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0046 TRACEY ROAD
0 � �_ � � �(far, Shed ti T WN OF BA TABLE Permit O RNS * BARWSTABLE. MASS 9� 1639. ArED A� Permit Number.• -Application Ref 201508003 20153594 Issue Date: 12/09/15 Applicant: HILL, SCOTT A & PATRICIA W Proposed Use: Accessory Structure Permit Type: SHEDS 200 SQ FT &UNDER Permit Fee $ 35.00 Location 46 TRACEY ROAD _ Map Parcel 005055 Town COTUIT Zoning District RF Contractor PROPERTY OWNER c. - Remarks 16X12 SHED Owner: HILL, SCOTT A & PATRICIA W Address: 46 TRACEY RD COTUIT, MA 02635 Issued By: JL POST THIS CARD SO THAT IS VISIBLE FROM T STREET ` Ik Town of Barnstable Regulatory Services Richard V. Scali,Interim Director MAWBuilding Division 6a` Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMI /v v U V FEE: T $ SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less f V Location of shed(address) Village 4 I ll � Property owners name Telephone number Size of Shed Map/Parcel# iiiature Date Hyannis Main Street Waterfront Historic District? 4s Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Zt ,3 Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 cs� r-- PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ' rn ABOVE COMMISSIONS;THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:110413 Iba.�3' 60.00' • j w� .0 0 aw \� N l o $l•i'7 T RACEY ROAD N OF STE-PHEN P. SESSOMS a OWNER : N0.33945 � T $oi 9F41STEP��, FEDERAL ps� 11Js- coca f�a, a �c unos° BUYER: PATRICIA WEIR G- y- 93 SCALE : 1" 3& DATE : JUNE 4,1493 �J . s t , I2' in D E c K 29.4' 9 • 4 lay ti TRACEY ROAD STEPHEN P. y SESSOMS a OWNER : NO.33945 FEDERAL DEPOSIT 1#45. CORP. $��f��OWEP J� BUYER: PATRICIA WEIR G- 9. 43 SCALE : 1" = 30' DATE : JuNE 4,i993 Mortgage InSDecti®n Plan PROJECT NAME:. ADDRESS: PERMIT# PERMIT DATE: M/P: LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered in MAPS,program on: 3 BY: h q/wpfiles/forms/archive TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 00_ Parcel 0 Application # t !�-wZ�K Health Division Date Issued Conservation Division F' Application Fee . Planning Dept. Permit Fee Ay let Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 4b Village O( Owner SCD tl M 11 Address y6 Telephone Dog �7 Permit Request GdaKle �avn�r� Rooms-. A4d A',n, zv,''J.- Lk',"_ Pe"'I'-kon C I`� r3rL�1,/ �P! �6�e.f� A✓1�1 �1�� OiNef' �A /yet./ � �D . Square feet: 1 st floor: existing 115J_ proposed 101 2nd floor: existing J���proposed Total new Zoning District �i`F Flood Plain Groundwater Overlay Project Valuation a Aoo, o a Construction Type Lot Size . q� Aeres Grandfathered: ❑Yes ❑ No If yes, attach''�upporting documentation. Dwelling Type: Single Family 9( Two Family ❑ Multi-Family(# units) : ?, F Age of Existing Structure 16 yrs Historic House: ❑Yes C(No On Old King'srHighway, ❑Yes M(No Basement Type: 2 Full ❑ Crawl ❑ Walkout ❑ Other a Y Basement Finished Area (sq.ft.) I� Basement Unfinished Area (sq.ft) MS: s 67 Number of Baths: Full: existing- new / Half: existing f new Number of Bedrooms: g �existin new 3 Total Room Count (not including baths): existing new J First Floor Room Count Heat Type and Fuel: i(GaS ❑ Oil ❑ Electric ❑ Other Central Air: Lff Yes ❑ No Fireplaces: Existing I New Existing wood/coal stove: ❑Yes Li No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: 4existing ❑ 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) 11 Name (Yne,/' 1 06 Telephone Number 5-09-?37.-e1911 Address /l Ca7ua'1 r,"V, License # ('S- 10y3?S �d fti�T. 0439 Home Improvement Contractor# Email �c,��aTe D��( /� iSTn��„/. C� Worker's Compensation # GUCC- 9 o u -So i 3 yd i—1.oi`A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 3or l! 5,46A, C:r1C[C S1GC1 v,n � l /�5 SIGNATURE ' DATE f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME L-A wwtY g-r. C!`ljj 3ja3hsT: t INSULATION %3Q FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING C4 DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth afHassachusetts Deparfrnent of1nduFfrza1 Acddents Office of brvesfigafions kvi 600 Washington Street Boston,HA 02111 www.Mass got//din Workers' Compensation Insurance Affidavit:Btdlders/Contractors/Electriciam/Plumbers Applicant Information Please Print Le jbjE Name ass! DVS�GI(Norm organizaiion/Individual): pos e I �• -�S Address: (.I C 0�'Ua"I Cow, e, Rd , City,/State/Zip: .4 6 3 Phone - -- q �t � #: S � �3� j11 Are you an employer? Check the appropriate bow Type of project(required); 1.9 I am a employer with 4. ❑I am a general contractor and I p Y �—` employees(fall and/or part-time).* have hired the sub-contractors 6. ❑Neat/construction 2.❑ I am a sole proprietor or partner- lid an the attached sheet �7. [Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me is any capacity. employees and have workers' Build ing m [No workers'comp,insrr �#ance comp,iomtMn ❑ g addition 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions Tj 3.El officers have exercised their I am a homeowner doing all work 11.El Plumbing repairs or additions myself o workers'co right of exemption per MGL ` Y � mP• 12.0 Roof repairs • insurance rmpired_j t c. 152, §1(4),and we have no employees.[No workers' 13.E]Offer comp-insurance required-1 *Any applicant that checks box#1 must also 5II out the section below showing their workers'coumpensation policy fi formztion. t Homeowners who submit this affidavit indicating they arc doing aU wor3c 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 tine sub-cont actors and state whether or not those catities have employees. If the sub-contractors have employees,they mast provide their workers'comp.policy nmnber, I am mt emplayer that ispravkgng workers'compensation insurance for my employees Below is thepo&cy anal job site information. / Insurance Company Name: C$b( ,q C &' 'y PAS E� a C P , Policy#or Self-ins.Lic.#:'Wclr—-S-D 0 - S 0,3 q6 5 ,�_01 yA Expiration Date: b 8 ),Q S Job Site Address: Attach a copy of the workers' co pensation 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 imprisonramt 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 tbat a copy of this sfatemerrt may be forwarded to the Office of Investigafions of the DIA for insurance coverage verification. I do hereby c under the pains and penalises ofpm jwy that the information provided above' true and correct Si attire: 6 Date: / OJ S` Phone Official use only. Do not write in this area to be completed by city or town ooTcIaL City or Town: PermitlLicense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: V -Information and Instructions Massachusetts Ga)amzl 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 m player 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 oa 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 Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a.business or to construct buildings iu 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 ofpublic work until acceptable evidence of compliance with the in uran ce. requirements of this chapter have been presented to the contracting auihority." Applicants the workers'compensation affidavit coin letel b checking the boxes that apply to your situation and,if Please fill out Y, Y g mP P necessary,supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s)of insur- ce. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'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 insrr =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 lime. 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<Ante"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the ' applicant as proof that a valid affidavit is on file for 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 (ie. 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 CQi32manvjealth of Massachusetts Depar iamt Gflnduizial Accents Q ice of Zttvesfigatio= 6GQ-Wasbivola Street Boston,MA G�11I T(J,9 617-727-4900 ext 4-06 or 1-977 MASSAFE Fax 9 617-727-7749 Revised 4-24-07 Rawer m=, govldia WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876.2765 NCCI NO 40959 POLICY NO. WCC-500-5013469-2014A PRIOR NO. NEW ITEM 1. The Insured: Dennis O'Reilly DBA: Mailing address: 11 Cotuit Cove Rd FEIN,**-***2038 Cotuit, MA 02635 Legal Entity Type: Sole Proprietor Other workplaces not shown above: 2. The policy period is from 06/08/2014 to 06/08/2015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury.by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States.lnsurance: Coverage Replaced.by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated. Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 0972030 INTER SEE CLASS CODE SCHEDUiLE I � i Minimum Premium $500 Total Estimated Annual Premium $2,701 GOV GOV Deposit Premium $695 STATE CLASS, MA 5645 j MA Assessment Chg. $2,354.00 x 3.4000% $80 �= - ' � . This policy, including all endorsements, is hereby countersigned by 06/09/2014 Authorized Signature Date Service Office: Rogers&Gray Insurance Agency Inc 54 Third Avenue 434 Route 134 Burlington MA 01803 South Dennis, MA 02660 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, used with Its permission. ` ^ ' > ' � . | ATYC-Gadde to i-Vood �o �i�� ��u/�r�uJ ����oh �hudZono | . ~~^^~~-~^�^'^ . ~`m- ' ^ � Alassacliu8etts Checklist for Com"iiiance u80CNIfIZ5301:2.1./l/ cuCheck - ' Compliance 1.1 SCOPE Wind Speed(3'sec gust)....... ..........................................................__--r----__-- ........ 110 mph .' Wind Exposure B Wind ExposureCategory...—.........Englneedng.. . ' _--- 1'2 ��PL2C�BD-�`� ' ' . . � ������m�w���O�12d�s����a����stodes :92stodes � Roof Pitch............... ..........�----_._.....----'--__- 1 � � Moon Roof Height.............................................................. � 8uUding\Vidth.UV ............................................................... Building Length, L ..............................................................(Fig Building Aspect Ratio' ' ................................................ 4)................................................ ~' Nom�oHe�hto[ —.-.�'_s,�.-.r—' - 4)----------'-'--''-' ��` . 1.3 FRAMlN[�'CO00ECTiONS / � General compliance with framing connections.....................(Table 2)................................................................ ~/ � � 21 FOUNDATION ` Foundation Walls.meeting requirements of78OCMR 54041 ' Concrete------'--`-----'---------.r'-----'------''—'----- ff�+ � IV onon���amon�--._--.'-_'_�.--_-�---^--__-------.'_--__._____�_.____ � � 2. �2 �0�H�R��E�QFDU�D� Q0"3. � � 5/O^AoohmrBoks�mbsddador5/O^Pnopd�ary/Nechan�a|Ancho�oaona�an�advninconcn�eonk/ � 8o�Spac�g-Qanena ..........................................(Table ~' Bolt Spacing from andrJoindcf plate............................. ..................:................. NA in. O^ 12'' Bolt Embedment-concrete.........................................(Fig ......................................:.' 7- Bolt Embedmen -masonry.........................................UFiQ '_..--;................................ � Plate Washer...--_-_'-_----_''-_-_--_.(Fig 5).............................................. 3^z3^x�; ' 3.1 FLOORS Floor-framing member spans checked ...............................(per 78OCMR Chapter 55)................................... � ' Madm�m�oorOpan�g ...................................(Fig ---..,.-------_-'--.... �l_ft�12' . FuUHe�htVVaU��ds��F�orOp�n�go�so��n2'�omEmtadorVVaU(�gG)..-.---.__---..-.-'.. ���um�o�J�tSu�od� � 3uppordngL6odboahngVVail�cvShaaiimaU.......... .....(Fig 7)............. ............................. Aft :�d Maximum Cantilevered Floor Joists . ^/ Sh U ft �d ' ua�ouovn8m'uo�:x �*�u o/.--_--.-_-'_.-_.---�_��_ Flo. ^~...g.^^~~~~_ -,-._--_'-------__--_'-_--'- � Floor Sheathing Type ........................................................(per/uuCMm Chapter 55 Floor Sheathing Thickness ............................................. (per 7ODCMR Chapter 55).............................. Floor Sheathing Fasberiing..................................................[Foble2)-_ d nails at_1�_in edge/J1.infield 4.1 VUA-L0 � -Wall Height ' and Table � walls................................................. and Table 5)........................... 11 20' � Wall Stud Spacing ..........................................................(Fig O and Table 5)................... L6_kn.!�24^uc. Wall Story Offsets ..................................................... (Figs7&8)............................................ ft :9d 4.2 EXTERIOR-WALLS' Wood Studs Loadbeadngv�alls.........................................................(Table ................. ftkn, (Table 5) X ft in. Gable End Wall Bracing' VV3P -'FborLeng�-_-__�:_--'�---_--''Y�o11)-._.�-''---_'----_ �u6�3 - � � and 2x4[ombnuoumLatendBna�� 11�-----.---_-._-._-'---'-..- ^ or I x 3 ceiling furring stdps @ 16'spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays Double Top PlateSplice Length ---__-. ............. G}.................................... 6_ft � . Splice Connection(no cf1Gd common nails)..............(Table G)........................................................._�_ U AWC Guide to I-Vood Construction in High 11, nd Areas: 110 niph IYind Zone Massachusetts Checklist for Compliance (780 CtMR5301.2.1.1)I Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Tables')..................................................... Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ........................................................(Table 9)..................................... ft-3 0 in.<11' ,L Sill Plate Spans ........................................................(Table 9)................................... ft in.511' ✓ Full Height Studs (no.ofstuds)....................................(Table 9)....................................................... Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) HeaderSpans.............................................................(Table 9).................................. 4 ft_in.-<12' 77 SillPlate Spans...........................................................(Table 9).................................. G) It_in. 12' Full Height Studs(no.of studs)....................................(Table 9)....................................................... _!— Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4. Minimum Building Dimension,W Nominal Height of Tallest OpeningZ ..............................................................................a5 6`8' Sheathing Type...................................6..........(note 4);:...............................................*... Al 1A Edge Nail Spacing.........................................(Table 10 or note 4 if less)......................... in. Feld Nail Spacing ... able 10 in. Shear Connection no. of 16d common nails (Table 10 Percent Full-Height Sheathing........:..........:...(Table 10)..:................................................ 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts) .. Maximum Building Dimension, L Nominal Height of Tallest Opening2.........................................................................4.5 6'8- SheathingType..............................................(note 4)..........................6.......................... l[A Edge Nail Spacing.........................................(Table 11 or note 4 if less)........................in. Feld Nail Spacing able 11 i . Shear Connection(no.of 16d common nails)(Table 11).......... . ........................ ........ Percent Full-Height Sheathing.......................(Table 11)............................................ _...-.-• 5%Additional Sheathing for Wall with*Opening>6'8'(Design Concepts).................... Wall Cladding / Rated for Wind Speed?.............................................................. ............... ..................6......................... .... ✓ 5.1 ROOFS Roof framing member spans checked?...........:............(For Rafters use AWC Span Tool,see BBRS Website) 44 Roof Overhang ...................................................(Figure 19) ............. ft<-smaller of 2'-or L/3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift................................................(Table 12).................6...........................U- pif Lateral.............................................(Table 12).............................................L= plf Shear............................:..................(Table 12)............................................S- pif.. Ridge Strap Connections,if collar ties not used per page 21... (Table 13)...............................T= ptf Gable Rake Oudooker..........................................(Figure 20) ............. ft-<smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift.......................:........................(Table 14).................................. - Lateral(no_of 16d common nails)...(Table 14)............................ =L lb. Roof Sheathing Type...................................................(per 780 CMR Chapters 58 and 59)............. Roof Sheathing Thickness.....................................:..... ............................................. 114 in.>_7/16-WSP Roof Sheathing Fastening ......(Table 2)...:............... Notes: 1. . This checklist shall be met in its entirety, excluding the specific exception noted in 2,to comply with the requirements of 780 CMR-5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 fL shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. • THE l Town of Barnstable � r Regulatory Services ASS Richard V.Scali,Director 16g9. 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 �-Y ProP e Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize ��/ c7 to act on my behalf, in all matters relative to work authorized by this building permit application for. (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. all A its/ � �a�a� (/N✓1� Signature of Owner Signature of Applicant �, - d-W-5 Print ame PrintN Date Q TORM&O WNERPERMISSIONPOOLS Town of Barnstable Regulatory Services p tf[e rotyy Richard V.ScaIi,Director Building Division Tom Berry,Building Commissioner ibs� ��� 200 Main Street; Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62-30 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. Si omeownerr 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 2.1S) 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 Iicensed 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. PP f5' r. On the last page P p pg 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:\WPFIIM\FORMS\building permit forms\EXPRESS.doc Revised 061313 Massachusetts -Department of Public Safety Board of Building Regulations and Standards j Construction Supervisor License: CS-104375 t DENNIS T.ORE"Y 11 Cotuit Cove Rd Cotuit MA 02635-7 i Expiration Commissioner 05/15/2016 ��ie Cpoon��w�ruue�a�C�o�cr�eG� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the.expiration date. If found return to: Weigistration: 166842 Type: Office of Consumer Affairs and Business Regulation piration: :=8%16%2016= DBA 10 Park Plaza-Suite 5170 7: - Boston,MA 02116 O'REILLY&ASSOCIl ES ILDERS/DEVELOPERS 1 DENNIS O'REILLY `�a � r✓ ,1AAMD i 11 COTUIT COVE RD`� F I&AY COTUIT, MA 02635 Undersecretary. Not valid without signatu Unrestricted-Buildings of any use group which contain less than35,000 cubic feet(991M )of enclosed space. - 'Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. I For DPS Licensing information visit: www.Mass.Gov/DPS C�1ie (pa7nmwa2cae o�Caac�ivaem Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: ,, 96842 Type: Office of Consumer Affairs and Business Regulation xpiration:r--W46%201.6_; DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 O'REILLYi3<ASSOCIATES B ILDERS%DEVELOPERS DENNIS O'REILLY 11 COTUIT COVE RD•'���,;'����, ' g���-� COTUIT, MA 02635 Undersecretary Not valid without signatu61 t} h + ya �_,,i 'ff "" ■+, t' L �y ,, �• , _�..+ . My �f 6¢rfka tY° �'-, 'y y+� r1� "'° A , , i , 4F' 5yr?� t' .� ■�' f 'r' *ter ••• + �,i;. •� y �,��_�a J if y �' �° `i'�kP;if f'� ` n,R - • x �fi� � iF4,s f^a,n. ._ i" ,y'l... : 7{ ': .: x 5 • ,u .Y f. _"+P,. 7 ;= k?y'¢ 1 a_tia _ [r . "�fj , r " t'W� �u.r c _ +—isp W ti .f. ,�,, •f,L,. _ - f yv ti� c ,i '��r� �'�,�i"� _ � i"! � r�s��tr �r� 1.',�a, „9 SSf..�- e . 'til, �'+ '- -5s � '-�'--�`�Ph-i'�`,• " •M1,,il, •e N , �•°y f31t''k��'�i�" J'1:�.ra.f' a, ; q'�`-��, 1f" t.� ya�.° t'•re5,"� "i ��' �� '� ='�y,98' t •a ,�a°'+"`4 ,"L'h� __._t- �.• . ��■ r,.� �i'`8 .,�_..,� b � 1,�4• v_.'i.- ��' �° �.ii Cc 4M� h�i_ .y, '6•``�,"' r :� f d: Y'�+f''.',SJ 4 Ey!5'.•. --,Y,dir.,-_� �i lip t�,f, k�1 - '[ "a ' ..yT-i�•a .I ! ".- `7 `,;r fti•'. 1 r h�W *3•,i..1 +r'�t1 i,'1, +� .: rs ylljytr '�Lr'� r r �t lk • .m°p� j+F {•..,x '•` a I!L ,}.'J'.t7e�t' i,� 4 .*i++'.° Ia S'4 .':'y 9' L�rk �'d+' i t y o ! ,�.! ,f,,�•�'■�r�'.,dC�`q i°et. � P i r ��.s' art- t - a link ,, y' ♦ 7' Y, �i ��e�•�••• �+f��, , w 4 �•, � +t..� � w� . _ F r Ll 4 r.t °'• r - �y ^� - ;'� 4�``ram`� ��}f �• , .,,. Ar T f'a -'�-L .�` { -:• , 9 ,"'• .�'1 "� � � r•"ram'i 1 '�a,+k �1..�tif+ � „•f•;�,f, a, ,� ry q ... i y ,,,�..'' :�i: ,rr,E� 'mil. �- �� +y� � •� i ° tom_ice• - a •� ip- �� - , i s • 4 i• n� iP ■ r =�"1 - 3^'° ,ray ' w..,, �a - � +► -, u' .� ''fti' a�.�oN. p� iA �' .--�`;+r AVIR P TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t Map Parcel ® Application# 1p�C�Health Division ,�. � © 34 0�P_0 Conservation Division 0�4 Permit# C/// 3 , Tax Collector Date Issued �d d Treasurer Application Feed Planning Dept. Permit Fee �� 2 EXISTING C SYSTEM Date Definitive Plan Approved by Planning Board LIMITED TOMOF BEDROOMS Historic-OKH Preservation/Hyannis t .�. Project Street Address r - Village Owner �� 77 ff��G� Address Telephone Y ' i Permit Request h U ✓Y Square feet: 1 st floor:existing proposed - 2nd floor:existing �� proposed Total new ✓� Zoning District �'`� Flood Plain C Groundwater Overlay Project Valuation Ofd Construction Type Lot Size Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Struct �� Historic House: ❑Yes o On Old King's Highway: ❑ ®'N Yes o Basement Type: ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new —� Half:existing 1 new Number of Bedrooms: existing new Total Room Count(not including baths):existing new ✓ First Floor Room Count Heat Type and Fuel: YGas b Oil ❑Electric ❑Other Central Air: ❑Yes 9'N0 Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:g-existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# T75—Current-Use, A :�-�--. Proposed-Use �_ _ ny'/ r- ��� _p / BUILDER INFORMATION Name J +i A/ tp_fe I pholneNumber Address :S � y�Tv{ ,� License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ►/vUL rS✓(i A SIGNATURE DATE U FOR OFFICIAL USE ONLY • PERMIT NO. DATE ISSUED r IAP/PARCEL NO. ADDRESS r VILLAGE OWNER' I c DATE OF INSPECTION: _- FOUNDATION ® e'k FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL I PLUMBING: ROUGH a FINAL GAS: ROUGH FINAL i FINAL BUILDING 0 DATE CLOSED OUT o ASSOCIATION PLAN NO. J The Commonwealth o,fMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M4 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Buildens/Contractors/Electricians/Plu hers Applicant Information Please Print L.e °bl Name (Business/Organization/Individual): t P.L 4,;�44101 r- � Address: �i�v. PJ, City/State/Zip: y_4 Phone#: �U Are�u an employer? Check the appropriate box: Type of project(required): 1.9 I am a employer with_A 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t ? ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. [FBudding addition (No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10,❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1,L[] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. (No workers' 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 lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie. #: 6,0 J 10� Expiration Date:� Job Site Address: , a6 OPYCity/State/Zip: Gki"I 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 sander the p 'n and pen d of perjury that the information provided above is true and correct. Signature: ! Date: Phone#: 715 Official use only. Do not write in this area,to be completed by city or town officiad 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#: Information and Instructions ey 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, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or pce ermit tooperate 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-contractors)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 ' to fill out in the event the Office of Investigations has to contact you regarding the applicant for o you g 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. #t 617-727-4900 ext 406 or 1-877-MASSAFE Fax Y 617-727-7749 Revised 5-26-05 w�w.m.2ss.gov/ciia. °FTHE r Town of Barnstable P ti Regulatory Services �BMAnWSTABL&A« Thomas F.Geiler,Director fo;ada�` Building Division Tom Perry,Building Commissioner, 200 Main Street, Hyannis,MA 02601 Office: 509-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work:. I Estimated Cost /i O-Ob Address of Work: f7 (i(/' AV J Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law ❑Job Under$1,000 E]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 1VIGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply r a permit as the a t f th er: Date ontractor'Name Registration No. OR Date Owner's Name Q:forms:homeaffidav 1 'I t'f t .f 4 Town of Barnstable Regulatory Services RAMMASS.i'E 'Thomas F.Geiler,Director v $' 0 'OpeDras►'�°` Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize l r 4 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address 6f Job) Signature of Owner ate Print Name Q TORMS:OwNERPERMISSION r N 7 . > egtat <�� a105548 1 /2006 VILLAGE'C } 1,� �568 SANTUIT i rs co MA 0205 " '"` tlR Admiuictratur , eN�osxywg REGULATIONS Lns 5OR :E fir Ni1mb •0,5023AP .BI =Tr�nQ: ;27779� �t MICHAE LU COT11T.; 'MA 0263 °M ° e Commissioner ,r _r kt VV R'E7>61 Cotv- �. 12' in In E V_ • I »' 29.4' � O �� pRwE N r 14' 4 30.3' N O S1.1-7 ' s TRACEV ' ROAD STEPHEN P. SESSOMS N OWNER : N0.33945 �0 9F013TEP�O FEDERAL,. DE-POSIT INS- CORP. f���kl( UNDS�P PA-TRICIA WEIF2 G - 9- 93 W SCALE : 1 .= 30� DATE DUNE 4 , 199 3 Mortgage Inspection Plan Well .�1MIX;'//,/%Mir/� l/�y� ,,Y'.S..'//?!{m{{.'/./.!/!/��//.!/.i{{y%%ii/{Hi{�{�/;•.yY �j ' t sys/ s i ) )r t=t l.Es q3-Z54-'T73 ' > i if..�a:.•x.:r>:.,:.>r.a/ .5:,<.�[..>,?:;,er,: ):•r'<:y<•.Gj:i;.F•r s,#i> :. i•,:..>r;,c,�.;;.,5.::. .x.<:..:i .�M,,�..;' k '% ' �//!r�1.rr/./•. );•+,)'ir::.....r., r ':• Yair:[$.ty'S �iGi>:K��KQ�"C•"r'iW:J)lHn4.i•:bi:4r.{•�Tr:'W.v ii))ri/+ .Lvrr/+i)/.{4YwvJ�d 'uuW:aiicw3.c•)S•r .:.huvrmvs>.u'ictb:•�rxtw ' BOX 204, MANOMET, MA 02345 (508) 224-3793 I•STEPHEN P.SESSOMS,A REGISTERED PROFESSIONAL LAND SURVEYOR,DO HEREQY CERTIFY THAT THE ABOVE MORTGAGE INSPECTION PLAN WAS PREPARED FOR CA LE DA f I A COI SUBJECT DWELLING LIES IN FLOOD ZONE r IN CONNECTION WITH ANEW MORTGAGE AND IS NOT INTENDED TO REPRESENT PROPERTY LINE AS SHOWN ON NATIONAL FLOOD INSURANCE PROGRAM FLOOD INSUR- SURVEY.IT CANNOT BE USED FOR ESTABLISHING FENCE,HEDGE OR BUILDING LINES.THE LAND AS ANCE RATE MAP DATED J ° Y I q q 2 SHOWN HEREON IS BASED ON CLIENT FURNISHED INFORMATION AND MAY BE SUBJECT TO COMMUNITY—PANELI 250001 OOz2D FURTHER OUT-SALES, TAKINGS, EASEMENTS AND RIGHTS OF WAY. NO RESPONSIBILITY IS BOOK 463 (L•C•) _ PACE 1 1 5 EXTENDED HEREIN TO THE LANDOWNER OR OCCUPANT.THIS INSPECTION PLAN WAS PREPARED BY USING CURRENT DEED INFORMATION, ASSESSOR PLANS AND RECORDED PLANS WHERE PLAN REFEnENCE: L C P I t?��o- AVAILABLE.FIELD DATA WAS COMPILED BY USING EXISTING MONUMENTATION FOUND,LINES OF DRAWN PER TOWN OR OCCUPATION AND EXISTING STREET LINES.IT IS NOT THE RESULT OF AN INSTRUMENT SURVEY. MAP I PARCEL/ ADDRESS: 46, "r Z A C�Y R o,�1 D THE LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON,EITHER WAS IN COMPLIANCE WITH C o -r u I T , M A - RUCTED WITH RESPECT TO — J N6N ANDER9ON BAY MNDOM ❑ ' arr.enue he°n+:.e LLAD 400 SERI89 '� • rvurm+� r as 1� LOPPFR LM YV YIPJD 9PBED ANIMOMBTER •� �w Yfi10W LEDAR SHINbL� / •� �. ° '� — I _. SFLDiID FLODF FINISH FIADR _ ._._._._.—.— —.— —.—. — 6.EV..a8'-b'FIBD VFStIFY � — rsarwtm. . 1 I I i- 11 I1 �1111 t STORM PANR 51N6LE SLAZBD �- h - 11 I_. T ATTERN _ r aonrwv Ire P I L wvDm MHN£LEDAR SXINfiLE9 SLREB�PDRLH FINISH FLDOF ELEV...OW`-U' I .. I P.T.PASLIA BOARD _ PA S3B° O P gL�E�I1I�5 .wa RAL LATTILE - . ORTIWiD O - S E W EST E L E V i E�XI9TIT BIRO FIELD VERIFY ZAK S ' RELOCATE i TI1S9 - __-� -- _ _ _ ______ • y AINTED 6X6 FIR POST - _ PAINTED ZXb PIR POST FIRO]M . .G /-ALIGN WITi POSTS - IWITI EIP NI FIN SILT?GLPAPJ OTION POR NEW I 1 I O O G K TOP KITCHEN �. - I Ilo _________________ � I S� "� /— a� �rc� nW (AS —• LAC —• dry-"-- 1 - • «� u bu --a AM -�— o, Sr � r { Assess ,�� Parcel ait Conservation Office(4th floor)(8:30-9:30/1:00-2:00), 312 LT5ate Issued�, Board of Health(3rd floor)(8:15 -9:30/1:00-4:45) Fees "0_ l Engineering Dept. (3rd floor) House# 4?(� ® ��p . 19 , TOWN OF`BARNSTABLE Building Permit Application ` Proj ..ect St ddress Village (S�V! may, Owner-f {�ek,A / f/ Address 22LwL woo .-Telephone ���- U ;:Permit Request _Dj+ io t<3 of - us First Floor 57 square feet t Second Floor _ 57rn / square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size �-/� Orandfathered ? Zoning Board of Appeals Authorization ��� Recorded Current UsQF si +,AL i-k;, I!`' Proposed Use Construction Type yt 75,+Q^j Commercial LAO Residential .a Dwelling Type: Single Family l/ Two Family Multi-Family Age of Existing Structure /,0 �� Basement Type: Finished Historic House Unfinished Lim Old King's Highway 4162 Number of Baths— No.of Bedrooms 3 Total Room Count(not including baths) First Floor �Z Heat Type and Fuel UJcentral Air Fireplaces Garage: Detached Other Detached Structures: Pool Al Attached Barn �/,, None Sheds ,t/l14 Other Builder Information Name + Telephone Number Address (� Ti Ac-v �e4i7 License# l y!(U s yn A Oa 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 SIGNATURE DATE �J`c�la-9 C e BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ' 1i FOR OFFICIAL USE ONLY _. RMIT NO. 1 . R E ISSUED - - P/PARCEL NO. = _ DRESS ' VILLAGE ' NER s + DATE OF INSPECTION: FOUNDATION , FRAME ® K INSULATION FIREPLACE` ELECTRICAL: ROUGH s FINAL PLUMBING:, ROUGH FINAL - j + `� r it ' 7 •' ' r � r GAS: ,%ROUGH FINAL + _ i - P 77 •S t •� p r FINAL BUILDING- j® 23 ♦1 DATE CLOSED OUT ASSOCIATION PLAN NO. r 't The Coninionit'ealtll of Massachusetts Department of Industrial Accidents 34 ,t i _ : 01JIceoJ/�est/9at/oos »l ;# 611(I 1>T ashin;;ton Street Boston,Alas. 02111 Workers' Compensation Insurance AlMdavit location- LAC4 dCOA city C' 12hone0 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity rl I am an employer providing workers' compensation for my employees working on this job. comply name• address: ram— phone#• i cttr •!! mica �•. .r.. 1......Rl.�.�...,.�... •. 1 am a sole proprietor,general contractor, omeowne circle one)and have hired the contractors listed below who have the following workers' compensation polices: comnam,name: address• City: 11hone0: onsurance o. iMax7vW a - 157 1r:�+�L+� N- T%_ •' - _ K !il�r,'G..:. R�?rn•%' fR i:1�}.• .7F!" n!• - �?'AS ctimnam name• 4 V .IC) ( L >>11 'Y LA C.T10 address: PIP r-V i" .A� k A A a phone#: suet110lia# o ;Attach additidnal'sheet if tieeessa •r - ;; Failure to secure coverage as required under Section 25A of 1►1Gll 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. l do herebt•cerrifj•under the pants nd penaldes of peduty that the information provided above is true an/ nd correcL SignatureL ate 3/��0/ 102 Print name/` �C'c�'i T' A- ,� i l ` Phone# q official use only do not write in this area to be completed by city or town official city or town: permit/license# nBuilding Department (3Ucensing Board ` Q check if immediate response is required QSclectmen's Office QHtalth Department contact person: phone#; nOther I revised 319S PJA) information and Instructions Massachusetts General Laws chapter 152 section 25 requires all emplovers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership,association, corporation or other ;z-gal entity, or any two or more of the ford=oing engi,,cd 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 tite 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 1'52 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 common-wealth for any applicant who has not produced acceptable evidence of compliance with the in 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. 7 74...- y w r. . Applicants Please full 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 affida�it. 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 for regarding the"law" or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. y • ,...�ws�.eq+�..n,er•r� ..,...�..e.e.v ..�► =t _. ...� *�yy�� tcf`�?' :cam ram.,; • ��- ._. . 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 full out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permut/iucense num ber which will be used as a reference number. The affidavits may be returned to the Department by maii 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..l•+s►�.•ew!7tR' 777.tea .e .•...+►+. �:e .O.'%':•..�' ti 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) 7274900 ext. 406, 409 or 375 The' Town of Barnstable » Department of Health Safety and Environmental Services or 0 Building Division 367 Main Strut,Hyannis MA 02601 Ralph Curs= Office: 508-79o.6W Building F= 508775 33" For office use only permit no. Dau • AFFIDAVIT HOME 5WROVEMENTCONTRAC=ORLAW sUppLEMENT TO PERwr APPLICATION mcansttuction,alterations;rcamdon,�boa conversion, MGL c I42A requires that the" eel demolition. or construction of an addition to =T P owner I 00 improvement,.seno�al, which �asz add building ' *' g at least one but not more than four dwelling units or to save s with ache to such residence or building be done by mzgistered eoauac toM with certain cmepoz� g requirements- Type of Work: �tj Xa R�A6� �f� Est. Cost Address of Work: ' Omner.Name: Date of Permit Applic Lion: ,3 h LD I hereby certify that: Registration is not required for the following reamn(s): Work cmduded by law Job under SI,000 Building not owner-occupied �Otvner pniIutg own pernat . Notice is hereby gh-en that= OWNERS PULLING THEE,OWN PERNQT OR DEALINGr N ACCESSOT ELAVE �TI� FOR APPLICABLE HOME IIu�ROV�r WORK Do 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. Da e Co tractor name Registration Na OR 'i • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION ----- Please print. DATE JOB. LOCATION j Number Str et address Section of town "HOMEOWNER" Name Home phone Work phone . - PRESENT MAILING ADDRESS c City wn 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: Person(sj 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 to six 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 OfficiE on a form acceptable to the Building Official, that he/she shall be responsibl for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Ste 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 requirements and that he/she will comply with aid procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. f S 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 Owne 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 awarene 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 "dwner- acti as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/her responsibilities, ma. communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. A.nUAVT Wty41{S TO fM4W ' u4C hCH'NO I txtsn Ny c,ARA4C¢IAi—;'c _�= EXIT y �—bAN001V To ft-L�AtH LLIA LLD O-fl !i l - f: L. LEFT-ELL•VhT10 N I o.,s- 508.428- 091 /aevnLc swNczu i ��a eV i I Ot 1n8 BR!IFL$ AUM•4uTiCtA @UstOm 6 esigru TCn201t4QL Gt.. copyhght®�96 On DCDZ+ Pr 6w,('L� ..- - All R.ghts aS.24 tHSUL. Reserved .¢t..nu uuLUOq Klan e'Hxt 1RAA4LON.. `�HbOtv'UO CUeT.) --- -- --- - —. ' f I • 1eyhl 111L+'pyp r. _..I T'O.!no04 S Alb1TNy 66ri ') \v G.SshNG.Et. I � NUOIN .ai Gtnvnoattn5_ - jQ c p � . GoVGAra.oN ..... - l•.T.wOC1b sTt Ps � �^[� Yrel...nary plans and layouts by OC O are for the use of their Customers only Any other use-S Str.Ctly Proh.h.le - 66E66 �Mp�•E �R. f 4SvwG AP :N _ t 519'tc&:%6us4TCCt1 I � _ Q i �Al _ O I -SCALE DAT N' t. 508.428.6191 Levi i n " A"%A.[p.:.SL-?.,,:t.o .rp qA. I @ustom III \Y.'4.C'2:sL,EVb•'tiG G¢,t2� I I COMPACT LII^ i, ��• �i ��•Z,,. 1 a esigns copyright^r.t 1996 It I`r All Rights I (' Reserved I i ; t T��.. .. ..914..to.rAor if41 ei`4- Q.—Rop ii.�'• _ 4're Ii0 cc-fc '1 44 p' of v coF.illnhTiGN DUN r: �`rl Pr 77 7 plans and layouts by DC O are fnr the use of them customers only Any tithe,usr is strictly Prnhrh— _.....__�� LA�..c. Z. CE./u)ll•�114 CPA1•af)GV'•L' F.K'St1IJ.'r yAF 1.1 a_w.CnLociS RL44.4�) •..�l:E _. ....✓ I li cols CRJ VN Mou..-C, ftnR'4 Ert'Js ---CrAZAIGL COQIITRfM 24.:4 NN EKlit llllS Gt,'R4S(i IwyuL. 7J .0—WON a-,U.ER ISM?M ' 10 CFMfIrN I jp•141NSK.:L.CS-1 I C I-AR I i ) / 2n-C 10n<L C.B RJIPTGftS --- // Scov2.O enfiESS _ ... - /p���r o•- ytil G*• n 508.428.6191 (eve in @ustom o esigns 2.8 .KNSTS: AIASCN tICfSTINC�_-__- ;._�� Copyright.fj t996 �AW.Cu FIOtaC- A ll R.OhtlR-M lwSVL. t.S g¢AtT�y4 SEiRfStfveO SnAKAAA_. .f Sf 9F[.wC[-xuxM IW.. tyl.'V•GtlOn.lC.T.SCt wort- w�PLPL.*c,'lk 2Lu t - 2.4 PT.r,ILL HI SCAtEq I W ' � V Q 4A�gi- St CTIG'V Po2CN SECTION 43 AV 3 � � � Pfll,mfn.TfY plans And Iayotof% by DC D are tot the Ulf Of them CUStomerS Only Any Other use Il St ffCtly pr nh,h'fe 'V 1 (0O.00 12 in D E C IG I I � - { 28 + /9 9 29 4 O ,�C�• 4)PLIV E- a d1 wol 14' t, I I , TRACEY ROAD N OF M.4'r STEPHEN P. OWNER '. SESSOMS H N0. 33945 FEDF-RAL DEFpSIT INS. CORP. $�� 9f01STEPtO BUYER : PATRICIA WEIR G- 9- 93 SCALE : 1" = 3& DATE DUNE 4 , 199,3 Mortgage Inspection Plan rein%�/n �!,!/,i/�;!li�r://;;.;;{iiii%%/j/./. /.•/.///!�/i�s %/{{i� ,/ii/rii{{i{iy;�.1�� RtV'�Y' F 1 LE% 413-254--773 ' ' r r .... ..-... L.w.4..h%,V%IA:%::/.w nKv.vn•xm{p{{v::x.•n4xxx��:{vi:>ii:%:{{•:in{{:,{{ri;:;:i:}:iii>i:•i?: iji:•:<ri>vii ii:tii� . ~� P.O. BOX 204; MANOMET, MA 02345 (508)J224-3793 I,STEPHEN P.SESSOMS,A REGISTERED PROFESSIONAL LAND SURVEYOR, DO HEREBY CERTIFY THAT THE ABOVE MORTGAGE INSPECTION PLAN WAS PREPARED FOR_CALEhLp 4 IACol SUBJECT DWELLING LIES IN FLOOD ZONE C IN CONNECTION WITH ANEW MORTGAGE AND IS NOT INTENDED TO REPRESENT A PROPERTY LINE AS SHOWN ON NATIONAL FLOOD INSURANCE PROGRAM FLOOD INSUR- SURVEY.IT CANNOT BE USED FOR ESTABLISHING FENCE,HEDGE OR BUILDING LINES.THE LAND AS ANCE RATE MAP DATED—1ULY 2 199 ? SHOWN HEREON IS BASED ON CLIENT FURNISHED INFORMATION AND MAY BE SUBJECT TO FURTHER OUT-SALES, TAKINGS, EASEMENTS AND RIGHTS OF WAY. NO RESPONSIBILITY IS coMMUNITY—PANEL/ _250001 00 _�_n EXTENDED HEREIN TO THE LAND OWNER OR OCCUPANT.THIS INSPECTION PLAN WAS PREPARED BOOK- 3 (L.C.) PAGE 1 1 5 BY USING CURRENT DEED INFORMATION, ASSESSOR PLANS AND RECORDED PLANS WHERE PLAN REFERENCE:__L-C.P. 112e -- AVAILABLE.FIELD DATA WAS COMPILED BY USING EXISTING MONUMENTATION FOUND,LINES OF DRAWN PER TOWN OF: OCCUPATION AND EXISTING STREET LINES.IT IS NOT THE RESULT OF AN INSTRUMENT SURVEY. MAP/ PARCEL/ THE LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON,EITHER WAS IN COMPLIANCE WITH ADDRESS: 4�, -t 2 A c E y C2 nA D THE LOCAL APPLICABLE ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED(WITH RESPECT TO c o-r u I T ,_&A A HORIZONTAL DIMENSIONAL REQUIREMENTS ONLY),OR IS EXEMPT FROM VIOLATION ENFORCE- RECORDEDAT RA J 1,1 5-T A R MENTACTION UNDER MAL TITLE VII,CHAPTER 40A,SECTION 7,UNLESS OTHERWISE NOTED OR COUNI Y IIECISIRY OF DEEDS SHOWN HEREON. - - - C,�, F.,•� i Assessor's offioe (1st floor): YME TG Assessor's map and lot number ......e........................... `......... ... Board of Health (3rd floor): 3 PAR g g6, Sewage Permit number �.t?.... (�..?.�......... 31AR33T LE, Engineering Department (3rd floor): �o rasa �1 f . House number? (—� o6iraY a`e� APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. L,L. ,,' v" TYPE OF CONSTRUCTION ��Y.!�� � - R /Fi�/ .......................... .................... ......-.........,..:................................................... TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according to the following information: location ...0/....8.../!e.. ..... Tu,. ............................................................................................................. Proposed Use //✓�.!.�=.....fllM.X.!y......!'Igme............................................................................................................. Zoning District '................................................Fire District ..�.7. ,/!/ Name of Owner ?,P.T...l c'►l.P �................................Address C.N..V.,!.:....... ................. Name of Builder ... ............................Address .../(— 1...................' Name of Architect Address .. `1!.Jv. ,P?ee�.../�!` // Number of Rooms ....F..........................................................Foundation .YV,1/.2 f.............................:. Exterior . !/Sfl... .I/t=- r S, I.................................................Roofing ... 7.y....,............................ .......................................... Floors ... .........Interior Heating , .1 ;1�.:........................Plumbing............. ........ .. .. ...................................................... Fireplace .... �5.................................................I..................Approximate Cost . .OOd _ ......................................................... Definitive Plan Approved by Planning Board ------ '/ 19 Area .......................................... Diagram of Lot and Building with Dimensions ( Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH DES POND 37,,-?;r lt� 7VIFIV T �erAv ram _ a / 77 0 7-2/ zld OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 4 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. w Name ....... %.......... ........ Construction,/Supervisors License �........................... LENTELL, PAT A=5-055 F No 30764 permit for .12 Story .............. Single Family Dwelling .......................................................................... Location ...Lot #8 ,....... . ... 4 6 Tracy. . . ...Road. .. . .. .. .. .... .. .. .. ....... Cotuit .....................................................................I......... F � ' Owner ...Pat Lente1 ............................................. Type of Construction Frame ............................................................................... Plot ............................ Lot ................................ Permit Granted .....Mai'...2.1.l.................19 87 Date of Inspection ....................................19 Date Completed .................:....................19 �o wjz - 5 C 1_» '�� .. ''#t'! .. ^ .. � :.�{ 4^ Mf•J,.w _ '7_.4.;f'±4Y`„«.C^'.�A. '1T'... -. ."y*'>`y, .'.."w�;1S'`�:). t ... ._ W r ...re �^k.►'... _. ± *INC TOWN OF BARNSTABLE 34764 Permit No. ................ • BUILDING DEPARTMENT I D,uR I cash �$. . . ... �, .`�,) FF fiff TOWN OFFICE BUILDING w�p63y HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Pat Lentell Address Lot #8, 46 Tracy Road Cotuit, Mass . USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ` May 31; 8 8 d� /%�"' y Building Inspector THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I M A DATA '•y r' ,,�`e# fSi �,e1Y•.. ,:. T.rv...: :.; ... E ,fi:rj �i.l;+Yv;Q 6ryR-'ut'rh,.'t ,r., .�d rw;C' t :B�4tNSTB 'crM � C�iUSETTS �'" DIN ��/r �� ' ", "' O. pp` u* °s a r" d. '!�`•il'1,' ',r�( � ��T: id �`•....5 i)7s �S'\ �-.-�,i� i4}� y'�r DATE " 19 PERMIT N ADDRESSry 1.. ..•il v._ r��.; IN 0 ). t3 '5�1�• A'at'�Y'1' `� ,i. - 5 �, fE. t.. i r i ITr�QI °' ll STORY3rn1 DWELLING UNITS �1�1iyy--�c t't'}R..__..' n`' .; ,.-•.s +.a,., .. J �, .,,.."�..L t .,_.._�.. ...2 .. :..,. ( R LOGA IONh D I ST RICT w J *I �R Xr�n?H*+•�0 t) ya'� S 7 R E E T f AND a ryr• J,,_s.! , n '.ACROSS STREET) � � .(CROSS'STREET) V]I��S//IO.dNI' ' LOT BLOCK ' SIZE ING IS TO BE FT� WID�BY FT; LONG BY FT.:IN HEIGHT AND SHALL CONFORM IN:CONSTRUCTION PE - USG GROUF —,BASEMENT WALLS-OR FOUNDATION (TYPE) I j.' RKS �iPwaffA #R6 i nKn . Pat Lnt�e oR Sherborn, .Fr st r +PERM[T dE ESTIMATED COST g1�1/1/1 �� f+6 } y C BIC/SO DARE FEETI_ 7 4 0 • O O T sJ ■ f i �77�4. a�-- 97 BUILDING DEPT BY. Y f i d4Y,`y, � ':4iy Is v. ` F{` ,. ' mc W. to:r..at_. y..:�..1.. .�'C' 'k • .,.I.�. .w•CrU THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELVEASE THE APPLICANT FROMr THE'CONDITIONS Y APPLICABLE SUBDIVISION RESTRICTIONS. UM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE CTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR IONSTRUCTION WORK: ELECTRICAL, PLUMBING AND NDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS, OR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL L INSPE T11 TO LATH). FINAL INSPECTION HAS BEEN MADE. AL INSPECTION BEFORE 'UPANCY. - - POST TIHIS- CQRD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I � I c4 I� ! HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 1 i : Jl t:Z 7` .BOARD OF HEALTH ALL NOT PROCEED UNTIL THE INSPEC. P-E R•M I T W!L L BECOME NULL AND VOID I F Z 0 N S T R U CT ION INSPECTIONS INDICATED'ON THIS CARD CAN BE APPROVED THE VARIODUS STAGES OF ( WO`RK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CTION. ARRANGED FOR BY TELEPHONE OR WRITTEN PERMIT ISSS ISSUED AS NOTED ABOVE. NOTIFICATION. �0 ,�3� /� y I� r DATE - CONTINUATION OF ROAD BOND BUILDING PERMIT 8 ' The undersigned owner/contractor hereby agree to maintain their road bond in force until the following work items are completed to the satisfaction of the Engineering Section of the Department of Public loam and seedshoulders as soon as weather permits. other (explain) 't j L&ATION" C-ork 2 SIGNED Owner/Co tractor NGINEE AUTHORIZATI N ! =ti n ;v . /111 HERITAGE ASSO'CIATES 2 PLEASANT STREET :`Ha0ie(Beech.er Stowe Houm" SOUTH NATICK, 'MA. 01760 617,=653-0880 C( 9T1FIl -PLpr Prr f OWNER. WPC ASSoCtATEs l.or.."�3 rRF1C Y -- -ZO�NORT_N_MgL . _._ • COT��T._" MAC ;f �i ` I HEREBY CERTIFY THAT THE BUILDINGS ON THIS PROPERTY ARE. LOCATED AS SHOWN ON PLAN ABOVE AND" COMPLY WITH THE ZONING 'BY .LAWS OF THE; TOWN OF 8A/ZNST�;BLE AND IS NOT LOCATED 'IN A FEDERALLY 'DESIGNATED FLOOD HAZARD AREA. THIS. PLOT PLAN WAS ,MAiDE FROM A I NSTRUMENT SUF�VEY. EGI STERED PROFE� .SI O J VVV �R''Y MAC Nevlry NAL 'GINEER p ATE A 'Vo t�. ' � O� IST�����4 • �oNAt X QD • 0 6 a- oy_'Sc'` d ly o- o a- 2 �D N 14'0 ;oar/ V M . rv, 7-AAC.Y". ,9OA0 y h Assessor's otfioe:,(1st floor): '. - � ' o' o Assessor's map,and lot number" ....... .....: ......... . �PTf�i SYSTEM MUST BE S %T"E t �Q� o Board of Health.(3rd floor)• ' 6Z Sewage Permit number ..........:�.6..:.. 9.6,0....:. ` INSTALLED 9HdVIR 9TGDLE, Engineering Department'(3rd floor): ``JJ ; WITH TITLE 5 �, .� rasa . ...... ..ri.—S ONMENTAL �%®® 00,,�163o.a�0�° House number ..:....................... .. ....... -, APPLICATIONS PROCESSED 8:30_19:30 A:M, and. 1:00 2:00 P.Mj only TOWS REGUQoQaT!(a � cMpv i; a TOWN OF ` �"BARNSTABLE BUILDING „ INSPECTOR { y APPLICATION 'FOR -PERMIT TO .................................. �!.. C . �� / .............. ... ... TYPE OF CONSTRUCTION ..........:�.. �.!.S .L................................ ......,�. . .. ' .......................... . ...............19..ot<J TO THE INSPECTOR OF BUILDINGS: The undersigned hereby, applies for a permit according to the following information: Location Via% 8 jje �)-ey fZp �'o%u 1. Y > Pr .�op sed -Use .1 / .....L.4m././X.....MO.��...................... ...... r� F`. .........Fire District ..�4.�1/! ............................................................ Zoning District . .... ....................................... ....... . ... ..• Name of Owner .. .n7..1..... eT —e.d.:...........................:.Address .�d../"T .!T...�1..1 ...... drS/.Qt11....�Ct.............. Name of Builder Address i .. . Name of, Architect �......... ................Addrress ....................................... Number of Rooms ....F......................................................:..Foundationr.. ..................... .................................. Exterior .`� ���`.�: ���' .....Roofing ...�T..��` ... .......................................... ............... ............... ........................................... Floors ` c:�..........................................:....:............Interior � . .Heating GcG... �� ��......! if✓. ..���/�!........:.......... .....Plumbing ...Fireplace t�s OOCJ p ................. :................... ...................................Approximate Cost ....:. �...................................�........ Definitive Plan Approved by Planning' Board 7 ------� ----`�;=-w�---19�� Area .�07�J. ......................... in with Dimensions 1 Diagram of Lot and Build QQ11 g 9 Fee ...�l�4?..!..��.......... SUBJECT TO APPROVAL ,OF BOARD OF 'HEALTH ', �' ;V;,n:7 ' 'Of� O �9, gd OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ... Constructio upe vis s license. ..... ' 'i LENTELL, PAT ..'. 30764 Pe"rmit for 12 StoryNo .0. ...... .......................... Single Family Dwelling A location .. Lot, #8., ....46 Tracy' Poach Owner ...Pat...Lentela................. LF se V # c � � • �;, Frame Type of Const �F• . � �,. -• y � _ - ...- R . ruction ......................�......,............ .. .....'.............................................................. 'Plot ... .�....................... _ Lot .......................... <, K1f/„ y ,� Permit Granted My... .1.!........:......1987. � .. i• _ 'Date of,Inspection � . �.........19 r T{g .. • �� Date Completed � :19alo „ .r ,i, {'� - • J/. "�' Y��,,+,� fit✓} dam+„" 3 ff - -•, .r '/,�y//+_��/'� r' ' � ! ,� _ .. f� " ,r,.I � !�• � , �R.. ', - F f-` �,/!T ''.ems e') Q F, V BIKE A Town of Barnstable *Permits 4 f77& lapires G tnaatlts frottt issue date BMtNSTA �. , Regulatory Services h L Sj �bMAS& `0 Thomas F.Geiler,Director ' To Building Division wN OF 20QJ S Tom Perry,CBO, BuildingCommissioner V �AB, . R�S �E 200 Main Street,Hyannis,MA 02G01 www.town.barnstablc.tua.us Office: 508-862-4038, Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint. Map/parcel Number 00 S 10S5 Property Address (o (i e e Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 4� -F(Znce 3S Contractor's Name P I Telephone Number 1 Home Improvement Contractor License#(if applicable)_A 3'7 1 y Construction Supervisor's License it(if applicable) rj l^ 2 IRWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 7A A-Y eA cs —7—o S Workman's Comp.Policy# ���jQ�G�j fj l4 AO Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to l " ❑Rc-roof(not stripping. Going over existing layers of roof) ❑ Re-side - ❑ Replacement Windows. U-Value (maximum.44) .. •Where required: issuance of this permit does not exempt compliance with other town department regulations,i.c.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvemen Contractors License is required. SIGNATURE: Q:Porms:cxpmtrg Rcvisc071405 �s The Commonwealth of Massachusetts i Department of Industrial Accidents t i ,I Office of Investigations ;1;i.:,; 600 Washington Street Boston, MA 02111 - www.fnass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbet•s Applicant Information Please, Print Legibly Name (Business/Organization/Individual): ch ' Address: .U31 R \ fJ Si— + City/State/Zip: ��1 r�`,Q a?J� Phone #: t�S• 2 \-1 Are you an employer?Check the appropriate box: Type of project(required): 1.� 1 am a employer with_.\"X 4. ❑. 1 am a general contractor and I employees full and/or * 6• ❑ New construction ( part-time). have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑ Remodeling ship and have no employees Thcse sub-contractors have $. ❑ Demolition -- working for me in any capacity. workers''comp. insurance. [No workers' comp. insurance 5. 9• ❑ Building addition ❑ We are a corporation and its required.] officers have exercised their '10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of cxcinption per MGL l LEI Plumbing repairs or additions myself. [No workers' comp, c. 152, §1(4),and we have no 12. toof repairs insurance required.]t employees. [No workers' comp insurance required.] 13.0 Other 'Any applicant that cheeks box HI must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I ant an employer that is providing workers'coirrpeirsatioit insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: e��B(� l,1 � Expiration Date; Job Site Address: Ayr—Q `— City/State/Zip: &AA 02-(4-- 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 forth 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 under the pains and penalties of perjury that the information provided above is true and correct Si nature: Date: -7 6 Phone#: F. Official use only. Do not write in this area,to be completed by city or tows:official City or Town: Permit/License it 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 - !'hone# 1 Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. 1 print) scoi" as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job TRA ce Z Signature of Owner Mailing Address of Owner Telephone# S� Date i (Please return this form to Cazeault roofing along with your signed contract; It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you)fax#508-420-4555 qe -P Board of Building Regulati ns and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault 1031 MAIN ST -" OSTERVILLE, MA 02658 - Update Address and return card. Mark reason for change. [] Address Renewal ! j Employment Lost Card DPS-CAI 0 5OM-05106-PC8490 �ae 1oam�novwrpal!/c o�,/�,aaacu/u�ae(.la • Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building Regulations and Standards Expiration: 7/9/2008 One Ashburton Place Rm 1301 Boston,Ma.02108 Type: Private Corporation PAUL J.CAZEAULT&SONS,.INC. Paul Cazeault 1031 MAIN ST Q a...` OSTERVILLE,MA 02658 Deputy Administrator Not valid without signature r. Board of Building egulations One Ashburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/2007 Restricted To: 00 PAULJ CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 Tr.no: 7696.0 Keep top for receipt and change of address notification. PS-CAI 5OM-04/05-PC8698 °T BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number;.,.,CS 026325 B(rthda�te:10/20/1959 Expires; 10/20/2007 Tr.no: 7696.0 Restricted:°p0. PAUL J CAZEAULT'.. 1031 MAIN ST G— OSTERVILLE, MA 02655' Commissloner ate, 5/24/2007 Timer 11r56 AM Tor 0 9,15084204555 Dowling & O'Neil Yager 002-003 Clie t# 9989 2CAZEAULTPA DATE ACOM., CERTIFICATE OF LIABILITY INSURANCE 05124107D PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling$O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyanough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURE D INSURER A. Western World Paul J.Cazeauit 8r Sons Roofing, Inc. INSURERB: 1031 Main Street INSURER C: Ostervilie,MA 02655 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLI MIFFECTIVE POLICY EXPIRATION LIMBS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE IMMIDD1111 DATE NMIDD A GENERAL LIABILITY NPP1082452 04/30/07 04/30/08 EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED $SO OOO X COMMERCIAL GENERAL LIABILITY CLAIMS MADE Q OCCUR MED EXP(Any one person $5 000 X BIIPDDed:1,,000 PERSONAL aAOVINJURY $1000000 GENERAL AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP AGG. $1 000 000 POLICY RD. LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea aoddenl) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTYDAMAGE $ (Peracddenl) GARAGE LIABILITY AUTO ONLY•EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ n AUTO ONLY: AGG $ EXCESSIUMBRELLALIIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WC $ STATU• OTH• WORKERS COMPENSATION AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ANY PROPRIETOMPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ mdesalbe under E.L.DISEASE•POLICY LIMIT $ SPECIAL PROVISIONS belaW OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CANCEL ION CERTIFICATE HOLDER LAT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Paul J.Cazeault&Sons DATETHEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAC 10 DAYS WRITTEN Roofing,Inc. NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BLTrFALURE TO DO SO SHALL 1031 Main Street IMPOSE ND DBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER rrS AGENTS OR Osterville,MA 02655 1 REPRESENTATIVES. AUTHORME05PRESENTATPJE ACORD 25(2001108)1 of 2 #47754 LS1 0 ACORD CORPORATION 1988 D'�4� �:yS�'J.'. ' M (�i n �`` Ya si a y E(MM1001YY) f :`.isl"s:��JATE'-: V JPi 'i t a OAT j. }. r._.:n....,..._...,..:,,:..... ;.:na'.•1+. ..,....,:;..;';!<;r..Jg1v;;.•::.;r., ,s ..>:!,.....•a1••:•PRODUCER -THIS CERTIFICATE IS ISSUED,AS A MATTER:O I rtw"§kA ., ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE: DOIVLING 6 0 NEIL INS AGC HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND-OR 222.WEST I•IAIN STREET, ALTER THE COVERAGE AFFORDED EIYTHE POUCIESL aELGW-. PO BOX 1990 HYANNIS I.IA 02601 COMPANIES AFFORDING COVERAGE CCUPAN 22LGR A TRAVF;LERS PROPERTY CASUALTY COMPANY OF' AMER.ICA INSURED COMPANY . PAUL J CAZEAULT 6 SONS INC. 8 1031'14AIN STREET COMPANY 057ERVILL6 h1A•02655 C COMPANY D .u{•o V;C17 ERA 15S=tN1s:i:, ,,;, ,:',,•, :ei•: zas:. ....'.r •^,.%>.o ..,,.;.:;n....:.n..a::'e.. .•::,.:.,:...y.:e,.:.:�:.:... ....o.,.;.;..,.�::,.:..,....ws.:..;ei:a;: cbY+} THIS 1S'111 CERTIFY THAT THE POLICIES"•OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TD'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-CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY'HAVE BEEN REDUCED BY PAID CLAIMS. ' LT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION' LIMITS �DATL(?A=Dn\YY) . BATE(MmQU%YY).- EO ABILITY GENERAL AWIIEGAIL 1 IiUUUCIx.(;IXvtftiUCLAIMS MADE a OCCUR. PERSONAL B AIN.INJURY gE fi S 8 90NIFWE 1ORJ PA01. EACH OCCURRENCC 6 FIRE DAMAGE(My one fic) g MED..EXPENSE.(Any vnn perevn) g. AUTOMOBILE LIABILITY COMBINED SINGLE 1 ANY AUTO LIMIT ALL OWNED AUTOS 89PIEY INJURY SCHEDULED AUTOS (Pvr I'mon) $ 141RED AUTOS NON•OWNCO AUTOS BODILY INJURY 3 (Pa Accident) PROPERTY DAMAGE 1 GARAGE LIABILITY ONLY:EA ACCIDENT' g ANY AUTO OTHER THAN AUTO ONLY'. EACH ACCIDEN T,AGGREGATE 1 EXCESS LIABILITY EACH OCCURRENCE . g UMBRELLA FORM AGGREGATE i OTHER THAN UMBRELLA FORM --. . .. ) WORKER'S COMPENSATION AND. A EMP.LUYER:SUABILITY. (UB-0095BG4-A-06 08-10-06 08-10-07 STATUTORYLNAtTS THE PROPRIETOR/ EACH ACCIDENT g, PARTNERS/EXECUTIVE v INCL DISEASE-POLICY LIMIT g OFFICERSARE: EXCL DISEASE-EACH EMPLOYEE g loo.on TtIIL RCFLACEG ANY PRIOR CERTII'ICATL° ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKER:, COMP COVERAGE. �.,....a,,..., to .<• ?,G r F�.' ,;,:,.::::::•:. .. ..�-_, __ V nr•:. ::'.•. .. .v:: Jr%..,"Ti:::i:.vi,:1'.i:..:1.iti::i✓:i i.C.t:pi::.i,n4�1•n�v\:�',:..i:,:•'�;';'��� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE , Paul J•Cazeault&Sons EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICETO THE CERTIFICATE HOLDER NAMED TO THE Roofing,l:Tc• LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATION OR 1031 Main Street ItuAallrty GF AUY+KIND UPutiTNECOYi+liii,lTSAGFI�TS�gpipFESEy�TASIyES. OStervillo, MA 02655 AUTHORIZED REPRESENTATIVE ' •.:..:....,.r,.4.•,. .I•,....,..o'onr,r.;. ,.,;., :, ...1`< 3:a.. <:e:: :'ur ....r, n..<.v,.,vr.'..:.,y..1:•,'•av,•wvn.:.....'nv f3 •:'f':S ,t .......... ;'�:: :'>b'AJ ORa<COHpdRATJOt+(�1893' l3utldM9liepasuanw••. Complaint quirt'Report Zr -ss Rec d by: Assessor's No.: Date: — Complaint Name: Location Address: M/P G Originator Name• �y Street: Village: State ` Telephone:D/E 1 Complaint Description: 17 Inquiry Description For 09ce Use only Inspector's `l_ 7— a / Inspector. Action/Conunents Date: Follow-up 'A Action . 51 ' of f Additional Info. Attached Cop}•Distribution: White-Depaz=cnt File Yellow-Inspector Pink-Inspector.Be to OlFce Manager) J FOR OATE_�TIME A.M. M , 7 —P.M. OF— HONED . PHONE RETURNED YOUR CALL NUMBER„ EXTEN5101�1 MESSAGE PLEASE CALL . iNlLL CAi_L AGAIN —� CAME TO :SEE YOU SIGNED WANTS TO �k SEE YOU 111Y2/Sal* 48003 ck -Y� Is gv.,l av}- (2/7zll III? 39.2 X 35.0 29. �- , � 5 - 13 -- \ I + }/36.3 }/35.2 44 .1 f 34 y' i .�, }/36.5 / 4.1 X 35.9 \` 4.1 }�35.0 ` i 34.8 i33.6 / 35.2 }/34.5 / 3.1. 7 I _ - .- 2 4 - 33e1. l�32.9 29.I 4 X27.3 X , 19.0; / >� X 31.4, l }/29. y 5 29.4 ____ 3 '54 }�28.4 i 30- r '•, 8 /30.7 29.0 / 32.5 / 4.1 l/3 2.4 , 60 }/ 31.0 8.6 }/30. i , /30.9 323 62 prorArty lines shown on this plan " are:12:-as-essing purposes only mnd do met represent actual rglationahops to physical objects N IMETRIC DATA INTERPRETED FROM 1989. AERIAL OVERFLIGHTS, PHOTOGRAPHY AT A DIGITIZED FROM 1 " = 100' ENGINEERING ASSESSORS MAPS 1 989 ARCE< DAT .