA TIONS, REGARDING YARD SETBACKS" t ; F PREPARED FOR i DA TE•APR.27, 1987 `l � L/A MES BA PGEP l DATE.'APR.27 , 1997 SCALE, 1"= 40 FT. � CAPE 6 ISLANDS SURVEYING FcooD ZONE C TEA TICKET - MASS. Assesor's offioe (1st floor):. /rfi �C; dr , Assessor's map- and lot number ...... .d........../... ............ `\ SEPTIC ������ ���� 1Ne to ff Board of Health ;(3rd floor): c✓�� 'ry^ TALLE® IN COMPLI o� r Sewage Permit number ...... .. ^.8.7.... .. 7 .1.3l.:�. -�.'. WITH TITLE 5 . �. . t 9aEa9Tsnte, Engineering Department (3rd floor) rat �`%n` 1ENTAL ®® 9 House number .........................:................ /......................... f rqlRJLA P0 �orpv ale 3 APPLICATIONS PROCESSED •8:30.:9:30 A.M. 'and 1:00-2:00- P.M.•only TOWN: OF .�BA'RNSTABLE, ' B.UI'LDIHG .° I#S`PECT0R APPLICATION 'FOR .'PERMIT TO,. 1. ':../.: V. a ..................................... TYPE OF CONSTRUCTION ........... ............................................................... W- w t r* ............19.a,- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following' information: Location ..........4^L2 .... ..:.... t 75s .. ..............4�.�. �1../..( .. �.....:.. ProposedUse ......:... M.' ..................................................................:........................................ ram** P Zoning' District .........� ................................................Fire Distract ............... i Name of Owner ...... . .... ...... /� /? ..... / � .... Address f I..�. .......................... Name of Builder ...c,d�i �..... 1?i,!�.......... r Address .:.... !.t!...... .. ./. ......................... Nameof Architect .................................u................................Address ......,............................................ .............................. Number of Rooms .................. .......................................Foundation 4..........� ....eloel m 0,74< ............... • ExlerI0 ...............................................Roofing .......... ... .. .. .................................: . .. Floors .............In. .... .�.............................................Interior 1! �` /�...................... Heating ......... f!:...........................................................Plumbing .................. .. .............. ................................ n Fireplace ............../...............................................................Approximate Cost ............. R..lI.. D...... Definitive Plan Approved by Planning Board _____________________________`__19______, Area �.... ...'...............:.. ' Diagram of Lot and Building with Dimensions Fee .../D '.... f SUBJECT TO PPRO AL OF BOARD OF HEALTH } 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 .. ^P............... Construction Supervisor's License ........... Barger, James 1. 1 2 story r "= 3,0739•_. Permit for , w single' family dwelling ............ ................................................ 4 �5 Location115...Santuit Roa .......... d.................. �r c. - +. Cotuit Owner .......:....Jamesr Barger...................................................... y Type ofl.Corist�ucfion frame ; .. ......... '' �• .... ........:.......:............ Plot ... �`--............... "Lot ,. ...................... Permit, Granted MayJ1 .:..............19 87 f A Date of-Inspection . '-� �/.........:.1.9 Date Completed .. ..'92.... .....:19 . . ' N � w . i Assessor's offioe Ust floor): ( K� � 0F TH E TO Assessor's map and lot number ...... ..... ..,.A`............... d�Q� �♦� Board of Health (3rd floor): qq, Sewage Permit number ......�?.^...1...^. 7•. ••�� T-.� �:�.� �• i DA235TGDLE, Engineering Department (3rd floor): F.�S +�° ra i6 39 House number ........................................................................ a MIR APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO / �r�����/,•,... /.. .....r /Z.d�4ve ..................................................... TYPE OF CONSTRUCTION ...................(�.......,.......� ! l!............................................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... ..... ? ...... . a?.......: 7.`�+ .Z, 7 ../�..............( :,,..C7..! ........................ ProposedUse ............� ............................................................................................................................................. n.�.Zoning District ..........,./ .. ................................................Fire District .............. d. ".�!..*'� Name of Owner .....a.. ! '!1' ..........Address Name of Builder ..s..< .... ' ....... ...............Address .......���pli. .......l..I. !a• "', °`° �" ......................... Nameof Architect ..................................................................Address ....................�......../..,j..�................................................. Number of Rooms .................�:. .......................................Foundation ..........,�...f!/.f ...C,� t.e.; `'.................. ................................................Roofin �!g ..........;�.� ... ................................................... Floors ............ ' ',✓...................................................Interior /(QZ, . Heating ......../e... .........................................................Plumbing .................. ...4................................................. Fireplace .................................................................Approximate Cost .............. /� l/ ................. `'....:.............. .. Definitive Plan Approved by Planning Board __________________________ �v ------19-------- • Area / ............................. Diagram of Lot and Building with Dimensions Fee / �—�' SUBJECT TO APPROVAL OF BOARD OF HEALTH } 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? li «-+.-t........ r�....................... Construction Supervisor's License >............ Barger, James A=021-092 ' No ....307.3.9.. Permit for .....1....1/2...........s to.r......y....... single family dwelling .......................................................................... Location 115 Santuit Road ................................................................ Cotuit . ............................................................................... Owner ...........James.........................Barger.............................. Type of Construction .....,frame ................................ ............................................................................... Plot .............:. ..33 ............. Lot ................................ Permit Granted May.13... .............19 87 Date of Inspection ....................................19 Date Completed ......................................19 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- Parcel Z6 I 9 Application # : Health Division Date Issued p on Fee "'A p!1cati Conservation Division Planning.Dept- Permit Fee, Date Definitive'Plan Approved by Planning Board Historic = OKH Preservation Hyannis Project Street Address -L15 3aah Pond Village Q Owner Address 1. 5 Telephone Permi eq est 0) Ah is fl M6 S�uare feet: 1 st floor: existinq 1079proposed 2nd floor: existina 1�1q�9\proposed -L&TOtal new Zoning District Flood Plain Groundwater.Overlay P179lect Valuation Construction Type Lot Size nC- Grandfathered: U Yes (A No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family Ll Multi-Family (# units) Age of Existing Structure Historic House: Ll Yes 4\No On Old King's Highway: L1 Yes �No Basement Type: 4 Full LJ Crawl Ll Walkout Ll Other Basement Finished Area(sqft) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing -new Number of Bedrooms: existing Znewe: Total Room Count (not including baths): existing new q2 First Floor Room Count Heat Type and Fuel: )0 Gas Ll Oil Ll Electric Ll Other Central Air: LJ Yes 14 No Fireplaces: Existing New Existing wood/coal stove: L3 Yes �No -vQ/ Detached garage: Ll existing LJ new size—Pool: LJ existing' new size Barn: LJ existing Ll new size �/,v Attached garage: ;existing L].new size —Shed: D existing Ll new size Other: Zoning Board of Appeals Authorization LJ Appeal # Recorded L3 k-A Commercial LJ Yes AV No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Numbero���T Address License # �9 "BSc Home Improvement Contractor# (S/ZA�� 19 r Worker's Compensation # (),a 700 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO— f—,Cc�� C,hour SIGNATURE DATE x f d FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: 3 FOUNDATION ,k 4 FRAME f t INSULATION FIREPLACE ELECTRIC AL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING R _ DATE CLOSED OUT j ASSOCIATION PLAN NO. } The Commonwealth of Massachusetts ra Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 IF . www.mass gov/dta Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgaiuzation/Individual):—bet) &w ,' 1 2 ]&A 1. 155—sler Address:� R � o, Roy 14 9 -te 11-n �S -r ir U City/State/Zip: Phone#: g g / Are you an employer?Check the appropriate box: Type of project(required): 1.DQ I atn a employer with 1 O 4. n I am a general contractor and I employees.(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have & ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no �_ employees. [No workers' 13.Wther ' e»r..rrn,J C comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Z u r ich �5 Policy#or Self-ins. Lic.#: "T G a e 700 Expiration Date: b 1�0129S Job Site Address: ' Ji�- TCO City/State/Zip: �-� Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage.as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer i un thepains and penalties of perjury that the information provided ab ve is lue and correct Signature: I AAA Date: Phone#: Official use only.. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: �A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ODIYYYY} 12/s/2olo THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. B SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER c Catherine Murray Oceanside Insurance Group PHONE (508)775-0500 FAX (500)790-7958 MAIL Oceanside Insurance Agency Inc :Catherine@oceansideinsurance.com PRODUCER 52 West Main Street 00006116 Hyannis MA 02601 INSURER(S)AFFORDING COVERAGE NA[C0 INSURED INSURERAArbella Protection Insurance Benabby, INC. INSUIRER0.Zurich-American Assigned Risk DBA: Disaster Specialists INSMERCRockhill Insurance Co P. 0. Box 480 INSURER D o INSURER E: Sandwich MA 02563 IN uR COVERAGES CERTIFICATE NUMBER CL1012901739 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBR S POLICY EFF POLICYEXP LTR TYPE OF INSURANCE r POLICY NUMBER IIUNIDOlYYYY MINma LETS GENERAL.LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Es occurrence $ 100,000 A CLAIMS-MADE ©OCCUR 8500038944 1/1/2011 /1/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 i GENERAL AGGREGATE $ 2,000,000 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X1 POLICY Ida LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Enaecktent) $ 1,D00,000 ANY AUTO BODILY INJURY(Perperson) $ A ALL OWNED AUTOS 7018400003 /1/2011 /112012 BODILY INJURY(Per acddent) $ X SCHEDULED AUTOS i X PROPERTY DAMAGE $ HIRED AUTOS - (Per acoldent) X NON-OWNED AUTOS PIP-Basic $ 8,000 cMPel $ 20,000 X UMBRELLA LMB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS UAB X CLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ A RETENTION $ X 4600038945 /1/2011 /1/2012 $ B WORKERS COMPENSATION WCSTATLL OTH- AND EMPLOYERS'LIABILITY YIN RYJ ANY PROPRIETDRIPARTNERIEXECUTIVE 0 E.L.EACH ACCIDENT $ 500,000 OFFICERi MBER EXCLUDED? NIA , (MandatorylnHH) 102P700 /112011 1/1/2012 E.L.DISEASE-EA EMPLOYEE $ 500,000 Mdesotbe under RIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 500,000 C Contractor Pollution Liao X PLE002420-01 11/22/20I011/22/2011 per 0 Ead,poo $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,B more space Is requIrad) Crawford & Company and Crawford Contractor Connection, a division of Crawford & Company, Srankenmuth, USAA and The Hartford are named as additional insureds for the above listed coverage0a and policies, as they apply to work performed for Crawford Contractor Connection (excluding Workers' Compensation). The policies shall not restrict coverage for completed operations for the insured or the additional insureds. The General CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. . AUTHORIM REPRESENTATIVE C Murray CIC/KG ACORD 25(2009fO9) 01988-2009 ACORD CORPORATION. All rights reserved. INS02b(2mam) The ACORD name and logo are registered marks of ACORD i EVE t Town of Barnstable Regulatory Services ' r RARNEMABLE, Thomas F. Geiler,Director UAM °rF1 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623C "Property Owner Must Complete and Sign This Section -� ---- If UinJff-A-Buildef_ as Owner of the subject property hereby authorize �! Su S- !� eG'►ti��S-{S to act on my behalf,. in all matters relative to work authorized by this building permit application for, �- (Address of job) Signature o er Date 10eAr��r�r Print Name ' if Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. ,` Q;FORMAS:OWNERPCRMISSION h'' e , o' 8 u o y > NlassachusOts- Department of Public Safct� y A Hoard of Building Regulations and Stan(furds Construction Supervisor License i } License: CS 49880 Restricted to: 00 ; m�` MARKJ FOUHY 1096 CROWELLS BOG RD BREWSTER, MA 02631 Expiration: 2/23/2012 i ('onuuis�iuucr Tr#: 21458 i r � 1 O �ce onsumTAKaI s and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement;.Contractor Registration k — Registration: 108642 t r/P Type: Supplement Card BENABBY INC/ DISASTER SPECIALfST' Expiration: 8/20/2012 MARK FOUHY 9 Jan-Sebastian Way 1 Sandwich, MA 02563 k Update Address and return card.Mark reason for change. _ PS-CA1 0 50M-04/04-G101216 Address Renewal Employment Lost Card •' Office of Consumer Affairs&Business Regulation License or registration valid for individul use only = HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation _s Registration:y;1.08642 Type: .10 Park Plaza-Suite 5170 .,' Expiration 8/20/2012 Supplement Card pp Boston,MA 02116 BENABBY INC/":QISASTERS.PECIALIST MARK FOUHY �= Box 480 ,e�— Gam/ pv, Sandwich, MA 02563 Undersecretary Not valid with o signatur 1 I s ire l " � ��f1t� ��- lac � S-e- Fir ram- r �L .4q. ow Fop ce �L `DJ'tHE Tp,;� Town of Barnstable BARNSTABLE. : _ Regulatory Services 7 MASS. 059. MP �0 Building Division prEO '�a, 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection Location GrT. Permit Number /!/0/lJ4---- Owner Builder One notice to remain on job site, dne notice on file in Building Department. The following items need correcting: DG/'r �ll S-U 6,q >/v Al 241vo i i n i -7.o% a uiP 4 W10 17. 'R 0 o /M To -70 Ak A — F � i c u or /O ®/37�91ti a rlowf L Y 1I6 5-.5 3 Please call: 508-862-40M for re-inspection. Inspected by Date 3117111 / I, M 41 O E \� O c� lam) IN � N io CC ---- -- oLn v tN • Z s fC O m N @) y. v cd O V r ( d i1+ c co DINING z LIVING o �; 0 iUU 41 RELOCATED EXISTING °1 DOOR - NEW 3 I/2" DIA.°STL. � -Jul � COL. ON BOX50Xi2 GONG. GENERAL PLAN NOTES (2) II 7/8" LVL HDR. FOOTING BELOW - NO REBAR - REQUIRED (GUT/REMOVE V w W/(4) 2X4 POST DOWN EXISTING 5LAB�A5 NEEDED) cu DN. - ALL INT./EXT. WALL5 TO BE 2X4'5 @ 16" F co ALIGN WALLS- O.G. (UNLE55 NOTED OTHERWI5E) 1�1 -- ~ V V z 8-OX6_8 G.O_ _ _ 3-OX6-8 GA p - - - V � } cu -- I 1 ti , LU KITGHEN ; PDR. to ; s V II I Z EXISTIN ill O 1 I ' Q II 1co WALL / DEMO I t � I 1 �vrP ul ' - `r = WALLS AND ITEMS TO REMOVE EXISTING i i �i � Ili 1 1 DOOR - PATCH WALL I I o 1 q �� 1_3_-��/2 l �' 1 -L u� - - - - - BE REMOVED A5 NEEDED - - 2', , If EX15TIN(5 WALL5 TO - I.1 1 I REMAIN N Q I 1 W I I I I 1 � LNDRY. --r �; co KITCHEN DESIGN �/ ______-- ; m ! ! Q� � I � � � � NEW WALL5 � � � BY OTHER5 ° Y �n_...----- --- - Po KEr DEMO NOTES 0 IL u o °O I FOYER a� LL- N`k � ,EXI5TING DASHED DOOR 8 WALL5 piFn 4'-I" 1'-5 1/2' �" I'-8'+/ EXISTING TO BE REMOVED AND PATCHED A5 I NEEDED OR REPLACED A5 NOTED. GJ IN 51� cif O Y N Q V � L- - ._ r • � T LPL Job no.: 1119 date Ib SEPTEMBER 20II scale A5 NOTED drawn KMW RST FLOOR F L A N 5GALE : 1 / 4 " = I ' - O " A- 1 ISSUED FOR CONSTRUCTION