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Home My WebLink About0042 JAMES OTIS ROAD �12 � �5 �iS � �D . � � � � a :� . � 0 � . ... JJJ a �. � ,. ,.. .. � -. o.. G � .. .� '� - n. .. i Ito Lot 266 REFERENCES: Tr Wt- Usse neftgip: 171 Parcel: 219 : lct1 o _ 66191 L 39:2� R=25.00 ZONE: RC 4=90°00'00" Ton=2=5-OG=- ,-. Setbacks: M-1 ISION ont: 25' Side: 10' Rear: 10' O O/ Lot 170 Lot 265 Q0Op O �S O L=39.27 Lot 264 /rote R=25.00 O 6=90°019'00" �oyJ •�� -i1 Tan=25.00\34.4' Q 2O, 290, Y 4� Lot 614 i 15,783t SF \ oSP�'P�f S 6 `L ' \ p� J:� 43.9' (Y (0 # 42 Lot 615 1 s ty w/f /- Dwelling 35.7' ,^�V 1 sty w/f J Lot 613 �� 25.6' Shed 10.0' .0 r,,o-los F c�/F S62 J,Q2 , Rol 76, 1 11.6' y a cs bps I certify that the structures shown hereon conform to RICHARD'R• m the setback requirements of L'HEUREUX the Zoning Bylaws of the PLOT PLAN 140. 34312 town of Barnstable., At 42 James Otis Road �B ,a BARNSTABLE rofe i I Land Survey r Da e (Centerville) NOTES: MASS, DATE: 08/MAR110 SCALE: 1"=30' 1.) The structures shown were located on the ground 0 15 30 45 60 FEET by conventional survey methods on 04/MAR/10 and 08/MAR/10. PREPARED FOR: John H& Cathy M Wright 2.) The property line information shown hereon was 134 Monomoy Circle compiled from available record information. Centerville MA 02.632 3.) This plan is not for recording and isnot, to be PREPARED BY: CapeSury used for construction layout or deed description purposes. 7 Parker Road Osterville MA 02655 DWG #: C583_3g1 FIELD BY. , RRL/MLL (508) 420-3994 / 420-3995fox T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map i Parcel Z Application # Health Division Date Issued Conservation Division�'� Application Fee Planning Dept. Permit Fee oz Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation/ Hyannis Project Street Address q _2 Village C F_/,J +a P,y,,w i-L F_ M�q Owner CC -J C—k WR e? ,'`7- Address Telephone S0 8 - L1 2 0 - _7/ 5 Permit Request -D E M O F �;S - i CAP, rL -N new Z_- :zdp�C.s; Square feet: 1 st floor: existing proposed 2nd floor: existing ----- proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Ica r s o Construction Type VA®O c4. Lot Size P-PP:zox- Zz,. (9a o Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family & Two Family ❑ Multi-Family (# units) Age of Existing Structure 30 1 QS Historic House: ❑Yes S No On Old King's Highway: ❑Yes 'U No Basement Type: a Full A Crawl ❑Walkout ❑Other SiA 3 - SC_LL4�, Ne'C" Basement Finished Area(sq.ft.) CJ Basement Unfinished Area(sq.ft) i 60© Number of Baths: Full: existing_ Z new 0 Half: existing new Number of Bedrooms: existing =new Total Room Count (not including baths): existing _�_new� First Floor Room Count Heat Type and Fuel: W Gas ❑ Oil ❑ Electric ❑ Other D� Central Air: aYes ❑ 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: Xexisting 4'new size _Shed: existing ❑ new size _ Other: ••:� C7� N Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ toCD •, = 7 \ J a Commercial Yes �No If yes, site plan review# ❑ , Current Use +Ac�iAS_ . Proposed Use G APPLICANT INFORMATION- (BUILDER OR HOMEOWNER) Name 2.�2. G©`��,c �r Telephone Number ST96-_5Zt - Lf-7LkL( Address f`l 0 W,\\A Y License # C.- S 060 16 0 ��e :-J �. ✓y 0"2-6 3Z- Home Improvement Contractor# P? 2 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE , J ' 2-p -2— FOR OFFICIAL USE ONLY -y ` APPLICATION# DACE ISSUED 4 MAP/PARCEL NO. ADDRESS VILLAGE i OWNER g F DATE OF INSPECTION: FOUNDATIONS FRAME . G ��18 ,Z ►Z INSULATION �%l l j FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS:. - ROUGH FINAL ;FINAL BUILDING x ti DATE CLOSED'OUT r ASSOCIATION",PLAN-NO. t �rtJ'HE Town of Barnstable Regulatory Services • BAtursrABLE Thomas F. Geller, Director MA55. $AjEibJy. Building IDivisio.n Thomas Perry, CB0,Building Commissioner 200 Main Street,'Hyanals,MA 02601 wwwaown,.barnstahle:ma.ns - ' 0ffice: 508-862.4038 Fax: 508-790-6230 PLAN REVIEW Owner: Map/Pai el: /W .2/9 Project Address 44LT MES VZ-b Bu lder:ROBEir )4APRI s The following items were noted on reviewing: FO ko b ATE o,z a riLY LS s ueb' PM,►Nl-S N E Eb F G L� 4z1 .S (S 14609 tI)A-urS lArrJc a 2 ; ,n LT SPA G : ETrz,'� { Reviewed bY: . Date: 7A/ - The Commonwealth ofhlassachusetty Deparhr &of lndustrial Accidents D,fwe of-Investigations - 600 Washington,ireet . Boston,MA 02II1 www.mass guv/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A &cant Information Please Print Legibly Name (Bnsiness/Ozga on/Individ : r2 y-tz CO yts t/✓ Address: 1/6fr1 Y -: ,ye D z6 City/State/Zip: #. Phone _ ®U' C L(-7(44 Are you an employer? Check the appropriate box. Lk I am a e�loyer with 4. []I am a general contractor and I Type of project(required): , employees(fim and/or part-tone).* have hared the sub-contractors 6• El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. L odeling ship and have no employees These sub-contractors have olifion working for me.in any capacity. employees and have.workers' [No workers'comp.insurance comp.fimura Ce# ding addition .regtured] 5. [] We are a corporation and its trical repairs or additions 3.❑J am a homeowner doing aR work officers have exercised theirbinmyself [No workers' co t of ex g reP or additions mp. righ emp�on per MGI, r• msuranee required]t c. 152, §1(4),and'we have no ' *employees.{No workers' ooIM.insurance required.] *AsY applicsat tbat checks box#I must also M out the section below showing.theff workers'compemation policy information. t Hz mcowners who submit this afGdavit mtiicabng they=doing an work and thm hire outside contractors mast submit a new afndavit indicating such $canhac[ms that check this box must attached an additional sheet showing the name of the sub co emplaycrs, If the sub-contract=have I 'tors and state whether or not those entities have oY�s they mast provide their workers'comp.policy number. I am an employer that is providing workers'coierpensatinn insurance for my errcployees. Below is the po&cy ar�d job site informadon. Insurance Company Name: �' C•Ae_ -2:Z"7� .�$ Policy#or Self-ins.Lic.A 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). F Fail=to secure coverage as required under Section 25A of MGL c. 152 can lead to the' osition:of crimaial fine up to$1,500.00 and/or one-year impiiso penalties of a of up to$250.00 a der maent,as well as civil penalties in the farm of a STOP WORK ORDER and a fine y against the violator. Be advised that a copy of this statement may be forwarded to.the Office of Investigations of the DIA for incuance coverage verification. Ido hereby certify under thepaim andpenal6es ofperjwy that the infornzafianprovided above is true and correct Si Date: Phone ------------ Edo only. Do not write in this err*to'be completed by city or town offzciaL n: Permitlhicease# ority`(circle one):Health 2.Build�g Department 3. Cifp/Town Clerk 4.lKllectrical Inspector 5.Plwml k Inspectorson:. Phone`#: j Apr. 30.. 2012 3: 51PM Lovelette Insurance Agency No 1326 P, 1 DATE IMMIODIYYYT) RV CERTIFICATE OF LIABILITY INSURANCE 4/30/2012 HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE':A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE.CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 1f SUBROGATION 18 WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on.this certificate does not confer rights to the certificate holder In lieu of such endorsement s CONTACT Timothy LOvelatt e PRODUCER N FAX Marshall K LoveXette Insurance Agency Inc. PHONE 508)775-4559 (50e)71S-4577 396 Main Street wig Fxti timothxOlovelettei(ne.com P.O. Box 836 INSURER$ AFFORDING COVERAGE NAIC 8 West Yarmouth MA 02673 INSURER AAEYC 006 INSURED INSURER B: R 6 R Construction Custom Homes Inc INSURER C 90 Nye Road INSURER o INSU ERE: Centerville . MA 02632 INSURERF: COVERAGES CERTIFICATE NUMSER:CL1243000990 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. 3 SR POLICY EFF POLICY EXY LIMITS L TYPE OF INSURANC19 BR P CY NUMBER GENERAL LIABILITY - - EACH OCCURRENCE S . RENTEDDAMAGE T5 COMMERCIAL GENERAL LIABILITY PR Ea S CLAIMS-MADE E OCCUR MED EXP Any one ereon $ PERSONAL 9 ADV INJURY GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: 9RODUGTS-COMPfOP AGO $ POLICY PR - LOCS COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY rddent i BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SGHEDULED BODILY INJURY(Per vwAant) $ AUTOS AUTOS ' DAMAGE( 0 TY PER NON-OWNED � ,.. t .; Per aeeW $ HIRED AUTOS AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION ORXtwS WC STATU- OTh�- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YEN E.L.EACM ,IDENT 9$ 5OO 000 OFFICERIMEMBEREXCLUDED7 NIA C5003799012011 1/29/2011 1/29/2012 ELDISE1� 'EAEMPLOYeE 500,000 (Mandatory in NH) If re,Gvs«Ibe under E.L DISEASE i?POLICY LIMIT" $00 000 DESCRIPTION OF OPERAYIONS below L y .. # DESCRIPTION OF OPERATIONS!LOCATIONS t VEHICLES(Allaeh ACORD 141,Additional Remark■Sehedule,R moro space le required) 1 Z= CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIESSF CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE :DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Department AUTHORIZED REPRESENTATNE 367 South Street Hyannis, MA 02601 John Mc3hera/JOIiN � "`" ACORD 26(2010105) ®1988-2010 ACORD CORPORATION. All rights reserved. INS025(2o1oos).ol The ACORD name and logo are registered marks of ACORD . I , z A PVC Grcirle 10 61 oorl Con u str• ctiorr iinHr l� Wind,dreas.•�1 rrcP 10 !r 1Virrd Zor e Massachusetts Checklist for Compliance (780 CAIR5301.2.1.1)1 Check Compliance 1.1 SCOPE Wind Speed(3-sec. gust).. 110 mph Wind Exposure Category....................................... ........................................................ ............................B r/ Wind Exposure Category................Engineering Required For Entire Project.......:...............................C 1.2 APPLICABILITY 'Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) stories 5 2 stories RoofPitch...........................................................................(Fig 2) .......:.................................... <_12:12 Mean Roof Height ............ .(Fig 2)............................................... 1` ft <'33' - Building Width,W . ............ ......... .(Fig 3)............ ....: ......... ft 80 - Building Length, L ...............................................................(Fig 3)............................................... ........... ......... ......._.........�:ft _<s 80' 7/ Building Aspect Ratio(L/W) ...............................................(Fig 4)........................ .3V' :5 3:.1 t/ Nominal Height of Tallest Opening2 ........ ................... ....(Fig 4).............................. ....... 1.3 FRAMING CONNECTIONS / General compliance with framing connections....................(Table 2)............................................................... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete.......................................................................................... ...........:....................... t� Concrete Masonry ................................................ ............................................................... 2.2 ANCHORAGE TO FOUNDATION'-' 5/8"Anchor Bolts-imbedded or 5/8"Proprietary Mechanical Anchors as an altemative in concrete only Bolt Spacing—general ....................................... (Table 4)................................................ 3 j�, in. 1/ Bolt Spacing from endrJoint of plate................:............(Fig 5)..................................... in.:5 6"—12". E/ Bolt Embedment—concrete................................ ............................. 1_2-in. >_7...._....(Fig 5)...................� �/. Bolt Embedment—masonry.........................................(Fig 5).............i............................... in.2 15" . PlateWasher................................................................(Fig 5),.............................................>_3"x 3'x'/4" '. 3.1 FLOORS Floor-framing member spans checked ............::.............:...(per 780 CMR Chapter 55 ................................... Maximum Floor Opening Dimension...................................(Fig 6 ............ .......................... `, ft:5 12' Full hleight Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)..............:.. i �!..........:... y Maximum Floor Joist Setbacks Supporting Loadbearing Wail• or Shearwall................(Fig 7).............,......................................_ft s d ,--- Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8)..................................................... ft 5 d --- FloorBracing at Endwalls.............................................:......(Fig 9).................................................................... Floor She Type ......................................................:.(per 780 CMR Chapter 55)................ 1+�..:...:.... 4-1 . Floor Sheathing Thickness ..................................................(per 780 CMR Chapter 55)......................iWin. 1� Floor Sheathing Fastening..:.::.:...............:..............:.:.....:...(Table 2).. d nails at_min edge/ J,in field 4.1 WALLS Wall Height Loadbearing walls..........................................................(Fig 10 and Table 5)...........................6 ft <_10' 1/ Non-Loadbearing walls.................................................(Fig 10 and Table 5)...... ..............eft s 20' t/ Wall Stud Spacing ...........................................................(Fig 10 and Table 5 .... n.s 24"o.c.. . Wall Story Offsets .............: :..(Figs 7&8)............................................ ft s d / 4.2 EXTERIOR•WALLS'. Wood Studs ,` Loadbearing walls (Table } 2x - ft ."I.in. ........ ..... Non-Loadbearing walls ......(Table 5).. .....2xx- ft Gable End Wall Bracing Full Height Endwall Studs............................................(Fig 10)..................................... WSP-Attic Floor Length.................................................(Fig 11)....................I......................:... ft zW/3, Gypsum Ceiling Length(if WSP not used)....:..............(Fig 11)............... .......................... ft z 0.9W and 2 x 4 Continuous Lateral Brace @ 6 ft..o.c. .. (Fig 11)........................................... ,.:.. or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 X spacing in end joist or truss.bays Double Top Plate Splice Length ... ........ ......... ...:......:.....(Fig 13 and Table 6) ...... ft.... ..... . Fl; Snlir-P r nnnrarrtinn Inn of 1Firi rnmmnn nailel �'ITahla AH,17 Guide to 1Yood Construction ht High 11,71id Areas: 110 riiph 1Yind Z01fe Massachusetts Checklist for Compliance (7s0 ci,-1R5301.2.1.1)' Loadbearing Wall Connections Lateral(no.of 16d common nails)................... (Tables 7)............ Yry�S Non-Loadbearing Wall Connections Lateral(no.of 16d common nails)................................(Table 8)....................................................... Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans .............. .....................................(Table9).......................•......•---- �1 ft in.511' +/ Sill Plate Spans ........................................................(Table 9)..................................�i ft in.5 1 V Full Height Studs (no.of studs)....................................(Table 9)....................................,.................. - . Non-Load Bearing Wall Openings(record largest opening but check all openings for compli rice to Table 9) Header Spans......:.......................................................(Table 9).................................. 5�'ft_in.5 12' .. SillPlate Spans......................:....................................(Table 9)................................... ft in.5 12" Full Height Studs (no.of studs)....................................(Table 9)................................I........................ Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W Nominal Height of Tallest Opening2 ................................. .........[i s 6'8' J� Sheathing Type..............................................(note 4) .............................. _'lz Edge Nail Spacing.........................................(Table 10 or note 4 if less)......................... S in. Field Nail Spacing...........................:..............(Table 10).................................................. in. Shear Connection(no.of 16d common nails)(Table 10)............:....:.....:...._...........:.:...:........_ Percent Full-Height Sheathing...:...................(Table 10).....,.:..................:.................... .....�% 5%Additional Sheathing for Wall with Opening>6'8'(Design Concepts).................... Maximum Building Dimension, L Nominal Height of Tallest Opening2...............................:.......................................(o�Y!_<6V Sheathing Type.........................:....................(note 4)..................................................... 4' Edge Nail Spacing............................1.............(Table 11 or note 4 if less)........................ ' in. Field Nail Spacing...........................................(Table-11).................................................. in. Shear Connection(no.of 16d common nails)(Table 11)....................................................... L.- Percent Full-Height Sheathing......:................(Table 11)............................................_......to % t/ 5%Additional Sheathing for Wall with'Opening> 6'8"(Design Concepts).................... Wall Cladding , J Rated for Wind Speed?...................................... ............. ...... . ........ .°.?1'�` ).l ............ . 5.1 ROOFS Roof framing member spans checked?........................(For Rafters use AWC Span Tool,see BBRS Website) Roof Overhang ...................................................(Figure 19).............` ft s smaller of 2'or V3 �- Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift............................. •--...........(Table 12) ..... U '3plf Lateral.............................................(Table 12) ••--•-•. --_: ..................L I_[,plf —� Shear..............I........ ..(Table 12)............................ ..........S==plf. Ridge Strap Connections, if collar ties not used per page 21... (Table 13)...............................T= pif Gable Rake Outlooker...........................................(Figure 20) ............. ft s smaller of 2'or U2 ' Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift...... .................... .. .................U=HI�Ib. --.✓ U (Table 14)..- Lateral(no.of 16d common nails)...(Table 14)............................. .........L=.!_� �1b. Roof Sheathing Type...................................................(per 780 CMR Chapters 58'and 59) .Gfl.4�.., pl Roof Sheathing Thickness................: .j r....................:.....: .....::................................... in._>7116'WSP7 Roof Sheathing Fastening.. .................... 2).:.. t/ Notes: .. .�......... 1. - This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the requirements of .780 CMR•5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required.perthe WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Comer Stud Hold Downs,per Figure 18a.and Figure 18b 2. Exception:Opening heights of up to 8 fL shall be permitted when 5% is added'to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. Town of Barnstable Regulatory Services • sexivsresr.�, • _ . MASS g Thomas F.Geile'i,Director 1639. t� o ` Building Division Tom Perry,Building Commissioner . 200 Main Street,Hyanais,'MA 02601 www.town.barnstable.maxs e Office: 508-862-4038 .Fax:.508-790-6230_.. . Property Owner`Must Complete and Sign This Section If Using A Builder L I, as Owner of tie subject property hereby auth e to.act on my behalf; in an'=tters relative to work authorized'by this.buildingpermit (Address of Job) _ x Pool fences and alarms are the responsibility of the'applicant. Pools are not:to be filled.before fence is installed and pools are not to be utilized until all final inspections are ' and-aecepted. On SlgnatIIr O Own Si gnat e'of Applicant Print Name / Rdnt Name D tef QFORMS:OWNERPERMISSIONPOOLS: 1HE r � Town of Barnstable -�� Regulatory Services BAx STA33M Thomas F.Geiler,Director MASS. 16yg. �� Building Division ArED BM'1 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 >a t 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 bn 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 i 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 EXEMPTIONtt ', 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�Tilicensed personas 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 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR- QUALITY ORIGINAL (S) IMFA- F DA T � on I--� THE COMMONWEALTH OF MASSACHUSETTS Registration: CD 0 Office of Consumer Affairs and Business Regulation f. o Home Improvement Contractor Registration Program O7 Z 10 Park Plaza,Suite 5170 Expiration: �� CDDO _ o Boston,MA 02116 Received: t` co D co D APPLICATION FOR RENEWAL OF REGISTRATION CD OME IMPROVEMENT CONTRACTOR OR SUBCONTRACTOR om - 3o'mZ mr0 1 oZ,� MGL Chapter 142A, 780 CMR R6 W >"y (PLEASE READ INSTRUCTIONS CAREFULLY) z -" o n cant as on Current Registration: 3 i2�b�_fi g o ° 0 $ m ? Applicant(if different from that used with current registration): / I,-, % KEEP A Copy OF THIS STUB j FOR YOUR RECORDS/ MANTENGA UNA COPIA DE ESTE RECIBO PARA SUS ARCHIVOS -"- �� Ipplicant(if different from address on current registration): RECE R1 �lo �� 2 � MAY 02�`2012 .4. No.of Employees: 0 #4 OFFICE OF CONSUMER AFFAIRS 5. If Applicant is a Partnership,Corporation or Trust,state the name of the individual responsible for Applicant's work: First Middle Last Telephone No: 6. Does the Applicant hold any other construction-related,state,city or town licenses or registrations? XYes No Construction i Expires: l LA, Supervisor License: E�57_ {l9 Motor Vehicle Repair Expires: Shop: 7. Is the Applicant claiming exemption from the registration fee?(Please see instructions) D Yes No 8. Registration Renewal Fee"enclosed:S ©O E. Make all certified checks or money orders payable to. "Commonwealth of Massachusetts." ONLY CERTIFIED CHECKS OR MONEY ORDERS WILL BE ACCEPTED Pursuant.to Massachusetts General Laws.Chapter 0C§49A,I certify under the penalties of perjury that,to the best of my knowledge and belief,I have filed all state tax.returns and paid all state taxes required under law. Signature of Applicant Title held with applicant Date A FALSE ANSWER TO ANY QUESTION IN THIS APPLICATION CONSTITUTES GROUNDS FOR SUSPENSION OR REVOCATION OF THE APPLICANT'S REGISTRATION. i Massachusetts -Department of Public Safety. I Board of Building Regulations and Standards jCunstructiun Suivnisur j License: CS-060160 ROBERTJHAI&IS n r- 90 NYE RD A �? CENTER%LE �0263 Commissioner Expiration 05/09/2014 Lot 266 REFERENCES: Assessors Map: 171 Parcel: 219 L=39.27 Plan Book 386/91 R=25.00 ZONE: RC A=90°00'00" Tan=25.00 Setbacks: Front: 25' Side: 10' Rear: 10' O O/ Lot 170 y`30 Lot 265 � O '00 Lot 264 L=39.27 �o R=25.00 P iy 0a d=90°00'00" Tan=25.00,,34.4' 92 Y Q` Lot 614 P°l i 15,783±SF \ Pam'"ter 6 °O �° 43.9' A � # 42 Lot 615 1V V., 1 sty w/f Dwelling A/ 35.7' •'� 1 sty w/f Lot 613 �� 25.6' Shed 10.0, 0S' Tho�OS 5621)� ? 1- I certify that the structures shown hereon conform to the setback requirements of the Zoning Bylaws of the PLOT PLAN town of Barnstable. At 42 James Otis Road BARNSTABLE Professional Land Surveyor Date (Centerville) NOTES: MASS. DATE: 08/MAR110 SCALE: 1"-30' 1.) The structures shown were located on the ground 0 15 30 45 60 FEET by conventional survey methods on 04/MAR/10 and 08/MAR/10. PREPARED FOR: John H & Cathy M Wright 2.) The property line information shown hereon was 134 Monomoy Circle compiled from available record information. Centerville MA 02632 , 3.) This plan is not for recording and is not to be PREPARED BY: used for construction layout or deed description CapeSury purposes. 7 Porker Road Osterville MA 02655 DWG #: C583-3gl FIELD BY. RRL/MLL (508) 420-3994 / 420-3995fox I 08/12/2012 11:32 5087785731 CAPE COD INSULATION PAGE 01 CAPE COD INSULATION " nfROt�a fMflfNf sl�rrw� wvwem - r. wrflll! nnWAilOr ClRnaf - 1-800-696-6611 Job Location—'- JPi n .S 0411% Builder Info g D N c C �� Y p; comW4 P4me 0 e A mber Date HEAT"tz" 08 SPRI4Y POLYl1gESHaNF,FDAP1O � Y! 14v- Y=200 ApplicMr N,)me Appliateer 51R�a W fe installedInsulationStatement Locatiowof insulat ors' _. Thidwass Total R=Va1we'per ESR 3210 ApproWma��te Sq.Ft. Walls Attic Cathedral Ceiling . IrdurnescentCaadng used Thickness/Caverage Rate R-Value=7.4 @ 1" Tensile Strength=45.4 psi Density=2.1 Ib/ft3 Compressive Strength=20.6 psi Dernllee Batch# p 08/12/2012 11:32 5087785731 CAPE COD INSULATION PAGE 02 y' CAPE COD INSULATION nlR�S lNM/U 11tlO1A710M ry®IM 1-800-696-6611 Job Location Z jper%e,5 0+15 Builder Info UIL G fjc.. `tQ Ny f. . - a1j 03-0&21 0Ayo-anbalanc6 Go -,Name P u Spray Foam Insulation Applicatpr Name. Applicator Signature installedzjh Location of Insulation Thickness Total R-Value per ESR 2600 Approximate Sq.Ft. Walls Attic Cathedral CeilingC1 U Inturnescent Coating Used Location Thickness/Coverage Rate R-Value=4.45 @ 1" Tensile Strength=3.87 psi ! Density-0.6-0.8 Ib/ft3 Compressive Strength=1.86 psi Demilet Batch# �. ac5U /ob f yyOF,HE r, Town of Barnstable r7 O� BARNSTABLE. • Regulatory Services 9 MASS. t639• ♦0 Building Division A�FD MPS� 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Inspection Correction Notice I Type of Inspection F A r— Location It ,? ,�A the 5 (T-\a 5 Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: Q u7-5 t>E M FA � /�. IQ5�- `f N0 f�L0CK3c. G AS P,FQui E�k ``� 1��:,y i i lk ►ur.�s 0ST S.E7A LE'6 7 E N P[.—z 12 D � ,/v - v� yd3�/ Please call: 508-862-4038 for re-inspection. Inspected by Date 7,L>h'd �V r 02/06/2010 09:56 508-790-4686 PAGE 04/04 TAYLOR DESIGN ASSOC., INC. SHEET NO. P.O. Box 1313 t B - -- — e6 CALCULATED DA } f Forestdale, MA 02644 T�II Tel./fax: (508) 790-4685 CHECKEDBY DATA Z. -i 5 SCALE II : , , , , I, i I 1 , i s I I 1 t �.... t ( - J.._._. -........... -' --'-'- i I ; 11 Lj ..._......__•-__.....T.._........._.._'-"'Y._.........+_._.....:_.._..__._._..__{...........i._..... .. .(....._...i�...jl�c ._.. __.j..� ..... .... .._ .� ...,¢...._....rl...r.,._ i r r i , ��.ff • it i a 7: 1 ! 1 ; i 1 ; Q , ( ; i I �,ne� 7 • V .> s.�p : i S,..i� \R!!:.L�..I.�...........i.........1� ....T.... _I.1—I rw....�• t..�._ if -_._.. . ►r-�.._..__ i 1 , Lc 1• I ) 1 �- 1. , f , ._..:.._:......_...:_._........._.......i..._...-!.._....._.:........... ._...._. ..._ _ _ ......i.__._i_ .. ........ _..._ ___ I ... .... ......... .._ _.... �.,� ,.._ ._�.. 1? ! ! : ko 4► 4�?b .,,.........+...........:.........._L.......__S_........:.........Y..__......_..._.y'..........F._..__..i.._.........:...........5._._..__:......... _...._._.e._........L.._.......?.....................t............:..._..................f....._.:..j...... -._ ..__ —•• - -._ -_.. _ ._.._ �•r• . 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SHEET NO. l _ oK PA. Box 1313 �'�' Forestda(e, MA 026" CALCULATED e f �.�T _ pA� Tel./Fax: (508) 790-4686 CHECKED BYOF o Ak SCALE i : : i i , : _._._ % 1 . .... _ _ _.._ _ ..- ,._ __.._— _...._ _... _._ __....._ ...._ _._. ... .-, _.. .. __._ ; ; 1� ta._..., ,, ...__ ....7._.._...._: ems.Tt 1 , I , I - ; : , , ...act. . rQ �. _._ , i i 1 1 , 9 i ' ; ; ,.04 . i , : i i" , , f : I i i i i I 1 i :....__....._........:...........__.._.,. .:: ' ...--..._...._b...._...;._.._.._.a.......... �........:i._....._ ._... _� ..._....T......... - -_...;-..._.._.:.......................p_:._..__.:......_.....1......._;........-,.;....:....._...__..;_.__...... I i ._._. �._._v. .,..,.w,-+^'--_.__........y._._._....• .._..._...•«...__._� .. _. _.i_...._....:_.,..:.. _ .... ..__..J..._._....'.....................:..._.......'}, 1 ' i ji , : cw ._........ .......::.........b._....._..e._._.._.. ±•--...... ..........• ` E ii._.... �.._..._..._..._..,. _ .._...�_._.._.. 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Boa— kSHEET NO. S '+ P.O. Box 1313 of FORESTDALE, MA 02644 CALCULATED BY CT Y DATE_ TEL./FAX: (508) 790-4686 �® — t _ CHECKED BY DATE BEAM 4 STRAP ...........a..__...._.......... ....'.............. . —.. .__...._..._..._.__<............ ._...._....__...._.._........ LSTA 0 EA. AFTER 2 % R END . F_.... ..._._..._:........... DISTANCE --........ _..._.._....._._...- --...___.._. .... _..... . o o• � 0 0 .._........`._._........_..._..._..._.. i o � ......._....----- o L ......_....>_......_...,.._.._.....�.._.._.....;..._._._._---._;.._...... � RIDGE BEAM NOTE: -- - .._.._......_........_......_.... RIDGE STRAPS ARE NOT T PS REQUIRED WHEN COLLAR TIES OF .. ........: ..._.. :. NOMINAL Ix6 OR 2x4 LUMBER E LOCATED IN THE UPPER _........... ....................... .... THIRD OF T ATTIC SPACE AND . ATTACHED TO.RAFTERS USING o..._.._...-......_............s........................ NAILS Od_...-- ) H END 5 I L5 F.AC RIDGE S A D STRAP ........._. CALE N.T.S. .._.........__....._..............-0......_----------- RAFTER 0 16" O.G. 00o H2.5 @ EA. RAFTER ... :_... ..---...._.._............ ;..... ....... _...__._.__.. o -- TOP PLATE .._........_._..-.. .. .......... O ........._..._..__..._....... .:...._. _............................._......... .._ RAFTER TO PLATE CONNECTION SCALE: N.T.S. _....... v�oucrat�i s��i(�nae� Lot 266 REFERENCES: Assessors Mop: . 171 Parcel: 219 � L=39.27 Plan Book 386191 R=25.00 ZONE: RC A=90°00'00" Tan=25.00 Setbacks: Front: 20' Side: 10' Rear: 10' O OIa Lot 170 0 Lot 265 O �50, a Lot 264 L=39.27 �o P R=25.00 iy O 0 Tan=25.00 7 37.4' Cps Lot 615 # 42 1 Dwelling NEW Concrete Foundation " / 35.7' ^^� Lot 614 1, 15,783t SF 1 sty w/f Lot 613 �� 25.6' Shed 10.0' (off .0 �lot - Tha�os F� � S62 R�! 16, 11.6' Y 10 OF 04s 'icy` I certify that the structures shown hereon conform to RICHARDR. 4,04 the setback requirements of L'HEUREUX the Zoning Bylaws of the PLOT PLAN NO. 34312 o town of Barnstable. At42_James Otis Road BARNSTABLE ILZ(Cente . NOTES: MASS, DATE: 24/MAY112 SCALE: 1"=30' 1.) The structures shown were located on the ground 0 15 30 1 45 60 FEET by conventional survey methods on 04/MAR/10 and 23/MAY/12. PREPARED FOR: John H & Cathy M Wright 2.) The property line information shown hereon was 134 Monomoy Circle compiled from available record information. Centerville MA 02632 3.) This plan is not for recording and is not to be PREPARED BY: CapeSury used for construction layout or deed description purposes. 7 Parker Road Osterville MA 02655 DWG #: C583_3g1 FIELD BY. RRL/MLL (508) 420-3994 / 420-3995fox PROJ"E NAME: ADDRESS v2 PERMIT# PERMIT DATE: sg.30//2_ M/P: / c;2-1 9 LARGE ROLLED D PLANS ARE : B O l� SLOT 7� 2 Data entered in MAPS program on: (� z BY: �� _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 17/ Parcel 2_ 1 I 'Application # �9 016 S Health Division Date Issued Conservation Division Application Fee Planning Dept, Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 4J Z j4 M€S Village C k,bj a..lQ LL_E_ M,A Owner -J A-C,� UJ&.`!1 0 + Address Telephone Permit Request f� A 12 KW) Li op,A E t Square feet: 1 st floor: existing proposed .21(p 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation uc)tD Construction Type u-10pA 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 Kintg's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 5 acvnz k-.)6-e. Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new o 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: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new sizeCD Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: j a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ �"? Commercial ❑Yes ❑ No If yes, site plan review# CD Current Use Proposed Use a APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �AA(ZdL.S Telephone Number J 08 m Z.6 w -Y 7 Address ` 0,114,E IZ License# C 3 6 l 6, O C2 -: Q�-J a L lP t�1 a C)26 2 Home Improvement Contractor# 4 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY 'APPLICATION# 4 DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 'F FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t v ,' Massachusctts t o The Comrnorcwe t� f Departrjtetzt of lr�dr�strxal�ccidents Office of I"nveEdgatdon9 600 Washington Street I3ostolx, MA 02111 �• yvwW.mass.gov/dia • Workers' Compensation lnsnrance davit: Builders/Contractors/:Electrici.aas/Plumberg Applicant lnformadoli Please Print Ledbl'Y Nagle(Busincsoorkanization/Individual): Address: CIE 2� City/State,/Zip: �'e,.� Jc I�t c/�l✓� Phone.#: 7i�•' `Fj Z( Are you an employer? Check the appropriate box, Type of project(required): 1. 1 am a employer with Z- ❑ 1 am a general_contractor and I 6 ❑New construction employees (full and/or part time).* have hired the sbb-contractors listed on the attached sheet 7, ❑IZcmodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have ship and ba.ve no employees S. ❑ Demolition wo employees and have workers' rking for zne in any capacity. 9, [] Building addition workers' comp. insurance c0mp' insurancc.f [No 5. We are a corporation and its to.[:]•Elcctricd repairs or additions r6quircd.] 3,❑T I am a homeowner doing all work offzcers have exercised their 1I_❑Plumbing repairs or additions myself. [No workers' compp_ right of exemption per MGL 12.E Roof repairs insurance required-]t c, I S2, §1(4), and we have no ci�ployces. [No workers' 13.❑ Other . comp,insuramcc required.] Any applicant that checks box#1 must also fill out the section below showing thcir workers'compcnszaon policy infrnir�ation. t Homcownt"who subnvt this affidavit indicating they are doing all workand thcrl hire outside contractors mostrubmit anew affidavitindimiing such. XConu-actnrs 0-at check this box must attached an additional shcot showing the name of the sub-contractars and state whether or not those entities have cmployecs. If the sub-contractors have cmployccs,they must provide their workers'comp.policy number. .Cam an employer that isprovidircg workers'compensation insurance for my employees. .BeXaw is thepolicy andjob site ' information. q • Insurance Company Name: �--- Policy or Self-ins, Lic. #: Expiration Date: # Job Site Address: City/S tatc/Zip: Attach a copy of the workers' compensation policy declaration page (show ing the policy number and expiration date). Failure to secure c e as required under Section 25A of MGL c. 152 can lead to-the imposition of criminal pcnalfies of a Snc tip to $1,500.00 and/or one-year imprisonrnent, as well as civil penalti'cs in the form of 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 Ofco of Investigations of the bIA for insurance coverage verification, jury ticat the information provided above'is true and correct X do hereby certify under the pains-and penalties of pe SijMature D Datc' — Phone#: Official use only. Do nof wale in this area, Ib be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one); 1. Board of Health 2. Building Department 3, City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector 6, 0 Lh er Contact Person: Phone fl: Inform ation and 111stru.ctions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for Contract )?ursuanf to this statute an employee is defined as "...every person in the service of another under any contract of hire, express or irriplicd, oral or written._" , An ernplDyer is defend fd as "an individual, partacrship, association, corporation or other legal entity, or any two or more Of tho forcgoing.ongaged in a joint enterprise, and including the legal representatives of a deeeas�od employer, or crthe receive or tzu.stee of an individual,partnersbiP, association or other legal entity, employing mp Y Mole than three apartments and wbo res owner of a dwelling house having not ides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or re air work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be m employer." �Ritlihold the issuance or MGL chaptcz 152, §25C=(6) also states that"eve alih for any ry state or local Licensing agency shall rearyval of a license or perMt to operate a business or to construct buildings in the colurnonwe applicant who has not produced•acceptable evidence of compliance with the insurance coverage required." Additionally,' MGL ohaptcr 152, §25C(7) states `Neither the commonwealth nor any of its political subdivisions shall onter•into any contract for.the performance of public work until acceptable evidence of conzpLiznce vtzth the insurance requirements of this chapter have bccn presented to the contracting authority." AppLi cants Please �11 out the workers' compensation affidavit completely,by checking the boxes that.apPly to your situation and, if necessary, supply sub-contractors)narne(s), addresses}and phone numbers) along with their ccztil icate(s) of insurance. Limited Liability Companies(LLC) or Limited Liability PartnershiPs(LIP)with no employees other than the members or partners, arc notxcquizcd to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required Bq 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 Dcparhnent of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation pokey,please call the Department at the number listed below. Sclf-insured companies should cntcr their self-uisuran(�o liccnsc number on the appropliato line. City or ToWP Oft'icials .Please be sure that the affidavit is completc and printed legibly. The Departmco contact oyouur girding thctapplicant. of tho affidavit for you to fill out in the event the O�icc o f lnvcshgahons b an applicant r. In addidorr Please be sure to fill in the permjVbccnsc numbcr which will be used as a rcfcrcnce numbe that must submit ruultiplc perrnit/license applications in any given year, need only submit onF affidavit indicating ccurrcol policy information(if Accessary) and under fob Site Address tho applicant should write"all locations in (city town)."A copy of the ef�davit 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 Fie for future perrnits or licenses. Anew affidavit must be tilled out each ycar.'Whoro a borne owncr or citizen is obtaining a license or ppmait not related to any business or comnncrciai venture (Le. a dog license orTorrait to burn leaves etc.) said person is NOT required to complete this affidavit. T'ho 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,,tcicpbone•and fax number: The. Commonv,tWth of Aassachu=,: t D-par ent of Indus 60 Accidcnts Office of Ji�vestiptl.ons 6O0 Wfi 4l gtQn Street BQstan, MA. 02111 TQ1: # 617-727-49-0.0 ext 406 Rr 1-877-Nu A.SSAFE Fax# 617-727-7749 Revised 11-22-06 WWW.Ma$$.,go-v/dia 4,, A� 1• • mopBarnstable,YHVr Townn of Regulatory Services $.A]UJSM'OLE, Thomas F, Geiler, Director ' y Mass. • �p t 619• `m _. r�L) Building Division Tom perry, building Commissioner 200 Main Street, Hyannis, MA 02601 www.torwn.ba rnsta ble.tna.us Office, 508-862-4038 Fax: SOB-790-6230 Property Owner Must Complete and Sign. This Section If Using A Builder Z a Owner of the subject property .hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit applicadoa for: (Address of job) Xwner Date Print Name If Property Owner is applying for permit please complete the Homeow nets License Exemption Form on the reverse side. Town of Barnstable of 7He rp�yT Regulatory t�r ezv>,ce5 Thomas F. Geiler, Director BARNSIA9LE� ,' MASS. Building DivisiOD sdo'y• N PTFo RA Tom perry,building Cornrnlssionet• . 200 Main Street, Hyannis., MA 02601 �)'wty.toivn.barustable.ma.us Fax: 508-790-6230' Gf>ice; 508-862-4038 jIonIEOWNER LICElgSE, ExEAqpTfON ' Please print DATE: JOB LOCATION: street Pillage number . "HOMEOWNER"' home phone N work phone I/ name CURRENT MAILING ADDRESS: state zip code city/town les The current exemption for"homeowners"Was extended to includot ymer- a license,Wrl]ing�s of ided that t nits or acand to allow homeowners to engage an individual for hire who does n possess supervisor. DEFINITION OF ROnjEO)VNER person(s) who owns a parcel of land on'which he/she resides or intends to r A eside, on which there is or is intended to be, a one or two-fanuly dwelling, attached or detached a�cWresaccessory not be ons such Xed use aa h/omeownst structures. uch person Who constructs more than one home in a two ye x p shall "homeowner"shall submit-to the Building Official on.a foml acceptable to the Building Official, that he/she shall be responsible for all such n o k erforme.d under the buildiu ernut• (Section 109,1,1) a The undersigned "homeowner assumes zesponsibihty for compl fiance with the State Building Code and other applicable codes, bylaws, rules.and regulations. Th'e undersigned "homeownier"certifies that he/she understands the Town °1 Bwithisaid proceding durres)and ent minimum inspection procedures and requirements and that he/she wzll comply requirements, Signature of Nomeowner Approval of Building Official Note; Tbree-family dwellings containing 35,000 cubic feet or larger will be required.to comply with th e State Building Code Section 127.0 Construction Control. fI0ME0WNER'S EXEMPTION The Code s tales that: "Any homeowner performing work for which a building permit is required.shall be exempt from the provisions of this section (Section lo9:1.,1 -Licensing of construction Supervisors);proyidcd that if the homeowner engages a person(s)for-hire to do such work, that such Homeowner shall act as supervisor•"' Many homeowners censwn o use i Construction Superviso;section 2,15)aware yThis lack of arc Rwar n the cesooftccnlre'sults in serioussproblemspparti ul�ariy Rides &*Regulations fort g when the homeowncrhires unliccnscd persons. In this cast,our Board cannot proceed against the unliccnscd person as it would Huth a licensed supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner tc fully awaTo the rcos otnshcr resp of a Slides.many co the last�pagc of[hiscs require,sissue is atform currcmy used by that the homeowner certify that hdshe and P Scyeral towns. You may care t amend and adopt such a fom,/ccrtifieation for use in your community. // ,/ '�� i Grp �� \r'A. 5. i' r 6, 1 i 1 F I 2 � � �5 2JiII � wlA.. -1 - 1 j R f b 1 } i { f / e 1 Y i t ' -vb...."...•,'.b'._.n.:,-,IW'S�V;1YxNW¢M16CMsE' �::. ;xv��.:-em.nw.wa::::r.+. .. .. 1 iO„ 5 as f3 r-®6D Z — ►31y 9 4 � a r i a6 0-c- i 1 f fi a G r Z x � P p►�t�.J�S F � o,,c, 2x8 c,�•s �`� } ill I 46 h\ Do LF�2 D�IV/s /Zv� n .So 'w/b E A DIZ/a/NAGS CASEM�i ,` 407 Jac 4s s I' 1 3l' kp I certify that this property 'is located in Flood Hazard Zone C (out- side the 500 year flood) as identified � by the Department of Mousing and Urban Development (HUD) . Date Dc=c.z3 2oa� CFRTI F1 ED PLOT PLAN Ile 9-55 f _ LOCATION . SCALE . . /si. .�o�... DATE .4 p'.Z3 ZcoIS' Reg and ' uve'yar PLAN REFERENCE .��!�G ?��/yz • ,+ �� y{ `e f r �.- �.S ..S�lu�/ UN /'��.V/t—. JUSO I .certify. to its title insurance company THE LOCATION OF THE ORIGINAL DWELLING that there are no visible encroachments SHOWN HEREON,41THER WAS IN COMPLIANCE WITH THE LOCAL APPLICABLE ZONING BYLAWS or easements except as shown and that this IN EFFECT WHEN CONSTRUCTED (WITH plan was prepared under my immediate RESPECT TO HORIZONTAL DIMENSIONAL supervision. REQUIREMENTS ONLY),OR EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER M.O.L.. . 4'NC�L ` TITLE VI I,CHAPTER 40A, SECTION 7,UNLESS c.TO14AI E, 5� �QAIC y - %T OTHERWISE NOTED OR SHOWN HEREON. a Date: 2/4/2010 Time: 4:16 PM TO: @ 9,15084203674 Page: 001 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company Burlington,Massachusetts NCCI NO 40959 (800)87654765 il"fiit r8 W POLICY NO. I WCC 5003799012009 ITEM PRIOR NO. WCC 5003799012008 1. The Insured R&R Construction Custom Homes Inc Mailing Address: 90 Nye Road Centerville MA 02632 (No. Street Tom or City Canty State Zip Code ❑ Individual [:1 Partnership ® Corporation ❑ Other FEN 04-3571420 Other workplaces not shown above: . 2. The policy period is froml1129/2009 to11/2912010 12:01 a.m.standard time at the insured's mailing d C, 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states li MA Ls B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. i► O V The limitsof our liability under Part Two are: Bodily Injury by Accident$ 500,000 each accident �CyC� �9 Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 500,000 eachemployee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy Includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans. All information required below is subject to verification and change by audit Classifications Premium Basis Rates Code Estimated Per$100 Estimated Estimated Annual of Annual No. Remuneration Remuneration Premium ]TV'I'RA 309397 SEE EXT NSION OF INFORI 4ATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 3,904.00 As indicated,interim adjustments of premium shall be made: Deposit Premium $ 1.039.00 ❑ Annually ❑ Semi Annually ® Quarterly' ❑ Monthly MA Assessment Chg. . $3,493,49 x 72000% $252.00 This policy,including all endorsements,is hereby countersigned by �-� 101n/2009 Authorized Signature Dale IGOV GOV I KIND PLACING CLAIM_ NAME SAFETY STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP Miller McCartin MA 15M 114 1504 1 1 dba Dowling&O'Neil Ins Agcy WC 00 00 Of A(11-88) 973 lyannough Road Includes coWignted material of theNationel Council on Compensation lnsuranc% Hyannis,MA 02601 used with its permission. 1 f� Board of Building Regulations and Standards i s �oard of Bauldirng:ltetiuiation and Gtandap d;r i f HOME INIPROYEMENT CONTIt1aC70R I. ! Con.:-truetion aup Srvisor License Llcense I Registration 159157 + E;p 00160 !# Ex iratso 1p 1a; 4'14/2010 Tr## 266017 ExpiraQi ra> 5/yf?Q10 Tr# 2�t P190 i 'A Private Corporationi i ' I� r' l F;nskrict€o��a OGk A R&R CONSTRUt'TIOPd Gkl3TOIVI'HOMES INC. ROEBRT HARRiS ROBERT ! MIaRRi�, I� 90 NYE RD 90 NYE RP � -y : ~ CENTERVILLE,ILIA 0263,2 CENTERwILLE, MA,0268'� Administrator Commissioner a �'. License or registration valid for individul use only a: . before the expiration date. If found return to: Board of Building Regulations and Standards k One Ashburton Place Rm 001 Boston,Ma.02108 \Kot v d without si nature g �. 04/24/2012 10:47 508-790-4686 PAGE 01/02 f TAYLOR DESIGN ASSOC., INC. sHETNo. 1 OF P.O. Box 0 Forestdate. MA 2644 CM.«,wWo UV— � DATE Tel./Fax: (508) 790-4686 coo " DATE .:.._.:...._ ... .. IWI,•r�a�cascrr 3........ ..... i...........Srp,,rtl7 _......_._. .._ .. ..... _ ... .�_ _...... .. ..a-. .._.. ....,..... w . 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Box 1313 ForesMale, MA 02644 cALCuLATEo er � 'f DADATE ' -3 — 7ca I Tel./Fax: (508) 790-4686 ` CHECKED BY DATE Z JA.&SM Qrls SCALE ............... . _:............__..•-=......... ..__....._..._._. .,.f.._.._..:_. .... ......... ......... ...... .......... ..... t 1 � :..._........ ...:....._.:.._._... .... ...... . :.. . . .... .. ..... `r .........................._.. .__..b.._....... .._....................._b ........:..........,�/�: /�. .... ..... , ,.. .... , ....y.... ...�.., :..... -�d ............_..._�......_.., .._......_._..........................:_._._.. ........._..:�_ ......,._ _ ..�... .. _ ...• ..` ....... .... 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SHEET NO. A, OF = P.O. Box 1313 Forestdale, MA 02644 CALCULATED BY DATE Tel./Fax: (508) 790-4686 �( D CHECKED BY ��O A r tV5 ©-Qi S P—P I ei.L6SCALE ►`�n,m,w c'y _13�1 Spa-n.o� a�a„e�- ,1 aY .. I;�s. . . ;...e.y .... ..._..... \ ... . iz g _ __..... __., _...... n .7.n.61r4>>4►.�. �-.(Irk ........... �"$...1('� ....... ...-..... �. C [it_ ..�`fa; . l.. ...... 1, _.: .. x. .._Zz... X ....... to X _..:..I c tc. . t L e-� x ..... ... ...... ..... Ca./ ts.C,e� . ... m., .�rte-rvJ .._ ................ .... ....... .... �'C:.�'C ......T��a ,r3 v5 T . Z ..... ...........:... •�... Z�C�SS ._ ... �` 74; tom. s .. .....:. .. i i1 r 3�.. ;. .. .......... ... At +t Z.t° ¢mac ...`Tltw .yt, p. C' k . ..... .. ....:_ . 3._Z11 t"� ►k _ uf�LtFT {�ucr..Q�� u. t�. ..:.. ..._ ;�. _� � tr . .. ...... .. ... . ..:. A.rav<,oD. . S.. _� ..:. ��._3 Z _o c- ..... : _A- ©'7.. ec-..,- .. Cam:. --,l�A-c �_ �.. OFF ..................... ..... ....... ...... i R JOB t AC rr Cr CoK� TAYLOR DESIGN ASSOC., INC. SHEET NO. A. G. OF - P.O. Box 1313 30— Forestdale, MA 02644 CALCULATED BY � l DATE� ., � Tel./Fax: (508) 790-4686 „ CHECKED BY DATE 'SCALE .......... ......... ................. ......... ......_.... ........-... ....... .::... ... ........ ... ............. ........ ... ...... . .. .... :. . ....... . ..... ... ... ..... ...... ....... .. ..... ....... -.. ...... ...... .... ... -._. .. C-� ........ m �6L. L.O .. . ....... s o s - Cis k-. .... ... .. C,a.ctt ..l as.,r. l--.... . . .. .. ......... . .............. ........c, t'rtE-ev°t_ �DLA-D ...l o �,Q l ...... 4....k -4.... ....S _. ... Ccsg�.t� .... 0-'c-art. $ .. ... ... ...s . ............. ....... .. .. ... . .... .. .. 77.E cc c.P� .......... c�. 6 Y e . as _ / O.. L S �dSt ... -� ... .. ..: . ... . c ... ... l©. e Le,ro. LAC- �ooPs,, .... ._ tic, = �" Z�t� K tCt:� . . ....... .. t G_`` i.�e..� t"'_' r.2...._-- .. .. .. I 5 � � �� -ot o no `f �r � � D a/� V �L I � M t i °FS►E,�,. Town of]Barnstable *Permit# F, v ti Expires 6 months from issue date Regulatory Services Fee BARMN Thomas F.Geiler,Director 1 '71 1639• ,m A Building Division rfD MA'I �,,(� C. UN 8 0 erry, CBO, Building Commissioner. L/� ?008 200 Main Street,Hyannis,MA 02601 �U2—. Vd/V OF B4�N www.town.bamstable.ma.us ��C`� Office: 508-862-4038 ST�� Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint V Map/parcel Number Property Address f z 41 ,C � . ��t✓e�-{-�. 11�,�r ®Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address a Q UE .p. (,o, !D Contractor's Name d �-�C� of �C' ca rx5i6y Ck(�--.n, Telephone Number Home Improvement Contractor License#(if applicable) Z. t n, y'�LD } ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner R I,have Worker's Compensation Insurance Insurance Company Name � �y�t.-.Ili - t �b Workman's Comp. Policy# .4\- Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) �] Re-roof(stripping old shingles) All construction debris will be taken to �� ,A S.+h.,,,tTW�-� ❑ Re-roof(not stripping. Going over existing layers of roof) �] Re-side 1�] Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required:-Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: - Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revise020108 License or registration valid for individul use only License the expiration date. If found return to: I Board of Building Regulations and Standards One Ashburton Place Rm 1301 I Boston,Ma.02108 of v II without signatur i The Commonwealth of Massachusetts Department of Industrial 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 Les=ibly Name(Business/organizationadividud): 2A-2 Ler"1kCL--,%-;+L 1V- — Address: City/StatelZip: e <�e. 6� Phone.#: ` , 'c� l-(7`{' l Are you an employer? Check the appropriate box: Type of piojent(required): 1.0 I am a employer with_ 4. I am a general contractor and I 6. ❑New construction . employees(full and/or part time).* have hired the sub-contractors 2.El am a•sole proprietor or peruser- listed on the attached sheet 7. ❑REmodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' g 0 Building addition [No workers' camp.•msuiance comp.insurance.t required.] 5. 0 We are a corporation and its 10.0 Electrical repass or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LF1 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance ram]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 roust also fill out the section blow showing their workers'compm =ion policy information. t Hu=owncm who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new of davit indicating such. tcouhactars brat check this box nmat attaehed an additional sheet showing the name of the sub-contractors and state whether or not$rose entities have mrployeez. If the subtonbactors have employers,they must provi&their work=l comp.policy nunnber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. hwu am a Company NamD� Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/5late/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to s�ctse coverage as required under Section 25A of MGL c.152 can lead to the imposition of crilnifial penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil pmaltits in the form of a STOP WORK ORDER and a fine o this statam ik may be forwarded to the Office of of up to$250.00 a day against the violator. Be advised that a copy f y Investigations of the DIA for insurance coverage verification. - I do hereby certify under the pains•and penaMes of perjury that the information provided above is true and correct Si e- Date: / La _ Phone#` so-?3 32,(— 4-Z /f Official use only. Do not write in this area,tb be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions. Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. PunnLmA to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing.engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or tmstee 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." r 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 inset-ante requirements of this chapter have been presented to the contracting authority." r 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 certificates)of in�nansr. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the m:mbers 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 confinmtion 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-insurod companies should enter their se;f-insure=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 permittlicense 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 on;affidavit indicating current pdjcy information(if necessary)and under"Job Site Address" the applicaant 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 born 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 tut 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 4-06 or 1-U7-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia f ) Client#: 15194 2RRCO CERTIFICATE 4F LIABILITY INSURANCE 0DATE 3124108° ' ",r ODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ti ~Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyanough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# -INSURED INSURER A: National Grange Mutual Insurance R&R Construction Custom Homes, Inc. INSURERS: Associated Employers Insurance Compa 90 Nye Road INSURER C: Centerville, MA 02632 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MMIDD/YY •DATE MMIDD/YY LIMITS A GENERAL LIABILITY MP12445F 01/29/08 01/29/09 EACH OCCURRENCE. $1 OOO 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $500 OOO e CLAIMS MADE a PREMISES(Ea occurte c OCCUR MED EXP(Any one person) $1 O 000 6 - PERSONAL&ADV INJURY $1 000 000: GENERAL AGGREGATE $2'000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 OOO 0-0-0 POLICY PRO- LOC I JECT El AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT $ I ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTYDAMAGE $ ' - (Per accident) I GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: .AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND WCC5003799012007 11/29/07 11/29/08 X WCSTATUL oTH- - EMPLOYERS'LIABILITY - FR E.LEACHACCIDENT $SOO,000 ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NO E.L.DISEASE-EA EMPLOYEE $50O 000 Ilyes,describe under - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500 000` OTHER )ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Dperations performed by the named insured subject to policy conditions Ind exclusions. Cindy Harris is included under the workers compensation policy. ;ERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING.INSURER WILL ENDEAVOR TO MAIL I_ DAYS WRITTEN South Street NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR . REPRESENTATIVES. AUTHORIZED FPRESENTATIVE - m 1CORD 25(2001/08) 1 of 2 #51364 LS1 © ACORD CORPORATION 1988 ��ie 1°omvnzaruuPaC// a1"Aac/ucae�ta i Board.of Building Regulations and Standards �. HOME IMPROVEMENT CONTRACTOR e RegistratiOd'.-R 159157 piratlo 4A/2010 T►# 266017 !=' 4 �Y� l'g �r�Yate Corporation NJ R&R CONSTRUsTfOfJgC M4 l h r�1STOMtHOMES INC. ROEBRT HARRIS 'i -, 90 NYE RD � I CENTERVILLE,MA 02632 Administrator R&R Construction Custom Homes, Inc. Building Specifications & Contract Date: May 1, 2008 Name: George Haddad Address: 31 Maple Street Phone: 508-485-0819 Site: 42 James Otis Rd., Centerville, MA 02632 Model/Plan Type: Ranch Style CONTRACT PRICE: $ 70,000.00 *The Final purchase price to be determined by addition of all extras or credits. Purchase price based on list plus extra (Addendum A). GENERAL CONDITIONS: 1. All work to be done in a good and workmanlike fashion according to.attached plans and specifications in compliance with the Massachusetts State Building Code. 2. Contractor to provide workman's compensation insurance, comprehensive general liability and personal property and guarantee all mechanical components and cosmetic features for one year. All structural work to be guaranteed for five years. See warranty form for details. 3. Owner to provide Contractor with a certificate of insurance for a builder's risk policy naming Contractor as certificate holder before site work commences. 4. All changes/extras made subsequent to the signing of.this contract are to be approved in writing, subject to the terms and conditions of Additional work Authorization order(s). All changes and extras are priced at cost(time and materials) plus 10%, unless specifically quoted; to be paid at time incurred. 5. Builder shall be responsible for all taxes, and all costs relative to permits and licensing necessary for the execution of all work. 6. Builder shall be responsible to give all notices and comply with all laws, ordinances, rules and regulations, of any public authority. 7. Builder agrees that no lien or claim of any kind shall be filed by any subcontractors under him of by any other person against the property of any other property owned by the owner for any work or any materials furnished for the construction of the said work and work incidental thereto. 8. The builder shall indemnify the owner against any and all loss, claims, or suits, including costs and attorney's fees for or on account of injury to or death of persons, damage to or destruction of property belonging to owner caused directly by the builder. 9. Plans provided by builder are the exclusive property of the builder. Payment drafting fees beyond $500.00 is the owner's responsibility. Hourly drafting fee is$75.00 per hour. ;j 10. Price quote is provided with expectation work will commence within 60 days after contract is executed and will remain valid during that time. 11. If there is a conflict between the plans and specifications, the specifications control. 12. Claims, disputes or other matters in question between the parties to this agreement shall be resolved by binding arbitration in accordance with the Construction Industry Arbitration rules of the American Arbitration Association in effect unless the parties mutually agree otherwise. If either party files a claim subject to arbitration, the prevailing party shall also recover attorney's fees and costs. . ESTIMATED COMPLETION DATE: APPROVAL: R&R Construction Custom Homes, Inc. -� By: By: BUYER Robert J. Harris DATE - ', ..." .++,: .. .:- ... - � _ ^+ � ... .ti r -= f.1 r:ri...:�,-t 4»%.Lrit.: ,...Y%=ar-.+....r•i..a:••..- ... �-.,y�,•::;.-..w+•��,"t✓s.i. J � . TOWN OF BARNSTABLE = Permit No. --2a644----------- 1 sn.ar i Building Inspector Cash --------------- — +ww X OCCUPANCY PERMIT = Bond " i ---_-_ Issued to Alan Small A, ` Address Lot #614, 42 James Otis Roa&;x CentierviIle Wiring Inspector f !� � ' Inspection date Plumbing inspector ¢ Inspection dateC Gas Inspector _ ' Inspection date .� Y1 & fie`- nj�r?. XEngineering Departmeriti� �� / ��r� � � inspection date �/ s-`7 is Board of Health �` �;i�tlry� y�3 .� ��' Fly, ?' Inspection date 14 THIS PERMIT WILL NOV BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. �' Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT = rUR1°T TOWN-OFFICE BUILDING � rua HYANNIS, MASS. 02601 �OIUY M. MEMO TO: Town Clerk FROM: Building Department DATE: (��(�leZ- An Occupancy Permit shas been issued for the building authorized by BuildingPermit $k.. 1 r40.. 1/1// ....................................................................................................._.................»».. ......»»». issued to .......... ................ ... .... r y Please release the performance bond. , _��S/G/V DA77A rQ ► SOD _. . I.lb' �A{ZC fLG .Gt:W-DL'2. [SA1LY . FL'oW _ j�s' x 3 .�53'o G. P. D. W-- ? N Sep-ric , m^tjK :.330 X lSoyo * 4gS C•r.P. ` MOO'. LU �°+!--,..TA►J'►C,. � n i-�"`�r Q—�,, '� � �'r _............ _ ._.. ....�. :. F 2 1, '!:E'— -`�0 i} d P�T --� s E t o0o GAL. � -� �TO 4 � �.51 OEW1AU . ./NFICA.• '.p5p 5, 1=. L S �J 375" Gn F. O. a xi r r= ._:goTl`fl.(� r ...PtfLt:A. ;_ So S.F..... . -. 1�•' f ID. � -TO c. V c5 i G►) = 4�— o- P. D. ToZ'AL: DA%Ly F'{,OQ = 33o G.P,t7, PErZto LAM 6PJ RPtTC- ; �u ►N 2 MAN o2: LESS - ( ., d l Iz U 1_ PG TE ,. `�'I /•37 tit 1 ,� �.1'+ `.i.(J {'td 1.�P l�iJ ,C ,�. AX F Z. i �I S50 Sa v f /t�On BOX /N✓. GAIL_. /iW. :• ka 6 ... o' PiT .o TAN%C St)o Q 3�y ��,'r •� 5�,2 Sq A G'.E.QT/F/EO PG DT �L.4N t W41HC-D * STo�E eo �y8,c7 •��{--- G�:��-. LOG.GT/O.Si �':`'N T_�;�Y/i_e-� %s`./,�_ � . S i �c•� OQTE W PRO F I 1.L ¢may -Aq,� pGQ.si .�.�E,P�.Vc� o, e Np SC ALG / GE,E�r/p'y Tf/.4T THE Fo�,•vu<4ri b.�! Si�OW.V �"�'�:.►�' A��(:t�3, 1�3'�-� IMe ANC SE-rgAee .eEQU/�'E'kl�NTS d� T//� ,2,EGisr�•ecI,t crvo sU,evEyo,�S IV • /1.�,G/cas�T- _ 71-W /,f Ala7-f3�E0 ai✓ 4 /y.ST,e- -/Ji�lEiS/>-�Svecic'y.4ic%O Ta ES?A1�L/S.y.LaT"G/N4S 1 , 4sessor's map and lot`number ......47J..-.A�........ SEpyIC SYSTEM MUST �5 _ l MSTALLED lid COMP Sewage Permit number ............................. . ................ WITH TITLE MENTAL C STABLE, i House number ........................... 4................ tlIRO•-rn �n^ a �� n ,9� k'MAO& l'"4� � � +� C^.'.i639 •� �0 MPS \ TOWN ' OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. . ... TYPE OF CONSTRUCTION ......... ................................................................................................ ............ ......... 19. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a perm' according to the fQ#owing info motion: Location .... �P. .......................... ................................... r �� ProposedUse ... . ..... ............................................................................................................................................ ZoningDistrict ........................................................................Fire District .....................:........................................................ Nameof Owner ......................................... :.... :Address ............ ............. ...... .................................... c Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Room .....................................................:............Foundation ........... ..... .. ..... ........................................... Exterior .... .. ��...............................................Roofing ....... ......... . ............. ..... ...............I.......................... Floors ...:...... ........ .Interior .... ........................................... G ........................................................... Heating ! . .....Plumbin ..' -....................................................................... ... .. .. ................................................. .ti g { Fireplace .................... .. .............. ..:.......................................Approximate. Cost /. . ....... ........... Definitive Plan Approved by Pi Wing Board _________��j_�_----------19---R;. Area ..... ............................... Diagram of Lot and Building with Dimensions Fee 1�.�.......... ..... ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH r a i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... .......... ..... .. . . ....... • Construction Supervisor's License ....r�.. 7.5 ... V, MALL, ALAN Vo .... Permit for ....One Story w. ................................ Single Family Dwelling ................. .......... Location .... 42 James Otis Road ......................................... ....................Centerville.......................:*�............ . ...... . ...... . . Owner .......Alan -Small ......................................................... Type of Construction TraTe............................... ............................................... ............................... Plot ............. ........L.' Lot .:7.........4..................... November ,�7, 85 Permit"Granted - .........................................19 Date of Inspection ....................................1.9 Date' Completqd .................1.9 M oll f Assessor's map and lot number ....../.~�,�..`.. .........o oFTHerc �5 K� Sewage Permit number ............................. Z BAUSTABLE, i House number 4?— 9 MAea ................................................. 00 i639 9� fi y �D YPY{r TOWN OF BARNSTABLE s BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...:} :.:.::.:: =.' s TYPEOF CONSTRUCTION ........: r t ................................................. ................................................. ................................................ 9..:...�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... , / �' !:............ ..` s�r r r ,..j . .`..................................................................... ................................. . ... .......... ..... ProposedUse ...... .......t............ ........................... ................................... r ZoningDistrict ........................................................................Fire District .............................................................................. Nameof Owner ..::e«:`.......... `........................................Address .........:..................:%::::.. ...................................... Nameof Builder ....................................................................Address .................................................................................... r.. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms Foundation f ' ' �.................................................................... ...............................:.............................................. Exterior ................ ;.:.:.. :...:...................................................Roofing .......(..ti .. f:....:......'............................................... Floors ............................................................. .......... .. `��'-f .Interior ....'r t 7J �.. . -� ............... / Heating Plumbing ....:::........ Fireplace ....Approximate Cost ...... ....:�:.....`......... ........................... I� Definitive Plan Approved by Planning Board __________19___ Area s Diagram of Lot and Building with Dimensions Fee . SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ' Name ................ :::.... ' ........ Construction Supervisor's License ....:..... ...... >............ SMALL, ALAN A=171-219 No 28644 . Permit for ...One Story ................. Single„Family Dwelling Location Lot 614 42 James Otis Road Centerville Owner .....Alan Small ........................................................ Type of Construction ..........Frame......... ........... ................................................:.............................. Plot ............................ Lot ............................... November 7, 85 Permit Granted ........................................19 Date of Inspection ....................................19 -mate Completed .................19 Via. ............. 1 �7a 31 - 'Co 67