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0016 COVE ISLAND ROAD
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Y •4 �! r, r r, �`.: d'Y�'� '"t°� � ,r� #Y�"�1 y +s:.:::p,�t,r'k`3 f{s,l�' •.J„t Y:'Y,'r i,"H,, n I; x lY � � �� 1, r�'i; �Y ! y�, >n,PCy ti'I r � #r yr y „ G:7 •, t ,;Yi t � '( - k1" �, aU r :P p 2 y m.� +, �tl � ;,, f Ay '�',li�' ,�d'" „�, .:""d,.JR<' ,'.?��fPL�rr' ' .,,., y8ry_.:,_'�,y I.,:_,.'i.+/�rC,it� r,.� _1- ..;_ , •'•.t+�fS �r' '+' d,y'a,-.,�..r!f'..x:.i;:i.v1_PrlI':.�7,,d..i!rt!�,,.,.:,nr. �9�'W '_/'...1:.,:i i drY�„y.�•'',d�#,;',.�ra'7�,..At��+'4�d�`•.'".:.''. f:r",9'°.�' ,�p G'�t�,i nr Y, F _ . •r' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma ! Parcel 5-0 p Application # Health Division Date Issued Conservation Division yJ Application F C Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 16 Cove l s 1a Y1 c/ K6J4, Village Cers4-e_kUf11t Owner a 4:P- , �►�e�W_I i 1.1 Address /?a 9.kioad Telephone 9�k Alf- �U5"� Permit Request >(,P3 Arp-1 A4A ems. Cho uQ4/b l-rm odel Square feet: 1 st floor: existing proposed 33 6,7 2nd floor: existing proposed Total new 3d p Zoning District Flood Plain Groundwater Overlay NProject Valuation fro ago k Construction Type���►aM� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes W No Basement Type: 3l Full ❑ Crawl H Walkout ❑ Other Basement Finished Area (sq.ft.) ?36 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 3 new Half: existing / new Number of Bedrooms: existing —new Total Room Count (not including baths): existing ?—new First Floor Room Count y Heat Type and Fuel: ❑ Gas JA Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing INew Existing wood/coal stove: ❑Yes ® No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:3.existing ❑ new size _Shed: ❑ existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use � APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name y I���ha r�� 1� V�i��� � Telephone Number 9797 66D- �3a3 Address /a 96 E/rn S4• License # C S -6/3 a 7� cb YY1 ihs��h , MA 0)16 3 Home Improvement Contractor# Jl l a G Email Ma Vag//eW e d-V6_12„A . hc 4- Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _C SrhVic iv ���p r)�h��✓ SIGNATURE DATE /0/a/x5 X FOR OFFICIAL USE ONLY APPLICATION# PATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE OWNER d . - DATE OF INSPECTION: FOUNDATION 1t-h r - FRAME Q�4�lr < INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: _ ROUGH FINAL FINAL BUILDING rOX Ioll ll�kl DATE CLOSED OUT. ASSOCIATION PLAN NO. ,y., ��e�pryr��niwoicaealC�o�Ci�/�aaoacLccoeGt- \ Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration: <1=11`216 Type: xpiration:,'-_]2L91201.6 DBA M.A.VAILLETTE ji f MICHAEL VAILLETTE,?� 1296 ELM ST LEOMINSTER,MA 01453\ `- Undersecretary `ee r LLOZ/604L JauolssiwwoO :u0ilejidx3 j�0 VW 1131SNIWO31 1S W13 96ZL 3 111VA V 13VHOIW 't JosiAladnS uoilonilsuoO 8LZUL SO :asuaoil spiepuelS pue suollelnBaa Bulpling to pjeoig Ajales ollgnd ;o luaw:pedaQ s:pasnyoesseW .p }ram 3 - - {_ � •�z� H.` a .._ »�� i+'* i� r , -x � x P q X : , Y .Qf- r' 33': of , 4 _, ",i u w 3 271e Commonwealth of-Vassachusetts Deparament of rndTfs&ial Acciderds Offs of 1mw tigat`Ions 600 Washington Street =y Boston,-414 02111 Workers' Campensatian Insurance Affidavit.Builder-dCuntractnrs/EIectz cians/Phunbers Applicant Infin-matian. / Please,Print LeaililY Name(Basmess,Drganuza�anlln na /�/� VQ/��TTe �bh�Mc�/!�4 Address: 67L . L City/statelZip AMMI&4ek /�� O/ - Phone hl c17dr "C5 -73.3 Are you an employer?Check the appropriate box: ' Type of project(required),: I am a general contractor and I 1.❑ I am a employes urtb. � - 6. gI'Iew constiuctioa employees(full aadlor part-tithe)_* leave lured the sub contractors c 2.K I am a sole groptietor orparEner, listed on the attached sheet. 7_ ' ,Remodeling ship had have as employees. These sub-•cmtrac#ors have 8.1❑Demolition woaiang fur me in any capacity.. employees and have wodcers'[PTO w-orkem.comp.insurance comp-insurance`I 9. ZLBuiFdsn g addition required-] 5. ❑ We are a corporation and its 10-R Electrical repairs nor additions 3.❑ I am.a homeoum-er doing all work officers have exercised their 11-gLFlumbingrepairs or additions set€ o workers' right of exemption per MGL ime 12. Roofrepairs i�+�t�nceretluired.]i .c.152, §1(4handvrehavena employees-[No workers' 13.❑other camp.insurance required-] *Aay gTKczZt d at checks box#1 mast also fill out the sectionbelow shaving their waAers'compensatiauporicg infoamauM r I Eameoanerswho submit this a±6datu indicating tbzy am dais alI wort aid thm hits outsidecontractorsnmst submit a new affidavit indicat n,snrfi (Contractors that check This boat must attached sa addidnail sheet s'hatsmg the name of the sub-contrzaom sad state whether.or not those entities have emplu3ees.If the sub-canttactorshave employees,theyaasstpmvidetheir workers'comp.pa&—ynumher- I arrt an errrpl�•vrr ticatis prax�durg workers'cotrtperrsatirrtt itrszrraruce for city enrplay�es $etoty is tictt policy curd jab she information Itissurance Company Name: Policy#or Self-ins-Lic_ i Expiratioa Date: Job Site Address: City/Stafe�: Attach a copy of the workers'compensationpolicy 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 criru=_ 1 penalties of a fine up to$1,56D OD andror one-year imprisonment,as well as ci,d penalties.in the form of a STOP WORK ORDERand s fme 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 the DIA for insurance coverage wrification. I rfa{ieraby c fjr tretd�r tFtRpctirts art'd�p/s�rialties uf-p-edury that trio inrfonnatiouprmzrled abm�s true and carrect SiMmture: / i,2,4 / 01 1L 6 Date: phGne 9�� hts6-�3a3 Ojokial use only. Da trot anite in this area,to be winp£etesd by city or town official: City or Town: PermitUcense# Issuing Anthor€ty(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: f -1aformanon and Ias&uefions ` Massachusetts Geheral Laws char 152 rmpires all empIoyees to provide workers'compensation far their employees. PMTUantto this stafztD,an EMPIoyee is defined as."_.every Person in the service of another under amy contact ofhire, express or implied, oral or wr>t� An errpfoyer is defined as"an individnA 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,patnership,association or other legal entity,employing employees. However the ving not more than three apartments and who resides therein,ar the occupant of the owner of a dweIln?g house ha - dlweliing house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appunh=zntthereto shall not because of such employment be deemed to bean employer." q&L chapter 152,§25C(6)also saes that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a bursmess or to construct buildings ia the commonwealth for any applicant who has not produced acceptable evidence of compliance with the msux`aace.coverage required" Additionally,MGL chapter 152,§25C(7)staff "Neither the commonwealth nor a'ny ofitspolitical subdivisions shall enter into any contract for the perform.ancO,ofpublic work until acceptable evidence of compliance With the insurance.. requ=emertts ofthis chapterhave lieenpiesentedtn the contracting anthoiity_" ' A -iPHcaats Please fol oiot thie workers'compensation affidavit compleirly,by che,6Hng e:boxes than apply to yorrr sitnation and,if necessary,supply sub-contactor(s)name(s), addresses)and phone n ber(s) along with.their certificate(s)of ins -ance. Liunited LiabD#Companies(LLC)or Limited Liability-Partnerships(LLP)with no employees other than the members or partners,are not requmed to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidayitmay be submiftt-d to the Departnent of Industrial Accidents for confirmation ofmsu=ce coverage. Also besure to sign and date-1re affidavit The a.ffidavitshould be retuned to the city or town that the application for the permit or license is being requested,not the Departiamf of In dust dal Accidents.. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Departnent of the number listed below. self-insured companies should enter their self-i saran ce license number on the appropriate lice. City or Town Oflscials t _ Please be sore 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 pezrit(Iicense number which will be used as a reference number. In addition, an applicant that must submit multiple permitiEcense applications in any given year,need only submit one affidavit indicating cmrPnt p olicy baf6 ation(if necessary)and under".Job sine Address"the applicant should•yrite"all locations in ( ty or town)--A copy of the affidavit that has been officially stamped or maimed by the city or town may be provided to the " applicant as proof.that a valid affidavit is on fle for fidnre'permits or licenses- A new affidavitmust be filled oist 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 bum leaves etc.)said person is NOT regnaed to complete this affidavit The Office of Investigations would like to thank you in advance for yoia cooperation and should you have any questions, please'do not hesitate to give us a ca1L The Depariment's address,telephone and fax number Thu Cammmweata of Massa chuar�tts ' Dtpa tm-ent cuff ladus'aial Accidents 600 woman t Bastou=MA GAIT T(,-L 4 617- -45QO Qx- 4-06 car 1-M- S.AI-E Fay# 617-727 7M xevised4-24-07 �s E gQV/dia �VE ro Town of Barnstable °4 'Regulatory Services 9 $ Richard V.Scali,Director 16 16 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 j If Using ABuilder 4 v . G ' �ol�� ,as Owner of the subject property hereby authorize �'I I K E VA) l.L CT7 f- to act on my behalf, in all matters relative to work authorized bytbis budding permit application for. GDV C 47S V (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. ; Signature of Owner Signature of Apphcant Print Name Print Name Q:F0RMS:0 VRgERPERMLSSIOIe00LS Town of Barnstable : ., •-> it Regulatory Services ppViE To Richard V.ScaIi,Director Balding Division r saBr R Tom Perry,Building Commissioner 200 Main Street Hyannis,MA 02601 $CEO a www town.barnstable ma us Office: 508-862-4038 Fax: 508-790-6230 . goACEOWN z 110EvSE EXFM=ON Please Print DATE: JOB LOCATIOK-- number strut village "HOMEOGT1dER: ' name home phone# work phonc# CURRENT MA=G ADDRESS: city/tawn state rip 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_ DEFWMOri OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,oa 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_ o , The undersigned"homeowner"certifies thathe/she understands the Town ofBamstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signatam 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 nol wnEIt s Fmh1 - ON - The Code states that: "Any homeowner performing work for which a building permit is required shaIl be exempt from the provisions of this section(Section 109.1A-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 hack 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. Oa the Iast 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:\wPFn ESTORMS1buUdmg permit Rrms\EXPRESS.doc Revised 061313 J �r BUILDING i ,. TOWN OF BAf:NSTABLE, MASSACHUSETTS PERMIT JOB WEATHER CARD /�^—.�( ')k DATE 19 PERMIT NO. 63 APPLICANT ADDRESS j (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO NUMBER OF _(_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ' ` ` AT (LOCATION) /('�� � CIOVc SL�'N� L/V/ eVo?r= (NO.) (STREET) j BETWEEN AND ( (CROSS STREET) (CROSS STREET) i LOT SUBDIVISION LOT BLOCK SIZE f BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION f 1 TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE)' REMARKS: AREA OR ,/► /� C A PERMIT VOLUME ll!///��L�T��! fTl� /T ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) OWNER BUILDING DEPT. ADDRESS — BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OF PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINEC FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITION' � I - OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. — I MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND ._ I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. j z. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBu FINAL I SSE TI. TO LATHE FINAL INSPECTION HAS BEEN MADE. Yl� 3, FINAL INSPECTION BEFORE , OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET I BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS z 04 � 1 2 2 ,( AvL� 3 1 .HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS 1 OTHER — 'Z ® - 01, HEWN i WCRK SnA.L'_,NCT PROCEED UNT:L THE PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION iNSPECTiONS INDICATED ON THIS CAR NSaECTOR -!AS AaPRCVEO -vE vA-!CUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHCN ' STAGES OF CONSTRUCTION' PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. .. TOWN OF BARNSTABLE 29653 Permit No. ................ BUILDING DEPARTMENT H°eiaa TOWN OFFICE BUILDING Cash ,.,.,Qa16 .. .. HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to FRANCIS & LEAH MOGAN Address lot: #6 16 Cove Island Road, Centerville 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. February. 27. 19.....87....... l%Ge� /'� "-✓ .... Building Inspector `/Ass%skr-'s office (1st floor): / UST BE THE i Assessor's map and lot number ......1.. .... ..�� SEp-rIC SYSTEM t T�1�o COMPLI "?ward of Health' (3rd floor): —�2� ���,Tp►LLED TITLE 5 e age Permit number ....� WITH CODE ;pi"l ASTABLE. En ineering Department (3rd'floor): y �%JS w I�®NME�TA 90, 1639. Heuse number .................:......:................ .. .......................... ff� ` 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 ......... 2 TYPE OF CONSTRUCTION ..........L.).Q<? C... !^^ ..................................................................:. .............. .............AXE..........19A6.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a �pe(r�mit according toi the following information: . ai�1.Location ..6..... 4-..�?�u c ...Izo.... ......................................................'............................ ProposedUse ......`)`.C.S.1 tLCc ..cR. .............................................................................................................................................. ZoningDistrict ..............................................Fire District .............................................................................. Name of Owner Address ,3: ..�.� Yt�.. �...QS 't!`!��.................... Name of Builder :............Address sli. c Nameof Architect ................Address ..:....................I................................................... .........................................................,.. Number of Rooms ......7.............3-6. -r..........................Foundationsc, .................................................... Exterior ........ 5'17.z.!�.l::.s.......`..C�lc��,?.. RG-.✓...(�C. .......Roofing ....(jLs1/� , lc.�T Floors ......Lr? .4.. ..-. !�Sg..................................................Interior 4 Heating ..0.!A....'.. ........................................Plumbing ...............�............................. ........:...................... Fireplace ......�J..1.2x .....C:,f. .n'r 1.........................................Approximate Cost ..... ........................................:.. Definitive Plan Approved by Planning Board ________ _________�___ 9_ Area ....1. �� Diagram of Lot and Building with Dimensions Fee � SUBJECT TO APPROVAL OF BOARD OF HEALTH '5 2-� 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 j!.!!..�-�..t- .`,� .................................... Construction Supervisor's License .. ,-- ,� ............ Fri MOGAN, FRANCIS & M. LEACH Jf r 2 Stor' Y 296 No ........ rniit for ....1......... **. ................. Single , Family Dwell' g ............ ......................................................I.. ...... Location ........Lot #6, 16 Cove Island Road Centerville ............................................................................. Owner Francis & M. Leach Mogan .................. A Type of Construction .......s.Frame................................. ...................................................... .. .................. Plot ....... . Lot ................................ 4 Permit Granted ......j�Ajy,...14 86 ......................19 j r..9 . Date of 1&pection ........19 'Date Completed ........ .. ........................19 4-7 r- - Assessor's dt- office (1st floor): p / THE T Assessor's map and lot number ..........c..•...................1........... Board of Health (3rd floor): T \,Sewage Permit number ...........I.............................�...2.-- - R 2 13AWSTAMLE, p Engineering Department (3rd floor): /_ "'js so YA°a m lam' House number !:�...................... i639AV 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 ......... t.5 7�.... .:^.5 � 2 TYPE OF CONSTRUCTION ...........A., 90V...... 4 ................................................................... .... V /I- .........19 1. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: LocationStu.. s�............... �. �* .....�.I.�........... '�................................................................................. ProposedUse ...... . ..... ............................................................................................................................................... ZoningDistrict ........................................................................Fire District ..................................... ....................................... --.,Name of Owner .Fri:r�1��..4...�-.e�-�.-V'Lo�a•r�..e!�....Address �.,�.�..�-� Q��`?�. GZcQ Os....rv„'l..`.................... Name of Builder .Flkf.:nA !.:>..E..!/�. u�..�Y• ...•Address ............. ....:............................................................................... Nameof Architect ..................................................................Address ........................................................:......................... Number of Rooms F b.� ` hn`�r ,.,........................Foundation C U�c;J�. Exterior ............. .!. ...........C,�;.tJa•-L�vc .......Roofing ....r.x. Floors .....`t,��c�.Q..-. C1--�. ..................................................Interior ..... .,/� s r........................................................... Heating ....... .:��... �; - ...Plumbing ., _ a :.................... Fireplace ....... .... ..............Approximate Cost ....... /© UU 0 i1 ......................................................... g Definitive Plan Approved by Planning Board __________________ __�_______19_�_-- Area ..... •.. Diagram of Lot and Building with Dimensions Fee ......! /. ./,.t. . ...,.. ............... SUBJECT TC?,,APPROVAL OF BOARD OF HEALTH si r tiri�� a i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. �i�'`: :` ..<:..w .��' ............... O 7/ Construction Supervisor's License ............ MOGAN, FRANCIS & M. LEACH 1� A=187-54 No 29653n 1 Permit for ..... Story Single Family Dwelling , ....................................................... Location ..,,Lot 116, 16 Cove Island Road .................................................... i 3 Centerville ......................................................... Owner ..Francis & M. Leach Mogan . ................................................... Type of Construction „Frame - ................................................................................ Plot ............................ Lot ................................ a Permit Granted .........July 14, 19 86 ...... . Date of Inspection ....................................19 Date Completed ......................................19 7 6? vv, f j I-A �t r Town of Barnstable Permit# M Expires 6 mo�ths from issue date Building Department Services r'ee areat.�, = 0PRESg iltiv twti o er S-71. qb 0 Mess t639. ' ArFD NtAr 200 Main Street,Hyannis,MA 02601 OC IT +.2a.barnstable.nIMILDING ���� Office: 508-862-4038 TOWN OF BARNS(ABLE ®Cl' 19 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION -TRESIDENTIAL ONLY Map/parcel Number 65(1 No'Vaud without Red X-Press lmprt hi87A-Li ll Property Address_ ) 00 U or-- 7 `g mi/ J '/ Ud;6,3 eZ ❑Residential Value of Work$fin y;d _ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Y B 1_ / E o�SLAL/ NT l JeVI L_ r% woj> T -T- Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner - ❑ I have Worker's'Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(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 O /(maximum.32)#of windows #of doors: 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit formsTYPRESS.doc 08/16/17 . a The Commormeakt ofMasyadiusdls DVarktreut&f1udrts&id Accidents - l�,face a,f�rru gadem ' 600 FPashfiWon&treet _ Batston,MA 021-11 invimmramgtovfdia WiarIters' Campensafia LnurauceAffidavit:SmlderslCantractarsMecfdcians/Phmihers AppEcant Infmrma6m Please Pant �V Na=Muse. g im,�r�a any . �1 l� G• {���� J L I E Ad&ess: �ifgf�tat�ilr_ V LG •t��6 ne�' Are you an employer?£freckthe appropria&bom ' Type of reject r I_❑ I am a ere 1 with 4- ❑I am a general contractor and I e ] ( ettio eel}: employees(full artdfor part-ime).* have hired the sar�r-contmctors 6. ❑Ide�r oo Sian 2.❑ I am a sole prop:ietor orparEm!e- Tested oathe.attached sheet.. 7. ❑RemadeHng These saib-confradors have slug and>�e no employees. � � ❑Deanalifiort wading faprrne in.any amity eurployears andhave wodmrs- 9. ❑B.Oding addifian [N4 WPd05 ` CAffip.fiLT=nre comp-%na4r mme required] 5. ❑ We are a cmporafion and its la[]Electrical repairs or addrtious 'work officers have escscised fhesr3.Iamafw Plnaabkgrepairs or additioms. set€ o workers' rightof cremgfiou per MGL , finmranre required l y - c.152,§1(4k andwe have no 1 r❑Roai repairs employees.Wo workers` -❑Other camp.insm.MMce required.] 'RayappEicintdfiatched3box Im�stalsofiIlo�tLesectioabeTow�atdagdiieii�uo�cess�compeasalianupolicyiffilms`urm. ffaaieoaraerswhusubmit this xTdaeuind7Y1i1 . they Rm&iagRUvralmidGeahimautsideconbmrn,. 7 mhmitanewzMdaeRiudicsbcgsacfi_ rCaglncdnat;Zt dheckth€ebox mast Z=Rdred amaddifiansl sheet shotid=gthenneof abe sub-�a.=d ststmvrhe m ornoMare eW16u&M employees.IfthemVcaatradveshaveemployees,dfiey I pmvi&th&wodmw romp.paRcynumbet I art[an empLoyer die ispnm dia> workers'coaprsd ian fimirascs jor ray*empkyees ,Sefodv is$tapaiicy artd job sate Frrfbrrair on. Insurance comipanyifame: Policy 41.or Self-isrs Lic_ ExpimfionDade: Job Site Addre= cityfStatdZip: Attach a copy of the workers'co a mpmsationpolr'cy-declaration page(showing the poRcy,number and expiration date). Fare to secure coverage as rerquireduuder Section 25A of MGL a 1572 can lead to the imposifi=of criminal pena%L-. of a fine up to$U00L OU and ictr one year irnprison-A as well as aril penalties.in the farm of a STOP WORK ORDERand a frne, of up to$250_DO a day against the violator. Be advised that a copy of this statement.maybe forwarded to the Office of Invesfigations of the DIA€or ifls,War,r¢coverage ti oa_ I dro IfawV cgd#Y' atud � �If�s OF cry th&the i f band fiwj?rm-vW abma fs bars and correct �' Siontare_ Date h 7 cphoaei QjyEdid um wifj. Uo twt write in flib orea,fft be d:r npfeted by�'artoinj o ffica'at City or Town: FermftT icemse 4 Bsuuin Authority,(d rde one): L Soared of He2f h Building Deppntn-ent I Cltyfowa Clerk d.Electrical Fnspeetor rr.Piumbing Inspedvr 6.Other Contact Person: Phone 9: I laformation an' d Ias ctiolls Massa Genmal Laws M reQures all enqioyem to FUvIdI--wmi=e w on far$ieir a nployees. parsmm3� ee is dammed as. _-every g ea 6u ia.tb a service of anoffim under any ccnfxact afliir, an fhzs S�s �'f - " or' ,oral or wit express �phed, . ezrplayer is defined as LQaa iadEvidA paxinmsb�,aSSDdZ on,corporation or of a legal may,or any two or more , m a oint andimbr mg the legal represcntafim of a deceased e�ployrx,or$ie of the foregoing J , to However the receivra or trastee of an i XwIdnal,per,associafion or other eniiiy,�oymg� �' owner of a dwelling house having not mare than tlnee arfine nt s andwho resides or the occupant ofthe- dw,Iling house of another who employs peSsans to do ,cmdr c on or repair vmk on such dwelling house thereto shaIlnotbmanse of employmm±be deemedto be an eSuployer" or am the,grounds or building appurfnnaz¢ MGL chapter 152,§25C{6)also states that¢everystatL- s or local end ageneyshaIIwitbheEd ffie issuance err renew I of a license or permitto operate a bn<smess or to construct buadings is the coromDnwealth for any applicant Who has notproduced acceptable evidence of cdMPLMre wiffi the hmurance.covexage required." AddhionaIly.MGM chapter 152,§25CM states=Ncdhmfhe nor a'mybfitsPolitical subs$visions shah ewer inb any caaira.d for the perf=aace ofpubhc WD&nrfI acceptable evidence:of compliancevIRh the fimnance._ regoireazrCMfS oftbis cbapterhavelieen.presentedto tiie c nir�.M iDZity:' Applicaafs ' =p y c apply to our sifnadon if Please flI out isle Woks'compeasaiiDn affidavit co leanly,b ijleboxes ii ly y , necess�Y,supply�s)name(s), addresses)and phone number(s)along v&ffi=ce�ficate(s)of Companies or L�itedLiabilityParineshi s(LU)'w&no employees other than the insurance. Limited I-ial?iIity Come (LLCM members or pmtaexs,are not rimed to cant'workers'cox<pensafion ms'r"" If an LLC or LLP does have empIoyees,apolicyisrequired- BeadvisedIhAthisaifrda�maybembmi�dintheDepartmentofrndlSfrial Aceide�for con�mahon of insurance covcragb Also be sure to stn.and dates the of davit The affidavit should beretumed to ,fie city or town that the application for the permit or license is being regaested,no t the D epaxtmenf of Tn ran efi-i al A c M =ig- gwnldyou.have ate,quest ors rega�mg the law or ifyon aie requa ed to obtsm a Workers'mse call the:D artoleof at tbz numberHvfmdbelow- Selfnfi m A carrpanies should enMr ilieir eusation oh , eP rAmp P. �Y Pl self-fi smmra licm se number on the apprvpriste liae- City ar Town Officials - f Please be sues that thb of ddavh is complete and primed IegibIy_ 'Ihe Departmenthas provided a space at fie.bot bom of the affidavit for you to fill Out in the event the Office ofInvm6ger hasto coMbIc.you.regardmg the,applicant Pleasebe sure,tofMiathep crosemmlberwMchvMbe used asareferencenomber. Iuaddition,anapplicant mient t�must sabmit multiple pace e,appli�ons m any givmyear,need only sab 'tt one affidavit c p olicy information Cif necessary)and under"Job�Q s"the applicant should write-aU locations in (Ciy or to•wn)."A-copy of the•affidavitifiat has bee.officially stamped or maked by lha city or tom m.ay be provided to the applicant as proofUnt a valid affidavit is on f ilD fur fuime'pennits or licensees A new afftdavitmust be ffiled oat each year..'Where a home owner or dtzm is obtaining a license or permit not related in auy business or commerc ial vd23t= Cie.a dug license or permit to bum.Ieavrs eta.)said person is RIOTIMFdred to complete this affidavit The Office oflnvestigat�nnswonldlflmtotbankyouaadvancefaryourcoaperafionandsbonldyonhavenay4 0 - please do nothes>fate to givers a CA the De partozef s amass,telephone and fax numbex- 1 . Cam' attbE of Massach.Mttfs DepaLtnmt of Accidents (ice of Inve9t tio= �4 T�a�.�an Sit 1477MASSAFE F #Q7 27 . Kevised424-07 a 1*fdiEL Town of Barnstable Building Department Services ` Brian Florence, CBO 16,19. ►`� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must µ Complete and Sign This(Section. If Usi=A Builder L ,as Owner of the subject property hereby authorize 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. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOT S Rev:09/16/17 Town of Barnstable , Building Department Services Brian Florence,CBO 6 Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 1659. Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EREEWTION Please Print DATE: I u b 2 )17 JOB LOCAnO : L)IJ E �C jAAlA sty V I /J village "HOUEOWNW: P ��lL t!g 8 EAW ze y q 7 P d-�? dame home phone# work phone# CURRENT MAILING ADDRESS: I 6-o 1) r ju L k L/I U. Prl ASS y a-G 3a ciity/fown 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. DEFINMON 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 procedurresan q ' is 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 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 08/16/17 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ' Parcel App licatiql23&i Health Division Date ued � ig Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address lb l OVQ S W �.Q a(ii Village 1 Owner + �GtV I ICU Address 1(sc m ) Sland eIJ0 TelephoneSO8 93 --02Y-Z Permit Request ���� ►Z �� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District &A Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size 14 rn n Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Sin Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes61y�,N® On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other �NCa Basement Finished Area (sq.ft.) -Ba$em e n. hed Area (sq.ft) Number of Baths: Full: existing new WOOF If: ®Sting new Number of Bedrooms: existing _new ST•Qe`� 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 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name br Telephone Number 01 - L4 N6 Address Z LC AL Sty License # &T-YIN LV Q.r h* ov 21 Home Improvement Contractor# GI fi�rnC�iv�wtcv�za ► rnl.Ccar� Email Worker's Compensation #DR4gZ�`7 - ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO oracle SIGNATURE U DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. -ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. rlown of Barnstable Regulatory Sakes Pdthar� `V.Scab .Dirertor . .Building DhrisxuA Tom Perry,Building L'ominissioner 200 Main Street Hyanf is,AA V-601 E mvww.town.barnstable.ma_us C} E= 508-862-4038 FM 509--790-6230 Property Owner Must Complete an Sign TI-jis Section. ff-VA Lux 1 e Owner of the stibJect P' I-op hcxchy W actbn,ni behalf, in aU maumn relates to work authorized b'y this huEdi g peimat applic ' n:for: ! CQU �. (Address of-job) i Pool,fences mdakrms are. the resporisibkycsf the applic=t:. Pools axe not:to"be-filled or ua zed before fence is gstallcd and all firms`. inspections are performed and accepted. w n:ature of er Sig ture:of pliant - S'rint Name . 'rant Nan Da Q:FORIyIS:0W'3FI,;t1?F.AISS ION POOL, The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 °¢ www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC. Address:2 LARK ST City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. New construction 1[]1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp,insurance required.] 3.M I am a homeowner doing all work myself.[No workers'comp.insurance 11 required.]t'° 9. El Demolition1 ' 4.[—] 10❑Building addition I am a homeowner and will be hiring contractors to conduct all work on my,property. I will . ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[3 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.:insurance.# 6.n We are a corporation and its officers have exercised their,right of exemption per MGL.c. 14.M Other INSULATION 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-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:STAR INSURANCE COMPANY Policy#or Self-ins.Lie.#:0849257 00 Expiration Date:02/26/2017 Job Site Address:I P/m K I rI nd &J City/State/Zip:Culra)&, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may'be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify the pain a d nal es o perjury that the information provided above is true and correct Signature: ILLVDater Phone#:508-56 2 '0 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#: ALTEWEA-01 TRAMIREZ • DATE(MM/DDIYYYY► A o� CERTIFICATE OF LIABILITY INSURANCE 31171201.E THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED. BYTKkf9LICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT.CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERM AU #iORiZfD REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the.certificate holder is an-ADDITIONAL INSURED,the Poiicy(ies)must be.endotsed. If St�BROGATiON iS-WAIVED;subject to the terms and conditions of the policy,certain policies may require an endorsement. A stabome, ton this cerdfica does not conferrights to:the csrtificaIs holder in Neu of such endorsement(s). CONTACT PRODUCER NAME: Mason&Mason Insurance Agency,Inc. PHONE,ELtIL(781)"7.5531 ire No:( 81)447•7230 458'South-Ave. ADDRESS:I aSonan0ri<1aSOninsurance.corn Whitman.MA 02382 INSURER(S)AFFORDING COVERAGE NAIC k INSURER A:Star Insurance Corrtpan 0.000E . INSURED INSURER S: INSURER c Alternative Weetherization,Inc. INSURER D: 2 Lark Street Fail River,MA.02721 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION 041111139R' THIS IS TO CERTIFY THAT THE POLICIES.OF 'INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED:NAMED ABOVE FOR.THE POLICY PERIOD INDICATED. NOFNICTHSTANDING ANY :REQUIREMENT' TERM OR CONDITION OF'ANY CONTRACT OR-OTHER DOCUMENT WITH RESPECTTO VIhiICH.THIS AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT-TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LUTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS ILTR TYPE OF:INSURANCE YJVD POLICY NUMBER COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Ea oeeurrerice $ MED.EXP{Arty One person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY JEC LOC $ OTHER: COMBINED SINGLE LIMIT S AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per-acadent) $ ALL OOWNED SCHEDULED AUT NOON-OWNED Pas $ HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR AGGREGATE S EXCESS LIAR CLAIMS-MADE DED RETENTION$ OTH WORIO RS COMPENSATION $TAME ER AND EMPLOYERS'LIABILITY YIN WC 0W257 00 021261201,6 0212612017 E.L.EACH ACCIDENT $ 500,000 A ANY PROPRIETOR/PARTNERIEXECUTIVE ❑ NIA E.L.DISEASE-EA EMPLOYE S � OFFICER/MEMSER EXCLUDED? ("dawry:In NH) E.L DISEASE-POLICY LIMIT $ If s describe Under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS.I VEHICLES(ACORD'101,Addtional Remarks Schedule,nmy be attaehed if r weaspaee is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE-DESCRIBED POUC(ES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTI-E WILL BE DELIVERED IN National Grid ACCORDANCE WRH THE POLICY PROVISIONS: 40 Washington St Westborough,MA 01681 AUTHORIZED REPRESENTATIVE + \ ©JNS-2014 ACORD CORP.ORATtON. A)I rW ts:reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 'ark Plaza -Suite 5 170 _ Boston,: Massachusetts 021.16 Home Improvement Contractor Registrafion egistration: 175683 Type.: Corporation Expiration: 5/M2017 . Tr#. 265489 ALTERNATIVE WEATHERIZATfON, 1I�C TIMOTHY CABRAL : 2 LARK ST -- — FALL RIVER, MA 02721 update Address and return'card.Mark reason for change. 1 (Address j Renewal jl Employment . Lost Card sCA• C 20-M cei+,j - Office of Consumer Affairs&.Business Regulation License or registration valid for individul use only. BOME IMPROVEMENT CONTRACTOR before the expiration date. 1f found return to:: T 'Registration: 175683 Type: Office of Consumer Affairs and Business Regulation Expiration: 5/2912017 Corporation 10 Park Plaza-Suite 5170 x Boston VIA 02116 ALTERNATI:VE.VI/EATHERiZATTON;INC.:: ' TIMOTHY CABRAL 2 LARK ST FALL RIVER,MA 02721 -.4 Undersecretary " f . o valid wit ut signatu }, Massachusetts Depattr elf of Pubic Saf�4�a ° t$aa�af Butttitrag Re�ulaatto�s and Stanrta km.a k'„ c s: r � ` �e �-L �CS..-105454' .. ... .. } �,� �� :-. °�''�'&�.µ•�aa►��:~t T rt (Sri V}„ %�.!' ,�„ ... .... ... .... .. k ' RaI[Rtv'er MAp. -0l21 � AL `l COIIIMIS' Ss 4 ... �46Y•Z.a�Y}14.�a�. .:,.�';S.m�1P+w'�k :.�Ai.4 YfA3..+�tr.rr"•at+rrdw�n�..�}hw.ik!�ia J.�. .. . DATE: Z SCANNED r- Home Improvement Contractor Signature Authorization Form 0 c We the undersigned, hereby authorize Michael D. Hebert to act on our behalf in all manners relating to the application for equipment authorization, including signing of all documents relating to these matters. Any and all acts carried out by Michael D. Hebert on our behalf shall have the same effect as acts of our own. This authorization is valid only for items pertaining to the installation and commissioning of a solar power system to be installed by Michael D. Hebert. Client Name and Address: � / 11-' �✓I y 6 co 4 Client Signature: Contact: Michael Hebert C:508-736-6633 Email Mhebert(cD-hebertsolar.com 177 Northwest Rd, Spencer MA 01562 rr 1 ' : Town of Barnstable ��c T 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-2242 Date Recieved: 7/17/201'7 Job Location: 16 COVE ISLAND ROAD,CENTERVILLE , Permit For: Building-Solar Panel-Residential Contractor's.Name: MICHAEL D HEBERT State Lic. No: CS-086870 Address: f Spencer, MA 01562 Applicant Phone: (860) 748-7633. (Home)0.46 er's Name: BEAULIEU,PETER G&DOUGH_ ERTY, Phone: (508)783-0247 r ' LISA J (Home)Owner's Address: 68 NORWOOD AVENUE, LEOMINSTER,MA 01453 Work Description: Install a roof mounted 9.9 kW solar system Iron Ridge Racking 33 Enphase Micro Inverter 33 Canadian Solar 300watt panels _n ` Total Value Of Work To Be Performed: $40,095.00 Structure Size: 0.00 0.00 0.00 t'—,, Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and,have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Michael Hebert 7/17/2017 (860)748-7633 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $40,095.00 Date Paid Amount Paid Check#or CCN Pay Type Total Permit Fee: $254.48 7/18/2017 $254.48 XXXX_XXXX-XXXX_ Credit Card 4505 1 ................................ ............:................ ...... Total Permit Fee Paid: $254.48 p,e .��o p F7w p •� � q�r, � �f F3'yFf F��, + i Y + _ 1 ° r r Y { 7. Y f v 4� ti�Dy �L p ip f_ 0?9 W o h. • 0 � o a d � N q� O qr �pQ"np�1-- _ T 9VD�C- 4 . 'vim �� A�1. •-3."'.. O C 3o •C N 5 3 C 4 r 0 TOWN OF BARNSTABLE ZONING OF �� BY-LAWS DATED JAN 23 1985 Mgsf (_Q o Q ZONE: RD-1 0 WHITING N �� � � o SETBACKS po No. 2SBr,9 0 r FRONT 30' ��.r ��CISTE��� �`t�' 'b s �� SIDE 10 REAR 10' d F PROPERTY LINES SHOWN HEREON WERE 'COMPILED FROM PLANS OF RECORD AND DO NOT REPRESENT PROJECT NO. 3-1507-01 AN ACTUAL SURVEY ON THE GROUND. THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN ON THE GROUND BY SURVEY ON JULY 11 1986 in AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE MASS . THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: 1" m AO' JULY 14 1986 SHOULD NOT BE USED FOR NY OTHER PURPOSE. n BSC / CAPE COD SURVEY CONSULTANTS -7 / 3261 MAIN STREET DATE PROFESSIONAL LAND SURVEY R BARNSTABLE VILLAGE, MA. 02630 (617) 362-8133 V Q� �h . � a /, ,/� Q 1�. ' 0 e tv � N ti g it LAB O C �' peew61 0 N 5 3 .�• 0 o ` �° , TOWN OF BARNSTABLE ZONING OF MqS �� Q a� BY—LAWS DATED JAN 23 1985 s C. ZONE: RD-1 25 w�ia hG In SETBACKS No. 2086 FRONT 30' SIDE 10' \3 REAR 10, q PROPERTY LINES SHOWN HEREON WERE 'COMPILED FROM PLANS OF RECORD AND DO NOT REPRESENT PROJECT NO. 3-1507-01 AN ACTUAL SURVEY ON THE GROUND. THE STRUCTURE DEPICTED ON THIS PLAN WAS LOCATED PLOT PLAN ON THE GROUND BY SURVEY ON JULY 11 1986 in AND EXISTS AS SHOWN AS OF THE DATE OF LOCATION. BARNSTABLE MASS . THIS PLAN IS FOR PLOT PLAN PURPOSES ONLY AND SCALE: i" = 40' JULY 14 1986 SHOULD NOT BE USED FOR NY OTHER PURPOSE. � BSC / CAPE COD S; ,---- URVEY CONSULTANTS 3261 MAIN STREET DATE PROFESSIONAL LAND SURVEYOR BARNSTABLE VILLAGE, MA. 02630 (617) 362-8133 43 SMOKE DETECTORS REVIEWS oz? r: (,$fWT8II BUILDING DEPT. DATE I FIRE DEPARTMENT DATE ' I i BOTH SIGNATURES ARE REQUIRED FOR PERMlTTIN \ / REMOVE 1 REWORK PORTION i I OF EXISTING DECK,RAIL 1 I 5TAIR TO GRADE TO ALLOW I I—— FOR NEW ADDITION I I �T T I I I DECK I J 'I T � I11 �Qosn NOOK DOTTED LINES! DESIGNATE IT' OR SYSTEM(S) TO BE Ill REMOVED TO ALLOW FOR NEW R WORK,TYP. r KITCEHN LAUND. : dog doom MUD ROOM (2)CAR GARAGE a �t�L� 5 iZri PR I O T' cFREE)AIR�. tc Q o� Q. A R«. No.4621 . HAVERHILL. 4:2 EXISTING FIRST FLOOR PLAN �o MASS' y�EQ�IHOFfApSS PROPOSED ADDITION E ALTERATIONS to BEAULIEU RESIDENCE I COVE ISLAND ROAD, CENTERVILLE.MA EXISTING-FIRST FLOOR PLAN ev ronald henrl albert, aia architect 69 island road, lunenburg, ma 01462 978-828-5411 dw RELOCATED STEPS FROM EXISTING DECK TO GRADE, TYP. A DECK — © O FILL-IN DOOR OPENING NEW 5'-0' WITH NEW WALL FRAMING. (2)2' X 4'TO PER CODE,TYP. SLID SUPPORT LVL, TYP. Q NOOK NEW FLOOR LEVEL TO MATCH EXISTING O O — — A ICEILI X 1 I/4'LVL'S KITCHEN,TYP. AT CEILING,TYP. 1 G EXISTING PROPOSED J ADDITION (2)2'X4' TO KITCHEN SUPPORT LVL, i TYP: —� FILL-IN DOOR OPENING WITH NEW WALL FRAMING. PER CODE.TYP. d= dan MUD ROOM (2)CAR GARAGE ——— ——— ——, — ——— — ——— , r- r- I I I I I �4;i41. • S I ZI✓ �R l��T I I I I C Do N o-r 5,C .LE> r - 19- 1--0- 1519•�R..clog � � PROPOSEO FIRST FLOOR PLAN 1/4' = I'-0' FEBEAULIEU SED ADDITION E ALTERATIONS to RESIDENCE LAND ROAD. CENTERVILLE,MA Orwing SED FIRST FLOOR PLAN m rona Id henri a Ibert, a is architect' s b. 69 Wand rood, Iunenburg, ma 01462 978-828-5411 I PROVIDE NEW COUNTER-FLASHING \ . 1 REWORK SIDING AT EX.GABLE-END NEW COUNTER- OF MAIN HOUSE FLASHING,TYP. MATCH EX• ARAGE ROOF NEW TRIM,RAKE,FASCIA 1 SOFFIT TO MATCH EX., Cd�1lIRACTOR'S OPTION: O !� TYP. LEAVE EX.RAKE BOARD TRIM IN PLACE.PROVIDE I NEW FLASHING.AS REO'D OR REMOVE ASSEMBLT 1 +/=4/12 BLEND-IN NEW SIDING TO EXISTING MATCH EXISTING = EXISTING ENO-WALL REWORK EX.DECK, OF GARAGE STEPS 1 RAIL TO © O © MATCH EXISTING, IN KIND. BLEND NEW SITE GRADES INTO i EX.CONTOURS,TYP. PROPOSED RIGHT SIDE ELEVATION EX.GARAGE ELEV.---r—NEW ADDITION PROPOSED REAR 0 OSED EA ELEVATION NEW ADDITION EX. HOUSE i i I Do No'T Scf41E) I E . 1/�aa 4:. r-o. Irr—w s ^ jll--rr °oti 09-70-I5 � C= Rw. I drR� 94 m II DOTTED LINE(S)DESIGNATE ____________ ___ r==, 111 ITEMISI OR SYSTEMIS)TO BE __ l - I II 11 la III �I I 1 REMOVED TO ALLOW FOR NEW 1 II' �I � h II! 94 I I WORK TYP I DOTTED LINE(S)DESIGNATE I I III I I ITEMIS)OR SYSTEMIS) TO BE II II Iq hll hpA I I _ REMOVED TO ALLOW FOR NEW 1 I _ II II II �I %���,' fv"?- L _I a�+`�$ 1 r 11 I1 -= -- WORK.TYP. ml �� "'-' C�`' I I -� 1 11 i IIII I I � IProod -"'��---'� E-°�—c -- `""""-"""' '-""J,Iji ,% PROPOSED ADDITION t ALTERATIONS to "HI -- "I�',t- BEAULIEU RESIDENCE u II EXISTING RIGHT SIDE ELEVATION EXISTING REAR ELEVATION G COVE ISLAND ROAD. CENTERVILLE.MA a 1/4' = I'-0' I/4' = P-0' EXISTING t PROPOSED EXTERIOR ELEVATIONS m rona Id hand a Ibert, a is a rchitect 1 L_ 69 island rood, Iunenburg, ma 01462 978-828-5411 t i I 12)I-3/4'X If LVVS PROVIDE CONT.RIDGE VENT AT RIDGE OF NEW OR GABLE END LOUVER(S). ROOF W/2'X[' TO MEET CODE TIE NEW ROOF TO EX. COLLAR TIES 0 I[' MATCH EX.• I RESHINGLE ENTIRE O.C..TYP. REAR OF GAR. DOABLE 2'X IV ROOF RAFTER SLOPE.TYP. a 6'O.C.FOR NEW ROOF AT REAR OF ADDITION M/5/8' ROOF SHEATHING,TYr. ENTIRE LENGTH OF NEW Y X r ROOF EXISTING RIDGE W/ RAFTERS a I['O.C. Y X 4' I['O.C.. Y X['COLLAR TIE W/5/8' THICK ROOF e IL'O.C..TYP. SHEATHING,TYP TYP. INSULATION PACKAGE FOR EXTERIOR ENVELOPE.BY EX. RAFTERS 2' jo.SQUASH OTHERS,TO MEET LATEST 2'X8' ri IL" O.C. BLoS.TYP. ENERGY CODE,TYP. EXTEND WALL, AS REO'D Y X 10'JOISTS a IV O.C..TYP. TIE JOIST-END FASCIA I SOOFIT TO EX.ROOF RAFTER,TYP. DETAILS TO MATCH EXISTING REAR EX„TTP. WALL OF GAR. NEW 2'X['EXTRIOR STUD WALL a I['O.C.W/VY NAIL-OFF ALL EXT. SHEATHING SHEATHING PER NEW 1-1/2'LVL LEDGER MATCH EX.FIRST FLOOR. CODE.TYP. ATTACHED TO EXISTING TYP. STUDS W/(3)4'LONG 'TIMBERLOCK SCREWS PER STUD.TYP. JOIST 9 1/2'TJ 230 SERIES HANGER. I['O.C.W/3/4' THICK TYP. ADVANTECH SUB-FLOOR APPROX.FINISH 2' THICK CONC.MUD SLAB GRADE.(V1.F.) W/VAPOR BARRIER PROPOSED BUILDING SECTION 'A-A' 24'-1 1/2' PLACE BOTTOM OF NEW CONC (N-) FOOTING TO PROVIDE FROST PLACE TOP OF NEW CONC COVERAGE.PER CODE FOUND WALL TO ALIGN NEW FIRST FLOOR W/EX FLOOR, TYP. CRAWL SPACE I I I I \ NEC ADDITION 2-THICK(ROUGH) 1 I Q CONCRETE GRADE / SLAB,TYP. .r_—SAW-GUT EX.CONCRETE \ I I I I FOUND.WALL TO ALLOW I 1 ACCESS TO CRAWL SPACE I I PROVIDE NSULATrON�ACCESS PANEL ZO ''ROT �l LTr, 1 PIN NEW CONCRETE FOUND. TO EXISTING FOUND,PER INDUSTRY STANDARDS.ALSO SE PROVIDE EPDXY TO AL D ° JOINT BETWEEN WALLS.TYP. p D EXISTING LOWER LEVEL Ax,Ale EXISTING GARAGE QNDM 5CHEDUE PROPOSED ADDITION t ALTERATIONS to ma 0=1 am mm OP�G C w TTPB 11A wjt= If�IArbCt3 BEAULIEU RESIDENCE A I 3541-2 35-3/4' X 41-3/4' CASEMENT PELLA Mid Mnt Cos"Dmp I'm re Rega B I 3259-3 9[ 3/4' X 59-3/4' L[COVE ISLAND ROAD. CENTERVILLE•MA C 5 2959 29-3/4'X 59-3/4' 0 1 2959-2 5e 3/4 x 51-3/4 ARCHITECTURAL COMPOSITE PLAN E I 29S3 29-3/4'X 53-3/4'c PROPOSED FOUNDATION PLAN cc rona Id henri a Ibert, a is architect 89 island rood, funenburg• mo 01462 978-828-5411