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Permit Fee • 0 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address `?Dg AA-C4ih3 /Veek Village - -i�lll� • Ownerl i6L2 4w Address / V/�� C7hee h, `W DISsZ� Telephone S-b g 7_'Y01 -00-?Q Permit.Request If-AC 0 9t 6ohd boila gpAte, to/ h e-4-V CrA4ky1S�acre Au.e 47.&M Square feet: 1 st floor: existing proposed 2nd floor: existing 000 proposed Total new. 2.`D .Zoning District �L) r Flood Plain C Groundwater Overlay Project Valuation Construction Type Wo Lot Size ®-, 44 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure 3 1�2 t-. Historic House: ❑Yes YNo On Old King's Highway:, ❑Yes XNo Basement Type: kFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new I Half: existing a>C �ew �� Number of Bedrooms: existing new Total Room Count (not including baths): existing new 1 First Flodh`,5 `'oom CoQJt. Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑Other Central Air: Xyes ❑ No Fireplaces: Existing g. New Existing wo /coal stye: Wes )(No m Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn:Xexisting%-_-nUn'ew size_ Attached garage:)(existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes XNo If yes, site plan review# Current Use S'!i 9f,- "l�/ Proposed Use S191Q %�1�1 APPLICANT INFORMATION / / /� (BUILDER OR HOMEOWNER) C,14NameTelephone Number Address 11- Sfill S ok AV- License # gs� 3.3 S. 'd'wOPti dIM� 6� Home Improvement Contractor# Email Worker's Compensation # AJIA' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO atitsek A s SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER I� DATE OF INSPECTION: FOUNDATION FRAME aK 1�2oM s�Ls (� INSULATION ©rE ?2ovt- Sl m)f y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL , GAS: ROUGH FINAL FINAL BUILDING C ( , DATE:CLOSED OUT ASSOCIATION PLAN NO. T w Cmvzomwal&ofHassacfiuses Deparhment rfhdastrccdAccidentr - - tie Of iamfigafions ' 6010 Waykington&'reef B astorry MI 02111 wmv YnasmgvWdia 'workers' CampensafianIusurance ffidavif_Builders/CantractQrsMecfriciansMumbers Applicant Infarmafion Please Pant Legibly, A-A&ess. &T�M I�l'arne(S 'onFfntiividnaly: C. /`{ - U /1/�CG�, `h e crtyfstatria, S.Ar*o,�tA *4 44 Pb�=;�- 744 —2J2 zel 9?6 Are you an employer?Check the appropriate b02: T of project r 4. I a�rx s contractor and I 3'Pe ��d}= L❑ I am a employer witEL ❑ 6_ ❑New oetasUm ion hiedemployees Cfu1t a4d(orpart#ime}* haves sdI'` o� 2_❑ I am a sole propfietor or partner listed on the attached shave Rem od ,>ra , ship and haze no employees emplThesees adsub-contractorsvehave g- ❑Demolition Itt and have wot�ers' woAing forme in any capacitjr P msuratsce I 9_ ❑Build-mg addition o.Wofirm'COnIp_inafrranre r 1 5. Ate are a cotlsoraticamd its 10-0 Electrical repairs or additions 3-❑ I am a homeowner doing all workofficers h a��e egetcised their ILEI Plumbing repairs or additions myself[No workers'oomp- right ofemmption per MG-L 12_❑Rvof c_15Z §1(4),and we bZ-,M no �s f mnanre required_]F 13-❑Other . eazplayefs.�a ifrotlCPiS' comp.insurance mgif ed_j # Fb that cbedcs box##tfmst$Isa fill ovttfesection b9ow dwydnj►then wodme m=9FL—,6 palirTinffirmadtm- ff�meowners vrbu subaut this s±Udzvif inXts f=they Rae dakg>rIIvf *and dfea bee aut d&coa xacmts mm snbafit a new adBdzvk in�r�MdL TCoubscmrs thst check this boot must rttscbed sa addifional sheet d iawhab the rmne of f e sub-amk3dx=and statEL Whether DrXWt fifnde emfifies have emplaYeps• IftbemTe-couttactucsh3veempIoy-ees,t$eyynstprovidetheirwarkx3'comp.palmaumbet lam an omployw thrtt is pratid&rg ti orkas'compon=tion insurimcz a for rzzy enWLayees Betntr is fha poTic}rind job seta inforrrtddam , Insurance Company Name: Policy 4 or Self-ins-U(-k E4xtrationI3ate: Job Site Address_ Cttyr'State/zip- Af#acb a-copy of the wGrkers'compensation policy declaration page(shoring the policy number and expiration date). Failure to secure•coverage,as regairednudes Section 25A of MGL c.152 can lead to the imposition ofcriminal penalties of a fin=rip t4$1,500.00 anClor one-year imprisonramt as well as civil penalties in the fbm of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator- Be advised drat a copy of this statement maybe fnxwarded to the Office of Investigations of ffie DIA for insurance coverage vecffication.- da ligreby c,e ' u tkepr^unsland enaWas ofpedmy thatthe irformdianpratididabove is h7w and correct sizaatam: Date: �� tQ l Phone Olichrl use anty. Da riot wrifzs in th&area,to be completed by do or town 6,f ciaL City or Town: PernritUceuse 9 Issuing Anthority(circle one): 1.Board of Health 2.Building Department I CCitylrowtx Clerk 4.EIe-d-dical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuaatto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or.other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,par araship,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 iu`the commdnivealth for any applicantwho,has not produced acceptable evidence of compliancewith the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)slates"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their cerrificatc-(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 retumed 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 pennitllieense applications in any given year,need only submif 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 fur 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 (Le.a dog license or permit to burn leaves etc.)said person is NOT required to complete this afhda-Ndt The Office of Investigations would lice 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 cif. -c al Accidents' office of kvesfigatioas 600 Washington Stet Boston=IAA G2111 Tel.4 617 727-4900 W 406 or 1-9 MAS WE Revised 4-24 07 Fax# 617-`�27- 49 w .mamgovldia Client#: 23485 2VINCENTCA ACORDTM CERTIFICATE OF LIABILITY INSURANCE • DATE(MM/DD/YYYY) 12/27/2013 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 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 NAME: Dowling$O'Neil No AI : 5087781218 CC,N o,Ext:508 775-1620 Insurance Agency E-MAIL aG 973 lyannough Rd., PO BOX 1990 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Hyannis, MA 02601 INSURERA:National Grange Mutual Insuranc INSURED I C.A.Vincent, Inc. INSURER B:Commerce Insurance Company - ' 17 Still Brook Road INSURER C: South Yarmouth, MA 02664 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER _ MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY i MPJ5429M 04/01/2013 04/01/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY 7 PRO- JECT LOC $ B AUTOMOBILE LIABILITY 13MMBBWC35 3/18/2013 03/18/201 COMBINED SINGLE LIMIT Ea accident $1,000,000 _ ANY AUTO t BODILY INJURY(Per person) $ ��ALL OWNED SCHEDULED N AUTOS BODILY INJURY(Per accident) $X AUTOS I XI HIRED AUTOS X NON-OWNED i PROPERTY DAMAGE $ X Drive Oth Car '—� AUTOS Per accident I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE 3 AGGREGATE I$ DED RETENTION$ $ 77 WORKERS COMPENSATION WC STATU- OTH- Y/� AND EMPLOYERS'LIABILITY TORY LIMITS ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A Mandatory in(f yes,describe under E.L.DISEASE-EA EMPLOYEE $ I � _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Job:208 Huckins Neck Road, Phase III-new kitchen,expand dormer. 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. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2.00 Main Street _ ACCORDANCE_ WITH THE POLICY.,PROVISIONS. Hyannis, MA 02601 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 fES1995dd/M199Fd4 r n ne Town of Barnstable tDAWaTABM Regulatory Services MASS. Richard V.ScaIi,Interim Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623 0 Property Owner Must _ Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize �'14 , t !,1i1�� I?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 f th P ty o e 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 /� • dam Print Name Date WORM&OWIERPERMISSIONPOOLS 10113 . N' Office of Consumer Affairs&Business Reg ulation License or registration valid for individul use only ( OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: � tegistration: 160948 Type: g Office of Consumer Affairs and Business Regulation J- 10 Park Plaza-Suite 5170 's Expiration: 9/15/2014 . individual ' Boston,MA 02116 CHRISTOPHER A VINCENT CHRISTOPHER VINCENT 4 F, 17 STILL BROOK RD SOUTH YARMQUTH,MA 02664 Undersecretary Not valid without signature ' P ,- U 3ca-d o �u': :17,C. �e�;_ =<c ; _ ._ Unrestricted-Buildings of any use group which Construction Supen isor contain less than 35,000 cubic feet(99,M )Of CS-095633 enclosed space. CHRISTOPHER A VINCENT .' 17 STILL BROOK ROAD SOUTH YARMOUTH MA 62664 , Failure to possess`a current edition of the Massachusetts State Building Code is cause for revocation of this-license. s _ ._. 08/20/2014 ► . For DPS Licensing information visit: www.Mass.Gov/DP5 _ ,, ' O were qNo i o° io w r t O PROPOSED ADDITION `�M EX. I TO REPLACE 77 4, DECK Op . ..EXISTING DEC. FCC Q I EXISTING"HOUSE h� LOT 105 0.44+/- AC. l SS9o2 E. try, E sC 1pp0p. . �DA . i DCE.412-133 CERTIFIED PLOT PLAN i PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE j LOCATION : #208 HUCKINS NECK ROAD, CENTERVILLE, MA SCALE 1 40 DATE 12 4 2013 PREPARED FOR: REFERENCE MAP 252 PARCEL 140 STE S LAND COURT CERT.# 193165 ,�ti�ri of MAs I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THEo DANIEL �� GROUND AS SHOWN HEREON: o:. A OJL+LA off 5a8-362-4541 o.'No.40S$0,� fax-508.362-9880 .. :..down cape engineering, inc. C/V/L ENGINEERS LAND SURVEYORS ss DATE REG. LAND SURVEYOR ? Morn street YARMOUTHPOR& MASS z TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION (HCO' � Maps _ Parcel lien # Health Division Date Issued c� Conservation Division Application Fee "" C , S x Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address �� MACJ. tl S New 120aJ— , Village Ce4,iA //'11Z Owner CA4-o 1/me_ �v�S Address ` Vl fl",e 6,-e�i L m ffvlde� ��g'2o .Telephone d 761-0-0-?O Permit Request -Square feet: 1 st floor: existing hwproposed �, �� 2nd floor: existing proposed/ Total new 2.s� Zoning District X/D— / Flood Plain Groundwater Overlay Al& Project Valuation=(vo Construction Type wood-42,vor2 Lot Size ®p Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family.(# units) Age of Existing Structure Historic House: ❑Yes XNo On Old King's Highway: ❑Yes *No Basement Type: X Full ❑ Crawl ❑Walkout ❑ Other ,�,�U Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) 1, 4v '^ Number of Baths: Full: existing 2 new I Half: existing f new Number of Bedrooms: existing ieew Total Room Count (not including baths): existing (J new First Floor Room Count Heat Type and Fuel: XGas ❑Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing Z New Existing wood/coal stove: ❑Yes° 1 No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: fisting nev8size_ Attached garage:; (existing ❑ new size _Shed: ❑ ther:;_Q existing ❑ new size _ O ::E Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review # Current Use S'rn91 4ployy Proposed Use si)?9!� f�1 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name C,A yiilc m e, Telephone Number 774� ' 0936 Address f T/W/ 6kV7>k License # sd ?'A"&V1A_M1 A114 046.4 Home Improvement Contractor# Worker's Compensation # NL14 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE `�/ 113 1 FOR OFFICIAL USE ONLY APPLICATION# r —bkrE ISSUED MAP/PARCEL NO. 'k ADDRESS VILLAGE r { OWNER DATE OF INSPECTION: 'y ,� �OUNDATION�:.s��e+a�3al��:�e�AJUFrT�r� ' FRAME FIREPLACE } ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: __-: ROUGH FINAL �. t _ FINAL BUILDING a1`�. DATE CLOSED OUT ASSOCIATION PLAN NO. I - r the Comarommakh afMrassacbusetts Depart aent o,f ludustrid Accidents QKwe of-Investigadons ' 600 Washington Street Boston,AfA 02111 1 4vivatiass go Idia Workers' Compensa6iuuInsurance Affidavit:BuilderstContractorsfE ectricians/Rumbers Applicant Infarmation ,�J 0 Please Print:Legibly Name(Bttsi Orpnim ionllndividmo: �f/`f: V d 17cekk,4-, h 1c c Address: t q Sh)l &DVK Rom. CityfstateMp:S, V4V-nI-0 t#k &A 0 Z664 ph.,�- q-�, Are you an employer?Check the appropriate box: T of project r 4. I am a contractor and I r.E]• 3 �xlnred}: 1.❑ I am a employer with. ❑ 1 6_ New constuction employees(M and/or part-time.).* �t=hired the sub caniractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet y- ❑Remodeling ship and have no employees These mb-oontractors have g- ❑Demolition working for me in any capacity. employees and have workers' g- ❑Building addition [No workers' coi4p-insurance comp-insurance I 5.KVTe are a corporation and its 10_C]Electrical repairs or additions 3.❑ fired ffi,cers have exercised their 1I_. Plumbing repairs or additions I am a h,orneowner doing all work ❑ g P , € o workers' right of exemption per 11+1GL ❑ �� -, c_152, 1(4),and we ka1'e no I2_. Roof repairs innumnre regaired.�F § 13..❑Othu employees-[Na workers' comp.insurance required.] *Any appticat tbit checks box#1 Hans#also ffi1 out the section below shovring tbeeit woikeis'compensadioa Polio informstion_ I Homeowners Who submit this affidavit indicating they are doing an vat sad then hire outside contractors omit submit anew affidavit mdtcstin sorb. Contractors that check this boat must attached an 7ddihonA sheet slue i g the name of die s b =Jft sand state Whether ornot those ernxfies have employees. Ifthe mVcontiactars have emplerfees,they most pitnade their warken'comp.Policy ntrmbez. I am an employer that is prm irfing it orkers'compemation iiisiirance for my employees. Below is Ste poUty and job site information. Insurance Company Name: Policy:9 or Self-ins.Litz 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 sere coverage as required under Section.25,E of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$I,500.00 and/or one-yearin4nisonment 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 c,Dpy of this statement maybe forwarded to the Office of .Investigations of the DIA for insurance:coverage verification_ I do hereby certify render the pmns and penalties ofpedurp that the information ormation prinided abmw is hus and.correct. Si, time: Date: F /2 Phone#- / 7-4--.24 2 Official use only. Do not write in this area,to be completed by city or town of ficiaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. li Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or IocaI 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 subdivisioas shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage._ Also be sure to sign and date the affidavit. The ala-davit should be retumed 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 proNided 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: rho Commonwealth of M ssachusotts Depaitmont of Tndustdal Accidents Office of kvestiptlans 600 Washington Street Boston,MA 02111 TeI.#617;727-4900 ext 406 or 1-9 MASWE Revised 4-24-07 Fax# 617-727-7749 www,mass_govldia f • . �TME Town of Barnstable Regulatory Services MARMAB MASS.14 Richard V.Scali,Interim Director i63q. • Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, C��/l�►ta 1. 1 -yl-)es , as Owner of the sub'ect �j l property hereby authorize C r 14 ' K, to act on nay 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. Signature of Owner Signature of Applicant C' A�'M�'e'ss It Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS 10113 . Regulatory Services . Richard V.Scali,Interim Director 4� Building Division Tom Perry,Building Commissioner s"mi6Ti ' * annis,MA 02601 MASS. �' 260 Main Street, Hy www.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village mber street nu work phone# .`HOMEOWNER home phone# name CURRENT MAILING ADDRESS: city/town state zip code possess a license, rovided that the owner acts as supervisor. The current exemption for"ho.me�ers''was extended to include owner occupied dwellin;s of six units or less an to ow homeowners to engage an individual for hue who does DEFINITION OF HOMEOWNER or is intended to be,a or two- eside,on which here Person(s)who owns a parcel of land on which he/she resides or intene and/or farm straccturets. A person Who constructs moreethan one family dwelling, attached or detached structures accessory to such usshall e in a two-year period shall not be considered a homeowner•le foSucr sumch work' erformed under the buildin ing official (Sectio on a n ac>Y Y acceptable to the Building Official,that he/she shall be res only _ 109.1.1) applicable codes, The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other bylaws,rules and regulations. "homeowner"certifies that he/she understands the Town of Bamstable Building Department minimum inspection The undersigne d procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Appioval of Building Official P y Code Not e: Three-family dwellings containing 35,000 cubic feet or larger will be required to coin 1 with the State Building Section 127.0 Construction Control. HOMEOVMR,g EXEMPTION construction up Sup provided that.if the homeowner "Any homeowner performing of cofor which a building permit is required shall be exempt The Code states that: from the provisions of this section(Section 109.1.1-Licensing engages a person(s)for hire to do such work,that such Homeowner shall.act as supervisor." it s of a supervisor. Many.homeow ners who use tliis exemption are unaware that they or Se n 2t1 This la k ofearvareness often (see Appendix Q,Rules&Regulations for Licensing Construction Supervis , serious roblems,.particularly when the homeowner hires unlicen The homeowner acting s Supervisor is t results m P proceed.against the unlicensed person as it would with a licensedSupervisor. ultimately responsible. mun tiesrequire,as part of To ensure that the homeowner is fully"aware of his/her rstandsresponsithel responsibil ties of a1Supery Supervisor. On the last page permit application,that the homeowner certify that he/she unders a . of this issu e is a form currently used by several towns. You may care t amend and adopt such aform/certification for use in your community. S\building permit forms\_VRESS.doc Q:\WPFILES\FORM a V Revised 061313. ::+K r =: Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ' , before the expiration date. If found return to: �� ( OME IMPROVEMENT CONTRACTOR eft,egistration: 160948 Type: Office of Consumer Affairs and Business Regulation p 10 Park Plaza-Suite 5170 ,,Expiration: 9115/2014 Individual Boston,MA 02116 CHRISTOPHER A VINCENT CHRISTOPHER VINCENT 17 STILL BROOK RD SOUTH YARMOUTH,MA 02664 Undersecretary. Not valid without signature 19-F 3ca;d or J Unrestricted -Buildings of any use group which Construction Supcn-isor contain less than 35,000 cubic feet(991m3)of _ �ese: CS-095633 enclosed space. CMUSTOPHER A VINCENT 17 STILL BROOK ROAD SOUTH YARMOUTH MA 02664 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. 08/20/2614 For DPS Licensing information visit: www.Mass.Gov/DPS wenq `r ND f 00 �"' jZ PROPOSED ADDITION E7E, t TO REPLACE �?g. DECK o EXISTING DEC.. EXISTING HOUSE LOT 105 0.44+J- AC. t ! SS90� 22S 00• �o� E DCE #12-133 CEIRTIFIED PLOT PLAN PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE LOCATION #208 HUCKIN$ NECK ROAD, CENTERVILLE, MA SCALE. ; 1" = 40' DATE 12-4-2013 PREPARED FOR: j REFERENCE MAP 252 PARCEL 140 � YRES LAND COURT CERT.# 193165 STE I' HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON.THE .DANIEL I��, GROUND AS. SHOWN HEREON. o A. a, - U . OJALA x She-J82-�54i f Na 40580' ' - mE 508-362-9880 down cape engineering, inc. OWL ENGINEERS LAND SURVEYORS 939 Main Street - YARMOIJTHRORT, MASS. DATE REG. LAND SURVEYOR is i i i l , bVfT�AND ` i EX o° co PROPOSED ADDITION � ' TO REPLACE �?4' DECK o0 1 EXISTING DEC, OFck Q� EXISTING :HOUSE ^h h LOT 105 0.44+/- AC. J _ i 6402 2S F At" I s 70 00, ! I DCE #12-133 CERTIFIED PLOT. PLAN PREPARED EXCLUSIVELY FOR THE PURPOSE OF OBTAINING A BUILDING PERMIT, NOT FOR ANY OTHER USE LOCATION #208 HUCKINS NECK ROAD, CENTERVILLE, MA SCALE : 1" 40' DATE 12-4-2013 PREPARED FOR: REFERENCE MAP 252 PARCEL 140 STE YRES ff LAND COURT CERT# 193165 ,r�;l'�H pF tygs I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE AN ELo� GROUND AS SHOWN HEREON. o A rm sob 362-98e0 a Na 40S$0 off 568-362-4541 down' cope engineering, inc 2 J9 os,� ClWL ENGINEERS I LAND SURVEYORS 939 Moln street rARMOUTHPORT MASS. DATE REG. LAND SURVEYOR F - _ I Commonwealth of Massachusetts Sheet Metal Permit Ma Parcel XPfj ESSpERMIT , Date. q 2.014 Permit G ov JAN 31 Estimated Job Cost:$ CI 0• Permit.Fee: Plans submitted: YES_- NO , QWI�I of:B T red: YES NO Business License# [ Applicant License# -Business Information: Property Owner!Job Location Information: Name: &t1q- ,V,(, Name: "LI Street: 4 i Street: ,clef s W&K, City/Town: k _ City/Town: 1r Z Telephone: — 7 7 Telephone Photo I.D.required/Copy of Photo I.D. attached: YES >/ NO �� Staff Initial J-1/( - estricted license s J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft.!2-stories or less Residential:-1-2 family ieL Multi-family Condo/Townhouses- Other Commercial: Office Retail Industrial Educational Fire Dept.Approval Institutional_ Other -- Square.Footage: under 10,000 sq..ft.A,-'- over 10,000 sq.ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney Vents Air Balancing Provide detailed description of work to be done: _ .. - ...... ---- ........_ ........ r i INSURANCE COVERAGE: / I have a current 11ibili insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes a; o❑ If you have checked Ya indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ f OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insuraac overage required by Chapter 112 of the i Massachusetts General Laws,and that my signature on this permit applicationAgMthis requinnertt i Check One Only Owner ❑ Agent [� Signature of Owner are Liees Agent i t t By checking this boxO,l hereby ce"that all of the detains and infdn nation I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit issued for Otis appiication wil ow l be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progms JuMeetiona 3 Date Comments , 9 f`tf` 3 i Finial Inspection i Date Comments j Type.of License: �. i 3Y "aster rifle- ❑Master-Restricted i .ity/Town ❑Joumeyperson Signature of Licensee permit# [jJoumeypersonn-Restricted License dumber. =ee$ ri Check at www.M=.gov/ds�l nspector Signature of Permit Approval The Commomweakh of Massachuseis Depart nqd oflndus&W Acdden& office oflnv&*adiom 600 Washixgion Street Bestoic,MA 02111 3www.mass gory/dr'a ' Workers' Compensation Insurance Affidavit:Builders/Contractors/Mectriciam/Plumbers Applicant Information _Pease Print Name(Busines00rgmiwtianitadivitiu :. avIr `" •Address: Pik, City/State/Zip:. Phone,#: j—]. 9U -2- 7 Are you an employee fteck the appropriate box: -Type of project(required):: 1.�am a employer with 10 4. Q I am a general cantractor and I 6. ❑New construction . employees(full and/or part-time)-*, have hired&e sub-contractors �p�� listed an te'attace seet 7• �"'�`e� 2.❑ I sin a sole propzietar or partner- h hdh ' ship and have no employees The have 8. Q Deraolitim woddng for me in employeas and Have war]=' ffiy t�pacity. 9. ❑$ufldmg addition [No workers'comp.insurance comp.insurance,$ required.] S.Q We are a corporation and its 10.Q Electrical repass or additions 3.❑ I am a hameowner doing all work officers have exercised then ;1.Q Pltanbing repairs or additionsmyse ' It o workers'ocimp. right of exemption per MGL Q Roof repairs insurance�e&)t c.152,§1(4),and we have no . 12. employees jNfl workers' 13.Q Ofhcr comp.insurance required.] 'Any appficmt awcl� er bax#t us also fM out&e wctionbalow showmg ftxdiworks'c=pensation policymforaz6m. t i"Iomeowntrs who m6mit ft 2Mdzvitbf==g Buy are doing all work and tl=tins outside contractors must submita new aff3avit mdirEiag such, tContractot's that check this box swat attached sa additional shxt shovvimg the name of fhb sub•cantractora and stair whether ornot thaw m5ties have " employees, if the-bc=wxj=bave employees,they mint V— .thr3r wozloas'wn*policynnmbar. I am an employer that lsprovfdtng workers'compensat vn fnsurance for my employees. Below is thepolicy and job site information. Insurance Company Name: r-A Mef r Policy#or Self--ins.Lic.# 6 kM 7 I U Expiration Date Job Site Address: GtY/Sffit�Zip: Attach a copy of the workers'comapensation policy declaration page'(showing the policy number and expiration date). Faat re,to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalfies of a fine tip to$1,500.00 and/or tine-year imprisomnent,as well as Civil penalties in the form of a STOP WORE.ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statxmem�may be forwarded to the Office of Investii;ations of the DIA for insurance coverage verification. I do hereby cwtyyur 'per the d penalties of perjury that the information protdrled above is, tte and correct S' Date Phone z I—7 l U_a OfflcLd use only. Do not write in this area,tb be completed by city or town offidd City or Town: PermitUcense# Issuing Authority(circle one): 1,Board of Health Z.Building Department.3.Cit l Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other s Contact Person: Phone#: { I A��® DATE(MMIDDIYYY`) � CERTIFICATE OF LIABILITY INSURANCE 6/14/2013 1 . 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 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 Debi James NAME: Leonard Insurance Agency, Inc PHONE (508)428-6921 FAX o:(508)420-5406 683 Main StreetE-MAIL debi@leonarda en ADDRESS: g CYcom Suite B INSURERS AFFORDING COVERAGE NAIC q Osterville MA 02655 INSURERA:Travelers Indemnity of America 25666 INSURED INSURERB:Travelers Cas & Surety of IL 19046 Bourque Heating and Cooling Inc. INSURERC:Travelers Indemnity Co. 25658 B&L Equipment LLC INSURERD:Continental Casualty Company PO BOX 770 INSURERE: Marstons Mills MA 02648 INSURERF: COVERAGES CERTIFICATE NUMBERkraster 2014 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDY EFF POLICY M/DD EXP LIMITS - GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEU- X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 500,000 A CLAIMS-MADE FZ OCCUR 6808B790617 /17/2013 /17/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY (Ea COMBINED SINGLE LIMIT 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED -8B791085-12-SEL /17/2013 /17/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Medical payments $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED RETENTION$ BB791269-12-42 /17/2013 /17/2014 $ WORKERS COMPENSATION I WC STATU- I DTH- AND EMPLOYERS'LIABILITY Y/NDRY LIM ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? N/A D (Mandatory in NH) 6S59UB-5B39530-A-13 05/17/2013 05/17/2014Fr."L. DISEASE-EA EMPLOYE $ 1 000 000 Ifyes,describe under DESCRIPTION OF OPERATIONS below DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,i(more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bourque Heating & Cooling Co. Inc. ACCORDANCE WITH THE POLICY PROVISIONS. B&L Equipment LLC AUTHORIZED REPRESENTATIVE PO Box 770 Marstons Mills, ,MA 02648 Tina Boulos/LEOTBI � 1 � ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 mmonei m The Arnion n2mn 2nrl Innn nrn ronic4o►nr4 mnrlrc of Ar`r1Rr1 Town of Barnstable Regulatory Services MASS Thomas.F CYWIer,Director ,�. Building Division - Tom Perry,Bu#hliag CommbdDaer 200 Main Sftr.-,Hyarmis,MA 02601 www.town.barutable ma us Office: 508-862-403 8 Pax: 508-7904230 .Property Owner Must Complete and Siam This Section If Usim A BWlder Ayp�� ,as der of the subjem property yr! }Jt�q YY� �,��y^ I.V ail VY•-• .��+I.:it�y e*eov^aut2C3tie €� < 1 —Z '✓F i in all matters relative to wotk autho&ed by this bw&ng tx=t. (Address of job) **Pool fences and alms are the responsibility of the applicant. Pools are nott to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of At��ca.nt Pti-at Nate Pint Name Date Q..rOR.k+[S:OWNEk?ERMLW.,,O1r'PW S 1 �T1 TV T., r gm F: �, ry 77 :5:[i60S13•P013.Rev 6T4ij009:' C70M ONWEALTH OF MASSAO.HUSETTS zw SHEET METAL WORKERS AS:A MASTER UNRESTRICTED �q 155iJES'..E ABOVE L CENSC TO t l ROBERT G :B0URQUE . C:R0-drK1=D. CAR'TWAY.` tARSTONS MILLS. MA U2648=IOG <6435 05/28/I4; Y53515' MINORCO i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 25�L- Parcel 14D Application Health Division Date Issued h ' Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ' Historic - OKH _ Preservation/ Hyannis Project Street Address 208 &�h.S NeCk k0d.J_ Village ( 6-44,ne, Owner /� t�' 'Ayresc Address 14 W11 6. �., Alt-4 615-zo Telephone S-D s'^ ,q 0 b,?c Permit Request k&04L P�C.I`S` 1 nGf D�x'L ulytA4-*^i rj, h Zw d-ZC k oylam( C0111eha Square feet: 1 st floor: existing 11 4a)pr000sed 2nd floor: existing(proposed It GD-0 Total new Zoning District t�A E Flood Plain Groundwater.Overlay _b Project Valuation VM Construction Type Lot Size ®,,44 0-C"- Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 9No On Old King's Highway: ❑Yes XNo Basement Type: XFull ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 01, Basement Unfinished Area (sq.ft) 19, 4oz Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing 4ew Total Room Count (not including baths): existing new First Floor'- m Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other 4- Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes XNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing 70 new; size_ r Attached garageexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes j No If eyes, site plan review# J Current Use 177m#1_0 420-I'lij Proposed Use S% f `[ APPLICANT INFORMATION p y (BUILDER OR HOMEOWNER) Name V`l�tcP.Fir/ Telephone Number 7-F4 -�2_/ 2 -6 qQgt� Address 6 T 57111 A License# Home Improvement Contractor# /Ca07 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO lya,Lseat- SIGNATURE�iGT U DATE f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAMElu INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r s PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL FINAL BUILDING -(&LIjZJh.3 DATE CLOSED OUT ASSOCIATION PLAN NO. 9: • r �\- L/Ll:• VVl/L//LVIi IYGLWLIL VJ 111 N4)J LL\./LN-.I LLLV ' Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston,MA 02111 ` =V www.mass.gov/din Workers' Compeftsation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Or-gz ization 'ndividual): . C- A - Vim Ce.fitf ' Address: 'jl Q{?Tb 4VAIA City/State/Zip:S_A-r.tw4L47%. 62,&W Phona.#: Are you an employer? Check the appropriate bog: Type of project(required):. 1.❑ I am a employer with 4. 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 oa the-attached sheet 7. RRcmodeling These sub-contractors have ship and have no employees 8. ILIDemolition working for me in any capacity: employees and have workers' [No workers comp,insurance cfficers have exercised their'omp.insurance. $' 0 Building addition required.] 5• We are a corporation and its 10.0 Electrical repairs or additions 3.El am a homeowner doing all-work. 11.❑Plumbing repairs or additions . myself. o workers' co right of exemption per MGL y � �� 12.❑Roof repairs insurance required.]t 152 § O - c. , 1 4 , and we have no employees. [No workers' 13.❑ Other comp.insurance required,] *Any applicant that checks box#1 must also fill out the section below.showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-Contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 'I am an employer that isproyiding workers'compensation insurance for my employees. Below is thepolicy and job site information Insurance Company Name: Policy#or Self-ins.Lic.#: 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 statemeiit may be forwarded to the Office of, Investigations of the DIA for insurance coverage-verification. Ido hereby certify under the pains andpenalties ofperjury that the informationprovirled above is true and correct: Si ature: 22 Date: Phone#: T r 212- 29' Official use only. Do not write in this area, to be completed by city or town of 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#: . I _ ('��c�oiriinnJuorrr�/�c��'.�lriifnc�nlr//i Office of Consumer Affairs&Business Regulation License or registration valid for individul use only -_ - before the expiration date. If found return to: � =�(_OOME IMPROVEMENT CONTRACTOR ` rRe9 istration: 160948 Type: Office of Consumer Affairs and Business Regulation 1 . >� 10 Park Plaza-Suite 5170 Expiration: 9/15/2014 Individual tom Boston,MA 02116 CHRISTOPHER A VINCENT CHRISTOPHER VINCENT _ 17 STILL BROOK RD SOUTH YARMOUTH,MA 02664 Undersecretary Not valid without signature S Massachusetks - ` Unrestricted-Buildings of any use group which 3oaTd of=Midi?:, Regjiaia iops i?d Standards Construction Supen'isor contain less than 35,000 cubic feet(991m3)of Lf.cense: CS-095633 enclosed space. CHRISTOPHER A VINCENT 17 STILL BROOK ROAD SOUTH YARMOUTH MA _02664 J t Failure to possess a current edition of the Massachusetts -x .;:x; . State Building Code is cause for revocation of this-license. miss Din 8" 08/20/2014 For DPS Licensing information visit: www.Mass.Gov/DPS r oF�HE ram, Town of Barnstable Regulatory Services aaaxsreaLE, F Mess.9•. Thomas F. Geller,Director i63 ,0� ' prF9. Building Division ' Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b a r nsta b le.m a.u s Office: 508-862-4038 Fax 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, (fet'kVl llrl Q-I C. f t& 5— ,as Owner of the subjectproperty �/ . l hereby authorize %`i • V IYICAE?47 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. oa Signature of Owner Signature of Applicant (a,�vl C. A-Vas f�e Print Name Print Name 8 � l Date QTORMS:OWNERPERMISSIONPOOLS 6/2012 oC1He r Town of Barnstable " Regulatory Services BARNSTABLE, ` Thomas F.Geiler,Director y MA89. A `b 1659. Building Division ArED Mp'I a � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor," Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The}iomeowner 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 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ``` Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �,,1131,z Historic - OKH _ Preservation/ Hyannis Project Street Address ;�V g Jjj"kls Nemec R&AA4 Village -�+t�"V/f�2 Owner C&!y 't e- 4 k-tj Address /4- V/1II4je- em"A&h 1".,YDVPh O/S26 Telephone Permit Request . L *Le4w CCwvI�IT Le/��i tQ�atc� Square feet: 1 st floor: existing 4_�proposed 2nd floor: existing lr 10 t� proposed_�= Total new Zoning District 9)-,) ( Flood Plain C— Groundwater Overlay AX Project Valuation 4 /�� Construction Type M O Lot Size m 44 az Grandfathered: ❑Yes ❑ No If yes, attach supporting-Aocurnentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes kNo On Old King`"sMighwaf_❑) ANo Basement Type: j(Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) 3o Basement Unfinished Area (sq.f,) 1 Number of Baths: Full: existing new Half: existing 1 new Number of Bedrooms: 3 existing Xew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: XYes ❑ No Fireplaces: Existing I 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 YNo If yes, site plan review # Current Use � e Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ' Name [r1S " ICT Telephone Number Address - C-7-' -SHJI Bak p Ddj_ License # 33 S. r&rrKoKA AY c244 Home Improvement Contractor# 16014-8 Worker's Compensation # NIA ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE C/� t` DATE I I/O/G2- i i r FOR OFFICIAL USE ONLY r. APPLICATION# N 4 � ' DATE ISSUED t MAP/PARCEL NO. ADDRESS ; r VILLAGE ' OWNER - { DATE OF INSPECTION: k jc y�FOUNDATION R FRAME k= INSULATION f FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL . GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT r ASSOCIATION PLAN NO. F The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information w Please Print Legibly Name (Business/Organization/IndMdual): C',4 Val Address: f 94711 8wb fi; go6td_ City/State/Zip: • Y40_ A4v67% M 4 dw6* Phone#: 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 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I an 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' comp. msurance.1 9. El Building addition [No workers'comp.insurance P• required:] 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 1 L❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.Q 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 01 must also fill out the section below showing.their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: - Policy#or Self-ins. Lic.#: 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 cer ' under the pains and penalties of perjury that the information provided above is true and correct; , Signature: Date• //,;L Phone#: 9!4- e936 - 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. S.:Plumbing Inspector. 6. Other Cont#ct Persons Phone#: I gTHE T Town of Bariistabl e Regulatory Services BAR*,STABLE v ,S.. AlThomas F. Geiter,Director a0 1639. �m �TFo � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barastable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property- Owner Dust Complete and Sign This Section If Using A Builder I, e,Ai�� , as Owner of the subject property hereby authorize ' �� to act on mp behalf, in all.matters relative to work authorized by this building permit. (Addxess of job) Pool fences and alarms are the responsibility of the applicant. Fools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. x Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORV,S-.0 TVv-,RPEPiMTSSIONP00LS 6/20I2 A Massachusetts -Department..41,F,yb�ip Safety `Boardof Building Regulations and Standards Construe ti6l.TSape ms,or'" License: CS-095633 - CHRISTOPHER A WIN 17 STILL BROOK RcsAn�� SOVTH YARM01 i. 0'164Y�3� Est 4 t l:_... Expi ration` + tion RrrJtni5sioner „+� �.,Qn /2QI2014 �1ae�pooaan�wa2coeczL�o,��aaa�u�e%rd. ,per �- \ Office of Consumer.Affairs&Business Regulation �y 6VEMEN'f-b.N1'�c 1-6R tia4i� t0948 Type Exp 5/201 on 4 Individual" CHRISTOPHER A VINCENT ?§ �. CHRISTOPHER VINCENT r 17 STILL BRQP. F?�, SOUTH YARMOUTH,Md 026'64 Undersecretary j License or registration valid for mdividul use only E . i before the,expiration.`date.: hound return to: Office df Con�uaner Affairs and Business Regulation =:Suite 5170 Boston,IRIS.02116 /` /lelot valid without signature 1 r; NY. w 1. .. .-..r. _�d4 {t r N;� w , 1. nNnt+n,rsMr.�u' -•-- ...tea `m+n°5 _ �.: er —z C T, [trey .� i f . e r , yr t )a y t n W e 2 FT MIN. BOND BEAM MORTAR CAP — MASONRY CAP R + OEFFECTIVE CLEARANCE A N P FLUE.AgEA 0 BOND BEAM FLASHING. OS ANQHORA�GE r .. FLUE LINING -=-F—..Ci. ' <-,ECJ-1 ON 40,'7- 4_,3 O BOND BEAM ANCHORAGE OHORIZONTAL DETAIL FOR REINFORCING TIES.,, FULL MASONRY WALL WALL THICKNESS VENEER TIE PARGE WITH CLEARANCE DETA11 WITH MORTAF11 R WOOD. MATERIAL m 8IN,MIN. SM2A 82 C" GNA l3FR 1/2IN.MIN, THERMAL , 1 DI(CTANC[21 OFI.. VERTICAL, IN.MIN PAROE�81N` .FIEINFQRG►N4 WITH MORTAR �✓ MEASURE MEIGHT OFIREBOX WALL OF FREEGTANO.ING TMKISIESS 1.I147ELq F)ALPLACE FROM HEARTH TOP OF FOOTING HEARTN2b.IN. 33j EXTENSION' FIFIEF'LACE"s MIN.FIREBRICK i OPENING O HEIGHT OA HEARTHtSLAB F THICKNESS ' 7 [. F w D HEARTH SCAB ASH DUMP OPTIONAL "': REINFORCEMENT 19 IN.MIN: OLEA OUT GRAB FOOTING IDFOOTING MOTH I—FOOTING WIDTH O BRICK EIRESOX AND CHIMNEY— SE.CTIONAL SIDE MEW,ON WUQD FLOOR ^ 790 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE located at noncombustible material. The minimum required equipped with a ferrous metal damper ) above the top the bearing length on each end of the fireplace opening least eight inches(203 mm shall be four inches(102 mm). The fireplace throat fireplace opening. Dampers shall be installleed in ing the or damper shall be located a minimum of eight and fireplace shall be operable from the troom containing�fireplace, inches(203 mm)above the lintel. the fireplace. 6003.5.1 Damper. Masonry fireplaces shall be 780 CMR TABLE 6003.1 SUMMARY OF REQUIREMENTS FOR MASONRY FIREPLAC ES UIREMENTSEYS ITEM LETTER A 4 Hearth slab thickness - . $"fireplace opening<6 square foot ..Hearth extension B 12"fireplace opening=6 square foot (each side of opening) 16"fireplace opening<6 square foot C , Hearth extension(front of opening) 20"fireplace opening=6 square foot Reinforced to carry its own weight and all Hearth slab reinforcing, D imposed loads. Thickness of wall of firebox E 10"solid brick or 8"where a firebrick lining is used. Joints in firebrick'/a"maximum F 8, Distance from top of opening to throat 6 G 8 Smoke chamber wall thickness Unlined walls Chimney H Currently not required in Massachusetts Vertical reinforcing'(For seismic consideration) ' J Currently not required in Massachusetts Horizontal reinforcing(For seismic consideration) R No specified requirements Bond beams Fireplace lintel L Noncombustible material. Solid masonry units or hollow masonry units M grouted solid with at least 4 inch nominal Chimney walls with flue lining thickness. • iv 8"solid masonry.Walls with unlined flue N See 780 CMR 6001.60. Distances between adjacent flues Ef fective flue area(based on area of fireplace p See 780 CMR 6001,12. opening) Clearances: See 780 CMR 6001.15 and 6003.12. Combustible material R See 780 CMR 6001.13. Mantel and trim ,• 3'at roofline and 2'at 10'. Above roof Anchorage' Strap Number S Currently not required in Massachusetts Embedment into chimney Fasten to. Bolts Footing T 12"min. Thickness 6"each side of fireplace wall. a Width For SI: 1 inch=25.4 mm,1 foot 304.8 nun,1 square foot=0.0929 mZ. NOTE:This table provides CMR Figure major r jorre which shows examples of typical constructiostruction of masonry n.chimneys r a summary of This table not Letter references are to 780 it cover.all aspects of the indicated requirements. .For the actual mandatory cover all requirements, nor does requirements of the code,see the indicated section of text. . a. The letters refer to 780 CMR Figure 6003.1. b. Currently not required in Massachusetts �. .. j 766 780 CMR-Seventh Edition 3/23/07 (Effective 4/l/07) PROJECT NAME: L ADDRESS: PERMIT# PERMIT DATE: I( . MIP' LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered in MAPS program on: 5 Z BY: q/wpfiles/forms/archive TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mapes Pairel - Application Health.Division Date Issued �. opce- DAck Re440"em, Conservation Division � % -wcTlfiN� iK �^''� '. Application Fe Planning Dept. Permit Fee l Date Definitive Plan Approved by Planning Board C5) 6/6,`/2- Historic '- OKH _ Preservation / Hyannis Project Street Address 2-0 MAC-al leeaA Village � V I (2_ Owner lVOe- A-Yhe-S Address 14 V0 1m Cwin t.81. 14do(ai AAA Telephone ,6_66''69_ 0o3£) Permit Request QeknDVe_ 30VII dgA�ct k?4-v K. S�!��r � iv s;�//:'Gy,�. h2-Arq-X4 tz3Y" i't•ltn� fiVit��JJ�rS � f�'Yov�l�' �-P.�tc�.�i.afn Square feet: 1 st floor: existing Ov proposed 2nd floor: existing proposed 94*1'15'Total new Zoning District /fib Flood Plain C Groundwater Overlay /ITT OM Construction T e S F yvewl @. Project Valuation yp , t Lot Size ®• 0Cr'S Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. .' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes N(No On Old King's Highway: ❑Yes YNo Basement Type: ; Full ❑ Crawl ❑/Walkout ❑ Other _ Basement Finished Area (sq.ft. Basement Unfinished Area (sq.ft) Number of Baths: Full: existing t�1 new _ Half: existing new Number of Bedrooms: 3 existing/dnew Total Room Count (not including baths): existing new First Floor lM County Heat Type and Fuel: >(Gas ❑Oil ❑ Electric ❑ Other e. (D Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/boal stote ❑Yes �No 1 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing :U newt size_ B _0 Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: '° ? ,- Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes WNo If yes, site plan review# =Current Use_ _� ,.E: g, Proposed Use S � APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �r �1l/0C2v► Telephone Number s ":2 Address 11- S;f 1 &YVDK P� License # SO Lk , VArGYir11A, Al I 02&&�t- Home Improvement Contractor# f tO0�¢� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �/ji�-� DATE S 2Zho FOR OFFICIAL USE ONLY r _ d ARPLICATION# DATE ISSUED MAP/PARCEL NO. F < ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION 4 FRAME INSULATIONlig Ly FIREPLACE ELECTRICAL: ROUGH FINAL 4 PLUMBING: ROUGH FINAL GAS: :_ ROUGH FINAL f FINAL BUILDING " DAT;E-CLOSED OUT, - ' ASSOCIATION PLAN NO: a r • The Commomvealth ofMassachusetis Depa7ftent oflndustriaiAccidents Office of fnvestpWorrs -600 Washington SYreet Boston,MA.02111 ' N"anass gov/dia Workers' Compensation Iusuran.ce Affidavit:BViiders/Contractors/Mectricians/Plivabers Appficant Information Please Print Lebfy Name(BnsmesdorgmiZationa#�.. Address: / If Yea city/State/Zip: .S t VArr"Ar M* Phone.# 7Z4" Are.you an employer? Check the appropriate bay •4. I am a oral contractor and I F ype of pi•oj ect(requu•e�:; ` 1.[].I am a employer with [] pen • employees(Lan and/or part-tbme)l have hired the sub=cordiactars New coastruc,2.❑ I am a•sole proprietor orpartnor- listed on the attached sheet; . Remodeling ship and have no employees These sub-contractors have 8, ❑Demolition working for me irt any capacity, employees.and have workers' [No wart-ors' camp.insmrance comp...msnrance.#' 9Buil�mg addition required.] 5. We are a corporation and its 10.0 Electrical repairs or adcU= 1.0 0 I am a homeowner doing aII•work offices have exercised their 11:0Plumbing repairs ar addtlions niysel•£ [No workers' cones. right bf eXemptian per MGI, 12.[]Roof repairs mince required_]t c- 152, §1(4),and we have no employees. [No workers' 1.3 ❑ otbar cone.inmira±re required.] *Any applicant fat decks b6x#1 most also fill out the section below showing their wwjmm'compensation policy information.t Hemeewaers who submit runts affidavit indicating they=doing all work and then bin outside contoactms.most submit anew affidavit indicating such. �Contzactors that check this box must attached m additional sheet showing fhe name of the sub�eatnactons and state whether ergot those entities have employees. Ifthe sob coateacina have employees,ihe5'aunstprovidb their work= camp.poficyn®ber. Ian an employer that isprov. . workers'compensation insurance for my'emzployees. Below is thepolicy and job site in•f"ation, Insr rance Company Name: Policy#or Self ins.Lic.#k ExpsationDate: " Job Site Address: Clip/State!Zip: Attach.a copy of the workers' compensation policy declaration gage(showing the policy nmmber and expiration date). Failure,to.secure coverage as mqaired under Section 25A of MGL c• 152 can lead to the imposition of criniihal penal"es.of'a f ne up to$1,500.00 and/or one-pear im7risommen4 as;well as civfl penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of ftrmsdgations of the 1DIA for jnr ira„ce coves e verification I do hereby c under the pains-and penalties of perjury that the information provided above is true and correct S e 222 . Date: Phone# / T — Z ( --------------- Officidd use only.._Do not write in this area, 0 be co lesed mp b3'coy or.town official City or Town: . . PermitUcense# ILssning Auithority(circle one): I.,B.ird of Health 2,Bm'Iding Department 3::Cify/Town Clerk 4.Electrical Inspector S.Plmubing Inspector !i. other Contact Person: Phone#: _._—...... License or registration valid for individul use only: Office`of�as3sumzraffa�r� Bunn al2e u D I 10 n before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Reaulafion Reg Office '6;945 TYPQ 10 Park Plaza-Suite�;l.'13 Expiration: 9 ;bt2t+i2 �Boston.NIA CI211.6 0 _ • L�nclsc`secr¢t�t�� ;Aot valid rvitltout5ignature public '�Jfct� St)ard (it Builtlij3� IZc2aal.atif?ta. and "t.andard, a. r Construction Super.risor License Failure.to possess a current edition of the License- CS 955633 Massachusetts State$uildin;Cade is cause for revocation of this license,. . CHRISTOPHER VINCENT Refer to: WWW.Mass,(;ov/DPS 17 STILL BROOK ROAD SOUTH YA,RMOUTH, MA 02664 - Expiration: 3.-20'20';2 ........................................................... 5JI�D.s3 op "rant-r C ume_^ G„pnstrc�ctrcl�Sa,�&Hen , ._ "fa:�4 61 Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 May 10, 2012 Re: Owners Authorization To Whom It May Concern: I, Caroline C. Ayres, owner of the property at 208 Huckins Neck Road in Centerville, hereby authorize Chris Vincent to act on my behalf in all matters relating to the building permit for the above referenced property. Sincerely, Caroline C. Ayres i Veering Dept. (3rd floor) Map a Sl;L- Parcel t'L1U PJ4 Permit# �{ t House# 'log" .fj, Date Issu d 2 _, Board of Health(3rd oa0or)-(8:15 -9`:30/1:00-4:30) OVe ee 0?-.,; 0PiMmi �..) THE - D 19 SEPTIC S ST BE f, INSTALL • LANCE TOWN OF BARNSTABL viR0N1ME ' ®DE AND Building PermrtApplication TOMMEULATI®NS Project Street Address ).Oq I U e 1-t RSS N eC k RID Clc& y LOT`� �OS Village O�, ' A� , Owner . �.P �;e G- a ixi a C/4?-b OUWI� Address 1976- O SI: W. 84 2ni 2 D Telephone Permit Request T6 noo STP a C T 9 � Qa i—m e?i- O UU h4 t=!< S 1 p-P 0 P h 0 U S-e- -14 First Floor square feet Second Floor square feet Construction Type Q)on D Estimated Project Cost $ $, OQ 40 Zoning District — Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New - Half- Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use 0 6 P Builder Information Name -Roru- l D FN-e czei}c-i 01►x M)II (4m, Telephone Number 5-09 Address f(�q Rym h-e E- �ftwe- License# ti�L 6 A,�l-S 1-'U tU 3 M I i k S MP O?�/,4-8 Home Improvement Contractor# Worker's Compensation#1)C 1 01 1 5 71 -3 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �1�4 YW►O u&IA, 015 SIGNATURE DATE BUILDING PERMIT DENIE THE FOLLOWING REASON(S) 0 c FOR OFFICIAL USE ONLY PERMIT NO. _ DATE ISSUED; F s MAP/PARCE'E?NO. x4'.,.x 1 nt 4 ADDRESS VILLAGE fit, :e.r•io OWNER DATE OF INSPECTION: FOUNDATION _ C�— ® _ FRAME / - - - INSULATION FIREPLACE - 1 i ELECTRICAL: ROUGH FINAL PLUMBING: If6UH FINAL p P d y, GAS: x FINAL a ! rz FINAL BUILDINGnr ¢` , DATE CLOSED OUT ` f y :rr ASSOCIATION PLAIN `' 1 7 . t . 1 1 7' THE r, _ - . ��.{.°. The Town of Barnstable Department of Health Safety and Environmental Services 1619. fog Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 4 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: bt-yr-el wSt1-UC'f16hi Est.Cost Si ,_00. CI Address of Work: LT PuCt-cous R-b Owner's Name P-t-e 1- r4/U 0 r11-y"A�-1 w- W U i+n Date of Permit Application: U..l.t/ A] 1 W7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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. 141A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 0P-3 6�_S_ Date, Contractor Name Registration No. OR nntP Owner's Name It' II/JJIJJUIJIt O : QStiQC IIJtiC -jr' ,— • s- Departlllt'l/t of Il/diarrial Accidents � is +.• ! OfIfCEDI/dYgdl1011S 6111111 ashbir t -a Street 4. Bus/rlr.Alum 02III Workers' Compensation Insurance Afridavit Anrilic:tnt inforntatitin• —" Plc:tse pRI1V'T•le•% j]v 1—ye r,e— 4U location• g 77 m h4e/— t Cin. ffJ-ts`r6Ais Mat fna 41 4;-fr-,�06f Q 1 am a homeowner performing all work myself. ` I'am a sole proprietor and have no one working in any capacity I am an emp lover providing workers* compensation for my employees working an this job. i cnrnn:inc• n:tmc• 1l11� � 1 ! ll /!1 P1ML yin � a 1QA C I l IL its MY7 la 42 1-d� of iwmi-nncr rn. .��'1/S6Lf �� (� ��lin•0 G I am a sole proprietor ^t'neral contractor, r homeowner(circle ant)and have hired the contractors listed beiow who th"Ilowing workers' compensation polices: cmmrinnc• nhnnc- adtirccc� cirt•• _ nhnnc�+• incur-inrr rn nniin•H •t_ vim.•_ - T'T••. �� Jp��:�_'�`�.'f!�-wy�• T��.�. �� ...y..s.�.�.... i cmmnnnv nnmr• aticlrccc• -in•• nhnnc ttr ncurnnee cn - nniin•d lltach additional sheet ifnecesiary. Y.r•• ., -^Ji":v "��•-``��+�s 'uiiure to secure cttvcrace as required un er.-jeetton 3A of 11IGL 152 can to the imposition of criminal penalties of aline up to SIS00.UU antuur nr%cars' imprtnonment ax tt'cil:ts cisii penalties in the forth of a STOP WORK ORDER and a fine ofS100.00 a day against me. t understand that a op} of this statement mac be funvardcd to the Ofrcc of lnvestications of the D1A.for coverage verification. r10 herchr cr f•,,% I/1c p„i,ts ar, pr�ia1des of perjurr Ilia,the i,rfomwrion prodded above is rare and correct ;=turc Date 'rint name f3 l/ l bl &4,eAR Phone f CA I' I official time univ do nat write in this area to be completed by tits or town official ' yin•or town: peentMicense it ►1Iluilding Department ❑Liccusinr hoard L. check if immediate response is required QSeleetmen's Once Qllealth Dcparnacut phone contact perrnn: it: r'101her_� Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' cnmpensatior. an enrpturee is defined as every person in the service iat'arather undc: empicnres. As quoted }rom the contract of hire. express or implied. oral or written. , An empinrer is defined as an individual. partnership, association. corporation or other legal entity. or arn- two tite foregoing, criamu :d in a joint enterprise,and including the legal representatives of a dcceasdd employer. or rcccii•er or trustee of an individual . pannership. association or other legaLentity, employing employees. Ho%% owner of a dwelling house hating not more than three apartments and who resides therein. or the dcc6pant of d��elling house or another who employs persons to do maintenance, construction or repair work on such dweI or oft the „rounds or building appurtenant thereto shall not because of such employment be deemed to be an e: MGL chapter 1�? section :S also states that eti•er• state or local licensing nbency shall withhold the issuanc retteil•:tl of a license or permit to operate a business or to.construct buildings in the commomve:i1th for s applicant who has not produced acceptable evidence of compliance with the insum' nee coverage requiret Additionally. neither the'-commonwealth nor any of its political subdivisions shall enter into any contract for tl: perfornianee of public work until acceptable evidence of compliance with the insurance requirements of this cf. been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situatio supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coterage. Also be sure to sign and daft fire aflidati'it. Ti' affidavit should be returned to the city or town that the application for the permit or license is being requested. not cite Department of Industrial Accidents. Should you have any questions regarding the "law'or if vats are rE to obtain a workers*_compensation policy. please call the Department at the number listed below. City or •Towns Ple_-se be sure that the affidavitis complete and printed legibly. The Department has provided a space at the bo- t}te affidavit for you to J-111 out in the event the Office of Investigations has to contact you regarding the applican be sure to fill in the permit/license number which will be used as a reference number. Tile affidavits may be ret: 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 qt- please do not hesitate to _give us a :11• TleDepartmenr saddress. to}ephone a nd fax. number. � The Commonwealth Of Massachusetts ="' Department of Industrial Accidents _.. Office of Investigations 600 Washington Street Boston,Ma. 02111 fry o• rrt'n 727_7749 +.,r,�.�- _. ... - ^.f'' t'+��-<�tian—a;^.. .%a.�,.., '-rr �'J,;,.4i-,�ry,;i'-r .:y"�'`v�'"LJ`,.'.y'.'ra...i;i.:�w`i-;jra-i�,..r....•�...,. Assessor's map and lot. number 2 ..... 4wage Permit number ............... .. AFT"Er°� TOWN OF BARNSTABLE 1 BASBSTADLE. M p 1639- �e0� '� DUILDING INSPECTOR 0 MAR 0r' ..1 f APPLICATION FOR PERMIT TO ... 1 ........ .... #qzj.... ........................................... TYPE OF CONSTRUCTION IWO 010 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location /,, � / Cl�' C,�J . ..... !?I/a,c� ' �+'.........� ...................................................... • Proposed Use ..........~7—). s_1;AAI "........................... ................................................................................................. Zoning District .......j&!:!. ...............................................Fire District P_'�'X'7,,C;V— �l� ,r5 Name of Owner ....../ A ... .rt ...�G ..........Address Nameof Builder ....................................................................Address .................................................................................... Name of Architect �C',,.!�Sl �1!�PX?05e,e ......Address .......... / �' .��'r� ./WSP� . ........... ......................... Number of Rooms dt) 137Foundation C +4/�..................................... .. ,..... � :....................................... Exterior ............:,;,!,� .................�..��..�..�r...�...�...��..�.Roofing ......................,............. ........................................... Floors �'�'`J, ........................................Interior 4/— .. .............................................................. Heating l., y„ Plumbing 1Tf, s ......................................... .........:................................................ Fireplace J !5F ............................................Approximate Cost ...... C3.,dd.�.....................................:.. ri Definitive Plan Approved by Planning Board '' _________19 jter . Area .................. ....,,.$�.�............... Diagram of Lot and Building with Dimensions Fee .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH7y'?� t - 4/ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name :.... ........... -- f ffl Holly Development Corp. A=Zti 2-140 19100 two story No ................. Permit for .................................... single family dwelling D�Huckins Neck Road Locotio ............................................................... Centerville .................... .t......................... Holly Development Corp. Owner .................................. ............................... - Type of Construction ..............frame............................ 7 'Plot ...............................Lot ..).....#105............... June`15 77 {Permit Granted ........................19 Date of Inspection...................................19 Date Complete' ......................................19 PERMIT REFUSED ................................................................ 19 ..:. ................... ! ... % :... f ................................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessors map and lot. n .......................................•.�-o' v ®��-4 �• J � _ SEPTIC SYSTEM � _ • . � � INSTALLED IN .MUST SE :+ wage Permit number ................ WITH ARTICLE IL COMPLIANCE STATE R► o�THE roe TOWN O F • B A R 99t7Ty;&c ,%A1E T®wN i BASBSTADLE i r 9 MAS&c') ' G ry �p i639. .9� B �ILD1N �� INSPECTOR U . ! APPLICATION FOR PERMIT TO ... ...................................................../LD . 1......1....F....................................... y TYPE OF CONSTRUCTION W„D 0,'r.�.....��............................................................................................... '; ................... ....�—�........:.....19..��/.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .......144..�......r>r? '•........: � .r ta�/�5°..... C-A.......... ......................................................... • Location .... ProposedUse .......... ........................... ............................................................................. ................ Zoning District ....... . �.�...............................................Fire District ........ 7A!41 eee.1 .......... ....................... Name of Owner ..........Address ... ......I.�c..l��i.l 7-1. Nameof Builder ....................................................................Address .....:..................................................:............................ Name of Architect .<:d4 ..... /`�1 � .......Address ........../ -tyr.� ..e u�l..r..................... 317 Number of Rooms ............. ....... 1` oundation .......c C. .4. .................... . ............. Exlerior 6.1d ......Roofing •.......... ,,f��/4 s�L Floors �' ! ...... :.....Interior .......... / ,?91+--........................................... Heating /r.. ...............................................Plumbing ..................... ...r { .mil .a .............................. Fireplace ...................... F............................................Approximate Cost .......:. a�........ ............................... ...r... Definitive Plan Approved by Planning Board ----------F'45-&---------19-�O. Area .....................................-. Diagram of Lot and Building with Dimensions Fee /i7•0 SUBJECT TO APPROVAL OF BOARD OF HEALTH 2, . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... .. ............ Holly Development Corp. two story No ....:............ Permit for .................................... "• - §ingle ,family dwelling , .. Z07• 'Huckins Neck •Road................. -" - Location Centerville ........... ... ................. Owner ........Holly.............................................. Development T e of Construction frame ...y ......... YP t ............ ...................................................... r Plot ................ .... .. Lot .............#.105.......... r Permit Granted :.. June 15 77 t .f19 Date of.Inspection / ' Date Completed ... 6....... ....'. �:.19 a li. 'PERMIT REFUSED +} - ........ ......`. ................. .............. 19 ................................................. ...... ................... ' J. f ............................. ...............................................- - ti ..........................: :A Approved ..... 19 j ............................................................... ....... 1 - , ,• _ T. ........................................................... '.• t/ r . ' f `h A i I $4 i I ' i • � � r I i I' i2'f p I R 6o'a-• �d �-� i f I os �577 ��i�SniArr \•�f fd'r�e� R A :S'I- -I-,La ,alva vrJ'. =7nnaayHa7� _-- L.:. dl'h�f-�Jac'Soy -•.� ! bW�13DG 4F1YCW�brc' O ,t�,,��1 '•31dJro . 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