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Home My WebLink About0653 LUMBERT MILL ROAD , F �INKE,� Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee = snxxszA1314 MAM1639. Richard V.Scali,Directog ♦� 011�7 (/ • QED MA'I°i 1110i�� is Building Division Tom Perry,CBO,Building Commissho�gr 200 Main Street,Hyanni 'U21601 CC111 www.town.bamstable. �� Office: 508-862-4038 4RIVSln�� ccFa�x: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL�ILY ! q Valid without Red X-Press Imprint Map/parcel Number �] � ] ( 1 t� � Property Address (05Z L,(J MbL -k I y�V� �Q� � � 11 r l Residential Value of Work$ N•1 ��=[�_ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address r7` la Uu 6e� vv� Al t`z y�l�, t&A Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 Im rovement Contractors License&Construction Supervisors License is required SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215' Town of Barnstable Regulatory Services off Richard V.Scali,Director Building Division STAB Tom Perry,Building Commissioner mass. 039• �� 200 Main Street, Hyannis,MA 02601 Eo www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 17 I t kP Please Print DATE: 9 JOB LOCATION: V!b,�) '_,umb a " 0%&� V i number street village "HOMEOWNER': ,QLI name home phone# (w�or.�k phone# CURRENT MAILING ADDRESS.qp�Vv�) tO�� ' _l l V &- 1 fV1�� Wit-, �`� t�_ 2. city/town state zip code. The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one 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 ep rmit. (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"h er"ce 'fies that he/she understands the Town of Barnstable Building Department minimum inspection procedures an a nts d t at will comply with said procedures and requirements. Si a r omeowner 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. i HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 All materials used to be of first quality. Materials and workmanship will meet or exceed all state building codes. All work to meet manufacturer's specifications. BHII is responsible for the removal of any job related waste. BHI will not be responsible for electronic security alarm systems BHI will not be responsible for any town permitting or historic permitting. BHI is fully insured and licensed and warranties its work for two full years. To include the following Replace any rotted pine trim or framing not already described above on a cost plus basis. Any additional work on a cost plus basis at $75.00 an hour on upon approval from owner. M-Adam Boegel Date Bob Foley Date Feel free to contact me with any questions or concerns. I look forward to doing business with you The Commonwealth of Massachusetts Department of Ind usirial Accidents - - O9ice of Investigations 600 Washington Street Boston,,MA 02111 wmv.ma-& .go►1ilia Workers' Compensation Insurance_.davit:Builders/C-ontractors/Elechicians}Plumbers Applicant Information Please Print Leuibly Name aNsine�organizationrladivid=D: Address: city/state/Zip: Phone.3#- Are you an employer?Check the appropriate box: Type of project(r equired): 1.❑ I am a employer with 4.�] 1 atn a general contractor and I 6. ❑New construction employees(full and/or part-time)-* eve.hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑modeling ship.and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have wormers' 9. ❑Building,addition [PTO workers'comp-insurance comp.insurauce.l required.] 5_ ❑ Ale are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all wodr officers have exercised their I Ln Plumbing repairs or additions myself [No workers'coffip. right of exemption per 1b1GL 12.❑hoof repairs insurance rewired.]€ c. 152, §1(4),and we.have no employees_[No worms' 13.0 Other comp.insurance required.] *AnyapplicawthaidiecksboxCum also fill out thesection below*shaving their woakers'compensation policy information. t Homeo mus who submit this ifMark iu hcaatiag they are doing all wails and then hire outside,contractors rarer submit a new affidavit indicating sach- =Contractors that dwa this box must attached are additional sheet showing the zee of the sub-cmntreztoas and state whether or not those entities have emVloyees. If the sab-contractors have employees,they r mist provide their workers'comp.policy number. I am an employer that is providing workers'competnaaden irasasra nce for trig empb*-mm Below is the policy a nd job site information. Insurance Company Name.- Policy#or Self-ins.lac.#: 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 S 1,500.00 andlor one-year imprisonment,as well as cixil penalties in the fonts 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 ce,,*,Bander 1 a phahles of petgaerr that the informanrion proWded pbosT ' true and correct Si tare: Date: Phone#: Offlciatl case aptly. Do not write in this urea,to be completedd by city or town afficiaat City or Town: PermitUcense Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 9: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 Nccl No 26158 POLICY NO. I AWC-400-7034131-2016A PRIOR NO. I NEW ITEM 1. The insured: BHi Exteriors LLC DSA: Mailing address: 91 Boardley Road FEIN:**-***3433 Sandwich,MA 02563 Legal Entity Type: Limited Liability Corporation Other workplaces not shown above: 2. The policy period is from 03/03/2016 to 03/03/2017 12:01 a.m.standard time at the insured's mailing address.. 3: A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit _ Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All Information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTEA 1112978 INTER SEE CLASS CODE SCHEDU LE Minimum Premium $550 Total Estimated Annual Premium $3,898 GOV GOV Deposit Premium $4,099 STATE CLASS MA 5645 State Assessments/Surcharges > $3,498.00 x 5.7500% $201 This policy,including I p y, g all endorsements,Is hereby countersigned by 03/07/2016 Auliwflzed Signature Date Service Office: Legacy Insurance Agency 54 Third Avenue P O Box 700 Burlington MA 01803 Wareham,MA 02.571 WC 00 00 01 A(7-11) Includes copyrighted material of the National Council on Compensation Insurance, ed us with Its permiswom f"IISR 2016 Northfield Insurance Company COMMON POLICY St.Paul,MN 55102 DECLARATIONS Policy No: ws25o2ao Agency No: 739000001 Producer No: Previous policy No: ws207365 POLICY PERIOD: From 0 4/0 2/2 016 To 04/0 2/2 017 Term: 1 Year at 12:01 A.M.at your mailing address shown below. Named Insured: BHI Exteriors LLC Mailing Address: 91. Boardley Rd Sandwich MA 02563 BUSINESS DESCRIPTION: Siding & Carpentry Cbntractor IN RETURN FOR THE PAYMENT OF THE PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. COVERAGE PART DESCRIPTION. PREMIUM Commercial General.Liability Coverage Part ..................................... $ 973 . 00 PREMIUM TOTAL $ 973. 00 Policy Fee 125. 00 Surplus Lines Tax $ 38 . 92 POLICY TOTAL $ 1,136 . 92 This policy Is Insured by a company which is not admitted to transact insurance in the commonwealth, Is not supervised by the commissioner of Insuranceand, In the event of an Insolvency of.such company, a loss shalt not be paid by the Massachusetts Insurers Insolvency Fund under chapter 17513. FORMS AND ENDORSEMENTS The schedule of coverage declarations,forms and endorsements shown on S1 D-ILS make up your policy as of the effective date shown above. Agency Name/Address: 401-431-9883 E.A. Kelley Co. Rhode Island, Inc. 450 veterans Memorial Parkway, Bldg 5 East Providence, RI 02914 , Countersigned: 04/04/2 016 JR _ By Date Authorized.RepreserrWvs S1D-IL(9l05) Includes copyrighted material of Insurance Services Office,Inc.,with its permission: APR 0 4 2016 t pay COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS y ' . ve Date: 04/02/2016 12:01 A.M. at your mailing address Pollcy No: wS2502ao . Named Insured: BHI Exteriors LLC LIMITS OF INSURANCE Each Occurrence Limit $ 1, 000, 000 Damage To Premises Rented To You Limit $ 50 000 Any One Premises Medical Expense Limit $ 5, 000 Any One Person Personal and Advertising Injury Limit $ 1. go, 000 Any One Person or Organization General Aggregate Limit $ 2 , 000, 000 Products/Completed Operations Aggregate Limit $ 2, 000, 000 BUSINESS INFORMATION Form of Business: ❑ Individual ❑Joint Venture ❑ Partnership 0 Limited Liability Company ❑ Trust ❑ Organization, including a Corporation (but not Including a partnership,joint venture,trust or limited liability company.) Loc.# Address of Al Premises(Including Zip Code)That You Own, Rent or Occupy 001 91 Boardley Rd Sandwich NIA 02563 PREMIUM Loc. Rate Advance Premium ## Classification Code No. Premium Base Pr/CO All Other Pr/CO All Other 001 carpentry - construction of 91340 P IF ANY 38.535 25.260 $ If Any $ I€ Any residential property not exceeding 3 stories 001 siding Installation 98967 p 22,000 18.875 25.349 $ 415.00 $ 558.00 Subline Premiums $ 415.00 $ 55e.00 Total Advance Premium $ 973.00 FORMS AND ENDORSEMENTS The schedule of coverage declarations,,farms and endorsements shown on S1 D-ILS make up your policy as of the effective date shown above. THESE DECLARATIONS AND THE COMMON POLICY DECLARATIONS,IF APPLICABLE,TOGETHER WITH THE COMMON POLICY CONDITIONS,COVERAGE FORM(S)AND FORMS AND ENDORSEMENTS,IF ANY,-ISSUED TO FORMA PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY. S2684D-CG(9/07) Includes copyrighted material of insurance Services Office,Inc.,with its permission. Pagel of 2 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ApplicationVFee , Health Division Date IssuedConservation Division Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address h6f 5 Village Owner Address Telephone - 150 41, 1.4 6 Z Permit Requ st WNr4 A��W p,7& rA'J MV Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District , 1 Flood Plain Groundwater Overlay Project Valuation ` (� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Exiting Strucure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No BasVent Type: ❑ 11.ull ❑ Crawl ❑ Walkout ❑ Other BaseWent Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Numkgr of Baths: Fufl:existing new Half: existing new `" _Number of Bedrooms•.':. f existing new Total R96m Count (note,including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authgrization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name CTelephone Number ��5-qb2� Address License # G �� Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT ILL BE TAKEN TO SIGNATURE DATE I� FOR OFFICIAL USE ONLY APPLICATION# k DATE ISSUED MAP 1 PARCEL NO. y ADDRESS VILLAGE OWNER f' i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 1 FINAL BUILDING; a DATE--,,CLOSED OUT A5@OCIATION PLAN NO. i Massachusetts - Department of public Safety :.Board of Building Regulations and Standards Construction supervko'l, License: CS-100988 HENRY E CASSDDV 8 SHED ROW X WEST YARMOI FTH "?,•tea �� 1 � ✓,.G.� �11 " "' Expiration Commissioner 11/11/2015 °b Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cntractor'Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change,'• Q'A`ddress [:],,Renewal 0 Employment Lost Card 1 45 20M•05/11 �e tpai�r��eo�ruue«�C/a�C�/�/Z��ulJric�creeCt�; _ C-\ Office of Consumer Affairs&Business Regulation' License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration; 1.53567 Type:' Office of Consumer Affairs and Business Regulation t xpiration:.;A211:5/201.6 Private Corporation' 10 Park Plaza-Suite 5170 ip" Boston,MA 02116 PE COD INSULAtil,N'.INC'. .NRY CASSIDY REARDON CIRCLE''.: I.YARMOUTH, MA 02664- Undersecretary N valid wi ut sign e The Commonwealth of Massachusetts Department of Industrial A cciden ts W Office of Investigations J a d 1 Congress Street, Suite 100 1C' V0M Boston, MA 02114-2017 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p Please Print Legibly Name (Business/Or� 'zation/Individual); II I— Address: City/State/Zip: Phone #; Are you an employer? Check Jhe 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 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling shipand have no employees These sub-contractors have w 8. ❑ Demolition working for me in any capacity, employees and have workers' insurance,t 9, ❑ Building addition comp.[No workers' comp. insurance p. required.] 5, ❑ We are a corporation and its 10.7 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12,❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' `: 13 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: QVV k� /1 �(,r` OL-1 Policy#or Self ins. Lic. #; 460 � QExpiration r Date: Job Site Address; City/State/Zip: j Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties'of a, fine up to$1,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of , Investigations of the DIA for insurance coverage verification, I do hereby certify n r pains and penalties of perjury that the information provided abo a is true anrnrect. Si nature; Date; '[ Phone#: Offlclal use only, Do not write to this area,to be completed by city'or town_offtcial. r T 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#: r CAPECOD-27 KLIGETT AC y 76/13/2014 E(MMIDD/YYYY) �- CERTIFICATE OF LIABILITY INSURANCE 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(les)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: Barbara DeLawrence Rogers&Gray Insurance Agency, Inc. PHONE 434 Rte 134 /c o c A/C No): 877) 816-2156 South Dennis,MA 02660 E-MAIL SS: bdelawrence roaersg ray.corn INSURERS AFFORDING COVERAGE _ NAIC u INSURER A:Peerless Insurance Company INSURED INSURER 13:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C:Evanston Insurance Company 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP _ South Yarmouth, MA 02664 INSURER E: INSURER F: CO ERAGES CERTIFICATE NUMBER: REVISION NUMBER: T J11S IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CRTIFICATE 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 TYPE OF INSURANCE POLICY NUMBER POLICY MM/DDIYEI' LIMITS A Y A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 i CLAIMS-MADE T OCCUR CBP8263063 64/01/2014 04/01/2015 PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER:PR GENERAL AGGREGATE $ 2,000,00 X POLICYEl O• a JECT LOC PRODUCTS•COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT OOO,OOO B COMB $ 1, ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED _ AUTOS AUTOS BODILY INJURY(Per accident) $ AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ C X UMBRELLA LIAR X OCCUR EXCESS LIAR EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE XONJ453514 04/01/2014 04/01/2015 AGGREGATE $ DIEDX RETENTION 10,000 Aggregate $ 1,000,000 ORKERS COMPENSATION PER OTH- D J'NDEMPLOYERS'LIABILITY STATUTE ER NY PROPRIETOR/PARTNERIEXECUTIVE Y/N WCA00525904 06/30/2014 06/30/2015 E,L.EACH ACCIDENT $ 1,000,000 FFICER/MEMBER EXCLUDED? ❑ N I A Mandatory In NH) f as,describe under E.L.DISEASE•EA EMPLOYEE $ 1,000,000 ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CER IFICATE HOLDER CANCELLATION i n^µt PARMIPATING mass savecounutcm WOWS though anam affiW V - PERMIT AUTHORIZATION FORM Robert Foley , owner of the property located at: (Owner's Name, printed) 653 Lumbert Mill Rd Centerville (Property Street Address) (City/Town) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. r�Le Robert Foley(Jan 2,20(5) Owner's Signature Jan 2, 2015 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services. Participating Contractor to the above referenced project: Participating Contractor bate Rev. 12132011 Ce zlei lis STABLE CAPE C INSULATION FIBERGLASS SEAMLESS- SiRATFOAM SUSPENDED - SATTS GUTTERS INSULATION CEILINGS 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St .Hyannis, MA 02601 Date: s Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village ` Insulation Installed: Fiberglass ' Cellulose R-Value Restricted. Unrestricted Ceilings Slopes Floors Walls .414 Fiver�.y GVOr Sincerely VHy ssrationpin sident Insc. P Town of Barnstable Regulatory Services Thomas F.Geiler,Director / BARMAZY, Building Division 2a2- . Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $ 5i— SHED REGISTRATION 200 square feet or less ,Z L/1�4,a 4=-�12 IV,'Z 0V7-6-0eV1 Zzc Location of shed(address) Village h/-/2r _ Property owner's name Telephone number �l 7111 00� Size of Shed Map/Parcel# Signatur Date x p Hyannis Main Street Waterfront Historic District? Old Kings Highway Historic District Commission jurisdiction? —9 If over 120 square feet,you must file with Old King's Highway01 Conservation Commission(signature is required). - Sign off hours for Conservation 8:00-9:30&3:304:30 `r rn co PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE'MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN f Q-forms-shedreg REV:05201 i R 1 � � 1 ;s A a 1. 1 . :r c • h. "Y G7o;o x y :. v L y�� ci OF IV -r b I� vl o � BERT ti0 193Fi7 0l i� •� Z y: _1 '/�� a�,',, �` �p Est, jol ` y/b � ♦�ya9l �,w�F� r CERTIFIED PLOT .-PLAN 3,, _ Lo T..GB L u sBtl�T r�C t IN . . ` S.��3�` J'.1 SLAo�1AS SCALE - DATE" GEE G! EE ING C .1 TGljiN' I .CERTIFY THAT THE f02Ll& �r oW T ofr.Nso�� SHOWN ON THIS PLAN 13 LOCATED. E0.15TER,ED REGISTERED JOB N0. 8 °Y-� ____. ON THE GROUND A9 INDICATED AND CIVIL.` LAND f' J CONFORMS TO THE- ZONING LAW.3 ENGINEER SURVEYORa . DR.BYI OF BARNSTABLE , MASS CN.BYE 712 MAIN STREET ' �. H YA N t�LS, :MASS. SHEET/:OF. !, ATE RED. LAND SURVEYOR OF THE Tp� Town of Barnstable *Permit Expires 6 mont sfrom issue date Regulatory Services Fee M + BARNSPABLE, 9� 16.39. � Thomas F. Geiler, Director AlED MA'S rs Building Division Tom Perry,CBO; Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address �� JN,e?fl-< l�L�. i�'� 00 esidential Value of W 1k Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address UL�� Contractor's Name t�?�at� ��1� 'Telephone Number j i-T) I lome Improvement Contractor License# (if applicable) Construction Supervisor's License# (if applicable) `g 00 RESS PERR.1 ❑Workman's Compensation Insurance M1z00g �eneAY: I am a sole proprietor Elm the Homeowner 7 TOWN OF SARNSTABLE I have Worker's Compensation Insurance Insurance.Company NameN1 � �`�P L0��i�2 Workman's Comp. Policy # 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 ❑ Re-roof(not stripping. Going over existing layers of roof) E5�-Re-side ❑ 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: P Q.`\A I'I-II.F.SU'tl�tMS\buil ing permit forms\EXPRESS.doc Revised WON 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 Le 'bl Name(Business/Organization/Individual): _1�3t'N 1 Address .0 9)6�0z aa2 i eo y4pna_ '�k-�`iJ City/State/Zip: QA_rk ,_)Ac, 'OA. 0403.-� Phone.#: 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 6. ❑New construction "lo ees full and/or art-time ,* have hired the sub-contractors ' y ( p ) Remodeling ..2:[�I aim a sole proprietor or partner-' meted on the attached sheet 7. .❑, ling ship and have no employees These sub-contractors have g•'❑Demolition workin for me in an capacity. employees and have workers' g Y P ty $ 9. ❑Building addition [No workers'•comp..insurance comp• ms�ce required..] 5. ❑ We are a corporation and its . 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself- [No workers' comp. right 6f exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no \- employees.[No workers' 13.❑ Other%V.-X1 ( zsiJi 1js comp.insurance required.] �j,(/M_ l/U H &Uea— *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infomation. 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 subcontractors and state whether or not those entities have employees. If the subcontractors havo employers,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. Insurance Company Name: 660C(l ii • Cfl-�S Policy#or Self-ins.Lic.#: �h I a�� Expiration Date: ' • � - 1. � � C��o3�" Job Site Address: 0;�� LAIC biA City/State/Zip: _ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure 4o secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a finq tip 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 he 'by certify unnd r the pains-and penalties ofperjury that the information provided above is true and correct: Si e: t✓ Date: S 40S Phone Official use use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health'2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M ,l.. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more - of the foregoingg-engag in a joint-enterprise;�=iuel-u�n` gtlie leg represen�a'ti�ea-6f de asezl'em�l r,orrthe=._---.- receiver or tiustee of an individual,partnership,association or other legal entity,employing employees.'However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the inrauce 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-contiactor(s)name(s),address(es)andphone number(s)along with their certificates)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 workeri'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be'used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the appicant should write"A-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 fo any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a calL The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Dgmtnent of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext-406 or 1-977-MASSAFE Fax# 617-727-770 Revised l i-22-06 www.mass.gov/dia ..rY Ta�ti Town of Barnstable . Regulatory Services vh $ Thomas F.Geiler,Director �'rEn 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Mus t Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorized .� . �} to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner ate ` Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. 0:F0 RMS:0 WNERPERMES10N Town of Barnstable THE Regulatory Services • R l R,157MBi f Thomas F. Geiler,Director 19-16 Building Division �rfD F Tom Perry,Building Commissioner _._.. _. .200Main�tr=i Hyannis;M*026,01 _.. ..... ... _ . _.._. . . --._.-... www.town.barnstable-ma.us Office: 50 8-862-403 8 Fax: 508-790-6230 HODfOWNIER LICENSE EXEMPTION Pleaee Print DATE JOB LOCATION: number street village 'HOMEOWNER!': name home phone# work phone# CURRENT MAILING ADDRESS: ctty/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 suneryisor. DEFINMON OF HOMMOWNER Persons)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 siructures 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."homeownee'certifies thathe/she underst;mds the Tpwn of Barnstable,Buildi.g Department m;r,;rrn,m inspection procedures and requirements and that he/she will comply with said procedures and requirements. SignatLim of Homeowner Approval of Budding Official Note: Thrce-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOHLOWNER'S EXEMPTION The code states that Any bomcowner perfommig work for which a building permit is requitsd shall be exempt from the provisions of this section(Section 109.1.1 -Ucrosutg of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,,that such Homeowner shall ad as supervisor." Many homeowners who use this exearption are unaware that they are assurtring the responsibilities of a supervisor(see Appendix Q. Rules&Rcgulations'for Uemuing Conshuction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this use,our Board carmot proceed against the unlicensed person'as it would with a licensed Supervisor. The homeowner acting as Supovism 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 hdshe understands the mspom ibilitics 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 curb it fotmlcertification.for use in your corrnrtunity. Q:forms:homccxcmpt I,I Board o m mg egu at �(io sand Standards ` } Construction Supervisor License License. CS 14007 ' Expiration w5125/2010 Tr# 23257 IL -R- �testnction UO dl i; i JOHN P DUNN ; BOX 924/80 MARIE,ANf�TERJ -pa 1 CENTERVILLE,MA 02632n js' Commissioner I i Board of Building Regulations and Standards f II HOME IMPROVEMENT CONTRACTOR I ; RegistratiQqi,\101149 E�Cp at on 61 5//20lug 10 Tr# 267680 i a+ t fiype—lrI iduai JOHN P.DUNN , " John Dunn 80 MARIE ANN TERR;;. Administrator CENTERVILLE,MA 02632 " License or registration valid for individul use only before the expiration date. If found return to: i ,I Board of Building Regulations and Standards I" One Ashburton Place Rm 1301 I Boston,Ma.02168 ; 13 Not valid without signature y17 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_. 1 SI 7 Parcel i /mil �d c9 Permit# Ao-:7- He h Division a Date Issued* O _ ` Conservation Division Fee U�� no Tax Collector % Treasurer �- - j Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ;' I / Village �J Owner E Address Telephone Permit Request Square feet: 1 st floor: existing_ proposed 2nd floor: existing proposed Total new Estimated Project Co �' Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: O 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 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:O existing 0 new size Pool:0 existing ❑new size Barn:O existing ❑new size Attached garage:0 existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial 0 Yes ❑No If yes,site plan review# Current Use Proposed Use UILDER INFORMATION Name Telephone Number _ p Address "� License# AAW Home Improvement Contractor# / Worker's Compensation# �Vv ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATU DATE z r ` - FOR OFFICIAL USE ONLY Jr. . PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTIO-': f FOUNDATION FRAME } ` INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL = - GAS: ROUGH FINAL FINAL BUILDING. 4 DATE CLOSED OUT } ASSOCIATION PLAN NO. - F The Town of Barnstable BAMSTABc.e, `1 `0$ Department of Health Safety and Environmental Services VATEo �" Building Division 367 Main Street,Hyannis MA 02601�- Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 % Building Commissioner 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: OE Type of Work: "/ = Estimated Cost Address of Work: i ,Z Owner's Name: Date of Application: Lo I hereby certify that: , Registration is not required for the following reason(s): Work excluded by law oJob Under$1,000 C]Building not owner-occupied ' Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the age of the owner: Date .Contractor ame Re istration o. „ OR Date Owner's Name q:fonns:Affidav ,41 Assessor's map and number ...11../..... .f... THE. • QyoF toffy Sewage Permit number ..... .... ............ SAWSTL LE, i House number .. ' �a�s?, ...... `.....:......................... .....`... f j f = ,1' ae _S�? f ate` Op 1639. \00 �v. _•. 1 -"' 'FO NAY�`' TOWN OF BAR.NSTABLE BUILDING INSPECTOR 6 APPLICATION FOR PERMIT TO ...... 4�.f f�!C l.......!� , ...; TYPE OF CONSTRUCTION .................... f.!v.. . .. ......:�:.!:r. Lf .,1.................. ............................... �!L�./�i. ..../.. ..........19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for/a permit according to the/ Jfollowing information: Location ........ ......... ......................... ProposedUse ........... ........... . .. .. .:... ._...J...................... ........................................................................ Zoning District `. � I ..Fire District .................. Name of Owner .....'i� ./..:.../..f...... �tlfc�`�. ......Address ... J( .. X..: .1..... VA.'.)/f... : Name of Builder ... .....I.......l..7.......:. 11101`J.I..C.E..........Address ..... .......................................................... Nameof Architect ..................................................................Address ............../...................................................................... Number of Rooms .....:. .....:................:.:........................: "�6 Foundation .......L....!JYvfcf lll / ........................................ Exterior .... �j �I( s..............: �h�/ .!C ..SRoofing .'.;: � .� /i��rC:. ..�.. /I(� �. ....... Floors .Interior �� / ...........................................:... .................................. ....... ....... .......................,..f.......................................... Heatingf. ........................... `................. Plumbing ......... ....... : !J.. .:,: 00 Fireplace ....../... ............................................................!...: Approximate. Cost i Definitive Plan Approved by Planning Board - -- 19f--. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r; i .n 4 s 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. : Namev \ .... � .......... Construction Supervisor's L JOHNSON, ROY H. A=147-119 -0 No .... Permit for ...?!...Story... Single Family Dmpal;Lpg...................... . .................................. Dwelling Location . ..................... ................................. Owner ......!&9y.H......Jqhn.s.qn............................. Type' of Construction ....FKAMP............................ ................................................................................ Plot ............................. Lot ................................ Permit Granted ...Sep.t.e.mb.e.r. ...5.............19 85 Date of Inspection ....................................19 Date Completed ......................................19 k 16 • TOWN OF BARNSTABLE Permit No. _---_____-- Building Inspector cash ----------------- teiR OCCUPANCY PERMIT Bond -__-----------—�P _ Issued to Roy H. .;ohnson Address lot #68 , 653 Lumbert Mill Road, Centerville Wiring Impe�ctor_-, Inspection date Plumbing Inspector - Inspection date Gas Inspector `�.�y Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY-THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. , ..,oa...�........:: /.... ........... ;.s;r �%�_�c.... Building Inspector °�. TOWN OF BARNSTABLE BUILDING DEPARTMENT = smir°T ' TOWN OFFICE BUILDING � rua g i619. \ HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department,�y,�._---- DATE: ,f An Occupancy Permit has been issued for'the building authorized by BuildingPermit #...... .. 3. ... .. .......-.._ _................................... ...... ._.... ._.. .... .........._ .._._... ...... .... . issued to :. .. /l�.rJ Sd�/ ..Go /........ b 5.�. ..... v� >,fe�j/�s•LG C'E,v)7 Please release the performance bond. + i ..,. . . ... a .._.�.�.... . �. .._ . .. _... s.. .�.�.. TOWN OF BARNSTABLE, MASSACHUSETTS PERMIT JOB WEATHER C kR 0- W , DATE "" ' 19 PERMIT NO. � -� o l� APPLICANT ADDRESS tom."''"3'` IN0.) (STREET) (CONTR'S LICENSE) — i _ :1•: __ NUMBER OF PERMIT TO (=) STORY -"• DWELLING UNITS (TYPE OF IMPROVEMENT) N0. (PROPOSED USE) t ZONING 1 AT (LOCATION) - w -- DISTRICT - IN0.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR PERMIT VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) OWNER ` BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR , PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED® FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. S�• 2. PRIOR TO COVERING STRUCTURAL QUIRED,SIJCH BUILDING SHALL NOT BE OCCUPIED UNTIL S MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. ): 3. FINAL INSPECTION BEFORE OCCUPANCY. POST T IS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION {� VALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2. t 2 2 86 3 HEATING INSPECTING APPROVALS slim VALS O HER _ _ m_ 12 s 2- - .,.....,.... .�4�..C.-x#i• 't:. -�..f�,.�:�: _. :.t,v=�- 1 ."�.� ,�,.t�;:."�.. .. .. .`.'�..? - F.;�z,.a's'k*k'�=i.'�c.ai^r.}`=:-. ..�._ fin.� '�`#; �'?-'�#f '; ,.,f.':•rv. .. 'N CRK S,AL'_ NCT =PoCEED UNTIL THE PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIpN;S INDICATED ON THIS CARD NSPECTCF SAS APPROVED _HE •JAa�CUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES JF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. ba WRITTEN NOTIFICATION. TOWN OF BARNSTABLE, MA�SACHUSETTS J 0 B WEATHER CAA 0. e 3 '.ir w ',DATE �19 -�` PERMIT NO. UU.J" L".ri2c: ADDRESS "51 APPLICANT INOJ (STREE-T) (CONT R'S LICENSE) iJ t•.+S, _ � ' L _� .. NUMBER OF PERMIT TO - (_) STORY DWELLING UNITS_ (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) <0 :'_` .._ ._ __ ZONING AT (LOCATION) ' J DISTRICT (NO.) (STREET) , s � BETWEEN AND (CROSS STREET) (CROSS STREET) j LOT SUBDIVISION LOT BLOCK SIZE 'BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT,AND SHALL CONFORM IN CONSTRUCTION i TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: AREA OR PERMIT VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) r, OWNER BUILDING ! _ DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR.SIDEWALK OR ANY PART THEREOF., EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED -UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND ` 1. FOUNDATIONS OR FOOTINGS. MADE. ,WHERE A CERTIFICATE OF OCCUPANCY IS RE-- MECHANICAL INSTALLATIONS. `( 2. PRIOR TO COVERING STRUCTURAL QUIRED,SIJCH BUILDING SHALL NOT BE OCCUPIED UNTIL _ MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE - OCCUPANCY. POST 41S CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION A&bpVALSjPLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 0 2 z z S 3 �p HEATING INSPECTING APPROVALS VALS 11 1� --- „'HER ;Z 2 a /_ wCRK _,AL_ NCT =RO_EEO LINT:L THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION iNSFECTI S INDICATED ON THIS CARD NSPECTCF. iAS APPROVED 74E VAR! US WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE AN BE A`ARANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. WRITTEN NOTIFICATION. PERMIT IS ISSUED AS NOTED ABOVE. _ ,AssessW's map and lot numb. /......../...... . SEPTIC SYSTEM MUST HE Tp� Sewage Permit number •. .. ...6.61.9 . .......:��;, INSTALLED IN COMPL WITH TITLE 5 anLE, House number ........ ........................................ :.....'t' ENVIRONMENTAL CO ,b 9. m� c4 TnwN REOULATIO �41 OWN OF BARNSTABLE a ono o� 4 aw BUILDING ., INSPECTOR a y0s QS O r v PLICATION FOR PERMIT TO ....: .�........................................II.V...�?........ . ...:..................................:.. w� PE OF CONSTRUCTION �l 1 s 7 L �L LI �/6 � Y ........!V. ......5.................. �.. ...... a' •�- TO E INSPECTOR OF BUILDINGS: The undersigned�herreby applies for a permit according to the following .following information: / / Location ......... J.1........�t�.� 1 f7� L .l�a....� /.1..� l�. �{�./L/Cam............................. ............. ProposedUse ........... .. . . .. k . .. . .. ..../........................................................................................................................... Zoning District .......lq1! � . ..��.1.........................Fire District .............................................................................. Name of Owner .....l..L�./:...... :... � �1�� ./.��✓......Address P ...5..:2 Name of Builder .-Si�.1 .......Address ......4f ....................................................... Nameof Architect .................:................................................Address .................................................................................... /�,•� . Number of Rooms ........ ....................................................Foundation .......l..�<l�',f;, -c . ...................................... Exterior ..... .A , /:.. � ........ ....( . .� �9/G�* oofing ....... 11 1l..l. .l..... ... ��.I..CF.. ~�....... ' �� Floors . Interior ....... :... ......:::....�..............:................................. ........ . ..................................... Heating .... ...... ,�,e..................:............................................Plumbing ........... . ...... /�s��.. .. . .:,�... ........ . ................. Fireplace ....... ........................................................................Approximate Cost ........C?.�` �� > J. ..�...................... Definitive Plan Approved by Planning Board ____ _ __ -------- 19% . Area .......� �. . ........../ Diagram of Lot and Building with Dimensions Fee / / {SUBJECT TO APPROVAL OF BOARD OF HEALTH ��I\j O , tU o � o 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. T ` Name Uh .......... ` Construction Supervisor's License ......004.d.y... JOHNSON, ROY H. 28384 11 -So '- . - N ................. Permit for `__Ey.............. SingleFamily, `ewe- ng .................................. .......R t�............. .. ....... Lot 6 53 Luigi..... .t Mill Road 6 .. ....e r Location ... .......... . ............... .................. ,Ace Apt erviiie� �Rb�4 .................................... ohnson Owner,....-V......................................................... Type'of Construction .....Frame..................................... .......................................................................... Plot ............................ Lot ................................ Permit Granted .......September 5,.......19 85 Date of Inspection .......lll . ............ig'),S-- 'Date-Completed ............. ......1, JM Cr ri d J 0- { r Y � 1 AF '4 Viz; G _ k 0 �,.v AC�� W�'T1.�i✓C -7747*1 y00y�� 7 ti vZ , 7S' �. Lo7 J ry 29 GF. FOGLRT a� r r ELDREDGE 1 No. 1J'F'7 ul CERTIFIED PLOT -.PLAN o 7 v h L v B�',e 7- c c i 5 r t SCALE, DATES 8�Z845- GEE GI EE lNG C .INC) I CERTIFY THAT THE �ay.�nr�rya T; C IENT jou"5onl ., E8.19TERE0 REGISTERED SHOWN ON THIS PLAN IS LOCATED JOB NO. 8 SOY ON THE GROUND AS INDICATED AND "x C i VI L LAND --Y-- - -- ENGINEER SURVEYOR OR.BYE CONFORMS TO THE ZONING LAWS OF BARNSTABLE' MASS CM.BYEf; ' 4 7 12 MAIN STREET. •� � Z . Ss , �:I•_----- ""` HYANRIS, MASS. SHEET;OF. ATE -�� RED. LAND SURVEYOR i ra :` L r F N� rj (� VA/Z1Ar-e C- 2C—r C'G (Fvu•fu (�F�t t ira :L'a.� �el IL, CD Go'r I SS Goo' s.�• Gam, i�• ^� �.07- iv t D 771 /o o Gr• q ! . fi4 V 3 � � ppa N 1000 ,AL r f� Eanc TriPiv, JPL.VG x 0q v �f1rf ' 1 Al 1� ,�,J.N11N S '7+uj�� .i_- TUc✓i:) Frr A s ° 1+1 x 122 D rA10 �- a ty 'P/7 i.o'i G l Uc-S 6',S, Da'%` 41 Yf p � b� Q IU g 1 Lq .. �° ' 6S �9 v r iN� a AL /N� ��ice, �• 5 1 'ZSE i No.10951 LEGEND > s�_� c, _+ EXliTiMO SPOT ELEVATION Ox0 6 `�% �� LXISTIN®:CONTOUR --- 0 ——— / CERTIFIED PLOT PLAN 'FINISHED SPOT ELEVATION F1' 1°.SHED CONTOUR 0 — Lo �." 6 Zv��r rt r� G c >> ;1. NOTE. The location of any existing underground sewerage, wells, or :other utilities shown on this plan is approx- IN ,' C imate:`onl as d..termined from records and/or' verbal \ information: The contractor is responsible for the �� '�\��•��"�� '^` �� s ..verification of the existinglocations in the field. �Ev1�E� 9CALE� / i`_. . DATE } .DREDGE ENGINEERING C0� IN N1 5�tJOW aV,0Vt iZe AaO CLIENT �Kf I .CERTIFY THAT THE PROPOSED ^� EGISTERE REGISTERED 6 n 2 JOB NO. `� ! BUILDING SHOWN ON THIS PLAN r CIVIL LAND CONFORMS TO THE ZONING LAWS DR.BYI / � , tPT ps ronp ofRV ENGINEER, 11 i e a: 712 MAIN STREET �. CH. 8Y � � S� MYANN I g, MAg8 OFr Z D TE REG. LAND SURVEYOR k NEST...., /YOTF /F E/TNAffR 7NE-SEP7/C TAN/C OR L .ZD FT. m/N. LA-ACNiivG P/T .4N4 /YORE THAN /2"QAFl0j'V /o �wr. MIN. 6;,eAOE.4 24"D/AMAF7E& .CON P CA-AFTAF COP& SMALL &F BRau6NT TO 4)rADE.(�A y &X-7-,VA GONG4ETE i -o PVC o/PE NEAYy CAST IRON COi�ER S/VALL BE USEd { M/N. P/TCN /f/N DR/VEN/AY PT. I A CO VER CZ EAN .SANG 4• •. LQt//D LEVEL , f 4'. A. $NEDmrs4O2�LAYFR ' L. 0 a o • P �o or /�g GA D/ST. 1 • • • • • • • • s o„ WASNFD ST1�NE PAFA IT.- SEPTIC TANK • s • • • • • s • • • • s • ?`:. BOX o • 1 B • • • •• • .•• " _dam•. Ems.92_� •••D� 1 • •EFFECT/✓E r ` • •• •3�4�- � �2� :: • • r • • DEPTH • • • • • 0 WASNED STONE ,�a. �- � o r • • • • .••• 1 Leo • ' rl _warn rwai� c ;1 • a• r • . • • • •• • o•�A PRE�ST SELJ94GE i-rG�Pifc/7; 4J� r4L ,'> j a o • • • •. • ® • • • e • P/7OREQdU/V. INl -A-r ELRVAT/0/Vs . a c� ,97. r I /NXERT AT OU/LD/NG 9 6.S Fr j c 3 ' 6 D1'AM• INLET . PT/C TANK 0°FT, FT D/�4M. C�SFE 7�9aLL.4TION� DU7LE7-3EP7/C TANK - 9 -5 FT, r' /Nr15l. v, 87, 1 P&L- !/V,GET DlSTR/BI/TION BOX 9 FT. 6ROV V o 14 4 rER TAOLE //!mot 6�o u.i>wd47r]L t �/�� 54 SECTION OF G�rtcvd-r;r7o"S OVTLETD/STJrIBt/T/ON OCW 9 FT. IA14-=T LEACNIJVG IC'/T 9S,1 r SEWAGE 01SAWAL SYSTEM 7A4W4A7I40N LEACHING /P!T D,FSl6IV CRITERIA sc.nLE omfirmi/oN% _ /._o D/NAW-5//0N P— 4 FT- 1 0 3 D/MEA/S/ON C � i7��'?i�✓/ NUMBdE DR R OF OE 4MS GAR8.4Gf0/SPOSAJ_41,VIT !V �/c SO/dL LOG TOTAL E?T/N11�trEo FLow 33o a4L./a4ir SO/L TEST.*/ SOIL TEST .�* SD/L TEST g� /YUM �' L, BER QdC54GN/NG P/Ts / r`�'LOK Z. ELFY. OATS OF"SOIL TEST /0 S/OL=LEACHING PER P/T l S/ 5%;t PT. n I r O _Z RESULTS h/lT/VESSED dY D c� ��o•z./� ;l 90T MYW LEGICH/NG P P/T /! 3 T �It AT/ON ILAT G�`�s INCH ER Sq. F `v�-.r� � CO.0 E/IE'/ MIS/ TOTAL IZ4CH//VG AREA MIN Sip FT. AEJKOLo4T/ON RA7',E j*Z' T`'`'�^� 1IIVCH Z,D �. ARSD•RI^EL84CN//V6.AREA .2�c.b $Q. FT. IL. .T&ST �•— 3S9 / . eQ _ r r YaTq P�(NOFM4ssy Ary/(� ! . L.D T GS' Z-6UM3C--2T MILL /-r-> 3' '/// ROB T �� o? J+ nix• �z .8_7,/ P�J/ `( A. — p.�. dP.w. A-ZUvsT j��yes�v 7 23 5rS' REV:i z7 Sr .o i E D<EE• �. o MORSE y i c; B G.z U ''No.10951, — a 6 ,o Q- k, _ � � E��; •*, ;. 90 GIST �v�� z � N 91F.t 14Y•iNw/9 dM.4 7Z, ij • , - _ { � Y..,{ �. - -�..i J"-T s 4 A. rl _ v,. x .tea� x � w. �•� -,s `. - e iiMuM .N: ..,P: ,� 9:x .t � }a. '.r o -�.r.y� -a..3-:. rw,. d .r{. ..`4 }.. �r ,.r..,kini�• wyr 4 •.�K .,,j.. -u ��, c Sm-r 3� ��"^'{ .K+ ,>ti .� 4.' y �.F• � r. ,..r+�Its':a7+w�i;:. ,�i: '. n;P` „ :.. .. 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