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0432 MAIN STREET (CENT.)
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Framing: *1 Address::` . 432 MAIN ST a Contractor License 194747 2 CENTERVILLE, MA 02632Est Project Cost: $ 17,325.00 Chimney: Description: strip 100%and reroof w asphalt shingles(landmark pro) in same Permit Fee: $88.36 color; remove and replace skylight,same size`o enin Insulation: pi p g h) `Fee Paid` $88.36 � Final: Project Review Req: + Date 6/9/2020 � I Plumbing/Gas r y 4.3 i -- Rough.Plumbing: saftOfficial All work authorized b this permit d hallcon conform to the approved application an d�thea erov�ed construction d cu�m-e t for wh ch this mi Final Plumbing: This p Y P y p pp pp ` pppermit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. Rough Gas: This permit shall be displayed ina location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. 3 Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: " 'a 1.Foundation or Footing v�i Service: 2.Sheathing Inspection ' ' 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed' r Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final:, 6.Insulation 7.Final Inspection before Occupancy Low-Voltage Rough: Where applicable;separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site ' Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town of Barnstable 'Building ri Post This Card So Thatit is Visible;From the Street Approved':Plans fVlust be'Retained on Job and this Car Must be=KeptSAMST § �*^ , Posted Until Final,Inspection Hasx�Been Made BILK i63 .� ermit Where a Certificate of Occupancy.is Required,such Building shall Not'be,0ccupied until a E�nai Inspection has been made. Permit No. B-20-1153 Applicant Name: Dean Fraser Approvals Date Issued: 05/05/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/05/2020 Foundation: Location: 432'MAIN STREET(CENT.),CENTERVILLE Map/Lot 208-019 Zoning District: RD-1 Sheathing: Owner on Record: ROHRBACK,CHARLES A Contractor Name.-,,Fraser Construction Company Inc. Framing: 1 Address: 432 MAIN ST "Contractor License: 194747 2 `x x CENTERVILLE, MA 02632 '' ^• ,Est. Project Cost: $ 16,825.00 t . Chimney: Description: strip and re-roof 37 sq landmark pro pewtervood B Permit Fee: .$85.81 I Insulation: Project Review Req: F Fee Paid" S 85.81 -Date: 5/5/2020 Final: Plumbing/Gas Rough Plumbing: .Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sixmonths afterissuance. All work authorized by this permit shall conform to the approved application and thet for which t approved construction documents his permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration ofthe work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,Oermit. Service: Minimum of five Call Inspections Required for All Construction Work:( • 1.Foundation or Footing Rough: 2.Sheathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to.Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:. 6.Insulation 7:Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT T 5 r TOWN OF BARNS TABLE BUILDING PERMIT APPLICATION Map Parcel O Application #A1 30r Health Division Date Issued Conservation Division F Application Fee j Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board R Historic - OKH Preservation / Hyannis Project Street AddressJ� >/���/ Village G'o,�j ���� ;,Ii/� Owner�, ,9���cf%v W iV Address Telephone Permit Request I ,� > o /��a //G' G't�����/�✓��'�' Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new. Zoning District Flood Plain Groundwater Overlay :Project Valuation 6 Construction Type,/ram 4.-?k�//,&/ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family GY Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 0'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: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: LOS fisting §gne osize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ —~ __Commercial_. ❑Yes ❑No . If yes,_site plan review # = = Current Use Proposed Use R 6 1J li _rtC APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� C� z,&;6V�i�&Z Telephone Number 0;o K 72--5 % Address /r �� �C� License# fer,&p Home Improvement.Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO d �v SIGNATURE DATE ®// �� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED_ MAP/PARCEL NO. Q ADDRESS VILLAGE OWNER i I DATE OF INSPECTION: I I FRAME - - - - - - �r - �. %:INSULATION.. i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FWAL BUILDING. DATE CLOSED OUT i I. ASSOCIATION PLAN NO. r . 1 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 A213ficant Information Please Print Legibly Name (Bus;ness/Organizatioa%dividual): Address: City/State/Zip: 2 G;Z G Phone #: Are you an empi yer?Check the appropriate box: 7 Z LEI❑ I am a employer with. 4, ❑ I am a general contractor and I Type of pro jest'(re>quired): employees(full an&oc part-time).* have hired the sub-contractors 6•. ❑ New construction 2.[] I am a sole proprietor or partner- listed on the attached sheet. I 7. [] Remodeling ship and have no employees These sub-contractors have working for me in any capacity. employees and have workers' 8' ❑ Demolition I [No workers' comp. insurance comp. insurance.i 9• [] Building addition I required:] .S e are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required] t C. 152, §1(4),and we have no 12 ❑ Roof repairs 3a.❑ I am a homeowner acting as a employees. [No workers', 13.❑ Other general contractor(refer to#4) COMP.insurance required.] 'Any applicarnt that checks box#1 must also fill out the section below showing their workers'cowpcnsatiod olicy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractor must submit a new affidavit indicating such. ;Coutracton that check this box must attached an additional sheet showing the nano of the sub•contracton and state whether w not those catitics have employees. If the sub-contractors have emptoyees,they must provide their workers'co oli number. comp.p cy !am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: %/'��:.i � �T G'/ Expiration Date:_ %,� Job Site Address:4, Ile- City/State/Zip: ,�ja d 7- 4 y 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. !do hereby certify th pains dnd penalties of per.ury that the information provided above is true and correct Milo ' Official use onlyy. Do not write in this area, to be completed by city or town official City or Town: Permit/LIcense# Issuing Authority(circle one): I.Board of Health 2, Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: CAPECOD-27 MYOUNG DATE(MMIDDIYMI �►c��re'e 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#PC-514062 CONTACT Margaret Young Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 fAIC,No Ext: AIC No): South Dennis,MA 02660 ADDRESS:myoung@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:PEERLESS INSURANCE COMPANY INSURED INSURER B: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 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE A BR - POLICY EFF POLICY EXP LTR D POLICY NUMBER - MMIDDIYYYY MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP8263063 4/1/2013 4/1/2014 PREMISES Ea ocanence $ 100,000 CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PE O--CT LOC $ AUTOMOBILE LIABILITY EOa aBINEDISINGLE LIMIT $ 1,000,000 B ANY AUTO 13MMBCKVMK 4/1/2013 4/1/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS r AUTOSX HIRED AUTOS NON-OWNED PER ACCIDENT) $ AUTOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 + C EXCESS LIAB CLAIMS-MADE XONJ463512 4/1/2013 411/2014 AGGREGATE. $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION WC STATU- OTH- TORY LI TS AND EMPLOYERS'LIABILITY 1,000 000 D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA WCA00525904 - 6130120 6/30/2014 E.L.EACH ACCIDENT $ , OFFICER/MEMBER EXCLUDED? - (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 9,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Compensation includes Officers or Proprietors. Addtional Insured status is provided under-the General Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Cod Insulation,Inc ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r P,+; :�I,tssachusetts - Dep;111111et1tol Puldir lafct� 13uartf of 13ui1'tliu' Re-ulation.s anti stalwai—lls f Gonstrur�tion Supervisor License a Ltcen :' C5 100988 HENRY CASSIDY r rats ^� 8 SHED ROW "r WESIT `¢ARMOUTH, MA 02673 .a . Expira onQ/11/2013 l .muuisvirnrcr' Trtt: 7,fi20 , l�?JC2, `I.,L()C'all.162- 011. r9 Uflice of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 :Dome Improvement Contractor Registration Registration: 'I53567 Type: Private Corporation Expiration: 12/15/2°b14 Tr# 233831 CAPE COD INSULATION, INC • HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card. Marls reason for change. Address ltenetval I inploynient Lust Card <, ,r,�, l� C.l L_-- .. ''�/r• `((•iurirtryrrrc:rrlll r�C-3rllra��tc'�u:u:ll1 < .. . O irc oI Consumer Affairs& Business Regulation License or registration valid for individul use only x1 Q before the expiration date. if found return to: ME IMPROV Wz— T CONTRACTOR Office of Consumer Affairs and Business Re utation registration 153567 Type: 6 LO Park Plaza-Suite 5170 xpiratio 12/'15/2014 Private Corporation . Boston,MA 02116 ' INSULA `I(7YtJ ir.i\rRY l;ASSIDY 16 Rt:ARDON CIRCLE ;Q YARMOWF(MA 02664 llnrlcvsecrcGtry otvah Avitho t flat re 142213 OWNER AUTHORIZATION FORM 5O A . (Own is Name) owner of the property located at , (Property Address) Cv�KQ (Property Addressi C'ct.- ©� -Sec-(li. �7 U?�✓ hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date JUL 8 2013' � � . � ol� �Iq/j3 CAPECOD TOWN OF � T B# INSULATION MCP 2013 AUG -2 4e 3 5 IIBER OLASS S[p MLESS SPRAT FOAM fYSP[NDED RAM OY"ERS IHSYLANON C[ILINOS - 1-800-696-6611 QIVI opyl 'town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: 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 (:jAa41ts ,4 , PAS �aCti L131 M410 st, Cenf.tiVllie 10 tc, Insulation Installed: Fiberglass Cellulose .R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors A,.•/ /�6 CY OrAwL Walls C 101-e a1 C e e 1 ( ), ( . ). (:Zd) ( : ) ( ) (P�D.FL�e� e-e �iv f�uClr+" Sincerely hECasJr,President on, Inc. ,m ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ Parcel °. Application # Health Division Date Issued J 3 Conservation Division . ' ': Application Fee Planning Dept. l Permit Fee 1 V 2 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis . • Project Street Address 432- K610 ST. Village CE4Lf-V I L&C ° Owner C.44Wt2_LI S 5-6 IZOO' " Address Telephone Sot Alt 665 Permit Request ITGN� F-Er�'� ADD(TI o p� X � fioI S-i Ak S11,4 P IN T_ENov�, (r h-IA- Pt--) CEA UJ Cr Square feet: 1 st floor: existing proposed Z� L 2nd floor:'existing proposed Total:new Zoning District Flood Plain Groundwater Overlay Project Valuation 21-000 .°D Construction-Type you Lot Size Grandfathered: ❑Yes �No If yes, attach"supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure ILS Historic House: Yes ❑ No On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑ Crawl / ❑Walkout �Ot r 5 o 0 FA-i L. 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- ❑Yep No Fireplaces: Existing New Existing wooWfeoal stoves ❑f4 ❑ No a 'd e fisting ❑ new size o xis ' ❑ ne " e _ Barn existing Llinew>size ac d gara e: ❑ exist ew size —She existi ew _ ther: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ r Commercial ❑Yes ?(No If yes, site plan review# w Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name -Sot w Telephone Number Address 33-DoPECrnL cA9- . _ License # CS"(00b_ C vl4 rAA 6163Z `' Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 11kR. 114Lt "('owa'IjaN. SIGNATURE DATE 4'1'�Z FOR OFFICIAL USE ONLY ' r APPLICATION# DATE ISSUED MAP PARCEL NO. _ ADDRESS r't VILLAGE i? ' r OWNER :f _ `iA.• .— may. -' . DATE OF INSPECTION: r %FOUNDATION FRAME 5i,,�- gw44s le'Da,G l 12 �F¢W���A�yyc . C4 - f' INSULATION. " FIREPLACE ELECTRICAL: ROUGH FINAL - } PLUMBING: ROUGH FINAL GAS: ROUGH --, ,, - .f FINAL FINAL BUILDING; DATE CLOSED OUT . ASSOCIATION PLAN NO. c+ The Commonwealth of Massachusetts. .Department of Indusfrial Accidents 050L-e ofbtveskgafiorrs 600 Washington Street Boston, MA OZIII Ww.mass goy/aria Workers' Compensation hsurance•Affida-,vit. Builders/Contractors/Electricians/P ambers APPlicant Information / Please Print Lepibly Name(Busmrss/or�fion/Indivi 1,0 S ti y 4•R44 Address: 3 -�Ojekp(L Glh . Ci y/Stawzip cEeTUY LA IVW 01.E)I- Phone Are you an employer? Check the appropriate box:' i.❑ I am a employer with 4. []I am a general contractor and I 1e of proj ect(required): • employees(fall and/or part-tie).* have himd the svh-contractors 6.. ❑New constru�on. 2. I am a sole proprietor or Partner- listed on f m attached sheet: 7. Remodeling KI tGE IF� and have no c�loyees These sub-contras have for me.in an capacity. to g• Demolition WO�g Y -� it5'• � Y�and have workers [NO.workers'comp.instn�ce comp,ins=mce.t 9 ❑ g.addifion 3.❑ �qd] 5. ❑ We,are a corporation and its 10.❑Electdeal repairs or additions I am a homeowner doing aIl work,. officers_have exercised itieiz 11. Plumb' el£ ❑ mg repass or additions mys [No workers comp.- right of exemption per MGL msuranee re Mimi]t c. 152, §I(4),and we have no 12.0 RoofrePairs employees. [No worker;' 13.❑Other comp.mstzame required,) *Any applirmt that checks box#I Est also M oat tho section below showing.the wCd='compensation policy infmmmtion. H-n-+rucks who mbmit fins e5davit indicating tbcy—doh an wo&and then hm oatade conhmct m mast snbmrt a new ffn-dxm mdicating such. tConizactom that check flan box mast aitachcd an additional sheet showing the name of the employees If flee sulk-cont�cs have employees,they nmst ,: II�tors and state pr}zetbq or not tbasc a>tities have provsde then wor)as.camp•policy camber. I am an emloyer that is providing workers'cotrrpensaiion insurance or information. f m3' P�3'eeS Below is the pofiry and job site Insurance Company Name: Policy#or Self-ins.Uc.# �. E#irafion Date: Job Site Address: City/State zip:Attach"copy of the workers' compensation policy declaration page(showing iiie policy number and expiration date). Fame to.secure coverage as re-T$ d under Section 25A ofMGL c. I52 can lead to the' sum er fine up to$1,500.00 and/or one-year �aI penalties of a Y . mar. Be adyi as weII es civil penalties in the fnan of a STOP WORK ORDER and a fine of up fn$250.00 a day against the violator. Be advised that a c of this Investigations of the DIA for' e co opt statement may be forwarded to the Office of. verage verification. I do hereby certify and pena'aas ofPmjwy�the information provided ab P ave is true.and carrecz: S' �•�' , ]?ate: Z Phone i ,tom [Contactrerson. l use only. Do rsaf write in i3ris arra,in be completed by city or fawn oZ Town: Permifll�icense#' Authority(circle one); d of Health Z.BtuldingDepattmeat`. 3. City/Town Clerk 4.BleciricaI Inspector 5.Plumb' r mg Inspector Phone#; ------------ 7. :: , Office otC�ons mer airs �13dsiness egulaho License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ,fa164299 Type: Office of Consumer Affairs and Business Regulation ; Expiration 02Wl 013 Individual 10 Park Plaza-Suite 5170 SV1/ _ Boston,MA 02116 ARTZ - i, �� JOSH SWARTZ ' `r 33 DONEGAL CIRC111LE %i�F �5 CENTERVILLE, MA 02632- `- Undersecretary of valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards - I Construction Supers isur License: CS-100792 JOSHUA B SV�tTZ 33 DONEGAT?CIR j CENTERVIILEMA 02632 of—..4.. 1w" Expiration Commissioner 02/22/2014 ot� Town of Barnstable Regulatory Services DAMMAKXMASS Thomas F.Geiler,Director D µel►��g 1 Building DWISIon Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www:town.barnstable.ma.us Office: 508-862-4038 +, ..Fax:..508-790-,6230._ _ Property Owner Must Complete and Sign This.Section If Using A.Builder as Owner of the object property hereby authorizeOS (r b to act on mY be in all'mattets relative to work authorized by this buLin permit �2 �a�tr- ST• � �y ( wE � A 7�1 pp 2 (Address of Job) Pool fences and alarms are the responsibility of the a lica'nt. 'Poo. tY . pp Is are not to be filled before fence is installed and pools are not to be utilized uni til aft final inspections are performed and accepted. Signatate of Owner S-4) Signs e o A plicant print 70S Sw�`Name Print Natae Date QTORMS:OWNERPERMISSIONPOOI.S . c �jHE Town of Barnstable Regulatory Services i M Thomas F.Geiler,Director . y A8.SS.9. _ fp�"��� Building Division Tom Perry,Building Commissi er 200 Main Street,.Hyannis,MA 2601 www.town.barnstable. .us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE MPTION Please Prin DATE: JOB LOCATION: number street village "HOMEOWNER": name ho phone.# work phone# CURRENT MAILING ADDRESS: -ty/town state zip,code The current exemption for"homeown s"was ext ded to include owner-occupied dwellings of six units or less and to allow homeowners to engage an indi 'dual for e who does not possess.'a license;'pioyided'that the owner acts as suvervisor. E ION OF HOMEOWNER Person(s)who owns a parcel of land on wlu she resides or intends to reside on which there is, or is intended to be, a one or two-family dwelling,attached or ched structures accessory to such use and/or farm structures. A person who constructs more than one home in two-year period shallMriot be consid red a homeowner. Such "homeowner"shall submit to the Building 0 'al ono form acceptable to the Building Official;"that he/she shall be res onsible for all such work erfonned and r th boil ermit. (Section log.1.1) The undersigned"homeowner"assumes r onsib 'ty for compliance with the State Building Code and other applicable codes,bylaws,rules and regulz ons. The undersigned"homeowner"certifies t he/she un tands the Town of Barnstable Building Department m;n;mUm inspection procedures and re ements and t he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building OfficialGt t ` Note: Three-family dwelling con taming 35,000 cubic fe t or larger will be required to comply with the State Building Code Section 127.0 Co truction Control. NW HOMEOWNER'S EXEMP N The Code states that: "Any homeo er perform;ng work for whteh•a buildi permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of c struction Supervisors);prquided that i e homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervi or." . F ' t� Many homeowners who use this.ex lion are unaware that they 'are assuming responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction upervisors,Section 2.15) This lack of a ess often results in serious problems,particularly" } a3 when the homeowner hires unlicensed persons. In this case,our Board cannotproceed against pnlicensed person as it would with a licensed' Supervisor. The homeowner acting as Supervisor is ultimately responsible, a To ensure that the homeowner is fully aware of his/her responsibilities,many communiy 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:for ms:homeexempt . THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �(�G�"- IL DATA o Fd I ? L 14) 3I ;e N N � c f .Of �crr N r L4 Of A?A No 1 ` \ 1, 4 i A L' 0 7- D/ A "v <''45 . ���•� Sc.G<:: /`=.��r .`APT .s >>�� 17 4 i �' I \ , ._' �~ /� vim+ \ � ,�� ��\~ ``•�.,� OF f�•�• , �'._____ �Dec;K..� rl`'i \. Cit..i'tir;t. •,ti�ft !07 /A `l LAMOFS y �� id SUfsuE 41- Nip L: /'� L / T a o / O WAllfD X. �570' PT 5 4-61 LAAl10IFS CXS ti�/���vIJQ(/EYr?F �•_� t�cf iP, die. P�o�a,.-+ h!� ^ter'. .4f H4 /N, t1 A: 1% 47,1 7,q74)0 06 IF � r Sri' • 'f H OFr/gss r 3If v 1r IL _ 0 CUDIL.p m �o.34774 y ���/ St UCTUggL STwpe r �N. 6� Mkit�N -�2012 i RO�oS� -tA1�ooM A-bDrno � � n. � x. ._ ... ..._.yam...• � _ — •. .. �., .,... • ..t,_..- -' . r_-,i•..�. �. n`-- .e� • _•r _ �._. i _w. �-:......\\_ „ . SCA ,�.OL 70 _ fib. F , e 1 - I wKeV , �0 , 4M Awrlr.� I t v 1� goy+ '---`l � Arty(f v1 •. !�'� POLY '� L_2 'Y-�30 . u St,PSo�Po � . lf C 71 �ael> 2" Y CONUZM --G;,AgF- a' 22-141 50 SHEETS t' , MICHELE `�G `� 22-142 100 SHEETS o CUDfLO m �AAWPA17' 22-144 200 SHEETS PIO.34774 _ 0 STAUCTURA� y 'oSIdSW19RxvcoL �` * f32 Mal►j.ST 1026 { t /.JA(n�ll \� t . . . s 33 { Y { ito x .i _ ..—...ir.._ _ d .� li _.— F• .i t .�f i; i f'. 1 I #—� f _s. � i � t :F. A y� 1 - I :.i- 4 a ti s: _ s, t t- t -, .. 1.s: '.r'j. !.'n� :. { ��- J E i � {.. _ —{ 1• ,� s M1 t Y i i c # F r 21 t j 7, t I pw i I ,9 i I �Y. �.` --?...� f L-1ylo- Roo^^ #� - --r-- _J1 ia : E �v O. / t # _4 L.rn 1 —., �.._ :i } 1 ' _.-1•— ± -� — 7 f - i_. ( s Y. ? + ---$"---"`__. � # S. +.,.3.." r�.. Iwq. J. t - E _ ._ ,1—. Y�23-- � r I 1 { { 'i }., 2p?/' f Q�U 5—..—i `'`.- - r:._._ _ .._.'- ; 4 t _ -`• �(�':. Y f t i '�—f r 1 i�L�t� _ 1. 7 S" s i j Yy i 0 �)• w t 1 i- � � h 1 Z`( ����L i t s 71 Y ---I--- - _-i_--•---,-.—�-' '14- 1� 11 tDA- " # t �{ �' 'F ! i r � ..,. t .r r_ t }. ».I� { ( � �e�t �. # ~�,a� T f. ..f ti r•. �l`."r •k.,�.r ';f.: 1 i ! (0� S7s; rAPA Lva- i • / (relv►F;-/ , 1-"bII7cy4) SNOFMASS 4 , 0 MICHELE ti�N CUDILO I ° No.347741 U) — — STRUCTURAL —4 SIONA< RESIDENCE MODIFICATIONS MICHELE CUDILO, P.E. C9 Consulting Structural En ineer Centerville, Massachusetts 02632-1979 508 771 7601 432 MAIN ST. Drawn By: MC Dater /6/12 Drawing • Scale:4 AS NOTED Rev. 0 CENTERVILLE, MA SK- 1 File Nome:SWARTZ Project No.201;!-52 GENERAL NOTES AND MATERIAL SPECIFICATIONS: FOUNDATIONS I.All workmanship to conform to the requirements of the Massachusetts State Building Code. latest edition. 2. For site location and grading information, see Site Plan,by others. 3. Assumed net allowable soil bearing capacity,q=3000 pst.fora medium sand/gravel composition. Other soils encountered. contact the Engineer of Record. 4. Concrete: Minimum 28 day strength.fc=3000 psi,3/4"aggregate.designed per American Concrete Institute Code,latest issue,maximum slump=4". a.) Anchor bolts ASTM A307 galvanized,,min. 5/8"diameter, 12"long,w/2-1/2"hook spaced "o/c.or in concrete piers w/ Simpson ABU-series base; SPACED 2'o/c for slab-on-grade construction(i.e.Garage.Basement,etc.). FRAMING 1.All workmanship to conform to the requirements of the Massachusetts State Building Code,latest edition. 2.Structural Design Loads: Dead Loads: Actual Weight of Building Components Live Loads: Snow Load =30 psf(plus drift)with applicable reduction ATTIC Storage=20 psf Living Floor=40 psf Sleeping Floor=30 psf Decks and Balconies=60 psf Wind Load : Criteria used for 1 10 MPH Exposure B,unless noted otherwise 3. Structural Steel: (as required) a. ASTM A572 Grade 50.shop paint with rust inhibitive paint.Thru-Bolts: ASTM A307, 1/2"diameter;punched holes: 9/16"diameter. b. Welds: Shop weld cap and base plates to columns;shop weld bearing plates to beams;use E70xx electrodes. Alternatively, field weld by certified welders. , c. Deflection Criteria: L/360 total load deflection. - 4.Timber Framing: a.All new timber framing: Spruce-Pine-Fir No.2 with Fb=1000psi, E=1;300,000 psi,or better. b.Pressure treated timber(P.T.):Southern Pine with Fb=1300 psi,E=1,600,000 psi,or better. c. Laminated Veneer Lumber:All L.V.L.shall be 1.9E L.V.L.with Fb=2925 psi,E=1,900 ksi, Fv=285 psi, Fc_ier=750 psi, Fc_par=3035 psi. Parallam(PSL):All PSL shall be min. 1.9E ES with Fb=2900 psi,E=1,900 ksi,Fv=285 psi. F'c_per=750 psi, Fc_par=-2900 psi. Note that Microllam and Parallam'may be used interchangeably. 1. Deflection Criteria: L/480 Live Load,L/360 Total Load s 2. Optional: Provide shop drawing submittal of engineered lumber systems for approval prior to materials purchasing. 5. Metal Connectors: As manufactured by Simpson Strong-Tie Co.shall be handled and installed per manufacturer requirements,with all nail holes filled,with the size nail as specified by mfgr.or herein. a. Rafter to Ridge Beam: Simpson LSSU-series,or Simpson Straps over top of plywood,spaced 16"o/c; Rafter to Ridge Plate: Collar ties min. I x6@ 16"o/c at top or Simpson Straps over top of plywood spaced 16"o/c b. Rafter ends to top plate: Simpson H2.5A c. Band Joist: Simpson straps at48"o/c: CS-14R-50.5"centered at band joist 6.Bolts: Bolts in wood framing shall be standard machine bolts unless noted otherwise. Bolt holes in wood shall be 1/32" larger than bolt diameter. Bolt heads and nuts shall bear on standard malleable iron washers,or square plate washers.All nuts shall be retightened at completion of job. 7. Blocking: a. Blocking shall be solid blocking,2x minimum,and full depth of member. b.Stud Walls::provide blocking at 8'-0"o/c,maximum height. Corners to be blocked at 48"o/c with plywood edge nailing to this blocking for the first 48"of these building corners. c.Nailing Schedule: Solid Blocking#o'Bearing 2-8d toenails ea. side ' Blocking Between Studs 2-I0d toenails ea.end,or 246d end-nails ea. End d. New-Framine: Provide.2x blocking for 2 joist/rafter bays and spaced 48"o/c in joist and rafter plane at all edge P� OF MASS plywood edges to this blocking � 8.Nailing Schedule: _ p`' MICHELE ciL All nailing shall be in accordance with Appendix 120.Q,unless noted herein specifically. CUDILO Multiple Studs 16d @, 12"staggered 0 a.All nails shall be common wire nails. O No.34774 Cnn b. Sub-bore where-.nails tend'to split wood. STRUCTURAL 9. Headersless than 4'-0 .:use 2-2x6;all others per MA State Building Code Table 5502.5 and Q171. RrGtST ��p, >/ MICHE O p Consulting Structural En` ineer t ZJ Cott wMd Lone, Cetrtervft. maesoehueeft 02632 7 Z i ► S T. Drawn By: MC Date: Drawing q Scale* AS NOTED Rev. 0 o— 1tt (� � i1 File Name: Project No.: S V- 2o�z— c 22-141 50 SHEETS �, l49ICHELE SG `� 22-142 100 SHEETS _- 0 CUDILO m C�-�MPAO' 22-144 200 SHEETS 0 ' NO.34774 S?RUC? 1 �. ' URA! u' oStfSWM1 ",e A P. I,<I-Fri /R.,r'►a P^+o -' _ (Z)Z8' +�} %i # E. l i1_ t _ { s jr— ! 3 i 1 1 Jt T J.fA - - a : •p-fir- _ - ._ _ _.-. LEJi f 67 { . r t cS _f :.$•" , k 1- ylo pol , s 1_ L i • : _-- i , , ! F , t - ��1 MJCHELI_ o CUDILp LO m ' No.34774 1 � B i�:r r'/�17, sTRUCTUR4L co �-_" �NERoF�R$ Gl S oS SwgR c�,SrbP. rt�Pf,yr Ckr'TtR.v i In,�, y f-,A 0 Lbw / �RR(,N �2o�z RoQoS�� 13a11kR*-M AID It10 SGA LF, o 0 0fe% �p d WA-\- I E - ►+�+� Ei�f� s 1 � S 4 o0 + I ./ O !� flE1N �N�"�Tyf Fir► N' Y. N Nl s NN 1 '_sl ylO � BUST l jb � / / New Cxlo�S VERO lb E�tST/1�N Q2_/30 U 151-953d POST �^SE i t7 � ' Z"1r lsq x �j 1 i� W�IL� I 5�U ! _._...�P-�r_o.-.ttL , -oil. �►.5�--_:.fit ,,�t I (� (��� G��DITI`'►'t� �NOFMASS,9 o MICHELE yGs CUDILO �+ O No.34774 U _ STRUCTURAL RESIDENCE MODIFICATIONS MICHELE CUDILO, P.E. /q Consulting Structural En ineer Centerville, Massachusetts 02632-1979 508 771-7601 432 MAIN ST. Drawn By: MC Date: v /6/12 -Drawing Q � CENTERVILLE, MA Scale: , 2 AS NOTED Rev. 0 SK- File Name:SWARTZ Project No.:201Z-5Z J GENERAL NOTES AND MATERIAL SPECIFICATIONS: FOUNDATIONS 1.All workmanship to conform to'the requirements of the Massachusetts State Building Code. latest edition. 2. For site location and grading information. see Site Plan,by others. 3. Assumed net allowable soil bearing capacity,q=3000 psf,for a medium sand/gravel composition. Other soils encountered. + contact the Engineer of Record. 4. Concrete: Minimum 28 day strength. fc=3000 psi,3/4"aggregate.designed per American Concrete Institute Code,latest issue,maximum slump=4". a.1 Anchor bolts ASTM A307 galvanized,min. 5/8"diameter.. 12" long,w/2-1/2"hook spaced o/c.or in concrete piers w/ Simpson ABU-series base: SPACED 2'o/c for slab-on-grade construction(i.e.Garage, Basement,etc.). FRAMING 1.All workmanship to conform to the requirements of the Massachusetts State Building Code, latest edition. 2. Structural Design Loads: Dead Loads: Actual Weight of Building Components Live Loads: Snow Load =30 psf(plus drift)with applicable reduction ATTIC Storage=20 psf Living Floor=40 psf Sleeping Floor=30 psf Decks and Balconies=60 psf Wind Load : Criteria used for 110 MPH Exposure B,unless noted otherwise 3. Structural Steel: (as required) a. ASTM A572 Grade%shop paint with rust inhibitive paint.Thru-Bolts: ASTM A307, 1/2"diameter;punched holes: 9/16"diameter. b. Welds: Shop weld cap and base plates to columns:shop weld bearing.plates to beams;use E70xx electrodes. Alternatively, field weld by certified welders. c. Deflection Criteria: L/360 total load deflection. 4.Timber Framing: a. All new timber framing: Spruce-Pine-Fir No. 2 with Fb=1000psi,E=1,300.000 psi,or better. b.Pressure treated timber(P.T.): Southern Pine with Fb=1300 psi,E=1,600,000 psi,or better. c. Laminated Veneer lumber: All L.V.L. shall be 1.9E L.V.L.with Fb=2925 psi, E=1,900 ksi.. Fv=285 psi.Fc_per=750 Fc_par=3035 psi. Parallam(PSL): All PSL shall be min. 1.9E ES with Fb=2900 psi, E=1.900 ksi,.Fv=285 psi. Fc_per=-750 psi, Fc_par--2900 psi. Note that Microllam and Parallam may be used interchangeably. 1. Deflection Criteria: L/480 Live Load, L/360 Total Load 2. Optional: Provide shop drawing submittal of engineered lumber systems for approval prior to materials purchasing. 5. Metal Connectors: As manufactured by Simpson Strong-Tie Co. shall be handled and installed per manufacturer requirements,with all nail holes filled,with the size nail as specified by mfgr.or herein. a. Rafter to Ridge Beam: Simpson LSSU-series,or Simpson Straps over top of plywood,spaced 16"o/c: Rafter to Ridge Plate: Collar ties min. 1 x6@ 16"o/c at top or Simpson Straps over top of plywood spaced 16"o/c b. Rafter ends to top plate: Simpson H2.5A c. Band Joist: Simpson straps at 48"o/c: CS-14R-50.5"centered at band joist 6.Bolts: Bolts in wood framing shall be standard machine bolts unless noted otherwise. Bolt holes in wood shall be 1/32" larger than bolt diameter. Bolt heads and nuts shall bear on standard malleable iron washers,or square plate washers. All nuts shall be retightened at completion ofjob. 7. Blocking: a. Blocking shall be solid blocking,2x minimum,and full depth of member. b. Stud Walls:provide blocking at 8'-0"o/c.maximum height. Corners to be blocked at 48"o/c with plywood edge nailing to this blocking for the first 48"of these building corners. c.Nailing Schedule: Solid Blocking to Bearing 2-8d toenails ea.side Blocking Between Studs 2-10d toenails ea.end.or 2-16d end-nails ea. End d. New Framing:.Provide 2x blocking for 2 joist/rafter bays and spaced 48"o/c in joist and rafter plane at all edge OF MA plywood edges to this blocking 8.Nailing Schedule: o� MICHELE N' All nailing shall be in accordance with Appendix 120.Q.unless noted herein specifically. g CUDILO Multiple Studs 16d!u>,, 12"staggered o No,34774 in a. All nails shall be common wire nails. STRUCTURAL b. Sub-bore where:nails tend to split wood. 9. Headers less than 4'-0",use 2-2x6:all others per MA State Building Code Table 5502.5 and( MICHE 2 Consulting Structural Engineer 123 Cottonwood lone, CeMerme. Moesochwette 02lf 2 Z f �p d , ` ( J "�'' Drown By: MC Dote: / Drawing / (7t `�F tale: AS NOTED Rev. 0 - HA J File_Nome: 5W r_r.a Project No.: /�" TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map v A Parcel 0 Application # C�?0f0 00 0 Health Division Wat Z vs- Date Issued ?i aZw` 0 Conservation Di sion Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 2� ° A-LL Historic - OKH _ Preservation/Hyannis Project Street Address % -3 2 ��1 - Village G e r►��rl�U LG e-//l �i ` ' Owner Ci '� S 5 /� V Iry AddressC-e(VT f 7 jLLP Telephone 5-0 Permit Request B A T-k 1oa-pi o pe Square feet: 1st floor: existing&O-dproposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation I�)&-O Construction Type Lot Size r_-)3 4q t-R--eS Grandfathered: ❑Yes fd/No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure -7' �� Historic House: tul Yes ❑ No On Old King's Highway: ❑Yes YNo Basement Type: U Full Crawl ❑Walkout ❑ Other /� Basement Finished Area(sq.ft.) - — Basement Unfinished Area (sq.ft) `'�0 0 Number of Baths: Full: existing .3 new l// Half: existing Z new Number of Bedrooms: existing enew Total Room Count (not including baths): existing L9 new First Floor Room Count Heat Type and Fuel: 15d Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ;4 No Fireplaces: Existing c7E New Existing wood/coal stove: ❑Yes)l No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn.)6 existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use - Proposed Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /1 0M A-S, BO1S Vet t Telephone Number S-0 -77/ Address i 12 2 ST- License # G A iyy 1 S , Nq 6 Home Improvement Contractor# P Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i SIGNATURE DATE / �D FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ;j ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION R� r FRAME C o INSULATION D 312�ja FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massach usetts Department of Industrial Accidents _ Office of Investigations w 600 Washington Street c Boston, NIA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): / u b ,1—C., 8 V 0 f z, I Address: G ck,R- 51 City/State/Zip: 11/A;)s 1nA oajW Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I �( employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.126 I am a sole proprietor or partner- listed on the attached sheet. 7. VRemodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp, insurance.t 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.❑ 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this.statement may forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify,under the pains �andpenalties of periury that the information provided above is true and correct. Signature: ? !J Date: Phone# �Ci � U Official tcse 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 Y Contact Person: Phone#: r r ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE AM TWO-FANaL'Y DETACBED RESIDENTIAL CONSTRUCTION (780 CmR.61.00) Applicant Name. Site Address: print Town: Applicant Phone: Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE of the folIowin two'o tions 780 CMR.TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR. NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM _ MB1IM[JM Ceiling or Slab QOption 1: Basement Fenestration exposed Wall Floor. Wall Perimeter AFUE HSPF U-factor floors R-Value R-Value R-Value R-V�ue %'Value and be th NAi°nal Appliancc•Encr 35 R-38 R-19 R=19 R-10 R-10� Cmsr_r ionAct(NAE( 4 1997 as amcndcd,minim rafcr as Bipplicabir . Nota: This form is not required ifyn choose either of the two versions ofREScheck as listed below. [] Option 2: RES check Version 4.1.2 or late software- analysis variant softwar analysis must be completed 780 CMR 6107.3.2 REScheck—Web which can be accessed at http•//www eDctgycDdes,goy/reschE ckl :AD�zT�orrs�o� �T�1�A:�zo�:s.To ��s�czZVG B�A��s:�o;t��.��YEARS oL�* • *)3uildings under 5 years old must use option#1 or 82 in New Construction section above,' Complete the following formula to determine the %p of glazing: (a). Gr05S Wall & Ceiling Area equals Formula: (100 x b = a) ' SF 100 x - _ % of glazing b a (b) Glazing area equals SF If glazing is<:40%.u�e the chart belpw. • • If glazing is > 40 % rQceed to "S UNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMTONENT CRITERIA ADDITIONS TO EXISTING. LOB'-RISE RESIDENTIAL BUILDINGS M AX NT(JM 1��1T�IMUM Ceiling and Slab Peru ) -nestradon Exposed floors Wall Floor Basement Wall R-Vali U-factor R-Value R-Value R-value R-Value and De .3 9 R-3 7 a R-13 . R-19 -R-10 R-10, 4 a R-30 ceiling insulation may be used in place of R-37 if the insulation acbieves the full R-value over the entire ceiling area i•e.not compressed over exterior walls, and including any access o rains , SUNROOM—An addition or alteration to an existing building/dwelling unit where the tot glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of t additiop. Note: Owner to fill out Consurnerlii ornmtron Form found ijApptndix 120T Taw of Barnstab-Ze o • Regulatory Services � • Thomas F_ Geiler, Director 619. �. o Building bxiszon Tom'Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 tvWW.fown.b arnstable.ma.us Office: 508-862-403 8 Fax: 508-79( A Property Owri.erMust Complete and Sign This Section If Using A Builder as Owner of the subject.property hereby authorize 1��llti. 1 J l S `C.��.�° to act oa my 6ehalf, is all matters relative to work authorized by this building permit application for: Address of J C9Y signature of Owner ate t : • t Isus o�0 IA PC) 2b ack Print Name If Property Owner is,applying for permit please complete the Homeowners License Exemption Form on the reverse side. r Town of Barustable ��of TRE ray° Regulatory Se)[-vices + Thomas F. Geiler, Director Building Division prED '�k Tom Perry,Building Commissioner. 200 Maid-Sheet~•Hyannis,MA 026.01 �s�.toFsn.barnstable.ma.us Office_ 508-862-4038 Fax: 508-790-6230 FTOMEOWNER LICENSE E MPTION Plcasc Print DATE: JOB LOCATION: village number street "HOM$OWNER": name m hoe onc# worlLpbone# CURRFiNT MAILING ADDRESS: city/town stato rip code The current exemption for`homco ers" was extend d to include owner-occupied dwellings of six units or less and to allow homeowners to engage an ' vidual for hir who does not possess a license,provided that the owner acts as supervisor. DE. ON of HOMEWVKER Pcrsoa(s) who owns a parcel of land on hLi he/s e resides or intends to reside, on which there is, or is intended to be, a onc or two-family dwelling,.attache+ or deta ed structures accessory to such use and/or farm strictures, A o-year period shall not be considered a homeowner. Such person who constricts more than one horn in a "horrieowner"shall submit to the Building ftici on a form acceptable to the Building Official, that he/she shall be responsible,for all such work pqrflormcd and e building permit. (Section 109.1.1) The u,odcrsigncd"homeowner"assumes respo 'bility for compliance with the State Building Code and other applicable codes, bylaws,rules and rcgulatio The undersigned"homeowner"certifies that e/sbc derstomds the Town of Barnstable Building DcpartrAcnt rrrin;mum inspection procedures aid require ants an at he/sbc will comply with,said procedures and requirements. • w • t Signature of Homeowner Approval of Building Official. Note: Three-family dwellings ontaining 35,000 cubic act or larger will be required to comply with the State Building Code Scction 127.0 Co traction Control. HO,,rMOWNER'S EXE TION The code states that "Any homed c prrformmg work for which a building perrrdt is required shall be exempt from the provisions of this scction.(Scction 109.1.1 -Licensing of auction Supervisors);pro%id d that if Lhc homcowncr cngagcs a person(s)for hir to do such wor% that such Homcowncr shall act as su sor., Many horimeownas who use this cx lion arc unaware that they assuming the responsibi)ities of a supervisor(sce Appendix Q, Rules&RLgulatsons for Licaising Constructs n Supervisors,Scction 2.1 is lack of awarcness'oftcn results in serious problems,particularly when the homeowner hires unlicensed pars . In this cast,our Board cannot proceed against the unlicensed'person as it H ould with a licensed c Supvssar. The homcover cr acting as sup •sor is ultirnatdy responsible, To ensure that the homeowne`is Ily aware of hisftr responsibilities,many communities require,as part of the permit application, that the homco,vmcr certify that hdshe understands thc responnbili6cs of a Supervisor. On the last page of this issue is a.form cuncnL)y used by several towns. You may care t ammd and adopt such a forrrJeartifiealion for use in your community: :Brd of Building Rei6ns ai✓, and�ar H)ME IMPROVEMENT CONTRACTOR License or registration valid for individul use only 4't j before the expiration date. if found return to: Registration 110657 Board of Building Regulations and Standards Expiration` ��, �,1/3/2010 Tr# 277280 One Ashburton Place Rm 1301 �} �, !,_ Type Ind'vidual Boston, Ma.02108 , HOM 1 i AS R BOI;S V t ERsT Si THOMAS BOISVERT 7<t 15 CHERRY ST �7 j HYANNIS,MA 02601 - � C��` �"� �� `'� F1dmi"'strut°'' Not valid without signature. i Ward,°g°"z"�,ynGrP ,yam -- d Construct dmg Regulaho s a K Supervisor nandards'. . f Fe�Ftse 10 i set ce 1 ?' CS 1 31T20 �� es r lorr 10 rr#71 j 7608 I THO t MgS- R B s OI.gV I 15'CHERRY.81F _ H,YgN T COmmissione �_ l TOWN OF BARI T Bl i 1 • Massachusetts- Department of Public SafetN^ Board of Building Regulations and Standards Consfr'uction,.Supervisor License -ibcense: CS 1810 Restricted to 00Ull _THOMAS R BOISVERT L 15 CHERR:Y STx HYANNIS, MA 026.01 Expiration: 1/31/2012 C ontnus,over F'' Tr#: 17686 l .. �' n t � Q �l i � i � 6 •1 81 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Q�1�OI � Application# Health Division Conservation Division Ir Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. ` : Permit Fee t?,;L�. Date Definitive Plan Approved by Planning Board Historic-OKH 4`�t� A eservation/Hyannis � M Project Street Address y ff�7�� Village aaCu A �kO I V� I ' Owner l..QvdCS A • �' sbN 0 . �����-�1 Address t Telephone 7`$ - 6(,5`I Permit Request Wik �ct�4csD «L� p► sJ�." Square feet: 1 st floor:existing proposed 2nd floor:existing proposed /Total new Zoning District Flood Plain Groundwater Overlay z , .v,t Project Valuation_ ��• cx� Construction Type Lot Size . `�I s ILQt-5 Grandfathered: ❑Yes ❑ No If yes, attach supporting do�umentation,' ti Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 1.15 Historic House: ❑Yes ❑No On Old King's Higpway: Oyes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout G(Other (� Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing �J 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: YGas ❑Oil -❑ Electric ❑Other Central Air: ❑Yes O'No Fireplaces: Existing New Existing wood/coal stove: ❑Yes W4 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:@'existing ❑new size L0 . Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization El Appeal# Recorded❑ Commercial ❑Yes C3lo a If yes, site plan review# Current Use 1,11 Y Proposed Use BUILDER INFORMATION Name �CL`V Telephone Number S-00 &L3 Address `l3I�FrUKS�4� ca_)��/ License# ©!gyp<"/4/ C'r '�AS.91C� kkk vi" Home Improvement Contractor# 90?C 1 63Z Worker's Compensation# ALL CONSTRUCTI N EBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 6 1 FOR OFFICIAL USE ONLY l , PERMIT NO. DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: I FOUNDATION Q! FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL {; GAS: ROUGH FINAL FINAL BUILDINGS/ DATE CLOSED OUT ASSOCIATION PLAN NO. �v \ 1lLG lrV//L/!LV lL IYGLLLLlL V•J lI1 LL�7J LL\.lL 64V GLL.1 Department of Industrial Accidents _ Office of Investigations a 600 Washington Street; Boston,MA 02111 www.mass.gov/dia Workers' Compensation Risurance davit: Builders/Contractors/Electricians/Plumbers A p licant Information ! Please Print Lelzibly Name(Business/Orgmization/Individual): . • •Address: 9'�� t�aS�' (�a:�1 �.,..-------.--- City/State/Zip: !C. �. • (�r PA Phone:#: Are you an employer? Check the'appropriate boa:; a ofP ,1 io ect re utred):.. 1.❑ I am a employer with 4. [] I ain a general contractor and I . T3'P ( .q employees(hall and/or part time).* have hired the stab-contractors. 6..❑New construction.. 2. I am a'sole proprietor or partner- listed on the'attached.sheet,. 7. ❑Remodeling ship andhave no employees These sub-contractors have g, Demolition , working for me in any capacity. employees and have workers' [No workets' comp.insurance comp,insurance.$ 9. Building addition d.uire req ] 5. 'We are a corporation and its 10.❑Electrical repairs or additions '3.❑ I am a officers have exercised homeowner doing work their 11.❑Plumbing repairs or additions .• myself. o workers' co right of exemption per MGL'- Y � �P• - 12.Q Roof repairs insurance required.]t c. 152,§1(4), and we have no employees. [Nc workers' 13 f❑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 affidavitindicating such. (Contractors that check this box must attached an additional sheet showing the name of the•sub-contractors and state whether ornot those entities have employees. If the sub-contractors have empioyges,they must provide their workers'comp.polidynumber. I sin an employer that isproviding workers'compensation insurance for my employees. Below is.thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic•#: Expiration Date: Job Site Address CitylState/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the OfFice of Investi ations of IA-for insurance coverage verification. I do hereby ce i fy Fr the c •a enaIties of perjury that the information provided above is true and•correct, Si afore: Date: `d _ Phone : 3 7 / iy Official use only,.Do not write to this area, to be completed by city or town offrciaL City or Town: Permit/License# iss-,ung Authority(circle one); :1.Roard of Health 2.Building Department 3. City/Town'Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other CoemetPerson: Phone#: k N InforMati®n- and Ins4r°ucti®ns r� 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 hiie, 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&-deceased employer, or the =eon�trit,�t<ee of an individual.partnership,association or other legal entity, eiuploying-employees. However the owner of a dwelling house ving not more than three apartments and who resides therein;or the occupant of the dwelling house of another who mploys persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building app errant thereto shall not because of suc employment be deemed to bean employer." 1vIGL chapter I52, §25C(6)also states t"every state or local licensin agency shall withhold the issuance or renewal,of a license or permit to'opei . a business or to construct b ' dings in the commonwealth for any applicant who has.riot produced acceptab evidence of compliance th the insurance coverage required" AdditionaIly,MGL chapter 152, §25C(7)state "Neither the coxnmonwe th nor any of its political subdivisions shall enter into any cottract for.the performance of p lic work un�•accepta a evidence-of oomplianze with the insurance requirements of.this chapter have been presented'# the contracting a rity." Applicants Please fill out the workers'compensation affidavit comp ely,by ch king the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),addresses)an hone ber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)of Limited Li a ' 'ty artnerships(LLP)with no employees other.than the ' members or partners, axe not required to carry workers' compe insurance. If an LLC or LLP does have employees,a policy is required, Be advised that ibis affidavit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure t si and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.o ficens 'is being requested,not the Department of Inclustrial Agcidents., Should you have any questions regarding th law-or• ou are required to obtain a workers.' compensation policy,please call the Department at the number Ii d below lf-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. a Department has vided a space at the bottom of the affidavit for you to fill out in the event the Office of Inve 'gations has to contact' u regarding the applicant. Please be sure to fill in the permit/license number which will be ed as a reference numb' . In addition,an applicant. that must submit multiple permit/license applications in any giv n year,need only submit o affidavit indicating current policy-information(if necessary)and under"Job Site Address" e applicant should write" locations,in (city-or town)."A copy of the affidavit that has been officially stamped or marked by the city or town ay be provided to the applicant as proof that a valid affidavit is on file for future pe is or licenses. Anew affidavit ust be filled out each year.Where a home owner or citizen is obtaining a license or rmit not related to any business o commercial venture (i.e.a dbg license or permit to bum leaves-etc.)said person is OT required to.complete this am The Office of Investigations would like to thank you in advanc for your.cooperation and should yo have any questions.- please do not hesitate to give us a can. The Department's address,telephone-and fax number; » - F Tbe,Commmwe!4 f Massach=tts Depazlmeut of W ..sWal AQ6dents' Office of s gations • �EIQ��ashi� �Stre� Boston, M U111 ' Tel.#617-727 49C�0.ext 6 ar 1-a7 -MASSAFE Fax*617 '27-7 749° Revised I1-22-46 w=w.ir�as..gevdie IKE, Town of Barnstable * Regulatory Services �$"MAC�'E� Thomas F.Geiler,Director �'AIEo;9.rp�e Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 ! - Fax: 508-790-6230 Permit no. a®O`) O a-`i Ti Date Lt/at,Lo 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. a Type of Work: Estimated Cost 3 b D jV— KsiJuCc11s wasp Address of Work: i Owner's.Name: Date of Application: I hereby certify that: q i Registration is not required for the following reason(s): ,ft ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied El 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. SIGN' D UND PENAL S OF PERJURY I hereb appl for a permit as the age t f thJ r: 10 �" Date Contractor Name Registration No. OR Date Owner's Name t � , Q:fomislomeaffidav Q} air Op1HE� Town of Barnstable. Regulatory Services " sa �'ASS,M � Thomas F.Geiler,Director asnss. AlfDMp'�A' Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ww'w-town.b a rnstable.ma.us Office: 508-862-403 8 Fax- 5 08-790-623 0 � Property Owner Must Complete and'Sign This Section if Using A Builder 1 J . �� asc-Nk , as Owner of the subject property herebyauthorize to act on my behalf, in all matters relative to work authorized bythis building permit application for (Address of Job) VJ Signature of Owner Date 0 Print Name Q:FORN5:0 v+rNElt?bRMIS5I0N d ...._......... u.cQS©a.3 .5-- ,��s i IL 'f- data® i p ✓/se L�anv�reovzulea,� o�,./�aaaac/arae� BOARD OF BUILDI G REGULATIONS License: CONSTRUCTION SUPERVISOR NUmbcr',CS 015044 I Expires 08/15207 Tr.no: 317.0 (LWI ( Restrict{ed PETER E KELLY� 93 PHEASANT CENTERVILLE, MA d2632 Commissioner a aan;ruNis Inoillim plleA JON roaaaaslu!ulpd--- — Z£9Z0 b W'apinJa;uaO � `•'�� AeM IUeseagd£6 Az 1 � Alla>i Ja;ad f 13N'3 N313d , f , lenpinip`�li 801 0'uL1I uo sog TO£i NaaeId u Inq auo 9699Z1• #al SOOZ/OGLE uoie�itlx3'+` f. sp upaels Par,suol;eln�Iag Nulpling;o p ruff 8Z6£0'l uogeils fiat :o;aaniaa puno,;31 •alup uol;ealdxa ay;aaolaq MOl3VMJLNO3 1N3W3AO21dWl 3WOH (Iuo asn Inpinipul 103 p►IeA uol;ea)s1213.1 10 asuaal-1 spaepuc;S pua su/opuln2a)l'u!pllnti jo p mot, i < Map V Parcel C� t /a Peimit#- ' House# Date Issuedr " �,�-- C-0 <• d of Health(3rd floor)(8:15 -9:30/ 1:00- . Fee• ' ' Conservation floo . -9:30/1:00.2:00) , Planning De oor/School Admi �.►+E rq, De ve P' ilan Approved by Planning Board 19 • BARNSTABLE. MASS p FO;9.sad 9 TOWN OYBARNSTABLE' Building Permit Application Project Street Address yZa A lu _ 1 Village - Ceu_ruw 1,CC[4._ Owner �Sjj� f'"C' Telephone - Permit Request g- ' . p First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family k__�Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing t New Total Room Count not including baths): Existing New First Floor Room Count ( g ) g Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Na a Telephone Number dress License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR TH. 0 OWIN REASON(S) _ FOR OFFICIAL USE ONLY a PERMIT NO: DATE ISSUED MAP/PARCEL NO. - f _ ADDRESS f VILLAGE OWNER t.� c DATE OFINSPECTION. a FOUNDATION FRAME INSULATION iFIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS:*. ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ; ASSOCIATION PLAN NO. " i THE Tq� The Town of Barnstable 9�A MASM1m�' Department of Health Safety and Environmental Services 16 rEo 9. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commission.: For office use only s Permit no. Date 1 AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work:—, Est. Cosh Address of Work: 43� AJ &1 1 Owner's Name Date of Permit Application: ` I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROG:2AM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY 1 hereby apply for a permit as the agent of the owner: Date Contractor'Name Registration No. OR Date Owners Name Assessor's map'and lot numbe f THE T Sewage Permit, number + B TAI E. House. number / �`�a TOWN OF, BARNjSTABLE BUILDING IHSPECTO APPLICATION FOR PERMIT TO ...........4.f1•r.r..xpz ...:.. .. .. All......... .... TYPEOF CONSTRUCTION ....................Gnt f...a.U. ........:...................................................,............................ ............... ..................19 ./ ' TO THE INSPECTOR OF BUILDINGS: ; The undersigned hereby applies for a permit accordingg to the following information- Location ...........:.... /-.z.... . ......./.... ......'.... .��/t. . /�............................ Proposed Use ...... r�� ........................... ............................. .......... , p .. Zoning District ..... .... ` ./.............. ................Fire'District .... .�"'Gy � o's—c �� c r�C�.�.......Address ......�� ..... ...:.�... Name of Owner ..... ,/. '........ Name of Builder ...GL..... ..:.Address Name of Architect ........... ..........Address ' Numberof Rooms ..........:..... .................................................Foundation. .........::..::....:.......................................................... Exlerior ....Roofing ..... Floors ................ :. :C.. .......................................Interior ......... .. ✓...... ' .`"....:.:.....:............................ G/� U� Heating . x f/`'....... ...............Plumbin z... �� ...✓.......................... Fireplace ..............................:.........:................................::.......Approximate. Cost ...� ..6[ (!..V.......... .... ....... ........ Definitive Plan Approved by Planning Board --------------------------------19________. Area ....... Q... .. ........ . Diagram of Lot and Building with Dimensions Fee .........1. .. 10 ..�................. SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby_agree to conform to all the Rules and Regulations of 4Town'ofarnstable regarding the above construction. N ...................... Construction Supervisor's License ..0.� 21 NICKULAS, LARRY A=20.8-19 , No ... `2681::4 Permit for .....Ad41.l. J.S?17... R....... _ single -family dwelling (bath) .... ......... .Y} Location ....432• Main Street•,..••••••••••••.••.••••••• ' Centory i 1 1 e ................ ................ 7 ,....Larry :Nickulas...... Owner Type of Construction n.........Fn e. ` .......... ............ r s......................... ........ ........ !• �,' f,fi - _-..... • - _ •Plot ............................ Lot . ... .......................... r, „ Permit',Granted .?August 7 �;` .. :19 84at T - Date of:Inspection - .....19 -- - r ` _ Date- Completed .......................... n - Ax _ f dim