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0207 HORSESHOE LANE
- _ _ - - - � �' � i Town of Barnstable Building a r ve ra Post'This Gard So That it is Visible From the Street-Approved Plans Must be Retained on lob and this Card Must be Kept Posted Until Final inspection Has Been Made. �rn11� llj • Where a Certificate of Occupancy is Required,such Building shall Not be Occupied,,until a Final Inspection has been made. Permit No. B-19-2653 Applicant Name: GOMBAR,JOHN D&BARBARA A TRS Approvals Date Issued: 09/04/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 03/04/2020 Foundation: Residential Map/Lot207-119 Zoning District: RC Sheathing: Location: 207 HORSESHOE LANE,CENTERVILLE -. .. Contractor Name': Framing'. 1 D Owner on Record: GOMBAR,JOHN D&BARBARA'ATRS Contractor License: 2 0 Io�Jd'�14 Address: PO BOX 461 - ---.- Est Project Cost: $ 15,000.00 SAN LUIS REY,.CA 92068 `t Permit Fee: $ 126.50 Chimney: ') Insulation: Description: REMOVE WALL BETWEEN KITCHEN AND LIVING ROOM ON;FIRST Fee Paid.1 $ 126.50 FLOOR. RAISE CEILING IN LIVING ROOM TO CREATE PEAKED FALSE Date: ' 9/4/2019 Final: d30"I' Jq CEILING. NO CHANGE:TO EXTERIOR OF THE PROPERTYANd .- •-': Project Review Req: � Plumbing/Gas Rough Plumbing: ,. Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless.the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and-the°approved construction documents for which this permit has been granted: Rough Gas: All construction,alterations and changes of use of any building and structures.shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street.or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. }, Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Buildingand Fire officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must fl lirnn is instal ed'"" a-. p be inspected at the throat level before firest ue g 4.Wiring&Plumbing Inspections to be completed prior Frame Inspection Final: g p P P P Ilr „ 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department ' All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: dF� \ J Application Nimmber... ................... s �. t MABELPemzitFee.....:.................................01ber Fee........................ TotalFee Paid.............. ........................................... TOWN OF BARNSTABLE ��• • / Permit ........................on. !.y.�c�............. BUILDING PERMIT : �4 MaP.......... .............. ......... cel-..Par .. ... ........................ APPLICATION r5i n mx�f— S Section I — Owner's Information and Project Location Project Address a2 01? A16 jzS5l-fDg- L!� �lageTg2U/Ll.�• Owners Name r3AT� f Owners Legal Address City /'Y� ����' State �� P '�' v Owners CeHL# - SSg= E-mail 4! 'IAL-:5,4 P—t / Cag-LL®Ax-T Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,IIg cubic tt o ❑ Commercial Structure under 3 0 cubicaet Single/Two Family Dwelling _ 4 Section 3—Type of Permit w ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other.—Specify. Section 4-Work Description a Tb 3MEA,7 l�lT4 E A, �.! lZl AJ� otil T Apt TTTTrj.'Iu�d--2A/2019 Application Number.................................................... Section 5—Detail Cost of Proposed Construction��$� _ Square Footage of Project O�X� Age of Structure t Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method +❑ MA Checklist ❑ WFCM Checklist ❑ Design' t Section 6—Project Specifics K%ing ❑ Oil Tank Storage ❑ Smoke Detectors -4 ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal ® On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No t Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed , Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last=dated M201 9 i a e4z( v-,"9 r: F I JOB TAYLOR DESIGN ASSOC., INC. SHEET NO. ` OF vo P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY C'I r - DATE 9- Tel./Fax: (508) 790-4686 CHECKED BY _ SCALE D C +v Tcxt ✓i w i J"C R-• AYLOd ........... ..... .... ....:.... , o . 77 .... l�..... . _. .......... _. 4.0.oQ. s �e•r�3 P Scw_r�•�.-. eeN�aE ... . - 3�►0 ,�9 G _za n�. rs . lip VIL, ct f0 5 o 3?4 ..o two Q YOLL ....... ............ . CP .. 00.... Y / r ........ r QQ n ; !Z�• ..... . /Z;.. ..... IWO q o0 _ L� t_ An 4- ,s jFr .... . .. .... Z`i, ... . al- Z- ZZ LAP g._ - Z�t," = S � lam• Zid ffr JOB XQ TAYLOR DESIGN ASSOC., INC. SHEET NO. OF P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY�Q `r DATE 9.. � •`IZ Tel./Fax: (508) 790-4686 7� @@ CHECKED BY DATE Grp O J O e LA. i SCALE ets1-�R.✓ - Kill}-,ti coo. �-1A•he,!.... 't.....t7 _-_. m 1 R. r1 r1.r 1 -S O C- GPa�a 4 t0�► cJ= �., (30 .4- tZ ,17 �tF �4wv 3- Zk S ...5 iZ . . . Q LVL Am. t z sZ 4. 0 �-f ........ Pc�_ ta:A _. _. i ............... �tdN.�l . Z � s �PLIz' ,. .......... .. t orq.4.. ................ ...... _... ..... n .>�.Y_. Z - _;l k t `_ �.,,,✓c.. d`?���.o cam'- �Z..— F> . t4 2 .. J 3�.c 754 ` ___. o cam.. . JOB d � �to TAYLOR DESIGN ASSOC., INC. SHEET NO. OF P.O. Box 1313 i k Forestdale, MA 02644 CALCULATED BY (31 T DATE 17 � -f L,`_ Tel./Fax: (508) 790-4686 CHECKED BY DATE 20? md s cz up SCALE . ...... . 4. S`Z _ The Commonwealth of Massachusetts Department of Indushial Accidents -_ Office of Investigations 600 Washington Street ' Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: o o Sa,— a G� City/State/Zip: ^T -1 [.� Phone#: . 7� Are you an employer?Check the appropriate box Type of project(required): 1.❑ I am a er with-' 4. 1 am a general contractor and I employer p y * �have hired the sub-contractors 6. 0 New construction employees(full and/or part-time). 2.'❑ I am a sole proprietor or partner, listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g•• ❑Demolition working forme in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance _ comp.insurance.1 j required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work t officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I 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: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of 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 under the pains and penalties ofperjury that the information provided above is true and correct Signature: Date: - Phone# Offccial 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): !`4s 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 ` 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." L 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 permit to operate a business or to construct buildings in the*commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public-work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877 MMSAFE Revised 4-24-07 Fax#617-n7-7749 www.mass.gov/dia -11" -T8-1c�-265"3 ao� 440 zs S sPa'E o'3, ACC>R" CERTIFICATE OF LIABILITY INSURANCE °ATE("°"'°°"n`Y' 0 811 6/2 01 9 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Deborah Kelly - Leonard Insurance Agency,Inc PXONnE o. (508}428 6921 (508)420 5406 683 Main Street A-FRAIL : deborahk@leonarrlagencycom Suite B INSURER(S)AFFORDING COVERAGE NAIC 0 Osterville MA 02655 INSURER A: Main Street America Ins.Co. 29939 INSURED INSURER a: NGM Insurance Company 14788 Michael J Dangelo Building&Remodeling,Inc. INSURER C: Associated Employers insurance FAIRAE PO BOX 144 INSURER D: INSURER E: WEST HYANNISPORT MA 02672-0144 INSURER F: COVERAGES CERTIFICATE NUMBER: Master 2019-2020 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPEOFINSURANCE INSO INVD POLICY NUMBER MIDD D POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIASHM EACHOCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR - PREMISES Ea ouyrre oa $ 500,000 MED EXP(Any are parson) $ 10,000 A MPB12958 05/28/2019 05/28/2020 PERSONAL&AOV INJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY EEC LOC PRODUCTS-OOMPrDPAGG $ 2,000,000 OTHER: Identity Recovery $ 25,000 AUTOMOBILE LIABILRY COMBINED SINGLE LI IT $ (EidanANY AUTO BODILY INJURY(Per person) $ 250,000 B OWNED SCHEDULED A M1P8382V 06/21/2019 06/21/2020 BODILY INJURY(Per accident) $ 500,000 UTOS ONLY AUTOS HIRED NON-OWNED OPERTY DAMAGE Ix AUTOS ONLY AUTOS ONLY Per $ Uninsured motorist BI $ 100,000 UMBRELLA LUUi OCCUR EACHOCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION - - PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNER(EXECUTIVE E.L.EACH ACCIDENT $ 100,000 C OFFICERIMEMBER EXCLUDED? NIA WCC 500-5006738-2078A •12/19/2018 12/19/2019 (Mandatory In NM E.L.DISEASE-EA EMPLOYEE. $ 100,000 - If yes,desarbe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES(ACORO 101,Addhimal Remarks Schedule,maybe attached It orespacelsrequhed) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN John Gombar ACCORDANCE WITH THE POLICY PROVISIONS. 207 Horseshoe Lane AUTHORIZED REPRESENTATIVE Centerville MA 02632 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered maNcs of ACORD 207 Horseshoe Lane Centerville, MA 02632 Revision to Building Plans and Permit Application Note: All construction to basement has been completed, inspected, and p p signed off on final permit dated September 20, 2013. Second phase of construction to first floor is being scheduled once amended plans are approved, and permit issued. Revisions to Existing Plans 1. No modification will be made to the exterior roof, or any other exterior area. 2. Remove existing ceiling in living room. 3. Install 2"x 8" rafters 16" on center to create a peaked false ceiling. 4. Install 2"x 10" ridge. 5. Finish ceiling with shiplap. 6. Install 15amp circuit from existing outlet for ceiling lamp. 7. Insulate attic area above false ceiling per MassSave recommendations. 8. All other modifications to ceiling, beam, posts to be done per existing approved plans. r Application Number............................................ Section 9-.Construction Supervisor Name Telephone Number Address City State Zip t t License Number License Type Expiration Date Contractors Email Cell# r I�derstand my responsi'b�i ie' under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the contraction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable:Attach a'copy of your license. Signature k Date Section-10—Home Improvement Contractor Name Telephone Number Address City State Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand tale construction inspection procedures,specific inspections and docinnentdon required by 780 CMR and the Town of Barnstable.Attach a copy of your HZ C... Signature Date S ction.11,7.Home.Owners-License Exemption- Home,Owners Name: It Telephone Number0-�5�- q Cell or Work Number I understand my responsibilities under the rules and regulation for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts S uilding Code.:I understand the construction inspection procedures,specific inspections and documentation regained by and To of Barnstable. Signature ( Date 5 ICANT-SIGNATURE - C:Signature c1 c — - Date 1 Print Name, 1J p f3 TeT hone Number, , ,E-mar permit to: 91--(A L - 1 - F_j Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required ❑ Fire Department ❑ Conservation ❑ For commercid work,please take your plans directly to the fire department for approval Section 13—Owner's.Authorization 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) ' Signature of Owner date Print Name 4 Lest wdeted:2J92018 Town of Barnstable _.�. uilding SAMSTA�'i.�. Post This Card So That it is Visible From the Street_-Approved Plans Must be Retained on Job and this Card Must be Kept - 1 ' Posted Untii Final Inspection Has Been Made. ��n1i� >aa�a 659. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-19-1303 Applicant Name: William McCluskey Approvals Date Issued: 05/28/2019 Current Use: Structure Permit Type: Building Insulation-Residential Expiration Date: 11/28/2019 Foundation: Location: 207 HORSESHOE LANE,CENTERVILLE Map/Lot ,207-119 -M Zoning District: . RC Sheathing: Owner on Record: GOMBAR,JOHN D& BARBARA A TRS w Contractor Name:`,WILLIAM J MCCLUSKEY Framing: 1 Address: PO BOX 461 i Contractor License: CSSL-102776 2 SAN LUIS REY,CA 92068 _. �` Est..Project Cost: $4,400.00 Chimney: Description: Add R-38 fiberglass,and R-37 cellulose to the attic.Air.sea[the attic Permit Fee: $85.00 lane with ex andin foam. General weatherization Insulation: p P . g i Fee Paid:.' $85.00 Project Review Req: i Date: f 5/28/2019 Final: JG t �y Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authoraed by this permit is commenced withinsixm. onths after ssuan&. icia Final Plumbing: All work authorized by this permit shall conform to the approved applicatiorrand the approved construction documents'for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the [ - Final Gas: work until the completion of the same. i The Certificate of Occupancy will not be issued until all applicable signatures by the Building-and-Fire.-Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: ' 1.Foundation or Footing Service: 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue Iining_is;installed g 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final:Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do'not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: d E7r11AkX:- s Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/12/19 o Brian Florence CBO Town of Barnstable 0 ze Building Division N. 200 Main St. XV Hyannis, MA 02601 ' RE: InsulationTermit 19-1303 Dear Mr. Florence: ' i • This affidavit is to certify that all work completed-for 207_Horseshoe Lane, Centerville has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. r All work performed meets or exceeds Federal-and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE U i I d i nt� g 201301199 * sARNff"LE, Issue Date: 03/29/13 Permit 9 MASS. 039• Applicant: MICHAEL J.DANGELO BLDG&REMO SEC�.l s Permit Number: B 20130659 Proposed Use: SINGLE FAMILY HOME Expiration Date: 09/26/13 [Location 207 HORSESHOE LANE Zoning District RC Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 207119 Permit Fee$ 35.00 Contractor MICHAEL J.DANGELO BLDG&REMO Village CENTERVILLE App Fee$ 50.00 License Num 048338 Est Construction Cost$ 5,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND BASEMENT REMODEL-INSTALL 1 WINDOW THIS CARD MUST BE KEPT POSTED UNTIL FINAL FAMILY ROOM,EXERCISE ROOM,TV ROOM LAUNDRY ROOM INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: GOMBAR,JOHN D&BARBARA A,TRS BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 775 MARSOPA DR INSPECTION HAS BEEN MADE. VISTA,CA 92083 Application Entered by: JL Building Permit Issued By: f V- THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEWIFORARILY NBNTLY. ENCROACHMENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE -OBTAINED FROM,THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS .• ._ . MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. . 7.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS c9 4. e 7 f 115 6FP.r- 7 f43 3 U 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # C)6 Is C� 1 Health Division Date Issued �- Conservation Division Application Fee Planning Dept. Permit Fee d� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Q 4 t Village ��1A , Owner �l�hn �'0�i.bGU1� Address 77 /Vc�S��bG� i_ Telephone (/W �f�� ' ��� yob DF/ Permit Request 's Square feet: 1st floor: existing proposed 2nd floor: existing—proposed Total new - Zoning District _ Flood Plain Groundwater Overlay Project Valuation Construction Type C) Lot Size — Grandfathered: ❑Yes ❑ No If yes, attach supporting d(gumeyation. Dwelling Type: Single Family E Two Family ❑ Multi-Family (# units) ` Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's u4�hway: O'Yes i%7 No Basement Type: Full ❑ Crawl 0 Walkout ❑ Other i� Basement Finished Area (sq.ft.) S(a Basement Unfinished Area (sq.ft) lko r` Number of Baths: Full: existing new - Half: existing — new Number of Bedrooms: existing -new Total Room Count (not including baths): existing `i new First Floor Room Count Heat Type and Fuel: 4"Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes QrNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes @'No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:,W existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes UN/ If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �e�A-e/ J DA_o Atlo &a y-✓a lephone Numberi(Q2K M - 3,9D F- Address l U S` dYS2Sld�e License # 1) 3 cl -C e)'vr��� MA, IJ d l 3.1 Home Improvement Contractor# Worker's Compensation # 5-ooi�7'i 3 o/a o/g ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE .k F '3 S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 1 MAP/PARCEL NO. ADDRESS `. VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME ?hLli3 Aft INSULATION FIREPLACE Y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Qo)�I► DATE CLOSED OUT ' ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ' Boston, MA 02111 - www.mass.govidia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): lNt�7 e�t7 Address: . /p S city/state/zip: 0 levy IUQ. 0) tea?) 77S AJS Are you an employer?.Check the appropriate box: . Type of project(required); 1,0i am a employer with f A. ❑ I am a general contractor and I employees(full and/or part-time),* have hired the sub-contractors 6• ❑New construction, 2 ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. _['Remodeling shipand have no employees These sub-contractors have 8, ❑Demolition working for me in any capacity, employees and have workers' coin insurance. 9. ❑Building addition [No workers'comp.insurance p• - mquired.] 5. ❑ We are a corporation and its 10.0 Electrical repairs,or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers'. 13.0 Other comp.insurance required] *Any applicant that checks box#1 must also fill out the section below'showing their,workers'compensation policy information t Homeowners who submit this affidavit indicating they ate doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that cbeck this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employers. 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 tiny employees,• Below is the policy and job site ` information Insurance Company Name: ei Policy#or Self-ins. Lie:#. k/aC 5-jIZ?v7p3 3P t St-01� Expiration Date: Job Site Address:_aO 7. `l�tsgsko-P °�2 City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00-and/or-one-year imprisonment,as well as civil penalties in'the form of a STOP WORK ORDER and a fine of up.to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains andpenaltiespofperjury that the information provided above is true and correct- Sim ature .f.>`J �sPp Gw/JG1fio.L Date Phone#: 77 `�/j Official use only. Do not Write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Aufhority:(circle one): 1.Eoard of.Health 2.Brulding Department.3. City/Town Clerk 4.Electrical Inspector 5'Plumbing Inspector 6.Other Contact Person: Phone .. Vo I . .. 2DANGELOMI Client#: 3860 7RH YY) ACORD',- CERTIFICATE OF LIABILITY INSURANCE 2 THIS CERTIFICATE IS ISSUED AS A MAT-TER LYOR NEGATOF RVELY AMEND, OR ALTER THE COVERAGE AFFORDED BY TCERTIFICATE DOES NOT AFFIRMATIVect BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), — REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. be endorsed.IMPORTANT:If the certificate holder is CefgDDlTIONLrcNYUe4 Dre an entile Pldorsement A statemet on ItSs BertOif cafe does oA the the terms and conditions of the policy, policies certificate holder in lieu of such endorsement(s). CONTACT NAME: FAX 5087781218 PRODUCER PHONE 508 775-1620 A/C,No), AICDowling &O'Neil -M IL Ex`: - E-MAIL Insurance Agency ADDRESS: IC# INSURER(S)AFFORDING COVERAGE 973 lyannough Rd., PO Box 1990 Associated Employers Insurance— - Hyannis, MA 02601 INSURER A, -- INSURER B: —'�—�— INSURED _-- Michael J. Dangelo Building INSURER C &Remodeling, Inc. INSURER D: 105 Horseshoe Lane INSURER E i Centerville, MA 02632 INSURER F: REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: THIS THIS IS 1"0 CERTIFY THAT THE I: ICIREEOOIREMENT TERM OR LISTED CONDITION OFEANY CONTRACT ORRT fIISSUEED I' HOTHER DOCUMENTD WITO BE- H RESOPECT TO WHICH HE POLICY PERIOD S. INDICATED NOTWITHSTANDING ANY ED CERTIFICATE MAY BE ISSUED OR MAY PERTA POLICIES.HLIMITS SSHOWNAMAY RHAVE BBEEN EREDUCED SBY PAID CLAIMS.HER IS SUBJECT TO ALL THE TERM EXCLUSIONS AND CONDITIONS OF S POLICY EFF POLICY EXP LIMITS .— _�.— ADDLSUB POLICY NUMBER MMIDDIYYYY MMIDD/YYYY IN SR — TYPE OF INSURANCE INSR WVD EACH OCCURRENCE _ $ LTR_ GENERAL LIABILITY DAMAGE TO RENTED $ ` PREMISES Ea occurrence ,;O,MMERCIAL GENERAL LIABILITY - MED EXP(Any one person) $ -- •� J CLAIMS-MADE E OCCUR PERSONAL&ADV INJURY $ _ GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG I$ GEN't-AGGREGATE LIMIT APPLIES PER: -� PRO- COMBINED SINGLE LIMIT LOC $ —— (POLICY JECT Ea accident AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ BODILY INJURY(Per accident) ANY AUTO f ALL OWNED SCHEDULED PROPERTY DAMAGE g f AUTOS AUTOS Per accident —� NON-OWNED $ 1 I HIRED AUTOS AUTOS iEACH OCCURRENCE $ — L UMBRELLA LIAB OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE $ -- - - I _ WC STATU- OTH- _�DED RETENTION$ 12�19�2012 12/191201 X A —RKERSCOMPENSAT16N WCCSOO6733012012 E.L.EACH ACCIDENT $100,000 — wo I AND EMPLOYERS'LIABILITY Y/N I I ANY PROPRIETOR/PARTNER/EXECUTIVE1 N/A E.L.DISEASE-FA EMPLOYEE $1 00000 , •OFFICERIME.MBER EXCLUDED? (Mandatory In NH) E.L.DISI EASE�O`ICY LIMIT ,$SOO+Oo—_�____.._._-- If yes,describe under jI—� DESCRIPTION OF OPERATIONS below ace Is required) RATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more sp DESCRIPTION OF OPE Michael Dangelo is excluded from the workers compensation policy. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE LCTHEREOF, P PROVISIONS. WILLBE DELIVERED IN ACCORDANCE AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD LS1 ) #S104759/M104758 r e,�ro rUc'j�.`�a` � L eparrm Standards is - R gulations and n; a sa e - Board of Building Famih µ a i`tc.�dia8 wr souti s�cnntn.e rg isorSu e Cunstructo❑ 1 B338CSFA-� License: cis -=— CAAEI'J GE �. � DA ES1�OE� ORS E.. CEN ER�1LE�'a 2632 ].anA' J. Expiration 0112y2014 rya �gj ` Commissioner v .+o h:� L DANGEt t - V'H EL DANG rp i'rrtSEmS,HQ�L -- 4�w ���� iJn&r ecretu y 4 k �VE T Town of Barnstable Regulatory Services •,k B, s ; g; Thomas F.Geiler,Director i639� ♦� • '�En w►►�" 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 O f-'l'k as Owner of the subject property hereby,authorize < ` • � -: to act on my behalf, . in all.matters relative to work authorized by this building permit (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. Signatute of Own Signature of plicant Print Name' Print Name Date - QYORMS:OWNERPERNOSIONPOOLS 6/2012 . L Town of Barnstable Regulatory Services i jAgpSTART.F., « Thomas F.Geiler,Director 059. a,�� )Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 62601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six,units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.L 1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official y 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: "Amy homeowner perforrning work for which a building permit is required shall be exempt from the provisions' of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by\ several towns..You may care t amend and adopt such a form/certification.for use in your community. Q:forms:homeexempt i JOB O 4 d) TAYLOR DESIGN ASSOC., INC. SHEET NO. OF ..:y P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY Or r DATE 9 Tel./Fax: (508) 790.4686 CHECKED BY O �� !I©� C.�►•,�V SCALE TA o ......... .. ....... ........._ ?� . ... . _ _ . _... _ ......1 4 0.4.) c� e o.._... .. _ ........... ``0 ........ 177 _._ .. M S c9 ®o. Z.�.... ..r je ttryry .�r _.. ..... ._ .......... .. ..... ... ........_._ l.f/ ^..»_ o.. .......... _ �15 _ ......... .._.... . ..- S.ow�-,,,� ..... 105 Fr Pr Y �8 TAYLOR DESIGN ASSOC., INC. SHEET NO. OF P.O. Box 1313 _(�' T DATE Forestdale, MA 02644 CALCULATED BY Tel./Fax: (508) 790.4686 CHECKED BY DATE 2. 0 C C- .. SCALE Ma 04. . . . .04.> L... . .�3d # tZ 217 Rr-F M ... . 2,15 17 IP . z 4Z.o... Pc-F ..... ...... ... 'i1R,Y. . � 2-- 1.l�k,�4� . 1...✓�-. .dy3Go. _4=:.,Z . 3gZ-"_._ -' 7F'4 '�7 F�s .tJ.= 3c o .. 7 84 •2R o... . . . _. I ' � JOB /46*."tL4 S TAYLOR DESIGN ASSOC., INC. SHEET NO. � OF P.O. Box 1313Ay Forestdale, MA 02644 CALCULATED BY�'? � DATE `�' Tel./Fax: (508) 790.4686 �J CHECKED BY DATE �® K SCALE 5'r'EGc._ t'.�.C- - -t. i'c. - Q e �.,....._� Atscl Cis _ ... ........_.... . . ..... _. _ '�•.1S. c Z .... _. . :...... ........ .... - - ...... ..... .. . .... _.. .. _ ....... _. .. .. a _....._ . .. ...... . .. 4 P. 1 Communication Result Report ( Mar. 14. 2011 4: 084 Date/Time : Mar. 14, 2011 4: 07PM File Page No. Mode Destination Pg (s) . Result Not Sent ---------------------------------------------------------------------------------------------------- 4874 Memory TX 915087881813 P. 5 OK a- Reason for error E. 1) Hang up o r 1 i ne fa i l E. 2) Busy E. 3) No answer E. 4) .No facsimile connection E. 5) Exceeded max. E—mail size t j� 4'3'Rai! 4" 4" 27-9"Rao 4" TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 Map Parcel ' 9 m n ` 'i `� , Application 1 Z Health Division Date Issued S e) Conservation Division `.,Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic = OKH Preservation/Hyannis Project Street Address �ZO -140 fZ54F S40Z LA_Q1_0 Villagei C L Owner Wf Address 20`� �/-f'Gr -y( Telephone Permit Request �-C i! iT¢ l •�, �1 lit V J 'MGt j Square feet: 1 st floor: existing {�proposed 2nd floor: existing proposed Total new t Zoning District Flood Plain Groundwater Overlay a� Project Valuation a `� Construction Type Lot Size Grandfathered: 0 Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: XFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing__ new ram' ( Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing 6 new First Floor Room Count Heat Type and Fuel: ;Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes XNo 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 # ZZ -i = CD Current Use Proposed Use M 3 k -- - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 4 Telephone Number Z/a l>lci Address ,�2 yQg��� Z-4) License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 15'3110 ti FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 6� 1136)10V41a o INSULATION C G—ht .whu. 911 2/1 u Alm- N FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 101q o DATE CLOSED OUT ASSOCIATION PLAN NO. - v tom. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Y 600 Washington Street Boston,MA 02111 ;y www.mass.gov/dia - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leprihlv_ Name (Business/Organization/Individual):. Address: R-5' L-1y alb Li "� City/State/Zip: f ����� Phone #: Walt Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction have hired the sub-contractors .. employees (full and/or part-time).* . .. _. _ listed on the attached sheet. 7. ❑ Remodeling 2-❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, _❑ Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition No workers' comp. insurance comp, insurance.$ i ed.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.�requr I am a homeowner doing all work officers have exercised their. I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. I52, §1(4),and we have no � �� �_ employees. [No workers' 13. Other comp.insurance required,] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating tbey'are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have . employees. If the sub-contractors have.employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation:insurance for my employees. Below is the policy and job site information - Insurance Company Name: Policy#or Self-ins, Lic.#: Expiration Date: Job Site Address: City/State/Gip: 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 D for insurance coverage verification. I do hereby certify ind i e pain a penalties of perjury that the information provided above is trice and correct. Si nature: �'�- Date: Phone#: _ Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2. Building Department 3: City/Town Clerk 4.Electrical Inspector 5.Plumbing^Ins pector 6. Other. Contact Person: Phone#: r^� Town of Barnstable Regulatory Services anxtvsrna Thomas F.Geiler,Director t p,� Building Division TFO MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: d')-k() JOB LOCATION: /"o number e , street �a Z� �ryl� village �^ [j „HOMEOWNER": �I N C_ZZnNA�/d2> �[��t�/®d�`1l/ �6®,qJ &: name home phone# work phone# CURRENT MAILING ADDRESS: 0 g® }C Gar HLeAwQcity/tow 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 undersi d"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum ' sp cti ro dures and requirements and that he/she will comply with said procedures and requirem 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 helshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC Town of Barnstable Regulatory Services 11MMi sARM Thomas F.Geiler,Director ''�Eo;pr►� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMIS S ION 108 211 fu 91111 1 2 N ' Cfl COJ O O r 1 C)1 N � CO � t W fl o ' 4Nsix� t AV- CN 33 711 16 711 11 e w Lc M °D1 v 20111 873n - . 4 11 9 11 96 711 166 8 11 4 108211 All dimensions size designations This is an original design and must Designed:4/30/2010 given are subject to verification on not be released or copied unless Printed:4/30/2010 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. rA Y Designl All Drawing#: 1 ■ a . � i '� � �� s ■ � ■ � �� r ■ � � ■ . . �. .�C ■ C � :° �■ ■ C: - � i. Adak IWI1 rtl 11 � T I 1 I I I I I I i 1 � . -- ewe . s — ^!e:: xa 4 ; _,JL L I I I _,►__ I I i I + Lt I I I I ___� 2 . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel aG 1> Permit# Health Division q JP Date Issued ff\" Conservation Division �r (� J 4 / ' Application Fee Tax Collector Permit Fee Treasurer O Planning Dept. , Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Addresses Village Owned f IU � �i`Z 13i4-�Z Address 20IZSFS//-D Telephone S^O�- 2�U-/ l j� —°l2.�-1- r D 7b Permit Request _(f0U,577-/20CT_ 0AJF Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Zoning District C Flood Plain Groundwater Overlay Project Valuation �0, Construction Type 4i625)j?) Lot Size Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family Ad Two Family ❑ Multi-Family(#units) Age of Existing Structure *3Y VA,5" Historic House: ❑Yes No On Old King's Highway: ❑Yes M No Basement Type: )W Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 1 new Half: existing riew Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing d5r new First Floor Room Count 6 Heat Type and Fuel: 2d Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes A No Fireplaces: Existing _Z New Existing wood/coal stove: O Yes A No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size Attached garage:A existing ❑new size ,� Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name ©1,oA_) i2 Telephone Number ` Address License# Home.Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Q[ A-, —/Z.4 C°T &.q7— "Tr— O12 7' �' S / lSADS' L G —ti2 SIGNATURE DATE ZZ I.r FOR OFFICIAL USE ONLY PERMIT NO. i DATE ISSUED , MAP/PARCEL NO. u t. ADDRESS VILLAGE OWNER R DATE OF INSPECTION: f a FOUNDATION ('QZ '7hjjbjjaAL FRAME • INSULATION f FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ,r ASSOCIATION PLAN NO. f ��oFt�r°wti Town of Barnstable y ��^ Regulatory Services * BARNSPABLE,M Thomas F.Geiler,Director � y 1 : 1�g'prE0,19. & Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ]�EC K 5. Estimated Cost Address of Work:(')^� Owner's Name: Date of Application: G Z Z D I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ®Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR z Z G �G I-t tJN 13ACIZ .� DatV Owner's Name Q:fomwhomeaffidav I -THE Town of Barnstable C Ip� Regulatory Services BMWSTABLE, « Thomas F.Geiler,Director 9� SS 6 9 .m�. Building Division prFo MAr p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 " - HOMEOWNER LICENSE EXEMPTION Please Print DATE: 2 JOB LOCATION: !F C ^L LL nuummber street village "HOMEOWNER": 1OEfN h-r rs,hfz 5 0� 21 9 ?l D 7.2 ,(,' 3�, (btu FoazN/•a�.- name home phone# work phone# CURRENT MAILING ADDRESS: 0-2 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.ortwo-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 minimu spe procedures and requirements and that he/she will comply with said procedures and require Signature of Homeo er Approval of Building Official Note:—Three-family dwellings containing 35,000 cubic feet or larger will be required to comply,with the - State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The,Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, _Rules&Regulations for Licensing.Construction Supervisors,Section 2.15).This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons: In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. - To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt r„ The Commonwealth of Massachusetts _( ` Department of Industrial Accidents —� 600 Washington Street Boston,Mass. 02111 �`- Workers' Com ensation Insurance Affidavit-General Businesses address: 209 R G►Z-S F 5ko r LA. F city Qt t4t(T RV fLC-q state: M an:Q, ;L phone# rO Tr-P70•1 ( 1 g work site location(full address):., !4t/WP;_7J+0 C I U l L LF ❑ I am a sole proprietor and have no one Business Type: ❑Retail❑Restaurant/Bar/Eating Establishment working in any capacity. ❑ Office❑ Sales(including Real Estate,Autos etc.) ❑I am an employer with employees(full& art time : ❑Other H I am an employer providing workers' compensation for my employees working on this job.. company name: sddre'ss _ city phone#• insurance co. : ohe #/ // I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: compariy name: city.:.. . ishone'#;. . t : insurance co... coinvanv namea .address:. . phone:M4. insurance co.' lice#. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement a fo to the Office of investigations of the DIA for coverage verification. I do hereby certi a pains a d p alties of perjury that the information provided above is true nd cor ect Signature Date G G� Print name .fit-141V 00 M/3�tZ Phone#�?- >9(J-l 7 / official use only , do not write in this area to be completed by city or town official . I cityor town: ermit/license# p. ❑Building Department ElLicensing oard ❑check if immediate response is required ❑Selector n'Bs Office []Health Department . contact person: phone#; ❑Other (revised Sept 2003) Information and Instructions Massachusetts General Laws chapter 152 section 25.requires all employers to provide workers' compensation for their employees. As quoted from the f 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 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 bean employer. MGL chapter 152 section 25 also states.that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or'to construct buildings in the.commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor.any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting . authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation.. Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. :Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding`the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and.printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact-you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits maybe returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. , The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department.of Industrial Accidents BMW of wesdoemns 600 Washington Street Boston,Ma. 02111 fax.#: (617) 727-7749 phone #: (617) 727-4900 ext.406 AM ■ � ■■■ ■■■■ ■■ ■ ■ ■ ■■■ ■I0 it a loss on m mill oo ■3 ► ■■ ■ ■ 1 ■, ■ ■■■ zT 1�■■■■■■■■■i■I ■ ■■■■■mtl# l�s lit I t, .�■■ ■■■ ■ ■■■ ■ '. ■1 111 �.■■■■■■■■ w■■■■■ ■■■ ■■ .,■1�■ III 'C ■■■■■■ OMEN ■■ ■■■■ME ■ ■� ■ � � ■■■ Ill OEM■ ■■■:■ ■ .ira■■■■ ■■■ ■■■■■■■■■ ■■ ■■ ■ t■�I■li■■■ ■ ■■■■■ ■ ■ ■ ■ ■ I�■■11 ■■■ 1■ ■ ■■■■■ ■■ ■ ■ ■■VVA ■■■1 ",l�■ ■ ■■■■■ ■■ ■ ■■■■ ■■■'I� ii ■LI 0 HIM ago 0 ME Ill■■■■■■■■MOM■■■■■ ■i 1,1111 ■■■W■■i ■ ■■■■■■■■■ ■■■■■■■Ill■ ■NMI itl■■ll ■ ■■■■■■■■■■■■■■■■■■ #■ li' t ■■i! ■ ■■■■ ■■■■■I ■■■■ ■■;■lid i�■l�1 ■■ ■■■■■■■�■■ ■■■■ ■ ■11! i ■■ ■■�■■■■1■ ■ ■ ■�■ ■. . ■ ■■ ■■■■■■ ■ ■ ■ Ali ■► ■■ ■■■ i■■■■■■■■■■■ '■!DINS ■■ ■■■ ■■ ■� ■ ■■■■■■ ■ ii►■II ■ I ---...r.. ■ !�'r��_, _. rrr r��■ ,,, , c�rr ■ ■rs■ r��rr ■ ■� rr■■ r,�rrr r ,r■rrr r■ ■r■ .,r■ :r■ ■ ■ ■ , �11■rr ■ ■■ rr - ■rr rrr■ 1 ■�lt��/(111rrr�■ :�t■r������■■■■■�■ ■■ ■r���■ r�■■ ■rrr al it S��rwIlls INwrwrawr+..r.r.w.w..,.r+..r!Mw+.w.r.rr iI/ /� irk ■ ��� ���■■ ��■� ■�■r I I■�rr��l■�r■■� �l�lIII11 � �Ir�vtill11�111■r■■ l ■■■■■�ri ■■■�■■ ,A, i Now MENmm ICI : �����■ ■ ■■■■■ ■ 11� ■ �■ MEN ■�■ ■��■■ ��� � ■■tit o �) 0 cY of �., 24.2 0 � Qz o' 0 F Io - � cz 1' C.11 G INSPECTION ! . ,, �. ., .. .�... This MOft'[' A iGE � C'Tf�N Plan �� t•�•r�r�t� r�.��t.' .r,.. F3anl, Use Onlp- - - - I'c)WN I4;(;IS'iR OWNER: rh't-M) 13 l I Y I'N: AYIN 6;0AIL I K PLAN FZEF /./0 33—- --- (':�I•I, I ' ;�/ I 'I' I HEREBY CERTIFY TO ----------- YAN1\1'.;1, 1 ' I 1, THAT THE BUILDING .!IOWN ON THIS PLAN IS LOCATED ON THE GROUND AS �'�)N�l ! , I':\N'I'� I1011'N AND THAT IT'S I''OSITION DOES CONFORM +.EHi,iitw, 1011 II 'I'0 'I'lII `ZONING; LAW ["TRACK REQUIREM . NTS OF THE NY, J ibii fNDI' `I'I�l IMAD .R_E ---AND THAT ..X0.T LIE tiVl'I'tIIN 'I'IIi SPECIAL FLOOD HAZARD ` �u, MAR�'R)N. N11!.I:. MA �.. c'., �:�. IiUWN ON 'I'IIL: Ii.U.1) MAP DATED_7_ �:'_-- . �'` ;,i„t''' " I'L:i.. I:'ii OW) w) ('c� �Itv- PitrieI �'50001 0008 D I';1\: I:'O THIS PLAN NOT AIAI)E F'ROhi AN INti'I'I'UNI ENT 1 ..l l \1Gail`I'III?�V I'I "URVVY NOT 'I'O BE 1•'OR I I•'NI'1 . FTC _ � J UPDATE PERMIT RECORDS : ADD CHANGE DELETE PRINT FEES HELP END CHANGE RECORDS IN PERMIT TABLE PENTAMATION----------------------------------------------------------- 09/30/04 PERMIT NO 77622 PARCEL ID 207 119 207 HORSESHOE LANE PERMIT TYPE BADDD BUILDING PERMIT ADD DECK DESCRIPTION 20 ' X 16 ' DECK/8 ' X 8 ' DECK/SHOWER ENCLOSURE STATUS C COMPLETED APPLICATION DATE 06/30/2004 DATE ISSUED 06/30/2004 EXPIRATION DATE DATE COMPLETED MASTER PERMIT VARIANCE VALUATION 2500 . 00 BOND 0 . 00 CONSTRUCTION TYPE 434 GROUP TYPE 1 CONTRACTORS OWNER PROPERTY OWNER ARCHITECTS/ ENGINEERS/OTHERS ENTER Y IF ALL ARE CORRECT OR N TO REENTER LEAVE BLANK FOR NON-PROPERTY RELATED PERMIT. CTRL-I FOR HELP. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0-7 KA 47-7 Map , Parcel a - Permit# = `�F/�, � Health Division Date Issued ` G� Conservation Division Fee, ' 5:. Tax Collector ,.A �r pi< F Treasurer C� lzaf Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address e.-2(7�f .SlS`LjI ,L/lam LOT 94 t Village \ Owner CSh«it/ �- �rZ22 Address x Telephone Permit Request /d IZ©oIC 4 L /4e;F2 OL A Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new 0 Valuatio &, ,6e-, Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family © Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: Cl Yes Cl No easement Type: 2(Full ❑Crawl ❑Walkout O Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:0 existing ❑new size Pool:0 existing ❑new size Barn:❑existing O new size Attached garage:0 existing 0 new size Shed:❑existing ❑new size Other: Zoning'Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes -0 No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name /1 M 07/4f, Telephone Number 7�r — Address WC9 0 4 License# C S Cq t z S— s � V &L&!V•V/S YOi�,Q x d r D/—4/1 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ft�/U�,,ZiCsyC� 7N v S g1 SIGNATURE <nA DATE �� FOR OFFICIAL USE ONLY PERMIT NO. r R DATE ISSUED .MAP/PARCEL NO. � y` ADDRESS; f r VILLAGE � - ."f . - ,.r } � .l `, �_ • + •� 4 OWNER - • _ ' DATE OF INSPECTION, - FOUNDATION m� FRAME - o INSULATION FIREPLACE = i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 4 FINAL BUILDING j DATE'C'LOSED OUT ASSOCIATION-PLAN NO. 1+ 1 1 ' • 3 G , � O O � � N Z O W W E > O G 0 - � � Q \_ _ cx W _ cc .•� I ' . 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Date J1i.1MIC Phone#" . otIIdal use oni do not write in this area to be exrmpieYed b7 city or fawn ;Devartment otucui Y ❑Bua� s permitmeesne a Board city or town: ❑Sdecmtews O1IIce chrcic it immediate response is required _ �$nlih Department ❑other----- p. phone ; contact person: • • •�� • 1••Ir ,6.•• •moo •I Ie1-1• • • 1• • Igl .••1/-/ rl .It • 11 1 •111 • •a �••�% '+ or. 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Y ✓• 1 •I � w••:1 r•11 wtl .1 •1 •111.1 •••• tw• • • • w• .11 . •1./111_4 w•• . 1 r w•1:1 •11..11 1 - .) . • .�. . . --••}} r •1 1 • �Yg 'Y.le •11A gl'• 1• r•111 V. •• • \ 1 w•Y., •111 • .• •Ig • «s•g1 • • • • t1I • 11 11 •t w11 rl - , i• _ - _ - 1 • i1I II /1 •�•rglll wtAV 11/111 • �• tl M• I \� 1 Yam• .,./�• w• M •111.1 .�. • , - • •H r1.1 1 • ,1 •I 111 ...v. • 11 .. .1g►=•1 •Iw•/Iwt1A 1V. •ww• •.✓. .� • •KU •/\ • 1 \ /• /1 .11 • • 1 11 1 • .It r 1.1 • 1 r•r •w .ge I all .11•fAllelf • • 1 .gl • •w • •• •• 1• t v-'11I9`.1 1• 'J%T71, —,I t ' •••w•1 •• � 1 • g u1 .0 • ry uglgl r ti 1 1 11 11 1 1 1 , 1 A• 1 1 t l l 1 1 1 1 • 1 1 •'' I I 1 1 1 1 1 1 1 1 1 I , � 1 1 � • 1 1 1 / 1 1 1 1 o� The Town of Barnstable � � �e� Department of Health Safety and ]Environmental n ronmental Services 59- Building Division 367 Main street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commission-,: Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,aft renovation,repair,modernization,conversion, -existing improvement,removal,demolition,or construction of an addition to any pre building containing at le one but not more than four dwelling units or to structures which are adjacent to ast such residence or building be done by registered conti'actors,with certain exceptions'along with other requirements. Type of Work: r-�/� Estitaated Costt�y �Address of Work: Owner's Name: "� fw Date of Application: 2 00 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law [31ob Under-$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: G Wig UNREGISTERED OWNERS PULLING THEIR OWN PERIVIIT OR DEALIN WORK DO NOT HAVE CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALIMS OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name . Registration No. OR Date Owner's Name q:forms:Affidav i� °`THE? TOWN OF BARNST'ABLE Z BABBSTABLS, i 9� 039. pYa� BUIL•DI G INSPECTOR APPLICATION FOR PERMIT TO ...................... . 'L' ............................................................... r� .a TYPE OF CONSTRUCTION ......... ... ....... .... . .... ......................................................... ........19..7 TO THE INSPECTOR OF BUILDINGS: p The undersigned hereby applies for a ermit according to the following information: Location ....... ... f ...... .............. . . . ProposedUse ............... .:: .............................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Cedar des Realty Trust Name of Owner .................24.zGreatPend.ogvo..... ress-- .._ ............................................. $ trtlt Yarmouth, Mass, Name of Builder, ��........` �4 ��� 'Z.fc�G ddress ............. . Nameof Architect ............... - ::............................Address ....................... .......................................... Number of Rooms .................... c .................................Foundation ........... . ........................... Exterior .....tA,1..h .....G � :..... . ....Roofing ...... .. f/J........ .... ..............Interior ................ Floors . `sE/:( .... ........................ l Heating ........ r.G ........./l14..... .................Plumbing .... Fireplace ..................rby ..............................................Approximate Cost ............... f�.,� � L� .......................... Difinitive Plan Appronning Board ________________________________19________. Sa Diagram of Lot and Building with Dimensions f r 1 , r i g9 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... G •�:.GC`L ��c cam... Cedar Acres Realty Trust � C WO No ..13180,.. Permit for .... one story.......... single family dwelling ............................................................................... ?0q- Horseshoe Lane Location ................................................................ Centerville ............................................................................... Owner Cedar Acres Realty Trust ................................................................. Type of Construction ..............frame ............................ .......................\..................................... .......... Plot ..........:............... Lot ................................ f Permit Granted .........June.23................19 70 Date of Inspection ... IPe....A.19 7v I Nw Date Completed ...........19 PERMIT REFUSED ................................................................ 19 ............................................................................... .................................................. ........................ ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... - - h N.. - E)OSTING ' z m v . I y � I�n—r------ - I II az .I., IIII i ili �P1� D D I{li li I I �5 y D ' /Y W yA IppI I 'II �iD W vCm IIII. I N .III mz3 pI ce Qmg IIpII I (I V• �D� iUi N" i L f0 pl 1 11 I r I I II I m PY O 3kz Z � _ -�" R A I I r P LJ Z I - _ L----J D_ m m CNN =N m�v + vDm m Z sa._o. r u u z ZD A x m �. 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REVISIONS Gam, T2I T°"'�OF 1700E FRAMING FLAN NORTHSIDE , NGR,HSIDEHER>BEXPRESLY 01 2 4 B s1E CTON 0R OoBem9eT6N RESERVES ITS COMMON LAW DESIGN ND E"• N°"" 6,,. - DE INN COPYRIGHT.THESES PLANS ARE• - ' LOSSES OR "� P90FA09ED MENOVATIONS NOT TO BE REPRODUCED SHEET NO, DATE: TO 0MORS OR OR M T E CHAt%OR COPIED IN ANY SON. aat�TH GOMBAR RESIDENCE AS OG�IATES FORM DR MANNER WHATSOEVER DRAWN Ar eo-6RE oa416NONc cONsnwc9oN, '" - WITHOUT FIRST OBTAINING THE _ A.4 9/18/12 ��T 2Q'J HORSESHOE LN DISTINCTIVE RESIDENTIAL k COVNERCIAL DESIGN EXPRESS WRITTEN PERMISSION CHECKED �Ask� c 141 "N STREET•nwMOVTHPORT•MA 02676 AND CONSENT OF NORTHSIDE af5 M st6uenntu CENTEI VILLE, MA. 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DATE �� OCIATE � DRA�Ii' ,� GOMBAR RESIDENCE ►� * °��"DOT ' HE . it/2B/lY Z07 HORSESHOE LN• D15fINCfryE IffSDf?111AL d WIIUERCUL DE9GN �SwR�ss y�yT�ENL�Is,,, CHECKED 141 WA urotm•YAFAW pm•WA 02M AND CON T(IF NORWODE DEWk GENTERVILLE, MA. �°0°�"''"1O K0°6�30�''°°'