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or e r 4 i �---- -� z 1 ' `'�' ®� � _ �� d�.-J ���� 3 PsA�v 1 Town of Barnstable � 305 30g Expires 6 months from issu date Regulatory Services Fee • 11ARNSTAMM • ma's' Thomas F.Geiler,Director i6396 �1 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 Property Address -70 6�CfU oe, S 7—.4 C07-1117 A—elf- 01 V[f Residential Value of Work$ `' tPOO• Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address d/1C4, &DCZ.cgod '?", G'oTv�T� 14T 0 212 �r Contractor's.Name s ° /¢dam ��� � �,JC Telephone Number,.. Home Improvement Contractor License#(if applicable) /0%604o Email: Construction Supervisor's License#(if applicable) )(-PhESS PERMIT ❑Workman's Compensation Insurance AUG 2 7 2013 Check one: ❑ I am a sole proprietor ❑ I am the Homeowner TOWN ®F �AR�ISTABLE [ ( I.have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# ��y/3- ®271�i 75/- 2 Copy of Insurance Compliance Certificate must accompany each permit. Permit Re est(check box) 7&N Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt,compliance with other town department regulations,i.e.Historic,Conservation,etc. i k ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the H e Improvement Contractors License&Construction Supervisors License is quired. SIGNATURE: QAWPFILESTORM uilding p6iiiit fomrs\E}2RESS.doc Revised 060513 Fmall. v 27m CmwommM gfMassachusetft Departrrr nt of Irndastrid Accrde>7fr OJTW--ofinvestigati-a"s ddl!Wmhi tgfon Street Boston,MA 02U'I rvft:�w.�x�ussgvvlrlia Workers'Compensafi=InsuranceAffidavit:Builders/CantractorsMectdcians/Plumbers Applicant Information Please Print Legibly Name �: ¢�' ` r�✓e` Address.- 70 Z?� CitylStat 9Zip: /CI- 0")71' Phone Acre n an employer?Check tl6te$pgropriate boa: Type of project(required): L I am condaxtion I El I am a sole proprietor or partner-a employer With 4 ❑I am a general contractor and I 6- El New employees(€all and/or part-ime)* have hired the sub-contractors listed on the attached sheet 7_ ❑Remodeling ship and bade no employees These sub ooatr�cbzs have g- Demalitioa forme in an employees and have wogs' a"og Y 4- ❑Snildmg addition [No workErs' comp.insurance comp.insurance t _ require&] 5. ❑ We area cotporationand its 10 ectrical rqm=or additions 3_❑ I am a homwwner doing all work of$cros hn-e ex ercised their 1 LD Plumbing repairs or additions myself[No worloers'gyp. right ofememption per MGL l2 nafrepaim T e.152,§1(4} and we bane no - msurance ) employees-[No workers' 13-❑Otber comp-insurance required-] �hnysQpteaattintchecksbm91amst-1 inkmmatim Hnmeaamers�rrbo submit&is affidavit iadscatiug they ase doing allvco>ic sad then hits outside coatnutnrs oust submit s new afidseit mirratmg sacb_ tCWtMctois that check this bm[mrast attached m additional sheet drawing the name of fim sub-couftacbm and state wbether ornat those mfities ham employees. if the mac c tactms bare employees,dreg must psmide their wakes'comp.policy number. I am as employer theisprevidittg worirem'colltpaLudion insurance for my onq;loyeas:.Below is Ste ptalicp and job site information. Insurance Company Flame: �!2'✓T�!✓G�/T>ZZ (-'�/4C�y7 �� " Polo y#or self--ins Lim U13 �2 7(G� �'L� xpi�tionI?ate: G Job Sife Address: ; � U��Y Cityfstate/zip: r, Dom_ Attach a capy of the workers'comp esisaf o t policy dertaration page(showing the policy lumber and expiration date). Failure to secure coverage as requiredunder Sectim 25A o€MGL c: 152 can lead to the imposition ofcriminal penalties of a fine up to S L500.00 and/or om-yearimpriscruneuk as well as civil penalties in the fbm of a STOP WORK ORDIR azid a fine. of up to$250-00 a.day against the violator- Be advised that a copy of this statement maybe forwarded to the Office of Investigations of fhe DIA for insurance co-erage veriEcation- I do hareby certify re' pains an allies ofpedm7 ihatths info rmatiarn provi&d above is h7 anrf correct tore: Date: 4 zF )-e,, /3 Phone# �zm — 011cial use only: Da not writs in this area,to be caamp&ad by city or town official`. City or Town: PermiffAcense# Ensuing Authority(circle one): 1.Board of Health 2.Binding Departinent I CityTown Clerk 4.EIectrical Inspector 5.Pluubing Inspector 6.Other Contact Person: Phoone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Puisuantto this statute,an employee is defined as"...every person m the service of another under any contract of hire, express or implied,oral or written" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased 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 budding appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also slates that"every state or Iocal 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(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the iucnrance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and;if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If as 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 incurrance boverage. 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 peffiitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple pennitllicense 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 may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum 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 Commmvealth of MassachusW;s Dapaitmont of I&Iustdd Accidents • Office of kvcwgatiom 600 Washington Street Boston,MA 02111 TeL#617 727-4M W 406 or 1-77 MASSAFF Revised 4-24-07 Fax#617-727-7749 www.mass_gov/dia Town of Barnstable * °* Regulatory Services SA MMASS&IE • Thomas F.Geiler,Director 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 Property Owner Must Complete and Sign This Section If Using A Builder I, b,U( Aid as Owner of the subject property hereby authorize 0tilE77V to act on my behalf, in all matters relative to work authorized by this building permit. 70 g�JGT (Address of Job) **Pool fences and alarms 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. r Signature of Owner ignature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 1 ` 4 Town of Barnstable Regulatory Services '" MABS. ' 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: 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. t - 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 procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. 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\decollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 3A V VAV + y CAVA WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S59UB-0276M74-2-13) RENEWAL OF (6S59UB-027GM74-2-12) INSURER: CONTINENTAL CASUALTY COMPANY NCCI CO CODE: 10243 1. INSURED: PRODUCER: A I ENTERPRISES INC HORGAN INS AGCY INC PO BOX 2056 PO BOX 250 COTUIT MA 02635 HYANNIS MA 02601 Insured is A CORPORATION Other work places and id e ' cation numbers are shown in the schedul attached. 2. The policy period is om 07-18-13 to 07-18-14 12:01 A. the nsured's mailing address. 3. A. WORKERS OMPENSATION INSURANCE- rt One of the policy applies to the Workers Compensatio Law of the state(s) list re: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in _ item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A 0 D. This policy includes these endorsements and schedules: o� SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. R� DATE OF ISSUE: 07-11-13 WC ST ASSIGN: MA OFFICE: CNA 04J. PRODUCER: HORGAN INS AGCY INC 28XBF 00275E I i f I. t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-050457 PETER M POME'-'IT -' L PO BOX 2056 �. COTUIT MA 02635 i. J.•G..� J 'r"��` Expiration Commissioner 04/19/2014 I I &ee Wpommn.oauuealCl o�U(Gaddad tldet6 ; Office of Consumer Affairs&Business Regulation License or registration valid for individul use only VYER OME IMPROVEMENT CONTRACTORbefore the expiration date. If found return to: egistration: J09606 Type: Office of Consumer Affairs and Business Regulation xpiration 9/21/2014, Private Gorporatioa 10 Park Plaza-Su e it 5170Boston,MA 02116 ARISES INC j PETER POMETTI 140 LITTLE RIVER RD 4 yEQ� COTUIT, MA 02635 ` Undersecretary j Not valid without signature j I i ,I - TOWN OF,BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 4922— ;y Application # —ao 31 Health Division Date Issued Conservation Division 07Application Fee Planning Dept. Permit Fee: y Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis W Project Street Address �� OU ��T/�7 Village CU-% Owner V� � o�co Address 70 4;q29G Telephone Permit Request /4�A ,-GsXlsl--;%w,, J �� A4et�_ _ w� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District of Flood Plain Groundwater Overlay Project Valuation A447 000-ov Construction Type Lot Size rl! Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ,W / Two Family ❑ Multi-Family (# units) Age of Existing Structure �ml�,� S ' Historic House: 0 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 2, new O Half: existing / new Number of Bedrooms: 3 existing 4 newCM s, Total Room Count (not including baths): existing new First Floor Room CounL ~ Heat Type and Fuel: U"Gas ❑ Oil ❑ Electric ❑ Other Central Air: M Yes ❑ No Fireplaces: Existing New Existing wood%coal stove: ❑°l%es ❑ No r Z�= Detached garage: existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing c�o neV 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) /67Iz / h-t�77� Name ` �.�G-. � �YBi ✓� Telephone Numbera Address ID, 2-0 6-4 License # SOT5'? Home Improvement Contractor# Worker's Compensation # j/S-�t7/. �f> ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r 4 FOR OFFICIAL USE ONLY = - / PPLICATION# i DATE ISSUED ; t MAP/PARCEL NO. ; i � 1 ti ADDRESS f VILLAGE ` OWNER _ t DATE OF INSPECT FOUNDATION,:. A71 !�/Q ! t FRAMER D !9 i . F INSULATION FIREPLACE j ELECTRICAL: ROUGH FINAL i4 PLUMBING: ROUGH FINAL I,I GAS:- =.f ROUGH r<<- - FINAL ,_��FINAL BUILDING;}_- . t,�4t • fR DATE CLOSED OUT I ASSOCIATION PLAN NO. I� r 4 , Town- of Barnstable .regulatory Services Thomas F. Geiler, Director D Building Division Aria�� Thomas perry, CBO,Building Con*=*ssioner 200 Main Street; Hyannis,M&02601 www.town.barns-b b le.ma.us Office( 508-862-4038 - Fax: 508-790-6230 PLAN REVIEW Owner.: �d G E—�e�/ Map/Parcel: 4_ Project Address S�fl�oc �i�,• �T, Builder: n,r-7Pf The following iter*is were noted on reviewing: `sS"-s u fq Cz� 77-3 5. fc To n Reviewed by:, Date: 7 o s` re Q:Fanns:Plnrvw F The Commonwealth of Massachusetts. Department of Industrial Accidents Off 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): Address 0 IAOSC 2-osze City/State/Zip: �JTI /�% � C Phone.#: � ^�� ��/ Are you an employer? Check the appropriate box: Type of project(required): am a employer with 4. 0 I am a general contractor and I 6. ❑New construction employees(full and/or part-timel.* have hired the sab-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 workers' 9 Building addition [No workers' conrp.-insurance comp. insurance.$ required.] 5. We are a corporation and its 10.[� Electrical repairs or additions e 3.❑ I am a homeowner doing all work officers have exercised their I LEI 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 13.0 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. xContractors 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: o `7�9"�® Expiration Date: Policy#or Self-ins, Lic. #: ��� ®2 7� P Job Site Address: V/ City/State/Zip: a/ /�� ��C ��' 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 rip 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. Ida hereby certify u e the pain a d penalties of perjury that the information provided above is true and correct. Simafore: Date: /m/W — Phone# �v9 7aZ l9 "Y' � 1Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): .1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector "6. Other Information and Instructions Massachusetts General Laws chapter 152 requires all employers to-provide workers' compensation for their.employees. Pursuant to this statute, an employee is defined as "._.every person in.the service of another under any contract of tore, 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 including the legal representatives of a deceased employer, or the of the foregoing engaged in a joint enterprise,and ncl ge e S individual,partnership, association or other legal entity, employing employees. However the receiver or tzustee of an 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 sball.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(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for the performance of public work until acceptable evidence of compliance vZth the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-conti actors)name(s), address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial lion of insurance coverage. Also be sure to sign and date the affidavit The affidavit should is for confirmation ' 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 completc-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 fin in the permit/license number which will be used as a reference number. fn addition,an applicant that must 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 may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be 5lled out each year. Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit 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 Massachusc is Department of ladustrial Accidents Office of Investigations, 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext406 or 1-877-:WSSAFE Fax 4 617-727-7749 Revised 11-22-06 www.mass.gov/dia 4,y,i • ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE'owmw " 0wowwo THIS CERTIFICATE 13 MM AS A MATTO OF WORYATION ONLY AND CONFERS No RW=UPON THE CERTItCATE NOLOO,TINS CERTIFICATE DOES.NOT AFFIRMATIVELY Olt MMWMIELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING HNSURER(S),AUTHOR12ED REPRESENTATIVE OR PR0010061%AND THE CERTIACATE HOLDER. IMPORTAW.U dw owgO b holder a an ADDITIONM.IISUR11%Ile poeoy(ws)must be mWom"Nr SUBROMUM IS WAIVED.00*01 To ft- arattand aoa10' atlltP PONY.ootaln P0Wm mqr ngW-&m!aodootomwft A s6l1nrerrt on ds of rHRasa Goes 1f�t aaNat tiilgs to tlw ow"441e1toldsr Neuatwa1A�.}. PRODUCER CONTACT NAME: PHONE FM HORGAN HO AGCY INC (AA:,No,Ib*. FAX 4413AMWABLE RD B L ADORBSS: PO BOX 25¢ PRIt HYAN=MA 02601 lXISTDYER is 2MM MURiRp)AFFDRDNVQ CWJwtAar pA1C; swum INSURER A. CONTINENTAL CASTJALTY COMPAW BSURER B: A I ENTERPROW PC INSWIER D: INSURER D: PO BOX 2<!56 NSURER C07W.MA 02635 INSURER IF; COMM CERIIFSATi REVIwN NUMBEII:TM16TOCEtaFY TMPOtJMOFlOULAHCEUK"Nmtwfum9b*40MTOWkMtW*MAMABOVEI OTWPGMVPSVWN CATTrQ, HOiTY1rHl mmwAHY tf.TMoRCOMMOFSITYCWnMcroeanmRoccuvwwm srro�In wuncmmwATEa►Yalssue� ORNAYF WWYLTNFl18UtAMCEAIFOEQEDSrTIEPOUgFSOEfiq DNEBSIR3fp1BiN:1tOALtTAWTBtIN,E](CLIJ810RbMOS701�I70N9OFIUpIPOf,m, Lars INOW MAT HAVE UM WMXM OT PM CLAMe ICIM ureR • POLIGY.4¢.4ATE TVPEOFl6U MCE 'j f` F, r: 4 x4�RAT�. - LTR 4 L LJA41jLi1(• .. .. •>:. a•gs ?. !.i 064Lam OQCIJRRENCie ; ,CLA11418 MADE' � .00Ct)R.` .< QAAAAOE 1'ORE7NtED $ PREMISE8(E1t oorxMKft) :. .. . .. MED EXP(Any oro person) $ ..,, :::•.,...: ..r....:..:....:::.:... PE tsjowaa'ADV INJURY $ OEIQI.•AQOREOATE UINT°APPLIES P9i!=; GENERAL AGGREGATE ; POLICY PROJECT LOC PRODUCTS•OOIIPA?P AM $ AUTofIDBN.E WBN.ITY COMBINEDSWOLE $ ANY AUTO LIMR(Ee ALL OWNED AUTOS BODILY INJURY_ $ SCHEDULEAUTOS (PwPe-1 f HNtEDAUfOS: . BODILYINJURY $ n autos oddoM PR AMAOE $ UMBRELLA LIAS OCCUR ;SAW OCCURRe4W $ EXQESS LEAS CLAAS-AIADE At�f3REOl►Tts $ DEDUCTIM E $ R£TEPO F$ .. $ `•VIOIFI(EPPS OOEATTDN AND WC STATU M u1MTs OMER ,:••, ::; EMPLOYIINS LIABILITY YIN US.0276I174zlo 07J.f8/ A). 0711MI1 E.L.EACHAOCIDENf $ 60Q,000 ANY PROPERITipRfp� p E.L.DWEASE-EA EMPLGYEE $ 5001OOQ t.L1DIBFASE-'POLlCYLN1pr $ 500AW it basemp D�tlPTION OF OPfiRATICIIS/l0NlATIpN4%Yf jyq, ITEMS IMS RM ACFS ANY MORCWtTWATE53tlPD 7-bM A=WL=M#ft7WWORItMC0WC0VMAOg DMIS&SWAN AUSM" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TNRe EXPIRATION DATE THEREOF:NO71t'N:WILL BE DELIVERED IN ACCORDANCE 80 CROSS ST WITH THE POLICY PROVI9ldN8 AU IlOR®REPRESENTATNE Coaztrr.MA 02635 Dennis Chooknszis ACOI�26 •,.' - 11�B-2tlOBMORD CORPORATION. All dgift resomd. M0310v@uvmpnju 50.00' N io oEX _._..M, BARN 05' N MAP 35, PARCEL 22 170 SCHOOL ST. o OLP COTUIT, MA 36'9 TANK 29.82' 0.5' PROPOSED w DECK 15.00 �316 42': PROPOSED {' C4 cn ADDITION �' EX cn DWELLING SH LOT AREA 20,254 SF EX. DWELLING AREA-1300 SF I PORCH EX. LOT COVERAGE= 6.4'L PROP. LOT COVERAGE= 8.5Z SEPTIC SYSTEM SHOWN IS DRAWN FROM AS—BUILT 90.00' ON FILE AT THE TOWN HEALTH DEPARTMENT SCHOOL ST. CER TIFIED PL 0 T PLAN TUCKER RESIDENCE I CERTIFY THAT THE IMPROVEMENTS SHOWN OF yAs 170 SCHOOL ST. HAVE BEEN LOCATED WITH AN INSTRUMENT COTUIT, MA �� 9G DRAWN: RBS SURVEY. o ,� DATE: APR. 28, 2005 ROBB I„ n_ JOB 1P E00601 o SYKES SCALE:1 —40 DING. CPP No. 35418 EASTBOUND p.d STE� LAND SURVEYING, INC. N P.O. BOX 442 ROBB SYKES, P.L . DATE FORESTDALE, MA 02644 508-477-4511 OfTce�12,60Oum ram' airs . `mess e u License or registration valid for indrvrdul use only HOME IMPROVEMENT CONTRACTOR beforeahe expiration date. Ifsfound return to: Registration: 109606 Type' Office of Consumer Affairs and Business Regulation VAERPRIS Expiration 9/21/2012 Private Corph�tt n 10 Park Plaza-Suite 5170 Boston,MA 02116ES 1NCF" PETER POMETT( 14&LITTLE RIVER`,. COTUIT,MA 02635 Undersecretary f Not valid without signat-ure ' IVI issachusctts- Departnrent`of PubU Safety } hoard,fir Buil(ling Rcl;ulations air.(1 Stand tr ds Construction Supervisor License License: CS 50457 Restricted to: 00 £ PETER M POMETTI " a PO BOX 2056 5 k COTU IT, MA 0635 ?{Y. cam- �s%tJ� Expiration: 4/19/2012 ('uuuuissioner Tr#: 21436 �YHEr � 'Town of'Barnstable °^ Regulatory Services , BARNSTABLE Thomas F. Geiler,Director s, Musa. 1619. n1,.,A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6231 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property herebyauthorize -/ i� < � TT� to act on my behalf, - in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner" Date Print Name" If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable OFJHE r, o Regulatory Services Thomas F. Geiler,Director i BAMMBLE, + 9 HAS& t6S9. Building Division ATEo t"�y A Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 0260.1 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 12TO 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. m o °Z zi Qziu 6 � Q N FM x aQ V a PORCH CLG. . WDWW NOR— ® a H . � o m OECK PLOOR D(ISTING z (7 FRONT ELEVATION p �. Q 2 w > w O � 0 Z Z W Q PX19nNG LIVING ROOM Z Z r Q a New PORCH RAIL To 12'-0 3/4•(+/-Y - - y _ REPLACE e%19nNG 1/2 WALL RENOVATED W Y New PORCH POSTS COVERED PORCH TO REPLACE mmr R O 0 IUMAHOGAWDECRING W a U O NEW 12'STEPS TO GRADE . - 13W(+/-) &-4•(+/-) DATE: 05/23/2011 SCALE: . PROPOSED DRAWINGS: FIRST FLOOR 'PLAN 1/4"-Y-0' Al 1 r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map—, � Parcel e9ola. a Application # 60 �;�Q 3 Health Division Date Issued ( � Conservation Division l,f Application Fey Planning Dept. Permit Fee a Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis I V Project Street Address 7d Village OC/-Ill/ Owner � / �Address i� �sl. o C,9/-VS® Telephone Permit Request A�A&ya / /�7Lfe� ��✓i�,J� ��� �� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new O Zoning District Flood Plain Groundwater Overlay Project Valuation !` V040-D d Construction Type Lot Size o Alk /�r Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family V Two Family ❑ Multi-Family (# units) Age of Existing Structure I . Ate' Historic House: ❑Yes UNo On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new ® Half: existing new Number of Bedrooms: 9 existing V new Total Room Count (not including baths): existing new First Floor Room Count 3 Heat Type and Fuel: 2/Gas ❑ Oil ❑ Electric ❑ Other ®Central Air: Yes ❑ No Fireplaces: Existing New ® Existing wood/coal stove: ❑Yes ®"No Detached garage: Vexisting ❑ 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 w APPLICANT INFORMATION SO rn (BUILDER OR HOMEOWNER) - Name�4'y_lf- � i ��/ ✓�- Telephone Number Address �O X License # `� Home Improvement Contractor# Worker's Compensation # C 5�1�13-Oa� 9�Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOy '� �-�- SIGNATURE DATE i FOR OFFICIAL USE ONLY tF. 'APPLICATION# DATE ISSUED MAP/PARCEL NO. f ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME x INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL l , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 8F 7.(0 DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street c _ Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers .Applicant Information Please Print Legibly Name (Business/Organization/Indivi dual): Address: 71t� aage City/state/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1.Z I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction. employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. Rrkemodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers 9 0 Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp; right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ( 6✓GJ7t// ��s �G/ ��� �}A/ - Policy#or Setf-ins. Lie.#: v!ps-6"�11✓13— oA7(©,tf'J,41—R-49 Expiration Date: 7/1-/® Job Site Address: -/,. &,YWG 67Xee_7 City/State/Zip:67V__r 1 dam'020W 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 certify c er the p is and penalties of perjury that the information provided above is true and correct Signature:_ Date: Phone#' 40?16 _�W Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased 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, constriction 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(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required: Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. 'Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the 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 must 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 may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 6177727-7749 www.mass.gov/dia THE roh Town of Barnstable r r Regulatory Services 9 � 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 Property Owner Must .Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize . / (�/V4 ` to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address ofJob) ll� 2 ° � nature of Owner Date DA Print Name If Propety Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable pp TFIE Tp� o Regulatory Services Thomas F. Geiler,Director swxxsTABLE, '""SS. Building Division v� i6�9 u `��' g ATEo A 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 4 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 procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. 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:\WPFlLES\F0RMS\homeexempt.D0C I CNA WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 09 ( A) POLICY NUMBER: (6559UB-0276M74-2-09) RENEWAL OF.,(6S59UB-0276M74-2-08) INSURER: CONTINENTAL CASUALTY COMPANY 1. NCCI CO CODE: 80381 INSURED: PRODUCER: A I ENTERPRISES INC HORGAN INS AGCY INC PO BOX 2056 44 BARNSTABLE RD B COTUIT MA 02635 PO BOX 250 HYANNIS MA 02601 Insured is A CORPORATION Other work places and identification numbers are shown In the schedule(s) attached. 2. The policy period is from 07-18-09 to 07-18-10 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: ...�.® MA A� S. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in -- item 3.A. The limits of our Liability under Part Two are: A� � Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, If any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A i D. This policy Includes these endorsements and schedules: .SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be deter mined'by our Manuals of Rules, Classiflcations,'Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. I DATE OF ISSUE: 07-09-09 TL ST ASSIGN: MA OFFICE: CNA 04J PRODUCER: HORGAN INS'AGCY INC 28XBF 000718 --p� /LZdaStaaaa"dards t ', > N'�.(j ulatio s a of f1idjogReg isor%ieense Board truetion Supe ry Con `. 50457 CS . Tr# 22406 i= • } ' iratlon 41191J2010 —�--�Artori it u pETERM POME�1 ` a '✓� J ommissioner. r Poe OX 2056 C GOTUIT,MA 02635 1 B( eot erpddr c im r� rrEl License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 109606 Board of Building Regulations and Standards Expiration\9/21/2010 Tr# 274229 I One Ashburton Place Rm 1301 Type:`.-Private Corporation Boston,Ma.02108 A I ENTERPRISE,- �• �t PETER POMETIh� 140 LITTLE RIVER"RD i COTUIT,MA 02635 Administrator Not valid without signature ��� �i -� � a � s � � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 fl Map E Parcel VIf If Permit# 8 /�1 60S 1 Health Division _1. 7 o S 'r✓` _�o �'1 Date Issued �7l) OS e Conservation Division j Application Fee Tax Collector Permit Fee , 17,7.5 Treasurer J SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board WITH TITLE 5 ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis r° .TOWN REGULATIONS Project Street Address 10 &W m m Village Owner l -t/�'- !n VL� I� (� Address 10 `2z I m` 4 Cabj l r Telephone Permit Request 'FWO r 0M (W I h> V (' ��rT I l�l P WUQ_ RA (V1J d 00VA �O I(YXYL M�f r_ A219(1 �00 &A(00M �Zd(dOIJA Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District _//,, Flood Plain Groundwater Overlay Project Valuation T1 / Construction Type Lot Size % Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Famil ❑ Multi-Family #units Y Y( /) Age of Existing Structure Historic House: ❑Yes U No On Old.Kings Highway:* ❑Yes [/No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Bn ishAArea(s .ft.) Basement Unfinished Area(sq.ft) Number 45aths , Full: 6xisting new Half:existing , new r� Number 6 edrooms: ex sting new Total Rod-m- Cogat'(not incl ding baths): existing new First Floor Room Count J i Heat TyV,e and;-ael: ❑(has ❑Oil ❑ Electric ❑Other Cam. t Central Air: ❑`Yes yNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑exiting ❑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 BUILDER INFORMATION Name S I ✓ ' Telephone Number Address �i�� AIA A `'{0(16 License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A&A (Av DATE SIGNATURE S I�� M a t FOR OFFICIAL USE ONLY - R- w PERMIT NO. DATE ISSUED 4 MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER 1 a 1 DATE OF INSPECTION: FOUNDATION 7 Gli' j6 y�Os FRAME l3dL to Ivy I 4 INSULATION i0��7��j FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL f.? � GAS: ROUGHt:s co � • FINAL FINAL BUILDING t) "+ a rr r — DATE CLOSED OUT 4 ASSOCIATION PLAN NO. "IS - a= y a - tT1 M e -*The Commonwealth-of Massachusetts _ Department of IndustriaiAccidents ! 600)T'ashin,ton Street r' Boston,Mass. 02111 Workers' Co m ensadon Insurance Affidavit General Businesses ' All !:1:10111 addre e. l� ; crate a � h e# work site ooatian fu address; _ rietor and one Business Type: [�Retail❑Restaurant/Bar/Eating Establishment ❑ I am a sole prop ❑05ce❑Sales(including Real Estate,Autos etc,) working in any capacity. YAM an em to er with eiz to ees fu & artna ❑ ther ovldinoco � /on for/�%�//�P/ working on this job.am l . g r an amp oy pr , •; -• , �+ COm 9n II9nle: n'r+L•J ,. . .• rt'y;,,;!•�+• ' •e••` ,�y ..\'t ',i..,E•..•,1 '•• ass add! bonia city; f•- ,•. ', ` c• • •', lij \. •'::�. ..�, : �,r�r1\;,� %O11C.///y' j..,%• / n ; insdr co; % r I am a sole proprietor and have hired the independent contractois listed below who have the followingworkers' . p polices: p . com cessation �:l {..,;•� ;,r• .t;.• '�. :E.,;.:;,�.:� r _ COIn BIl :'. i• �ti"'1 i•; '+P" �tti +•tt.: •r,:J;•. ?'+.t:. '•+a .�y'h�'1�`"• 't`t.,• ''.'•." •;+•d 'a. ••i :l:,j.•`�y' t,' �S r•• •t. 01 insiiranceco.'• lr..;=:.!• /• 4. / ./� �/// /1 / �� r•%• e .1;. �t'q,•: ••ti: ' ,:r"i i'.'•n•R ,�.v.Y a-i'. ,�6. •', •�,.y 'n' ...._ J n+ ..J, ':. * •• .t, .+ •p�•y,+'f,y: Yi'' ,t' !•.: r.: :« fit`R.«'..�•'•'t•' '' ..t. .i .45. ,r' �• 'r :�+.i:. cbm .'$eafe' �flII ` + address: •j ' t �; � .. •'.�.' "s•.y:? . . ' ',• ,: •. � •,,::,+'+:.; ,.,. . 'hone#s ': .• - CiEy:'• :44 •• . •'jl••: ''i'. ... •'t''i , •~r'. ' .:' ' •:.'; j,i�•t",'+'f.4',•,, •d ,I• '•7 . /N/ / � enaltfis of a fine up to 51,500.DOWNS" O sailor• Fallure to secure coverage as required under Section 25A of MGL 152 can]cad to the imposition of crimin p one years'1mprL9onment is wen as ctvff penalties in the of form of11 Investigations of the IAoRx fotEoverage verification 00 a day a;aia+t me I nnderatandthat copy of this statement may be fareyarded to the O g I do hereby certify un thepains and penal s of pedu that th t ormaiion providednabeave is true a come 5i�ature (/) Phone# , Print name — z• � - - official weonly do not write in this area to be completed by city or town official permit eense# Qguiiding Department city ortowmt QLiceasiaa Board E]Ueetmea's Office ❑checkif immediate response is required QHealthDepattment , phone#; QOther contact person: (.vnedeegLM03) r C Information and Instruc tions Massachusetts General Laws chapter�152 section 25 requires all employers t the provide workers'ser vi a of another under any contract ensation for their employees, As quoted from the"law",an employee is defined as every person of hire,express or implied, oral or written. An employer is defused 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 corignonwealth.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. ZEN Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply,company name, 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 ed to the city or town that the application for the permit or license is being affidavit. The affidavit shouldbe return requested,not the Department of Industrial Accidents. Should you have any questions regarding the•"law"or if you are required to obtain a warkeW compensationpolicy,please call the D.epartrnent at the number listedbelow- ' 1 x1g, / City or Towns _ Pleasebe sure.that the affidavit is complete and printed legibly. The Departmentlas provided a space at the bottom of the affidavit for you to fin out in the event the Office of Investigations has to contact you regarding the applicant. Please, p�t/license number which wiill be used as a reference number. The affidavits maybe returned to be sure to fill in the . the DeparimentbyrnaUor FAX unless other arrazigementshavebeenmade. The Office of Investigations would lute 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 ttthca o(let��Q�ions 600 Washington Street Boston,Ma. 02111 fax#; (617)727-7749 phone#; (617)727-4900 ext.406 Barnstable �pFTHE 1p� Town of B . Regulatory Services i saxxsTnsLE. Thomas F.Geller,Director MAN. 9`bp 163q a`� Building Division jED MP'� . II Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230, Office: 508-862-4038 Permit no. Date AFFIDAVIT HOME LVIPROVEMENT 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 adi acent to. such residence or building be done by registered contractors,with certain exceptions,along with other requirements. i /�. 1/91� �6 V ► Bstimated'Cost ��''; ��`y` }.'" Type of Work: 0 r U Address of Work: pwner's Name: iJv' a l� V . Date of Application: I hereby certify that: Registration is not-required for the following reason(s): DWork excluded by law I Job Under$1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: ED GISTEP OWNERS PULLING THEIR OWN PERMIT ORDROVEMENT WORK DO NOT HAVE CONTRACTORS FOR APPLICABLE HOME IMP ACCESS TO THE ARBI TRATION PROGRAM OR GUARANTY FUND IiNAERMGL c;142A a _ SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Registration No. Date Contractor Na e OR Date Owner's Name I Q:forms:homeaffidav 50.00' i N tp b EX. BARN .05' N MAP 35, PARCEL 22 #70 SCHOOL ST. o aLP COTUIT, MA 36'M TANK 29.82' 0.5' PROPOSED N DECK 15 00 16 42' PROPOSED o`, 4-1 ADDITION EX. DWELLING BH LOT AREA 20,254 SF EX. DWELLING AREA-1300 SF PORCH EX. LOT COVERAGE= 6.4% n PROP. LOT COVERAGE 8.5% h SEP77C SYSTEM SHOWN IS DRAWN FROM AS-BUILT 90.00' ON FILE AT THE TOWN HEALTH DEPARTMENT SCHOOL ST. CER TIFIED PL0 T PLAN TUCKER RESIDENCE I CERTIFY THAT THE IMPROVEMENTS SHOWN OF yqs #70 SCHOOL ST. HAVE BEEN LOCATED WITH AN INSTRUMENT 2��P` s9cyaMA COTUIT, DRAWN: Res T SURVEY. o s DATE APR. 28, 2005 ROBB �„ JOB * E00601 c SYKES SCALE:1"=40 DWG. CPP No. 35418 EASTBOUND p� STE����o LAND SURVEYING, INC. N P.O. BOX 442 ROBB SYKES, P.L . DATE FORESTDALE, MA 02644 508-477-4511 ` CAPIZZI ROME .IMPROVEMENT INC. - ' SPECIFICATIONS AND ESTIMATES PAGE 1.2 OF 14 STATE OF MASSACHUS]ETTS - ::.'. `LETTER OF AUTHORIZATION TO APPLY FORA BUILDING PERMIT MRS �)ONA .1) [T J Kra, OWN THE PROPERTY LOCATED :`AT CMQjj ST. IN COn.J1, MASSA CHUSET S.. WE HAVE AU&kal " I'M PT HOME TMPRQVErfi NT _ TO ACT AS OiJR AGER 'TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CP1R, THE MASSACHU;SETTS STATE3UILDIA7G CODE. WE GIVE OUR. PERMISSION TO Vh _ LESSEE TO APPLE'' FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, -THE mAsSACHUSETTS STATE"BUILDING CODE SIGNATURE OF OWNER: OWNER 5'ADDRESS: 7 0 is �� / . v,� OWNER'S TELEPHONE: LESSEE'S `SIGNATURE: LESSEE'S ADDRE,�S: LESSEE'S TELEPHONE: 7 APPLICANT'S SIGNATURE: APPLICANT'S ADDRESS:. rrj-rW"V.M' APPLICANT'S TELEPHONE: _ 508/!'' 8=9 1.8 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED By DATE _ THIS :,PAGE 18 PART OF AND IN CONFORMANCE WITH . PROPOSAL #29920 V ,,� �i8 �10-64u3 7-72h I,.uuuuuz r-lit ,: •�i �li' .•r>j�'yll. '' .j'• � .f:,• '.�`"?��^•., '�'•�; • .•�J.:�,i;•:•• }�Fih ,•'.i.'s, �tiy :7��"•.�-- C' RTC GAT 1 .0 : N U.R ►I +C1 ;i; �., �' '� /UPS f RO 'I HIS TIFIC•ATE I S i$8UED AS Ir,MAT7 ER O1' IN f QfWATION ONLY AND CONFERS NO BIGHTS UPON 7fii CERTIFICATE 201 My� Ins t,Sul>Inc' HOLDER.THIS CER1 IFICAATE DOFS NOT AMFNI.), EXTEND OR 2tI1 Main SsrlaAt 9ulie�11 ALZLf�1 HE COVERAGE -11ld1burg, MA Oti-42p AFFORDED BY I HE POLICIES BELOW COMf'MIIES AFFORDING iNSURANCE IW URED COMPANY A GRA111TE STAKE INSURANCE COMPANY - Resource Winagaments Inc 289 Main Streel,Surte 5 Fitchburg, MA 01•g2o THIS Is 1=POLICIES a... Hai',.' :.t .'• : ,., . .,. ?. ,:•.;. .. .;, ,. .• ... - .,,r.•, CERTIFY IN ?N POLiCI) 5 OF INSURANCE UST ® THE pOLICi'PERIOD INDICATEDS-LOW HAVE 13EF-N ISSUED TO THE INSURED NAt,1;p ABOVE FOR ,NOT 1 M-HSTANDING ANY REQUIitEMENT.TERN,DR 0ONDI770N Or-ANY CONTRACT OR OTHER DOCUMENT WITH RESPI=GTiO WH1C"THIS C1=RT1FlCA7E MAY BE 1SSUP-D OR W/y PERTAIN,THE INSURANOE AFFORDED THE POLiClE813ESCRIBED HEREIN iS SUAJECT TO ALL THE TERMS,EXCLUSIONS AND ICOND17IONS OF SUG#i MAY POLICIES.LIMITS 3HOWf�! HAVE BEEN BY PAID CMS. OE'N"—CL' PDUCYNUNIpER PDLtCI Ehfi_ _Tyy A �CO6'fi'E1Z871iiON FCT�6DATL ?-0UCYIDa'li2ATtONDATG dD',Mp)•Dy;nE'LiADiLirY NEPRpPRSE7aR1 ARTN E7�CUI�vi LmrrS 4. rrtc R ,9 y C Group 12/2612004 1212�I2UQ�T 5 S'ATUTD !;;t ✓'"9rr i' "; ,.'t ,� 047?192 I�YUMrra > Apptlen w MA OW�Pvrrs On1Y• �''' t i cn ACCIDENT 5 10D,D tsrti PQucYLJWT S 5DD,D ESORIi'TION OF OPl~RATt�t'#SVN�li1Gi.�8/19i�7CGlAL i'3�RG� S iD0,0 RE:COVERS THE EMPLOY�5 OF THE!NAMED iNSUi7ED LEASEp 7Y3:CAP1T,?_1 IiOMC iiVIPRCrVEA4F_.I�TI�fNC,'1645 NEWTON ROAp; OTVrT MA V;Ma5. C1=RTI1F)CATE 1401-OF-R CANCaLATION CAP;ZZI HOME IMPROVEMENTS INCDAttYOFTM�AEOYI`p6nCR1ElCDFOLtG6SR�C/iNC6Lt4D66PQR�TNE 1645 NEWTc)N ROAD D(PlRATION DATE niezEDT.THE 13WINGCOMPAKYV17LLENDEMIORToMAiiJR COTU iT, MA 02636 �YS''?'RIiTEN NOTICE TO THE CUM9CATE HOLDER NABS®TD THE LS:T.BUi FAILUt%TO MAIL SUCH NOT)CCSHAu tn7ro=ND oNuaA•nON ORL1+",Uyyor ANY KIND UPON TM COMPANY,ITS A13ENTS OR RGP MM,;TATNfS, AUTHOMZED REPRGSFMATIVE f Boar r,ir� Boardcl J3urJ n� > }:c�uJ ,a1�d �1�.»cJards �'.:.f Onc Ashbuj-lbn }'J�rcc 1301 'rUs cJ .��.. . c,li.5 02108 3olne linpi•ov ell)cnt 1 Rcpi tration: 100740 l ype: Private Corporation CAPIZZI HOME IMPROVEMENT, INC. Expiration: 6/2 312 0 0 6 Thomas Capizzi, jr. 1645 NeMon Rd. COtuit, MA 02635 — Update Address and return card. Mnrii reason•for cliziq � Address Rcnev,•a1 Employment ❑ Lost C ✓111.• ZJfm7mr•Orl.UC2(.(/1. pf✓!(�.CIdOQ'.�/fud('.(.�d _ - Board of)3uildinP Ttc�ulaiions and Standards HOME IMPROVEMENT CONTRACTOR License or.registraiion valid for-individul use only beforclhe expiration dais. It found return to: '• Registration: 100740 Board of Building Y2egul2lion5 and Standards Expiration: G/23/2006 One Ashbur ton Place Rm 1301 Type: Private Corporation Boston,1112.02108 CAPIZZI HOME J10PROVEMENT, I J'I^Ornas Capizzi,jr. 1645 Nevdon Rd. _ Cotuil, M 02635 Adminisirmor Not valid without ea3turet .. ,'a' ' � U/11!' -l!'097tg71077•f!K'Q:(��. f'1 �/J'lflJ:lf7.C'lLfCd('�4 - ' '.0 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 057032 Expires: 09/26/2005 Tr.no: 7171.0 Restricted: 00 THOMAS X CAPIZZI JR 1645 NEWTOWN RDA COTUIT, MA 02635 — Administrator The Commonwealth of Massachusetts - Department of Industrial Accidents' — 600-Washington Street Boston,Mass. .l12111 Workers' Co ensation.Iiisurance Affidavit-General Businesses MOM / name: �, l MY 1 V�I I state: U I/1 ap #Ilphone ��`-4 work site location(full address): �UV lVD l `� �•� :�. V 1 VY ❑ I am.a sole proprietor and have no one _)B4tsiness Type: ❑Retail❑"Restaurant%Bai/Batibg Bstablishmeat ' working 1n any capacity. ❑Ofce❑ Sales (including Rcal"Estate,Autos eta)• ❑I am an em to with ein to ees(full& art time.: ❑Other �I am an.employer providing veorkers' compensation for my employees working on this job. ..J .r f.t' :.ti�'••,i�;f? r ��{/,.-::�.•1,I`. f/{j'�i:.,...' t�14r5. .�;�/�• a;:.: t :..1J�►J'` T ' '•I.JU7 ..1;1•Y 1 d '1 't l �� i• +:.t,.• eoirii6ariy•name:.. <t' 4•t ad�'a ",/•,:�,�•'' c'�.:.•�j,^ •. '4�,:'-•`•`n�. '1/°;:.�,:tom..:;; ':{�'.` - �;%<.:t -I- .irisurariee.cot � .L`t'•' 1:�:.':_• •:;•fM:•� oli• .#� •.:�1.. I am a sole proprietor and have hired the independent contractors listed below who have the following workers' x. compensation polices: com�any'aairire� J• '-a��'` �t address:. .' 'L:" :•�• :i� ' _.r�;�'i: w4 Y..• 1. :i(i!,•: _ _ •. city. - uli'oiie'#5 - °.e. a.>•` :.r:'. psi::.: insurance co. :4'< b :s a �: a•�.: ; . C MOMME o' �a -no-me:.� f to ti. • addre ss ., ,. �i `r• insursuceso: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or on'e years'imprisonment as well as ciwll penalties'in the foi-E of s STOP WORK ORDER and a":rme'of SID0.D0 i day e`gainsfine:l nnderitand thst p copy of this statement maybe forwarded to the Office of Investigations"of the DIA for coverage verification I do hereby certify under the pains and pin ies of perjury.th t e information provided above is"true d ca sect �I►Signature t'GI Dgte Print name C I/U( Phone official use only do not write In this area to be completed by city or town official city or town: permit(license# ❑Building Department ❑Liceming Board ❑-check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised Sept 2003) __.._ ._._.____ ___..-._ _ e r h r6 l W �ilhbA—�^� h,TGLl LOW L 1 os '°°�° pv 330 UNAPPROVED JOB FORM JOB NAME: JOB NUMBER: DATE TURNED INTO LB: UNAPPROVED DATE: SALES REPRESENTATIVE: PRODUCTION MGR: REASONS UNAPPROVED: 1. Unclear scope of work: 2. Proposal incomplete: 3. Wrong proposal used: 4. Wrong quote: 5. Order forms incomplete:, 6. Color selection needed: 7. Trim/casings/baseboard style needed: 8. Estimate sheets incomplete/illegible: 9. , Missing photos of entire work area: 10. Plans nReeded/Sharon meeting with customer: 11. Subcontractor quote needed: 12. Appointment needed ASAP to review office/site: 13. Additional comments/concerns: t i F:\SALESISALETOOLUFORMSXUnapprovedjobform.DOC-Rev.4/6/05 I 1 MAScheck COMPLIANCE REPORT 1 Massachusetts Energy Code 1 Permit# I MAScheck Software Version 2.01 1 1 I 1 1 Checked by/Date 1 I CITY: Barnstable STATE: Massachusetts HDD• 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached , HEATING SYSTEM TYPE:Other (Non-Electric Resistance) DATE: 5-12-2005 DATE OF PLANS: 4/6/05 TITLE: TUCKER PROJECT INFORMATION: FAMILY ROOM, BEDROOM, CLOSET,BATH COMPANY INFORMATION: CAPIZZI HOME IMPROVEMENT COMPLIANCE: PASSES Required UA - 75 _ Your Home 75 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA - CEILINGS 330 30.0 0.0 12 WALLS: Wood Frame, 16" O.C. 350 13.0 0..0 29 GLAZING: Windows or Doors 19 0.310 4 GLAZING: Windows or Doors r 7 0.330 2 DOORS 36 0.330 12 FLOORS: Over Unconditioned Space 330 19.0 0.0 16 ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and .other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater tha 25% of th de gn oad as specified in Sections 780CMR 1310 J4.4. Builder/Designer Datd`_�— �� MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 TUCKER DATE: 5-12-2005 Bldg. I Dept. I Use 1 . CEILINGS: [ ] I 1. R>30 Comments/Location WALLS: - [ 7 I 1. Wood Frame, 16" O.C., R-13 Comments/Location I WINDOWS AND GLASS DOORS: [ ] I 1. U-value: 0.31 ] For windows without labeled U-values, describe features: i # Panes Frame Type Thermal Break? [ .] Yes [ ] No Comments/Location [ . ] 1 2. U-value: 0.33 I For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? .[ ] Yes [ ] No Comments/Location I DOORS: [ ] I •1. U-value: 0.33 Comments/Location FLOORS: [ l I 1. ,Over Unconditioned Space, R-19 Comments/Location 1 AIR LEAKAGE: [ l I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: I 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure i difference and shall be labeled. I I VAPOR RETARDER: ] I Required on the warm-in-winter side of all non-vented framed ( ceilings, walls,, and floors. I.I MATERIALS IDENTIFICATION: C l I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating 1 and cooling equipment and service water heating equipment must be d provided. Insulation R-values and glazing U-values must be clearly I marked on the building plans or specifications. I „ I DUCT INSULATION [ ] I Ducts shall be insulated per Table J4.4.7.1. 1 , I DUCT CONSTRUCTION: [ I I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted, The HVAC system must provide a means for balancing I air and water systems. I I TEMPERATURE CONTROLS: [ , ] I Thermostats are .required for each separate HVAC system A manual I or. automatic means to partially restrict or shut off the heating .I and/or cooling input to each zone or floor shall be provided. I .HVAC EQUIPMENT SIZING: Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified I in- Sections 780CMR 1310 and J4.4. 1 I l I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. . I ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.) : 1 PIPE SIZES (in.) i HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 1 l I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.) : 1 PIPE SIZES (in.) I NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F) : RUNOUTS 0-1 1 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 1 1.0 1.5 2.0 140-160 0.5 1 0.5 1.0 1.5 L00-�130 0.5 1 0.5 0.5 1.0 i ----NOTES TO FIELD (Building Department Use Only)------------------------- 0 C�'G ker e x ,-; y � r I-DO fll�kv- _ . : 6 dog �f tvew �� 1 SMOKE DETECTORS REVIEWED *AB� BUILDING DEPT. DATE FIRE DEPARTMENT. .._..DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING CAO ' - - r PORTANT - UPGRAD_E REQUIRED too/ STATE HWLDING CODE REQUIRES THE UPGRADING OF SMOKE DETECTORS FOR THE ENTIRE DWELLING WREN, ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. 14M. .A SEPARATE_PERW_. IS-REQUIRED FOR THE_ INSTALLATION OF SMOKE DETECTORS-THE ELECTRICAL PERMIT DOES NOl SATISFY THIS REQUIREMENT. �. �; : . ,� -,, ;.: . . ,r' ,, " 1 -�� �� . ' � ��C.� �/� ` � < '� `,, "�.. . . +` :.: , .. t. :E . - _ Engineering Dept.(3rd floor) Map 0� ' Parcel e �ermit#a�c� Q 4- House# �7b Gc.�-C,, Date Issued 2 ' U Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee Conservation Office (4th floor)(8:30- 9:30/1:00;2:00) Planning Dept.(1st floor/School Admin. Bldg.) nE rq _ Definitive Plan Approved by Planning Board ' 19 ; BARNSTABLE. M6AS5. TOWN OYBARNSTABLE 'F°"" Building Permit Application Project Street Address Village Owner Address L �� Telephone _ Permit Request E:A'01 Z)'J=) First Floor -2 9/ 1-_I square feet Second Floor square feet Construction Type Estimated Project Cost $ � � � 0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type:- ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) - ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number /J Address ry License# Home Improvement Contractor# Worker's Compensation#l d ® / NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO --- /�N -Ma4ge ) SIGNA DATE BUILDING PERMIT DENIED F THE FOLLOWING REASON(S) q-6 _ FOR OFFICIAL USE ONLY PERMIT NO. - F. iDATE ISSUED bMAP/PARCEL NO. f , ADDRESS - VILLAGE i t r OWNER • ' 1 DATE OF INSPECTION: `•} :, F '; — 1 FOUNDATION FRAME 'INSULATION FIREPLACE - ',ELECTRICAL: ' ROUGH FINAL ' f PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING , . f DATE CLOSED OUT f a f ASSOCIATION PLAN NO. ; t The Town of Barnstable $ Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA M60I Ralph Crosses 0l SOB-'T90-6ZZ7 Building Cammissicn: Fax: 3D8-790-6730 For offl=use only Permit no. Date AFFMAVIT SOME ZWROVEMENT'CONTRACTOR LAW SUPPLEBIENT TO PERMIT APPLICATION MGL c. t42A requires that the reconstruction, alteration, 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 tour dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain e=t.eptiom along with other requiremen/tL �I%Type of Wark: 49zst. Cast-` �- Address of work: 14— Owner's Name l�i� O l l lJUel-kap Date of Permit Application: -9 I hereby certify that: ti ' Registration is not required for the following renson(s): Work ezcluded by taw Job under SI.000. Building not owner-accupied Owner palling own permit Notice is hereby given that: OWNERS .PULLING THEIR OWN PERMIT OR DEALIIYG WITH UNREGMTETERRED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE,ARBITRATION PROGRAM OR GUARAf=FOND UNDER MGL Q I42A SIG UNDER PENALTIES OF PERJURY NED I hereby apply for a.pit as sat of the owner. Dan ntractor Name Registration No. b OR Dale Owners Name The Commonwealth of Massachusetts Department of Industrial Accidents �-_- � • �'-��� Olfice ol/osestigatlaos ' 600 Washington Street Boston,Mass. 02111 MMMIXIM/w/m/w/0� %/� �Workers' Compensation Insurance davit ran� t�tlttnnr�������/���� ///���///%�%%%�i,,� �q+✓�[t�E���� name: r J location: (� city hone# I am a homeowner performing all work myself. I am a sole proprietor and have no one tivorkill in amp capacity ❑ I am an emplover providing workers' compensation for my employees working on this job. company name: p."rTr T- G T Z T T WE T e::a s e:a flT—oc J R88F+?48 address: ' city: MAPqT6N MTT TT�c•__A4A phone#: 428—1 177 insurance co. R0flcV# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name- address: dtr• phone#: insurnnce co olicV# :. ... .. >.:. company name• address: dtv- phone#: inuarance co. . ::. . : . : : . <..:»»:;: ,...:..< 011cv# Failure to secure coverage as required under Section 25A of NIGL 152 can lad to the imposition of criminal penalties of a Me up to S1,500.00 and/or one yeah'hnprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a tine of S100.00 a day against me. I understand that a copy of Misstatement may be forwarded to the OMce of Investigations of the DIA for coverage verincation. I do hereby certify under the pars and penalties of perjury that the information provided above is tru.-and correct Signature �f[..�• ��'�{` �}.�'.�.�r' Date - Print name PAUL CAZEAU UT Phone# d?R_1 1 -7-7 Econtact do not write in this area to be completed by city or town official pertaitNcense# Mudding Department ❑LIcensing Board ediate response is required ❑Selectmen's OMee ❑Health Department phone q• ❑Other (mum 9195 PIA) ACORD. CERTIFICATE OF LIABILITY INSURANCE DAZE(/29/ Y1 CSR DR 09/29�98 PAIILJ-2 PRnl.xu;l.lt THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Drake,Swan & Crocker Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 14 Lot's Hollow Rd. ,PO Box 429 Orleans MA 02653-0429 COMPANIES AFFORDING COVERAGE - - COMPANY David D Rust A Assurance Co. of America pn""eflo 508-255-3212 F.,.No. 11 J511RI:A) - COMPANY B Credit General Insurance Co. COMPANY Paul J. Cazeault & Sons, Inca C P 0 BOX 930 COMPANY Marstons Mills MA 02648 D. COVERAGES 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. _. _.. -. POLICY EFhECTIVE POUCV EXI-IIRATION LIMITS 1 I YI1p OI.INSU2ANGE POLICY NUMBER - DAl L=(MMIUDIYY) DA IE(MMIDDIYY) GENERAL AGGREGATE $ 1000000 GLNLRAL LIABILITY _ 05/O1/98 OS/O1/99 PRODUCTS. $ 1000000 A X I COMMERCIAL GENERALLIABILIIY. CFPZ_55SZ'81Z PERSONAL&_ADVINJURY $-500000 CLAIMS MADE I X I OCCUR EACH OCCURRENCE b BOOBOO OWNER'S&CONTRACTOR'S PROT I - FIRE DAMAGE(Anyonelire) $ 300000 --- MED EXP(Any one person) $ 100 0 0 1 AUTOMOBILELIABILITY COMBINED SINGLE.LIMIT $ - - 1 ANY AUTO ..__.-_..._... __. j ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS --------- 1 PI7LU AUTOS - BODILY INJURY g - .i - (Per aWdenl)NUN-OWNED AUTO:i PROPERTY DAMAGE $ GARAGI_LIABILfIY _ AUTO ONLY-EA,ACCIDENT $ - 1 r '• OTHER THAN AUTO ONLY AIJYAUif) EACH ACCIDENT $ AGGREGATE $ EACH OCCURRENCE $ X(.1 b:.UABILII Y - AGGREGATE $ :UMHRC;LI_A FORM 011 iE B R THAN UMBRELLA FORM ,, - - WC STATIC OTH- - - X TORY LIMBS ( IJ. .. .-..- . WORKI:R2>C!)MI'I N`ilu iOhl HNi) I - I ._. - " 1 ; b 100000 EMI'I.OYEIi�I.IABILIIY 'ELEACHACCIDENT B ! 114E PROPRIETOR/ X I INCL SWC17005902 08/09/98 08/09/99 EL DISEASE-POLICY LIMIT $ 50000-0 1 - PARTNERS/EXECUTIVE EL DISEASE-EA EMPLOYEE $ 100000 OFFICERS ARE. EXCL - - 1)!7iSCRIPTION OF OPLRATIONS/LOCATIONSIVEFIICLESISPECIAL ITEMS Roofing. Corporation active l0/l/98. jCERTIFICATE HOLDER CANCELLATION l PEACOC 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 ! 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY j OF ANY KIND 'ON TI-E COMPANY,ITS AGENTS OR R-PRESENTATIVES. AUTHORIZE, •EP ATV { IE M, WJ _ACC " ACORD CORPORATION 198 I fie -Pa�t�:a�uue�r�t �,i2Zaaaa►,c;`u�del�a HOME IMPROVEMENT CONTRACTORS REGISTRATION j Board of Building Regulations and Standards One Ashburton Place — Room 1301 ' � 1 Boston , Massachusetts 02108 I HOME IMPROVEMENT CONTRACTOR Registration 103714 Expiration 07/09/00 Type — PARTNERSHIP HOME IMPROVEMENT CONTRACTOR Registration 103714. PAUL J . CAZEAULT & SONS ROOFING Type - PARTNERSHI Paul J . Cazeault j Expiration 07/09lb 22 Giddialt Rd . P.G. Box 2781 Orleans MA 02653 PAUL J. CAZEAULT & SONS ROOFI; Paul J. Cazeault L� •�I-e f�iddialt Rd. P.O. Box 278 ADMINISTRATOR Orleans MA 02653 Of-'PARTMENT OF PURLIC SAFrTY 136726 ONE AS11RORTON PLACE, RM 1301 BOSTON,.'`'MA 02108 -1618 CONSTRUCTION SUPERVISOR LICENSE '. om ° Number: Expires: CS 026325 1.O/2O/1.599 / Restricted To: 00 PAUL J CA7FAl1l'I ► ".,. w 1585 MAIN ST OSTE:RVI L LE, Mn O2655 Keep top for receipt: and change bf address notification. . �1ce �oaysca-nuealll�.tcy��Zfaeeat�i�aelld�i I OEPARTONT OF PUBLIC SAFETY CONSTRURION SUPERVISOR LICENSE .{ Nueberu Expires: f A. Restri a lo: 11 i. 1585 MAIN ST OSTERVILIE, MA 02655 ' DAIS(MMIDD/YYl ACO Q. CERTIFICATE OF LIABILITY INSURANCEPAULDJR2 09/29/98 a'R(?I:u u:r.It THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Drake,Swan & Crocker Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ,r Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR T4 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Orleans MA 0265,3-0429 COMPANIES AFFORDING COVERAGE - -David D Rust COMPANYA Assurance. Co. of America I lu�ric uu 508-255-3.212. Fax N., - Ucra.nll::U COMPANY B Credit General COMPANY _ Paul J. Cazeault & Sons, Inc. C P O BOX 930 COMPANY Marstons Mills MA 02648 D COVERAGES .. 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, . .r S.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ (_),ELUSIONS AND CONDITIONS OF SUCH POLICIES. - - POLICY CFFLCIIVE POLICY FXPIRATION Limits IYi 1G.Or INSLIRAI•ICL POLICY 11JUMBUR DAIE IMMIDEWY) DAIL(MMIDD/YY) GENERAL AGGREGATE $ 1000000- GLNLRAL I_IAUII IIY COMP/OP AGG . O98 _ $ lOOOOOO 0 / COMMERCIAL CEP25552812,• PERSONALBAUVINJURY $ SOOOOOA CLAIMS MADE I_X I OCCUR ^ { _ _ OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ SOOOOO _.... • - FIREDAMAGE(Any one fire) $ 300000 i _ ---- ' MED EXP(Any one person) $ 10 0 00 i I ALI IOMOBILE I-W31UTY COMBINED SINGLE LIMIT $ . I I ANY AUTO ... -� j ALL OWNED Al1TOS _ ` _ - - _ BODILY INJURY g' (Per person) SCHEDULED ALITOS n _.._.._--_---`--------_-- I IIRED AUTOS BODILY INJURY $ - - i - (Per accident) ' hION-OWNFU AUTOS I. PROPERTY DAMAGE $ I - AUTO ONLY-CA ACCIDENT $ —�t'ARAGI-LIADILIIY _ _- OTHER THAN AUTO ONLY I ANY.AUTO --...._.. EACH ACCIDENT $ I AGGREGATE $ _. -- EACH OCCI.IRRf_NCE $ IIX(.1:.SLIABILIIY - AGGREGATE $ ! i UMBRELLA FORM OTI IER THAN UMBRELLA FORM -- - TO STATIJ- OTI1- - iI WORKERS COMPI_H:SA r 01-11010 I TRY LIMITS.! __ tTt _.... ......... 1 1.;MI'LOYERS IJABILIIY EL EACI I ACCIDENT $ 100000 B ! ]HE-PROPRIETOR/ X I INCL SWC17005902 08/09/98 08/09/99 EL01SEASE-POLICY LIMIT $:S000O-- PARTNERS/EXECUTIVE EL DISEASE-EA EMPLOYEE $ 100000 OFFICERS ARE EXCL 1 1 _ _ D!i,SCRIP11ON OF OPEIt ATIONSILOCATIONSIVEI-IICLES/SPECIAL ITEMS l oofing. Corporation active 10/l/98. CERTIFICATE HOLDER CANCELLATION _ l PEACOC 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1 EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 - ! 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY j - - OF ANY KIND UL20N T1-E COMPANY,ITS AGENTS OR R-PRESENTATIVES. AUTHORIZE EP { ATIVE I 1 ACORD CORPORATION 198 ACC ,.,..:.,. ,Engineering Dept. (3rd floor) Map rj Parcel Qptermit# House# Date Issued . Board of Healthz(3rd floor)(8:15 9:30/1:00-4:30) Fee Conservation Office (4th floor)(8:30-9:30/1:00-2:00) 121SIA4 rq Planning Dept.(1st floor/School Admin. Bldg.) $�j �` DUST BE Definitive Plan Approved by Planning Board 19 . IN6 PLIANCE 5 ENVIRON ®DE AND TOWN OF BARNSTABLE TOWN � Building Permit Application ' Project Street Address � 4'2�3 d Village h-r�) Owner CAk(,,, (V CJU e-- Address I a i Telephone 1.��'� 5((4 q,5�--T Permit Request First Floor square feet Second Floor square feet 'Construction Type 5! Estimated Project Cost $ Z57C6 Zoning District Pi� Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1 Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing J: New r Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) a� ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑.Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name i Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE RA+��t- . BUILDING P MI DENIED FOR TH FOLLOWING REASON(S) FOR OFFICIAL USE ONLY L PERMIT NO. f DATE ISSUED MAP/PARCEL NO. .A ADDRESS VILLAGE OWNER : DATE OF INSPECTION: FOUNDATION -FRAME l INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH 7;FINAL GAS: OL1H JINAL FINAL BULL DATE CLOSE f _ . ASSOCIATIOrgcv"TKO° ' ` r • d ASSESSORS LOT 26 O ASSESSORS B LOT 21 ASSESSORS k 1p LOT 22 5' NEW OUNDATION ASSESSORS 9 ' c6 RR 1 SPIKE 1� cp o cry. ASSESSORS V` LOT 23 c.E. FLOOD ZONE "c"_ FO UNDA TION CERTIFICA TION RES ZONE: "RF" TOWN.-COTUIT SCALE.•1 "=40 PL. REF, 149 79 ELEV N/4 — —�---- I CERTIFY THAT THE ABOVE 'YANKEE SURVEY CONSULTANTS FOUNDATION IS LOCATED ON AA OF M�; THE GROUND AS SHOWN, -AND �� �y P. 0. BOX �85 IT 5' POSITION _DOES _____ PAUL A- � . UNIT 1, 40B INDUSTRY ROAD - q. MEROTHEw NIARSTONS MILLS, MASS. U�648 CONFORM TO THE ZONING LAW No. 320e8 TEL: MILLMA SO SETBACK REQUIREMENTS OF ' oFESso�P� FAX 4�0-0053 -- _ "BARN TABLE__-- � suRVE'�°� — ---06�' 044 --- — JOB PA UL A. MERITHEW DATE' 9113�96 NU,yrBER51036FND 1 Tkk �--4 --i 70 CC)I•l T tj , � f }. _ r._ }_ .,_ � _ _ —_. ..�. ., 1 _ '+'- - .�_-._�f^ •.-t---e.« .,�- . .i.._ 1.•. _ i-_ -}. -ram ._+...... .r._..5._.-,.-{____}_� _i_..<M-_. ,._- , Ciypi-0 , Paa Tk C,0 p o w.oa , IT D'� s - -;JF ;_ ..4.. • 1 1 1 I � t -1- � + — a s ' ... _ ._ _ . -i._ .-+-_ {..'_�.l_._.}_ t __+_'1„_ 'r`.--`_- _.—{,_ Ili. _. � .... _.. _...._._ __ - _...•.._ I 1 i a } 1 41 t r i E t 71 , f 1 i fsl t�C? t cs c + r 1 I , 615T f t Psi I CrES CTY Ptcr I I t f 4 �j 80* cis lb t_ , k- . � -� + E � � �. , ' .r � u och'f�r• �e-tom ��- - - -- �- - -- -t- -- - - .. ' i + tt k (� Ocv-tdIfC , + + _ c Tt*ES � ` r -- r a ,. _ ; t -•{ ..+. .} _. }-'t -'{. +_' t. -+ _.�. .. + i- '-+ ' � ' -}—' -j{F - `- - t i- IT -a } � .. ! 1 1 r , tt Iif t , f 1 . E t 11 { I , } + � � � - --•-� •-� --1_• .1. __ - .� � } �. - .� _ t � y. +- 4 �, f ' r � � � + r r r r , i 1 I , , • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB. LOCATION J yl 5f • �TV Number Street address Section of town r- r �( � "HOMEOWNER" OMT! 'v C�-�f . ..:.'. . .� Name Home phone Work phone - PRESENT MAILING ADDRESSCarrIr . ' S 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 such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, 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 Stat Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building De arttment minimum inspection procedures and requirements and that he/she will om ly wit sai procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OF CIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 01 Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such-Home Owner shall act as supervisor. " Many Home Owners who use _this exemption are "unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction' Supervisors, Section 2. 15) . This lack of awarenes often results in serious problems, particularly when the Home Owner hires unlicensed persons. 'In, this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home " wner-' actin as supervisor is ultimately kesponsible. I To ensure that the Home Owner is fully aware of his/vier responsibilities, man communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. ' On the lazt 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. The Contttion"walth of Massachusetts Department of lndustria/Accidents 1 ' N Office Of1flF9S igalfons 600 Washitrrton Street Boston, Alas. (12111 Workers' Compensation Insurance Affidavit �r�licant information• �Please PRINT name loc tion• L, ' �j 2 city 12hone t1 l ! D J t I am a homeowner performing all work myself. �l am a sole proprietor and have no one working to any capacity ..„x Tv�+a{f _?eror •^r-' .; 37T'9^�,77AeaKa!e.rzs;7'z.x+."'^5+�aox + sr ,:.•A•u+.+ rr .,n"«' 7".o.^"st+7!f+:r ^.;a+*�....�.�.r....__....__..._,..... _.....x.... ,.. ..• ._wr.,.;,,.:,,,n,,;;r,m-....uxsu.:.:..s ...:Yxi 6r,.._ ,,,,r�rr.r -. .._A�^'asi.+'� �tCs�t�Y. ... _.w.:s'.. ;, _ Wr mmrem sat 9- ampioy@@&;;Leflting an b. con ,ny name: address: Nk insurance co police# ,. �. .. p ..: �.. Y.n�%.. {H,,, ,..���yi8�•.»i+Yv',w�tY'FV '4YWN?4?K?,✓,!!4:[.,w.. � ,+ y Fx.i.'• n .rc, .. ra... w....• 1..._.�_..b:._rriw.X_.....�.—.=_.•.i..�_. 'f�::..rr . ...:.. ..Lri '...... Yi{i.NV"Y.i. .. .. ._' wt...:. '....�.X. ....•'.�'..` .y . 1 am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: compare,name: address: cih phone#: insurance co policy# a.,.......: a.. company name: address: city: phone#: insurance co policy# Attach additional sheaf if tiecessarX• t i> 4 l•a ,a1 y of�y� R ssue�.. r � r� jti `'�,. `'- YT °^ ;:o ...+...- :.n_.,�d�+_:'•�i•-'n?SA.''-�.�a�;+v+ �l .,,i,� 910....:.�.�"x9�i'!',b`3'.t$-iZl.:f4.c Failure to secure coverage as required under Section 25A of 1►1GL 152 can lead to the imposition of criminal penalties ol'a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NYORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of th4staentay be forwarded to the Office of Investigations of the D1A for coverage verification. 1 do heree he pail andpenalt es pe an,that the info Lion provided above is true and correct. Sicnature �'� A r UJU (I] DatePrint nam Phone# }official use only do not write in this area to be completed by city or town official ,►. city or town: permittlicense# rjBuilding Department pLicensing Board check if immediate response is required 0Sclectmen's Office 4' Dllealth Department contact person: phone#; r'IOther I ro,ised 319;P1A) 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 emplmyee is defined as every person in the service of another of der any contract of hire, express or implied, oral or written. , f An empkrer is defined as an individual, partnership, association. corporation or other legal entity, or any two or more of the foregoing enga-cd in a joint enterprise, and including the legal representatives of a deceased employer, or the recei�ler or trustee of an individual , partnership, association or other legal.entity, employing em,plpyees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwellino 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 -,vithhold the issuance or renewal of a license or permit to operate a business or to construct buildings in tli,e commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,ncither'the coni;monwealth nor anv.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. 77777-7-7 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 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. _•- :>..,., .,w��=:c.r•...,..�...-.. ..- '.q<, -.es-„ H...�+•w.•+ea+nrv+r �..f.^+• e.rn.-�!,..^.•.r .,.. .. . e ..-. .,�a..w 1 vt}n.. ..k .w.F.. -77 Cit-v or Towns Please be sure that the affidavit is complete and printed legibly. Tile 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. The affidavits may be returned 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. ` r J,.�'•ysuv�r-... «s.;irr-r.a •r=;,.,�._ .••^.xs tss•�nn"T,^^fe�,.�..:s+a�v�!'5y['�'e�."'rs s�+.m.�w ..+ewnv=nn�x-*arsri.tag-r.;'rr,.v*r!+�ngvar.s•"'m.ax.v, The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 NVashington Street Boston,Ma. 02111 +" fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 L I °F IME Tp� The Town of Barnstable * BARNSTABM 9� 1 MASS, Department of Health Safety'and Environmental Services ArEDMA'�A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only R Permit no. Date `v 3 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: �CL1�!/ Est.Cost �jt70 Address of Work: a t Owner's Name W"✓Iwx1 I Vclz-e/ Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. 7�uilding not owner-occupied ✓ Owner 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 �.-- Iv 3 Dat Owner's Name f ' . .� ASSESSORS LOT 26 �O o O. O ASSESSORS R LOT 21 0 ASSESSORS 1 LOT 22 2a 90 ti o � NEW 3� OUNDATION 1 � c5` G�6 �022 � ��0 ASSESSORS o LOT 97 � ✓...'Hgk' 11 q0::` RR 6 0L SPIKES �0 " Q ( 6' O 1 NNN iQC�,4.Jr� is Yk 31 � • cA- ASSESSORS C V` LOT 23 C.B. FLOOD ZONE "C"_ FOUNDATION CERTIFICATION RES ZONE: "R_F_" TO AN. COTUIT SCALE•1 "—40 PL-REF-149 79 ELEV NIA I CERTIFY THAT THE ABOVE �. YANKEE SURVEY CONSULTANTS FOUNDATION IS LOCATED ON O� `oF .. �� may• P 0. BOX 285 THE GROUND AS SHOWN, AND4 �\ ITS POSITION___ PAUL A. ,, UNIT 1, 40B INDUSTRY ROAD ERrTHEW CONFORM TO THE ZONING LAW 1&sus d. MARSTONS MILLS, MASS. 02648 SETBACK REQUIREMENTS OF �P� TEL: 428—0055 AlBARNSTABLE bs`�yo� FAX 420-5553 SURq_ - -- -- JOB PA UL A. MERITHEW DATE 9113�96 NUMBER51036FND f 50.00' 'r -1 yfow5Q A' - 7,5 Z6,+ •�A . 44 t t��� 94.40 � — DL s REET RES Zom% "RF''" This MORTGAGE INSPECTION n ya or FLOOlo ZONE.' "C" ----..®------------ E S O DATE REF: s --------------- BUYER: L NRRF Wbf�h' L..T.U�____ ---- I HERESY CERTIFY TO .. - _ THAT THE BUILDING �ttt� YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS CONSULTANTS SHOWN AND THAT ITS POSITION DOES —„_ CONFORM PAULP � 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE McRMgRW �: TOWN OF $$8WLI&Z-------------AND THAT �a�wt INDUSTRY ROAD IT DOES_. Q. LIE WITHIN THE SPECIAL FLOOD HAZARD *` sAR.STor�s MILLS, MA. 0264a AREA AS SHOWN ON THE H.U,D. MAP DATEI},.7�. ^/ __ l t�' TEL• 428-0055 00 017-- X: 42 555 TmIs .pw NOT R N MADE F 09 A U 19279 -8E US9A FOR qNCES, £6TZ9£L ti£:bT 966119Z188 Pvo Pvs�-p GfV-0<4e Ct��t � rnt� r vc K-C [L lAof i 1I I t t 1 I0"1 - I UTY TRUSS ENGINEERING CORP. HURLEY & DAVID ' LUMBER SPECIFICATIONS (NOS 1991) IAMEq FOPCES FTI M ! FT 73 91G�jT No excessive wane or knots shall Top Chord: 2X 8 1950f-i.5E SPF MSR I- 2 = -1912 1-10 = -1309 2-10 - 45 occur in =late conta-t Brea.' Btm Chortl: 2X 8 1950f-1.5E SPF MSR 2- 3 '"1747 :0 i1 = +i290 2-10 i81' 3- 4 -1637 11-12 +1130 7-14 = tl91 'deos : 2X 4 Stud SPF 4- 5 - -1275 t2-13 = Itf30 9-f4 -45 IExcEPt as noted below) 5- 6 = -1275 13-14 = t1200 T- 3: 2X 4 1650f-1.5E SPF MSR 6- 7 - -1637 t4- 9 = +1309 BC: 50 PLF from )t.10 to14 7- 9 -1747 7XB= Approx. trs. weight= 202if. 5 9 1912 X8 3X8= 3 9= i I1.5X3 1 15 a 0 3 B o 7X8(Soon j) o 7X9(Spl) 3XBN 2XX66 2X5° i 12 1 D / II.1&X6= 12-0' 8X9= BX9= ]4 10 7XB C i 0 3'-3 11/f6" 2-8 5/16' 2-2 i3/16'_ 3'-9 3/i'e' a 3'-9 3/15' 2 -2 13/16' _2 -6 5/1E' 3'-3 11/16" F 6-0" 2' 9 t;/16" 3 2 5/tE" � -2 5!15" 2'-9 11/16" 5'-0" 1 0' 24 -0 p=;578e 3'F A-1572f 3 5' PLATE: MITEK FURNISH A COPY OF THIS DESIGN TO ERECTION CONTRACTOR TYPE: ATTIC connector platss small to sale Iron 20 gauge Grave A ASTN jAe46-721 pr;r.e, rot-a!poed L D A D I N G g 1 . Designer: CJP ga lv sm lied steel. r'!ates shall oe aooiieo to ootn facgE of truss et each. joint. '+Wert aroenslons are not snonn, olace plates symmetrically eoout the ;oint or as i^alcateo CPITERIA ANSI/TPI '1 1995 Seale: 1/4.=1 ' dy circles jot. Cutting ants faoricetion small oe accodol,sned us i:•g eau cement wr.irn will produce snug fitting joints and fully enneddea plates. This aesign assumes that Top chord 35.0 f 7.0 psf DATE: OB/ 1/96 the compression ter;chord is tnnt!nJously oracea at tme roof sheathing. Only pernenent structural tracing,reovtreo of.individual memoers is rotea an trots aesign, masses can Btm chord 10.0 psf Check by: tse dangerous and can cause damage and persons, Injury if 1.*oroperiy instal Tee erd/ar aracm Persons erecting trusses ere aaviced to seet or^-less is^al eovice regarding Total Load 52.0 psf Version: 6.7i temucrary eraction ohacino vmich !s aIways redU Jeo to orevent tcpoling and domincing. Bracing shoNr on this orating is 40T ERECTION e0ACU4. Refer tc:'tWACiW MOOD TRUSSES: Duration f actor 15.0 % Drawing No. COMENTARy ANO aECOMMENOAT IONS" as auollshea oy the truss prate !rstitute for ]naustry standaras in erecting trusses. (TPI) is locates at 593 O'Onofrio Orive. Suite 200. Spacing �24,0' O.C. N=_aison Ai 5371E feC je00) 033-5900 I, ' The Commonwealth of 4 fassach usctLs �+.ir -- = Department of Industrial Accidents Office Ofinvesf 011011S VA '• w - �:.: ♦Its 600 1i asbi►rrton Street Boston,Afaas. (12111 Workers' Compensation Insurance Affidavit �pnls:tnt Information• _ • _ _ •�T Please PRINT�Ieg � nme loc•Jtion• cite ► phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity �.t?.: .a.••^e!�n' `.t".S' �R'E!"riTfVe[v4.Px.y�7lp�sSr"�4aT'�" t!p. .vlNl��•"Rvtp!•ri,�{f�y.......a..�� i.:_....d�.:.:'....:....1+- v, _�n.4,....:RJ.:ir:zelY.+«at: ....�_ .. at„c„`r. . r..a�:r _..�t�::'�,.,:._ ,•"","-�sa•c3:� .,-�,,.. �.. r::,..:a....._._.._,..._ 1 am an employer providing workers' compensation for my employees working on this job. company name: address: city: phone#• . insurnnee co. policy# 1 am a sole proprietor, general contractor or homeowner circle one)and have hired the contractors listed below who have the following workers' compensation polic company name: �5 � ��IJ�'1��6N ...�. ?21L OR 0:-� address: D cin: � if 1 t l phone#: iJl!! C)tq4 insurance co policy# !_»^6= ..__ �. :_.• «: •ao �-s.-� ^,qr� r^-�rerrt��^n�- rr!,.y ��:: ..+a' �i"•; T" -': -K r.._ _ �� n� (� .aaw +�.r�. �--�•-i1r��- A 1 - :�+►rt`a'�it�:.+,a.i.::::.cin company name: address: ( OCT— kiL_C _ city: ( Yi 1 U r phone#• ✓(a Z ^ D insurance c0 policy# ;Attach addi_honal sheet if neees_sa'_ry'��"T w a� i'w� s: �Yfam�-- _ Ut.Er•+ •'t.i•{` ,t..�.�r.+y�" ' `. i.9i'LIC!'�`JC.r7l:Mus- Yi.�ti Failure to secure coverage as required under Section 25A of 111GL 152 can lead to the imposition~of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. I do herebr certift cruder the`pa�i�s and penalties ojperjun•that the information provided above is true aanndn correct. Sienaturo, /L—, �r Q �I/� 1"r—_11 U Date 0 Print name Can:r�-� aL l.GfrG iy' Phone# �I ` *official use only do not write in this area to be completed by city or town official y city or town: permit/license# I'tluilding Department Licensing Board check if immediate response is required 13Sclectmen's Office r (311ealth Department (contact person: phone#; MOther IrcvisedV95 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 enrplitree is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrpl(tver is defined as an individual, partnership, association. corporation or other legal entity, or any two or more of the foregoing gaged in a joint enterprise, and including* the le-al 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 even,state or local licensing agency shall withhold the issuance or reneNval 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. Additionaliy. 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. f ._ _ .. •t _ 4 f .,a �. tea,- :•+v;paftt.Mw...••.eS.7r — 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 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 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. Tile affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. Tile Office of investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to nve us a call. I Y 9.R V.W},•wr-+ -•1'�R@.,•lYq '.i-4!R!SiPr �"'�'1R�'r'f�•^MR��..N�1R.VR.':." —!«' 'f'T,� `F The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 Nuo- C-5 Alt- _,q .. _.T ,_ . � ,^ i r ` _, � ��_t ' '' r� r� � ,_� - C f�=�..� ISSUE DATE(MM/DD/YY) Ci PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, E:'?:.?t'Ir='IRD _7 MC-: i':i=ETH i N Ul"'I'=NC E EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. E.. s.i r,"T' j;i;_;-, COMPANIES AFFORDING COVERAGE E! h• f (.' TL ETTERNY A r'AFt.'YL...r�'IND C...:h"*'-I L.jAl....-r•`'i' h•�.a Ir, M f'� COMPANY INSURED LETTER COMPANY C Jr:F F RF: -'s' A SWI—)rwSON LETTER E' 0 :CT)y 1.W COMPANY D P.,R'10L!1-If*-'f_I�"I" MA" (=i;_-6-7 5 LETTER Legion Insurance Company COMPANY LETTER e THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT,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 CONDI- TIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ALL LIMITS IN THOUSANDS LTR DATE(MWDD/YY) DATE(MWDD/1'Y) A GENERAL LIABILITY TO BE. .>:.?:"i_.rC::....) Tj 7,27 '-P F, 57_:•77'?'! GENERAL AGGREGATE COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPS AGGREGATE CLAIMS MADE OCCURRENCE PERSONAL&ADVERTISING INJURY OWNER'S&CONTRACTORS PROTECTIVE EACH OCCURRENCE FIRE DAMAGE(ANY ONE FIRE) MEDICAL EXPENSE(ANY ONE PERSON) AUTOMOBILE LIABILITY ANY AUTO CSL ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (PER PERSON) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS ACCIDENT) GARAGE LIABILITY PROPERTY DAMAGE EXCESS LIABILITY EACH AGGREGATE OCCURRENCE OTHER THAN UMBRELLA FORM I-! WC.1. 1 !.56rr9 Ell! _..,::�! .'_. Ci% ___� 7! STATUTORY WORKERS'COMPENSATION (�?(:;i (EACH ACCIDENT) AND EMPLOYERS'LIABILITY 5(") ? (DISEASE-POLICY LIMIT) t)t:i (DISEASE-EACH EMPLOYEE) OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS e e SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EX- PIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL '() DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE F'ACiL._ i r'Af_-'-,N I r=Cl'E LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR E"!•) {?-I '' ' LIABILITY OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. '::; )E"rlN 1;r r A 0�'�,t'�,(i AUTHORIZED REPRESENTATIVE °F FIE The Town of Barnstable ¢�' Department of Health Safety and Environmental Services �OrEp 9. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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. c� � Type of Work: �C).) cw SIC Est.Cost ('o Address of Work: Owner's Nam r GL4e-� Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied —�—owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME '11VIPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner:. Date Contractor Name Registration No. OR Date Owner's Name ' • TOWN OF BARNSTABLE BUILDING DEPARTMENT • HOMEOWNER LICENSE EXEMPTION Please print. DATE 1 :,. . Joe. ioCATlox 'Number Street address Section of -town "$oMEowrrERti -Vvckr l ,-.- • ._ Name Home phone Work phone PRESENT MAILING ADDRESS Kfk City town State Zip cc The current exemption for "homeowners" was extended to include owner-occ: dwellings of six units or less and to allow such homeowners to engage an dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends tc side, on which there is, or is intended to be, a one to six family dwelli attached or detached structures accessory to such use and/or farm structu A person who constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner"' shall submit to the Building Of on a form acceptable to the Building official, that he/she shall be resnc: for all such work performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes ,responsibility for compliance with thL Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requireme. and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be requir: to comply with State Building Code Section 127.0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which:- bui: permit is required shall be exempt from the provisions of this sectioi (Section 109.1.1 - Licensing of Construction Supervisors) ;provided ti. Home Owner engages a persons) for hire to do such work, that such HOE shall act as supervisor. " . Many Home Owners who use this exemption are unaware that they are asst the responsibilities of a supervisor (see Appendix 0, Rules and Regulz for .licensing Construction Supervisors, Section 2.15) . This lack of a often results in serious problems, particularly when the Home Owner hi unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home�'Owne as supervisor is ultimately responsible.. :.:. ... To ensure that the Home Owner is fully aware of his/her responsibiliti communities require, as part of the permit application, that the Home certify that he/she understands the responsibilities of a supervisor. last page of this issue is a form currently used by several towns. Yoi care to amend and adopt such a form/certification for use in your comet; L. u� � -ter �P- 42-�G -YG I i i Engineering Dept. (3rd floor) Map t. 5 Parcel 0 AQ Permit# House# Date Issued aA 2 If r Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) f Fee Conservation Office(4th floor)(8:30- 9:30/1:00- 2:00) Pla ool Admin:Bldg. THE rq Def' i ' R1 iRwri�r,&effd- 19 ScPT'C 154ST I TITLE OF BAtNS � ' .;��•d�'r`. .,� ZNT . Building Permit Application TOWN G��,� o �°�4° roject Str t Address /0 ,SCoQ®L la ( / lVl� �` ri ` , Owner CA- TftF9JX)6_ LU, 72 4M Address 96.-SCAofk" Telephone 9 7 Permit Request _ _ Aoa2p.L- 2gE (i('j pOflA T i�0 n I I P1}- First Floor square feet Second Floors O square feet Construction Type �l�b14�1 PX__10 Yf 4 Estimated Project Cost $ ®O Zoning District AA F Flood Plain Water Protection T Lot Size ® (,* Ac Grandfathered O Yes ❑No + Dwelling Type: Single Family ® Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes a)No On Old King's Highway ❑Yes [311Vo Basement Type: ❑Full ❑Crawl ❑Walkout NJ Other I H-U (C° VyE t0 D ) Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing 2 New Half: Existing New No.of Bedrooms: Existing 3 New Total Room Count(not including baths): Existing fO New First Floor Room Count Heat Type and Fuel: 4 Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes Z No Fireplaces: Existing O New Existing wood/coal stove ❑Yes Of No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) JA None Qd Shed(size) /* ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes �d No If yes, site plan review# Current Use E55/benjr/*L Proposed Use BES/.W�A-L_ Builder Information Name NALOILU- 1 Telephone Number ?A�' q z, Address &)( / — License# C :ZXty\ "t, Home Improvement Contractor# Q Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE��`f-L_�0 DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) 1 • 1 t `- S 1J- ' \ � � '' .. y t } � 1 � P' _, u ..f - , �'� .. ..•..,•� s y , . .. . �. .. _ _ . . . � -, �����` .�f • . . � �� • - ,� � � �. � . ^, • a . , e � � r •7 i r �'^ • Engineering Dept. (3rd floor) Map 6%3,S— Parcel � �R Permit# House# 76 b� Date Issued 3 -029 --9 yt Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) � e CJ (-,2, C)C) Conservation Office(4th floor)(8:30-9:30/1:00-2:00) ru,�7 ��, Plannin� BB��gg79 a�ygp p{p�}}�m�S pp[[� R �' rd 19 W1 d �� '? �! Irs�e,,,� ram^ •.: BNSTABI:E.` !` Itreet �i1.`a�t!'J'.:� .� &a"..�'.. - .MA • 39. TOWN OF BARNSTABLr . '%Building Permit Application Address vo t Village &TV 1-r- Owner f2'LQry x� av� V-- Address d surf I C0. r Telephone - 1 �b ro�(f�aran Permit Request r-a- U n X,L' First Floor square feet Second Floor square feet Construction Type U)00 Estimated Project Cost $ am Zoning District Flood Plain Water Protection Lot Size 110 T(6 Grandfathered ❑Yes ❑No Dwelling Type: Single Family f Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ld N o On Old King's Highway ❑Yes Basement Type: ❑Full ❑Crawl Walkout ❑Other N I Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1,J JA Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count t— Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No ,,Parage:P Detached(size) H YL Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name '-U1� Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. r ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO � i C (/SIGNATURI �,(o�� ,t�.� ZZZA4,e— DATE Y BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) \f �'1 ,�� i� t �Ol// .�/— Il � n....F.r.. ,,._.�...�rr...on. e.xa .w:�......�.,, •w -r �t� �'..0 { � .y � � ti a � � " � + �. _ _ � .� � j 1` '� . . • 4 J..• .r , t �i •1 � .r _ s � � .. i � � � ;'� ,t l 1 11 1 i r �� s � ry ,�! �, � �� �� } � { �- 76 5; S'e cx. \ :: :;:z::::::::.::::.::::• r:ar:>;:.;:.;;;:.;:.;::.::.;:.;:.;::. ::::: .. :. i. y.::o:>:>:;::::.... .......:..•:•::•:-:: c: ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Fe i to I be rg Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 222 Mi I I i ken Blvd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fa I I River , MA 02722 COMPANIES AFFORDING COVERAGE COMPANY 508-676-1971 A U.S. FIDELITY & GUARANTY INSURED COMPANY Robert B. Our Co . Inc. B Shorey Manufacturing Co. Inc . COMPANY 24 Greatwestern Road C P.O. Box 1539 COMPANY N. i M 02645 D THIS1' T RTIFYTHATTH:. mP OCE T EPOLICI> »>:FRAI::>:<:> ESO NSU NCELSTEDBE �WHAVx�ry LO EBEEIVISSUED•TOTFiEINSED f2 IVANI�•..A V •••U NAMED BO EFOF2TFiEPOLiCYFERiOD INDICATED,NOT WIT HST ANDINGANYREOUIREMENT,TERMORCONDITIONOF ANY CONTRACT OR0T HER DOCUMENT WIT HRESPECT TO WHICHTHIS CERTIFICATE MAY BE ISSUED ORMAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWNMAY HAVE BEEN REDUCED BY PAID CLAMS. 00 TYPEOFINSURANCE POLICY NUMBER POLICY EFFECTIVE POLIO Y EXPIR AT IO LTR DATE(MMIDDIYY) DATE(MMIDDIYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ 2000000 A X COMMERCIAL GENERAL LIABILITY 1MP301095509-01 12/01/95 12/01/96 PRODUCTS-COMP/OP AGO $ 2000000 CLAIMS MADErX OCCUR PERSONAL & ADV INJURY $ 1000000 OWNER'S&CONTRACTORS PROT EACH OCCURRENCE $ 1000000 FIRE DAMAGE(Any one lire) $ 50000 MED EXP(Any one person) $ 5000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ A ANY AUTO XM5879933 12/01/95 12/01/96 1000000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY -EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ �EXCESS LIABILITY EACH OCCURRENCE E 5000000 A UMBRELLA FORM 1MP301095509-01 12/01/95 12/01/96 AGGREGATE $ 5000000 OTHER THAN UMBRELLA FORM I $ WORKERS COMPENSATION AND STATUTORY LIMITS EMPLOYERS'LIABILITY A 7715216-95 12/01/95 12/01/96 EACH ACCIDENT $ 100000 THE PROPRIETOR/PARTNERS/EXECUTIVE INCL DISEASE-POLICY LIMIT $ 500000 OFFICERS ARE: EXCL DISEASE-EACHEMPLOYEE $ 100000 OTHER DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES SPECIAL ITEMS For records only . P.O .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Paula McN i e c e 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, P.O. BOX 9 1 7 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY South Dennis , MA 02650 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 707170000 ....................................................... � � I 19'-8 1/2" 7'-11 9/16" 4'-6" 7'-2 15/16" 54x40 R Ln io 39" 2' 30" O I KIT_ CHEN ' R 7'-4" � U�lfD1'i�' f Ien I _rn i � 29—1/2" 21-1/2" iiv I CL-0 s�7' 35" 164-1/2 . . ENLARGE OPENING TO40-44 12 -2"' CV �ic DINING RM N I BEDROOM 3'-9 1 2" N 1 rye. • The Commonwealth oflylasstuhuse&s - I Department of IndustrialAccidents '� -� = � o�iceoNnnesbgaliens 600 Washington Street Boston,Mass 02111 Workers'Compensation insttrancL.Affidavit Rpm. I=IIIIIIII iL1�nt� ^ 1llCulinn• city h� ❑ l am a homeowner performiu all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ I arts an employer providing workers'compensation for my emplovees working on this job. 7 - 71 -city:y i ' '•'� '' olio # ' ❑ I am a sole proprietor,general contractor,or fiomeowner circle one)and have hired the contractors listed below who have the following,workers' compensation polices: ` m an e: O 9 spin tan � . �a9urance c •nli vtt' Failure to secure coverage us_4...ed oader Scctioa ZSA or 4Ttt:t.152 can lead to the imposition of criminal penultics ota Out up to$1,500.00 an&or nac years'imprisotuuent us well a3 Civil penaldci is the turn ofa STOP WORK ORDER cad a time ors100.00 u day against me. t understand that a COPY or this statcmenr tray be forwarded to the(ltsree of luvestiaatinas of the DIA for coverage verification. 1 do itaeky certifppy under rhr pains annd penaide's ofperjrrty that the information provided above is true and coma. Signatu L�.yl C,/.C _ Datc 12 ,101 Printnumc� Ll�i—i�IQ c hcnc it l ,)fticial use anty do not wnte to this area to be completed by city or town oinciell sty fr or town; permitAiecaec k Building DCpnrtment ❑tlten3iaa daerd Q check if immediate reeponac is requirxd 0$deenatn's srd OHcalth nepariment eootaetpet3uffice n: phnaeA, ,�Other J .(revicM inn PJA? : . The Town of Barnstable • anarrsTnsce. • Department of Health Safety and Environmental Services ArFp �A Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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: 1���Z_ Est.Cost JS?00 0 Address of Work: 70 5c,1420L® 05T., C-®Tyl T{ Hd Owner's Name eJ+THE_lL/4JC 1-1 1_rZ/d!4G'X Date of Permit 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 Owner 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 Date Owner's Name TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER, LICENSE EXEMPTION Please. print. DATE JOB LOCATION -1 M. e� �',�7�l T YX- . Number Street address Section of town "HOMEOWNER" 408 f? _ 7 - • Name Home phone Work. phone PRESENT MAILING ADDRESS` 6k)7L8 City town State Zip cc • The current exemption for "homeowners" was extended to include owner-occ: dwellings of six units or less and to aJ.low such homeowners to engage an dividual for hire who does not possess a license, provided that the owne_ acts as supervisor. DEFINITION OF HOMEOWNER: Person(sJ who owns a parcel of land on which he/she resides or intends tc side, on which there is, or is intended to be, a one to six family dwelli attached or detached structures accessory to such use and/or farm structr A person who constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner"• shall submit to the Building Of on a form acpeptable to the Building Official, that he/she shall be respo for all such work performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with th; Building Code -and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requireim and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATIIRE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be requir to comply with State Building Code Section 127.0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for wh .ch.�- bui permit is required shall be exempt from the provisions of this sectior. (Section 109.1.1 - Licensing of Construction Supervisors) ; provided tk Home Owner engages a persons) for hire to do such work, that such Hoa shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assu the responsibilities of a supervisor (see Appendix Q, Rules and Regula for .licensing Construction. Supervisors, Section 2.15) . This lack of a often results in serious problems, particularly when the Home Owner hi unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home Owne as supervisor is ultimately responsible. �. .�. To ensure that the Home Owner,. is fully aware of his/her responsibiliti communities require, as part of the permit application, that the Home; certify that he/she understands the responsibilities of a supervisor. last page of this issue is a form currently used, by several towns. Yot care to amend and adopt such a form/certification for use in your comma - - _ tN.5TA cr It i V44 oc E a t i --1-•- f f t � 1 --- t - - - , - - _ - - - �_ --- -- - - - - . .. _ - _ ,, , � ;t. _ _ ..._ __.. __ ._ .. .__.__. __ _ _ __ _ _ __ - _- _ -- _ . _ __ _ _ - _ ���� r k - - ... -- - - - r---� __,u. _-�.�. _ r _�,._._ - _ .. _ ._ ,� ._._� .� - _.__-•- - -� _ ... _ � . .._ _ 1� - - y _ +. � _ -- ---�-- _ �. _..__ ��. � - --�_ _- V_ �_ _ .f - - -r-.-�--•--- - -r -i- --..----__.__.� ._ ___ �_ __ ___ �,. _� ._ - _ � .. Assessor's map and lot number .................... ...................: c SEPTIC SYSTEM MUST BE_ INSTALLED IN COMPLIANCE Sewage Permit number ........... :....... .......... V41Thl A TICLE II STATE SANITARY CODE AND TOWN yo�tNIEro� TOWN OF NrVrA131t-E Z BABBSTABLE. i 7 9O0,e. M6 9 ,0� BUILDING INSPECTOR 'EO NPY a' APPLICATION FOR PERMIT TO ....................... <.....!.1.�D TYPE OF CONSTRUCTION .................... 1..). /.. !. ........................... .f(!. .....�/�OUf ,............. ' ..........::r 2 ... ....19 — TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit y--according to the f-oll-loowing information: Location ................ .. .Q. -........- ../...:......Co.��l./........................................................................................ ProposedUse ................. .4'.. .1..... .......................................................................................................:................ Zoning District ........................................................................Fire District ........... .A'A—.4-.,.1�.................................... Name of Owner .. ��1 .. a...W. S ........Address ...` C. .O ..... f:...... V.�.. .......... Name of Builder Av'r? . .........M.4t lrl Address .............(2-1 v.r 1.7 ...................................... Nameof Architect ..................................................................Address ...............................................................:..................... Number of Rooms ...............Q).".. ..................................Foundation P..A a . . ...........cm 4�L......s A CC���I�...............: 11 ��� .......Roofing ?I . Exterior .......................... ...... ....... .. ......... ................................................ Floors C��.AO S� J Al .Interior ...........eW!9! !9��........................................ ............................. ................................................ Heating ..........!W,*R.1.'(..... 41.f�.�...................................Plumbing ....................... ......................................................... Fireplace ..................................................................................Approximate Cost ........; ... L................................. . Definitive Plan Approved b Planning- Board ________________________________19_______. Area �`� pP Y 9 ........................... . .... ....... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH �O ! 201 �G N / 7 - ' - Sty 6 6 1� 3rR, �T I hereby agree to conform to all the Rules and Regu ations of the Town of Barnstable regarding the above construction. Name .... .��.. ...... ..�.�..�......... .... - 1 West, Gordon E. No ....1b555 Permit for ...... ..ad ......single faani d�relling Locationj� Sohool Street............................. Gotuit ............................................................................... Owner ........................Gordon....E..............West......................... Type of Construction ...........f1;'f.L?AQ.................... ................................................................................ - i Plot ............................ Lot ................................ ! Permit Granted .......�ptember 10......19 73 Date of Inspection ............. ......... ........19 Date Completed .. ..Z. ....71.19 PERMIT REFUSED i 1 4 f ................................................................ 19 ............................................................................... ............................................................................... `. ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... �/+ � L� o use frL4 i k If-;1-G ttf-1 U L ? . uS v��� ' ' �� d 't% F .s_ ,�_. - � . . �; . '` �_ �. ,, � ; <i f� 14 - ` 1 � ... f� �h� _ { ,.t _ . i ._ � � „ �r 19'-8 1/2" - - _ - 7'-11 9/16 4'-6" 7'-2 15/16" 54x40 R in co 39" 2' 30" M O ' r KITCHEN L R .� 4'-11" 5'-11" N 9-1/2" 21 �! 4'-6" r w 35" D W 4'-9" r7 M •-9» 64-1/2 tt ENLARGE-OPENING r7 a, CLOSETDAM " . TO 40-44 r I 1/2 r -Lo 1 l Nto 10 I DINING RM �t re) L o' BEDROOM ` 3'-9 1 2" of IN 11'-10" of r' r N Ot 4'-9 1/200 _ 14'-4" LIVING ROOM j f7 0� I i 3'-4" 2�-8 -4- 2'-B" 1' y FIRST FLOOR PLAN SCALE: 1/4"=1'-0" r � 19'-6" , 3 1/z" 9' 10'-2 1/2" 39"-62" 37"-61 CLOSET ADDS OPENING j I. REM VOVO E DOOR 4'-j10" ` 3o_sp .— — N BEDROOM F M M j BATH in (-01/E OL iv 1{REMOVE o r30� -OOR' \ M I t15'� j6k sT — c a I ' N \ a .�31 so 34 CL DUCT • CHI NEY CLOSET Du N in O . in U _ 3' 12'-5" A, M 5 W MASTER aBEDROOM a : in SLOPE UP N ci 1 O t 39"-62" 39"-62" ' s r 3' 3'-3" 4'-2" 3'-3" 3'-2" 3 1/2 1 _ 11" 1/2" 19'-2" "SEGO-N FLOOR PLAN SCALE: 1/4 1'-0" l .., Pfyv PO-5 CD 600- E C-o�- ' Sc—rfiao` S7 . - - Coin 1" � c 1>05 I l l y S.0.ca. _ -- - Ell! p•+( Fie&M Uc Ktrq r��A I ` t �C P� �y . = � r 0uN'�P�T ION r HILL 3° / W ALA -EM T — t R1 i I I G JBI ' • � I IIIIII III � 11 � - - I r - �� - k - - - I I II i I _ SOL iD ' IZ�nrL ELtrVfYTiOn1 }ZI(�t+T �EL�v/F-�onJ r J_1 I-IL Lir w 1111 till I III ! III I III II 1 Ilfl If l L t FTGf/ff?1 n n J These drawings were.prepared-by Capizzl Home Improvement for the use of Cap"Home Improvement t Lpe employees and subcontractor:;.Anyone using theseK� 6 drawings should field verify U existing conditions, SD 6 ` r {f APPROVED BY. DRAWN BY drmensi,ns,:n.:conhSnrrfry to local and state budding code:-.nd r',e aderluac-of these drawings. Capizzi Home DATE: -6-O S REVISED S-Y D Imp: .+ent disclai��s any responsibility for any andall prof. •vv;h arise from the use of these drawings by y g /�hRon) Mst Ln,y�--,M)14 Anyone ol„=r II an employees&subcontractors of �r Capfzzl i torie improvement. DRAW INO NUMBER . Gyf-/�,rj�i Hriu-,�/hiP yr�8-9S/fir /Oh 3 . I rJSUt.4T7ON — - - k 13 UJAL L� . l n/.v v/Nf&- S/ JZ/N6 1'-17-,Ld,r - s VJNyL - RU664-E2 Poor Ir{ 5llvrren /3fstcr_- v/-,,yL PLy F���OUJ ✓EP_1F� T-D2 /rivc�e2 rjP�cl, VINyt T�/,,•l GUt/�2 �4Lf_ No Ix 8 'TRIEZ-r-- FOOT SLOPE _ aXla`/�16"0G 3"MhX' f�LC PVG. �lL/NCv /(a"OG ySrEr �_�7 - J CLLf.v7 Z' — SLoP& P"PE2 TOOT I��GKlN(>-_ 6� GLPf-- x v v X axyTaP PLATfy >Z Sltowcp � �� ax yy o O 1: 9a sag ff/6L1 19A y 3 fob r= -a— r�X6 pTj1L[�lr o ¢ a /a• c �0,0 6toaK (rJ/ S �YL n jOL/D L, ate' 3 3- RX16 P7- yUU11J 0, -77D A) 3 6/2 T „ !oAvG. LustLr._y 'crJ//i'xf' �P�� GvO p W �4ToP /O" w 7 I - 8'H/G!u Ag o/e ]J LlTTG V/n1 /L o 2 (:fom O f/ � L = J7A/1'(P P11-DO F �L U cJ G 2�1:�1= � o P-77°n,h-L Ext5Tnti& f/'CONG. srA-el x3 13&Gr- FRAM/NG 5EG77o,/J -- _ FQRM/.tJ6 �C-77onl- �U/NL'JtJ t- E}�TEIZ/O� 1>002 - -- A/11/n.6,E-i2 /LO. ---- (�L.it J/% e-/7-,5 - . _G &0)(6 SbjDe�e V/N/t ff�l2vfr� 2EV5= D 44. G These drawings were.Prgpared by Cap_Hume As diroverirent7orthe Tl/c K E/2 ; �9 y O ifo e s s �bf CapivJ Home Improvement y'' and subcontractors. Anyone using SCALE:/ _�// APPROVED BY: g these DRAWN BY n field verify al1 existinq condii ons,".�T^nit,�n4, •1n C°nI^rml DATE: 7-�- REVISED codes and t6c:adeyuac%Oi These draw nsta'n butict4 Improvemenr ilisrtarns ai ry ra y responsibility foand 1-me Problems Which arise from the Y and II Anyone other than employeesuse°f these dravings by DRAWING NUMBER Ceri721 Homa" 8 suboordractors of nnrr".�rnenL Qtl'GE 3 ON 3 9 - R'MOu� VENTUo1D6 u�fN°mow FA5cfA l) , 6, �?7u7xdC 4 - - - - - - NEW_ _ v GONG. WALL L//[ 5°L3r SD 81 PA55 j /6"XS° CO,UT. i. Vc Phyy '� . .. 11'XUJ 7VPJ 8-0'/,f/6 41 - 12EL.E.-rE o ' {� —ID 0QAA' a4xe6 Nc yo P- $Ot,r P X h D17E - Z>MuP P N&LJ CLogET' 6 n-NFL •�.' .- 44 co P �. 1 LOW C�RIa-D 97 « Ir POG KE 1 8 �„GONG 1.5 L h6 y. f 11' D 4-- no°K O` 3 �iLISY, T)(CJ f J6 7 7/a"4( A1ELJ 3�720�N4 ra • i � _ Q � - • �� Exns-r.r M/hY7-�2 SV i-7� . .. 3 OPT-. )=L.USN, - a''poce--75 a,/31.1 to/ " 601U6• GUG U M N LwA)Daao.5 rv�LlJ LS �pS�TTE4 a > x P T PO GS''t.r'7 / r NEW-D,}L..V�1N . t�l y 1 L7 � K�AAOUY 2xrST,t r „ V - - ,1 LIA�EN- Gn PrzZr 4TDP 30"x3U'x/O a � t] SUPr� O GoNLI. 19A 05 n D 5 !< -r1-9 v T Tpp KS 8r c b O, EXIST ti NEW I r G .0"Mhx - x �`�✓� Nsw �nNlr� po ( N+1,J O A-a E d Df /SLT 1n t wsT- � �„ RETAf ExrSr, w�STORAA L_� � NSW �iF'n.f1�.�{-2oou,t - +� FovND TTo� w�.e�-T�tr f v a an ` [1/X!.L GAP Le/GONG, AxW 41 Ito 'I v �r4 I Exf$T. 4M l hf r / .� r) NEW L,EC r Q r- ° PAAIC L �Lg oo -BEroc.J � - 'Dot76L.F,�U1ST(J SHow 2 aLOC DGT• - nlaec VEN A= I t I -- /D /�T WsrU • LE E y; 1 1, NO11T51D CfP!JaGbnneN7 �; 3°X-& © �"X/c� 51 fD V/N�L. vEN FngG[A C D- S W _f2 Do v �J l S L hFfl CVB_r( u//!oR cc'$7V I c.f�GGfCL 377/EtA4 fr SILLo 'f30�V- I �" a v /o'I -g" Ij — - o -iteIR c p E-X I S T, 6 a„/v 3 cJDROP �uLl< x -— -- � 1/0 Paox � ( � � New DECK 4 -3 x I0 T. G/ T 6 Go 1 T5 DEG ie-i u T°� CLI ENT 0° 50 f4[j [tt N, ` ALL KiF/L(Nv$ -B_y CL_I•ENT W/ GAPS 41 Eil , L- ATTI G r= 044E LOLJ V/A/Jt L s \ I\ -S r 00 7-5" " FL2 �4A-AJ - 1 TTiese drawings Were-Prepared by CapiVj Home TU C e EK a r9 U Improvemerd fonthe use of Capial Home Improvement employeesandsubcontractors. Anyone using these SCALE:' / APPROVEDBY: . drawings c (��/-Q DRAWN BY /� y ha!Id i;eld venh,cif ex siiny corditions, dimenslcn.S,alii)t;Orillrmil,Ir'l"C" DATE: [/-� QS REVISED codes and tie a 3 11^_nc;rate building ' d�quacycfIlies;drawings. CaplzziHome Improvemeat disclaims any r.s Problems which arise from ponsibility(ol any and all the use of those drawings by Anyone other than employees&sub DRAY lrt0 NSM�R contracforsot- Capizzi (//// C Homo Improvement, r i nq E �_ N 'z I w m 0 i N N V r I- / - - - �roCM 0 4zM v 10 _0 — �I— - - - - - - Q OWO. W x Z a a O �n aE W Z C 3'-2" i �� ' a a o • za m O� �o°O� new I o0 om - 8 0 -LA-V. j WALK IN CLOSET °o 0 N E. w3� I 1 ;za existing .i DINING �- - - exist. BATH existing REFRIG: I PANTRY LAUNDRY D W a o w J Dw W o w K. ISLAND existing I z - I I FAMILY RNI , F N Z ul _ id W a U existing/remodeled new - I I W W - KITCHEN BREAKFAST AREA i i a C y 8 �I_Oi m y W z J ° LU Y Z EQUAL EQUAL 0 o �- - - - - - - - - 4 W n a REMOVE EXIST.DM WINDOW NEW ANDERSEN DH VMNDOWS - - WDH244GE-2 . •3 R.O.5'-0 112"W x 4-8 7/5"H . DATE: 10/27/2009 _ _ = DEMOLITION SCALE:AS NOTED F L O O R P L A N , EXI5TING WALLS DRAWING M 1/4"=��-O NEW WALLS Al - ■ L r